Brace Therapy, Physical Therapy Each Play a Role in Tennis Elbow Treatment

Laurie Barclay, MD

March 30, 2004

March 30, 2004 — A new study published in the March issue of the American Journal of Sports Medicine shows that physical therapy was most effective for reducing pain and disability and increasing patient satisfaction for the short-term treatment of lateral epicondylitis (tennis elbow). In contrast, brace therapy was superior in terms of ability to perform daily activities. Combination treatment had no superior effectiveness in the long term, but it appeared to be better than brace alone over the short term.

"Theoretically, binding the muscle with a clasp, band, or brace should limit expansion and thereby decrease the contribution to force production by muscle fibers proximal to the band," write P. A. A. Struijs, PhD, from the Academic Medical Center, Meibergdreef, in Amsterdam, the Netherlands, and colleagues. "Despite the frequent use of braces, no definitive evidence is present in current literature concerning their effectiveness."

In this study, 180 patients were randomized to receive brace only, physical therapy only, or combination treatment, and follow-up was one year. Main outcome measures were success rate, severity of complaints, pain, disability, and satisfaction.

At six weeks, physical therapy only was superior to brace only for pain, disability, and satisfaction, but brace-only treatment was superior for ability of daily activities. Combination treatment was superior to brace only in terms of severity of complaints, disability, and satisfaction. By 26 weeks and 52 weeks, there were no significant differences between groups.

Study limitations include lack of a control group and the possibility of noncompliance in performing unsupervised exercises.

"Although we advise conducting more studies under different circumstances, a brace as supportive treatment can be considered. It is a relatively cheap intervention, which helps wait out the natural course," the authors write. "When the patients do not show a pain-decreasing effect while using the brace, physical therapy can be considered, although added value is limited."

Bauerfeind, a manufacturer of orthotic devices, funded this trial.

Am J Sports Med. 2004;32(2):462-469

Reviewed by Charlotte E. Grayson, MD

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