Effects of Various Taping Techniques in Lateral Epicondylitis on Functional and Ultrasonographic Outcomes
Condition: Tennis Elbow
MeSH terms: Tennis Elbow
Study type: Interventional

Summary: 
      To compare the early effects of the application of elastic (Kinesio Tape®) and non-elastic
      (Athletic Tape) taping as part of the conventional physiotherapy of the lateral epicondylitis
      using the results from ultrasonography and clinical tests.
    

Detailed description: 
      Lateral epicondylitis (LE), also known as tennis elbow, is an overuse injury causing elbow
      pain, and it is difficult to treat. It is characterized with frequent pain and sensitivity at
      the lateral section of the elbow, mostly at the extensor tendon (extensor carpi radialis
      brevis [ECRB]) origin and the extensor digitorum communis [EDC] muscle. It was estimated that
      annually it occurs in about 1%-3% of adult individuals worldwide. There is no consensus
      regarding its etiology; however, it has been associated with repetitive movements, smoking,
      and factors increasing physical load, such as obesity. In recent studies, workplace use of
      non-naturally positioned elbow and wrist have been associated with elbow pain. In addition,
      repetitive microtraumas have been known to be triggering injuries.

      Pain is the primary complaint in LE patients. Pain increases with activity, and it becomes
      acute with injury or trauma. LE is associated with decreased extensor muscle strength and
      variations in biomechanics; however, it has been a matter of debate whether these variations
      are the cause or the result of LE. In its pathophysiology, three interacting components,
      namely local tendon pathology, changes in the pain system, and losses in motor function have
      been reported. Recent studies have highlighted that, rather than an inflammatory condition,
      tendinosis (chronic symptomatic degeneration of tendon) occurs in the forearm common extensor
      muscle tendon adhering to the lateral epicondyle of the humerus. Ultrasound evaluations
      indicate various tendon pathologies, such as tendon thickening, focused hypoechogenic zones,
      tendon lacerations, and calcification.

      LE may heal on its own and usually responds to conservative treatment. In case conservative
      treatment is inconclusive, surgical methods may be opted for. Several conservative methods
      are among the treatment options for LE, such as resting, nonsteroidal anti-inflammatory drugs
      (NSAID), injection treatments, exercises, and physiotherapy programs involving manual therapy
      techniques, massage, braces, deep friction message, extracorporeal shockwave, low level laser
      therapy, low frequency electrical stimulation, and other electrophysiological agents. The use
      of non-elastic taping techniques is an approach utilized in the conservative treatment of LE
      and there exist reports examining its instantaneous effects on muscle strength, grip
      strength, and pain; however, it was indicated that further studies are warranted to show the
      effectiveness of taping. Kinesio Taping®, which involves elastic tapes, is rather a more
      recent technique used in orthopedic injuries in addition to physiotherapy, and it has been
      gaining popularity. Even though there are reports indicating the effects of adhesive tape on
      muscle and grip strength in LE patients, its effectiveness could not be compared with other
      treatment modalities because of several reasons, such as its instantaneous effects or the
      lack of a control group.

      The literature review shows that, due to the structural differences between athletic tape and
      Kinesio Tape®, athletic taping applications are rather adopted to control the movement of the
      joint with pain, to support non-contractile structures, such as ligament and capsule, and for
      stability. Studies utilizing non-elastic tapes in the treatment of LE are inadequate because
      they examine effects in the acute period and they lack comparisons. On the other hand, it has
      been observed that Kinesio Tape® is mostly used for functional support, muscular
      facilitation, and myofascial relaxation, and studies focusing on the management of lateral
      epicondylitis are scarce.

      The aim of the present study is, in LE patients, to compare the short-term effects of two
      different taping techniques in addition to an intense physiotherapy program on the severity
      of pain, grip strength, functional status, joint limitations, and structural changes in
      tendons that can be indicated by diagnostic USG
    

Intervention name(s): Strengthening exercises; Intensive Physioytherapy; Kinesio taping; Athletic taping
Intervention type(s): Other; Other; Device; Device
Intervention description(s): The exercises consisted of 3 sets with 20 repetitions of wrist and elbow flexion; 2 sets with 10 repetitions of wrist extension strengthening starting with 50% of the maximum strength and density increasing the resistance each week; and finally, 2 sets with 10 repetitions of the wrist flexor and extensor muscle groups comprising 20 sec of stretching and 10 sec of relaxing using the healthy hand.; The treatment consisted of a cold pack (enclosed in a moist towel for 12 minutes around the elbow joint), TENS (in an asymmetrical biphasic wave form and burst modulation, current width 150 mms, pulse frequency 5 Hz), and deep transverse friction massage (2 minutes of application to the locally sensitive areas determined through palpation on anterolateral surface of lateral epicondyle) followed by home exercises.; Kinesio tape has been implemented on forearm of the patients for the treatment of lateral epicondylitis; By athletic taping, similar effects with Kinesio taping were aimed to gain. Considering the McConnel principles
Other intervention name(s): KT; AT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: physiotherapy; taping; conservative treatment