Cyriax physiotherapy, a supervised exercise programme and Bioptron light for the treatment of lateral epicondylitis

Lateral epicondylitis (LE) is one of the most common lesions of the arm. Physiotherapy is a conservative treatment that is usually recommended for LE patients and a wide array of physiotherapy treatments is used. Two of the most common physiotherapy treatments for LE are Cyriax physiotherapy and supervised exercise programmes. More recently physiotherapists are able to use a new modality called polarised polychromatic non-coherent light (Bioptron light) for the management of LE. The clinical value of these treatments for LE is not known. The aim of this project was to investigate the clinical use and clinical effectiveness of Cyriax physiotherapy, a supervised exercise programme and polarised polychromatic non-coherent light (Bioptron light) for the treatment of LE. Systematic review (Chapter 2) found that there was strong evidence for the short-term effectiveness of acupuncture for LE. It also found that there was strong evidence that four physiotherapy modalities, low power laser light, ultrasound, extracorporeal shock wave therapy, and pulsed electromagnetic field therapy were not effective treatments for the management of LE. There was insufficient evidence available for other treatments used for LE, such as iontophoresis and home exercise programmes, to judge their effectiveness. Chapter 2 recommended that more evidence is needed for Cyriax physiotherapy, supervised exercise programmes and polarised polychromatic non-coherent light (Bioptron light). It is necessary to establish optimal protocols for these treatments before a suitable clinical trial can be designed. A critical literature review (Chapter 3) found that treatment protocols for Cyriax physiotherapy, supervised exercise programmes and polarised polychromatic non-coherent light (Bioptron light) were mainly derived from the views of advocates of these treatments, based on their personal experience. Two preliminary clinical studies were conducted to pilot the use of treatment protocols derived from the critical review in Chapter 3 on overuses injuries that were similar to LE and were regularly presented to the clinic (Chapter 4). In the first study (section 4.3) Cyriax physiotherapy did not reduce the pain in patellar tendinopathy, while the supervised exercise programme did. In the second study (section 4.4) polarised polychromatic non-coherent light (Bioptron light) reduced nocturnal pain and paraesthesia in carpal tunnel syndrome (CTS). The findings of these two pilot studies should be interpreted cautiously because the number of patientsincluded in the patellar tendinopathy was small and in the CTS study it was not possible to attribute changes to the light per se because the study lacked a control group. Before the effectiveness of these protocols could be tested, a questionnaire survey was conducted to establish the current clinical practices of these physiotherapy treatments for LE. This survey was based on the self-reporting of chartered physiotherapists in Athens using these treatments in their clinical practice (Chapter 5). It may be confidently assumed that the results of the questionnaire present a representative view of current clinical practice of Cyriax physiotherapy, a supervised exercise programme and polarised polychromatic non-coherent light (Bioptron light) on LE at least as these treatments are applied in Athens. How much this reflects usage in the rest of the Greece, Europe, or even the world, is yet to be seen by extending the research. When the effectiveness of Cyriax physiotherapy, a supervised exercise programme and polarised polychromatic non-coherent light (Bioptron light) for LE was compared, the three treatments reduced pain and improved function at the end of the treatment and at any of the follow-up time points (Chapter 6). Whether this is due to placebo effects is not known. The supervised exercise programme produced the largest effect in the short, intermediate and long term (Chapter 6). This finding suggests that, of the three treatments, the supervised exercise programme should be used as a first treatment option when physiotherapists manage LE patients (Chapter 6; Chapter 7). If this is not possible, Cyriax physiotherapy and polarised polychromatic non-coherent light (Bioptron light) may be suitable (Chapter 6; Chapter 7). Although the three treatments are promising interventions for the management of patients with LE, further research is warranted to investigate and confirm the effectiveness of Cyriax physiotherapy, supervised exercise programmes and polarised polychromatic non-coherent light (Bioptron light) in the treatment of impairment and disability resulting from LE.