Effect of Eccentric Stretching in Patients With Lateral Epicondylitis
Condition: Lateral Epicondylitis
MeSH terms: Tennis Elbow
Study type: Interventional

Summary: 
      Lateral Epicondylitis; is a disease characterized by insidious onset pain in the lateral
      elbow of the forearm, which radiates to the distal part of the forearm and increases with
      grip and wrist extension. Pain originates from the origin of the wrist and finger extensors
      and is more felt during repetitive, forceful wrist extension or pronation and supination,
      during exercise or occupational use. It is a musculoskeletal lesion. Although it is so
      common, no consensus has yet been reached regarding its clinic, pathophysiology, and
      treatment. It is known that the primary etiological factor in the pathology of lateral
      epicondylitis is the overloading of the aponeurosis of the joint extensor muscles attachment
      site. Repetitive overuse causes tendon damage with macroscopic abnormalities of tendon
      collagen. The final stage of tendinopathy is characterized by abnormal tendon structure and
      degenerative features, including neovascularization. Primary pathological changes occur at
      the proximal musculotendinous insertion of the Extensor carpi radialis brevis. The currently
      accepted theory is that the process begins with overuse injuries that lead to small tears of
      the extensor carpi radialis brevis, sometimes the extensor digitorum communis muscle.

      The prevalence of lateral epicondylitis peaks between the ages of 35 and 55, and lateral
      epicondylitis primarily affects the dominant side. There is no clear consensus on the
      involvement of men and women, and it appears independent of gender and ethnicity [6-8]. Due
      to the symptoms experienced, the people's daily life activities are affected and cause loss
      of workforce.

      Conservative therapy is usually the first line of treatment for lateral epicondylitis.
      Conservative treatment typically includes rest, non-steroidal anti-inflammatory drugs, and
      physiotherapy and rehabilitation. Physiotherapy and rehabilitation applications include
      activity modification, orthosis use, cold-hot application, deep friction massage, stretching
      and strengthening exercises, electrical stimulation, ultrasound, laser, extracorporeal shock
      wave therapy, and manual therapy. In addition to FTR approaches, invasive procedures such as
      corticosteroid/botulinum toxin/glucosamine/autologous injections, prolotherapy, acupuncture,
      and topical nitric oxide application can be used. In cases where conservative treatment is
      insufficient, surgical applications are used. Although there are many different treatment
      methods known in the literature, the superiority of a particular approach for the treatment
      of lateral epicondylitis has not yet been proven and a consensus has not been reached.

      It has been known for a long time that eccentric exercises based on the extension of the
      muscle length can cause damage to the muscle fibers due to stretching and late-onset muscle
      pain. However, when they are applied in a regular and controlled manner, they adaptively
      strengthen and protect the muscle tissue. In clinical and animal studies, it has been found
      that reaching muscle length at an angle greater than the optimum angle of the muscle causes
      eccentric exercise, which in turn reduces muscle damage and increases joint range of motion.

      Although studies continue to understand the mechanisms of post-exercise muscle damage and the
      protective muscle response that develops after exercise, no study has been found in the
      literature on eccentric stretching applied to patients with lateral epicondylitis. Therefore,
      the aim of our study is to investigate the effect of eccentric stretching on pain, grip
      strength, and functional level in patients with lateral epicondylitis.
    


Intervention name(s): Cold application+Deep friction+Home exercise+Eccentric stretching; Cold application+Deep friction+Home exercise
Intervention type(s): Other; Other
Intervention description(s): In our study, deep friction massage will be performed by the researcher with the tip of the thumb, maintaining the pressure for 3-5 minutes in the posterior direction to the tenoosseous junction. The application will be performed 3 times a week for a total of 12 sessions for 4 weeks. After the deep friction massage, cold application will be made for 15 minutes. Simultaneously with the electrical stimulation of the affected arm, the patient will be asked to stretch for 5 seconds and rest for 5 seconds, and doing this 15 times will be considered 1 set. After 1 minute of rest, he will be asked to do this practice for 2 more sets, so 3 sets of 15 repetitions will be completed in total. A total of 12 sessions will be applied 3 days a week for 4 weeks. In our study, a home exercise program consisting of passive stretching and strengthening (concentric and eccentric) exercises will be applied.; In our study, deep friction massage will be performed by the researcher with the tip of the thumb, maintaining the pressure for 3-5 minutes in the posterior direction to the tenoosseous junction. The application will be performed 3 times a week for a total of 12 sessions for 4 weeks. After the deep friction massage, cold application will be made for 15 minutes. In our study, a home exercise program consisting of passive stretching and strengthening (concentric and eccentric) exercises will be applied.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment