Tennis Elbow/ Lateral Epicondylitis /tendonitis: High Power Laser Therapy a New Treatment Approach
Tennis Elbow/ lateral epicondylitis or extensor tendonitis at the elbow is a condition that can case pain about the outside of the elbow (pain about the inside of the elbow may be flexor tendonitis or Golfer’s elbow). It is seen more typically on the dominant arm and aggravated by things such as gripping and squeezing. It is not only seen in tennis players but is common in tennis players. People such as electricians, carpenters and gardeners also get tennis elbow. It is more common in men although many times I hear woman who suffer with tennis elbow complain of pain with activities such as lifting a jug of milk or opening a jar. A tendon is a structure that connects muscle to bone. Tendonitis refers to inflammation of the tendon. Standard treatments for elbow tendonitis or lateral epicondylitis, extensor tendonitis include rest (which may include using a tennis elbow splint, ice and non –steroidal anti-inflammatory drugs such as Ibuprofen). More difficult cases are offered a cortisone injection into the tendon to bring down the inflammation.
High Power Laser Therapy has been shown to increase bone, ligament, tendon and cartilage repair as well as reduce inflammation, decrease pain and increase circulation. I have found this treatment to be very successful although it is not well know.
Here are a couple of recent articles from the scientific literature regarding Laser Therapy and Tennis Elbow/ lateral epicondylitis/extensor tendonitis.
Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong.
OBJECTIVE: The aim of this study was to evaluate the effectiveness of 904-nm low-level laser therapy (LLLT) in the management of lateral epicondylitis. BACKGROUND DATA: Lateral epicondylitis is characterized by pain and tenderness over the lateral elbow, which may also result in reduction in grip strength and impairment in physical function. LLLT has been shown effective in its therapeutic effects in tissue healing and pain control. METHODS: Thirty-nine patients with lateral epicondylitis were randomly assigned to receive either active laser with an energy dose of 0.275 J per tender point (laser group) or sham irradiation (placebo group) for a total of nine sessions. The outcome measures were mechanical pain threshold, maximum grip strength, level of pain at maximum grip strength as measured by the Visual Analogue Scale (VAS) and the subjective rating of physical function with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Significantly greater improvements were shown in all outcome measures with the laser group than with the placebo group (p < 0.0125), except in the two subsections of DASH. CONCLUSION: This study revealed that LLLT in addition to exercise is effective in relieving pain, and in improving the grip strength and subjective rating of physical function of patients with lateral epicondylitis.
Faculty of Human Movement & Quality of Life, Peloponnese University, Sparta, Greece.
OBJECTIVE: This study was undertaken to compare the effectiveness of a protocol of combination of laser with plyometric exercises and a protocol of placebo laser with the same program, in the treatment of tennis elbow. BACKGROUND DATA: The use of low-level laser has been recommended for the management of tennis elbow with contradictory results. Also, plyometric exercises were recommended for the treatment of the tendinopathy. METHODS: Fifty patients who had tennis elbow participated in the study and were randomized into two groups. Group A (n = 25) was treated with a 904 Ga-As laser CW, frequency 50 Hz, intensity 40 mW and energy density 2.4 J/cm(2), plus plyometric exercises and group B (n = 25) that received placebo laser plus the same plyometric exercises. During eight weeks of treatment, the patients of the two groups received 12 sessions of laser or placebo, two sessions per week (weeks 1-4) and one session per week (weeks 5-8). Pain at rest, at palpation on the lateral epicondyle, during resisted wrist extension, middle finger test, and strength testing was evaluated using Visual Analogue Scales. Also it was evaluated the grip strength, the range of motion and weight test. Parameters were determined before the treatment, at the end of the eighth week course of treatment (week 8), and eighth (week
after the end of treatment. RESULTS: Relative to the group B, the group A had (1) a significant decrease of pain at rest at the end of 8 weeks of the treatment (p < 0.005) and at the end of following up period (p < 0.05), (2) a significant decrease in pain at palpation and pain on isometric testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (3) a significant decrease in pain during middle finger test at the end of 8 weeks of treatment (p < 0.01), and at the end of the follow-up period (p < 0.05), (4) a significant decrease of pain during grip strength testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (5) a significant increase in the wrist range of motion at 8 weeks follow-up (p < 0.01), (6) an increase in grip strength at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.01), and (7) a significant increase in weight-test at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.005). CONCLUSION: The results suggested that the combination of laser with plyometric exercises was more effective treatment than placebo laser with the same plyometric exercises at the end of the treatment as well as at the follow-up. Future studies are needed to establish the relative and absolute effectiveness of the above protocol.
PMID: 17603862 [PubMed - indexed for MEDLINE]
Ankara Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Division of Hand Rehabilitation, Ankara, Turkey. okenoznur@yahoo.com
The aims of this study were to evaluate the effects of low-level laser therapy (LLLT) and to compare these with the effects of brace or ultrasound (US) treatment in tennis elbow. The study design used was a prospective and randomized, controlled, single-blind trial. Fifty-eight outpatients with lateral epicondylitis (9 men, 49 women) were included in the trial. The patients were divided into three groups: 1) brace group-brace plus exercise, 2) ultrasound group-US plus exercise, and 3) laser group-LLLT plus exercise. Patients in the brace group used a lateral counterforce brace for three weeks, US plus hot pack in the ultrasound group, and laser plus hot pack in the LLLT group. In addition, all patients were given progressive stretching and strengthening exercise programs. Grip strength and pain severity were evaluated with visual analog scale (VAS) at baseline, at the second week of treatment, and at the sixth week of treatment. VAS improved significantly in all groups after the treatment and in the ultrasound and laser groups at the sixth week (p<0.05). Grip strength of the affected hand increased only in the laser group after treatment, but was not changed at the sixth week. There were no significant differences between the groups on VAS and grip strength at baseline and at follow-up assessments. The results show that, in patients with lateral epicondylitis, a brace has a shorter beneficial effect than US and laser therapy in reducing pain and that laser therapy is more effective than the brace and US treatment in improving grip strength.
The advantage of High Power Laser Therapy over cold or low level laser is that High Power Laser Therapy provides more power which allows the physician to reach deeper (target) tissues. This permits saturation of the injured tissue with the light energy which creates the healing effect.
Dr. Mane offers one on one consultation for those who suffer from Tennis Elbow/ lateral epicondylitis /tendonitis. If you are interested in scheduling a consultation please call 813-935-4744.
For more information about Dr. Nelson Mane, D.C. and his treatment approach go to http://www.manecenter.com
By: Nelson Mane
About the Author:
High Power Laser Therapy has been shown to increase bone, ligament, tendon and cartilage repair as well as reduce inflammation, decrease pain and increase circulation. I have found this treatment to be very successful although it is not well know.
Here are a couple of recent articles from the scientific literature regarding Laser Therapy and Tennis Elbow/ lateral epicondylitis/extensor tendonitis.
Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong.
OBJECTIVE: The aim of this study was to evaluate the effectiveness of 904-nm low-level laser therapy (LLLT) in the management of lateral epicondylitis. BACKGROUND DATA: Lateral epicondylitis is characterized by pain and tenderness over the lateral elbow, which may also result in reduction in grip strength and impairment in physical function. LLLT has been shown effective in its therapeutic effects in tissue healing and pain control. METHODS: Thirty-nine patients with lateral epicondylitis were randomly assigned to receive either active laser with an energy dose of 0.275 J per tender point (laser group) or sham irradiation (placebo group) for a total of nine sessions. The outcome measures were mechanical pain threshold, maximum grip strength, level of pain at maximum grip strength as measured by the Visual Analogue Scale (VAS) and the subjective rating of physical function with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Significantly greater improvements were shown in all outcome measures with the laser group than with the placebo group (p < 0.0125), except in the two subsections of DASH. CONCLUSION: This study revealed that LLLT in addition to exercise is effective in relieving pain, and in improving the grip strength and subjective rating of physical function of patients with lateral epicondylitis.
Faculty of Human Movement & Quality of Life, Peloponnese University, Sparta, Greece.
OBJECTIVE: This study was undertaken to compare the effectiveness of a protocol of combination of laser with plyometric exercises and a protocol of placebo laser with the same program, in the treatment of tennis elbow. BACKGROUND DATA: The use of low-level laser has been recommended for the management of tennis elbow with contradictory results. Also, plyometric exercises were recommended for the treatment of the tendinopathy. METHODS: Fifty patients who had tennis elbow participated in the study and were randomized into two groups. Group A (n = 25) was treated with a 904 Ga-As laser CW, frequency 50 Hz, intensity 40 mW and energy density 2.4 J/cm(2), plus plyometric exercises and group B (n = 25) that received placebo laser plus the same plyometric exercises. During eight weeks of treatment, the patients of the two groups received 12 sessions of laser or placebo, two sessions per week (weeks 1-4) and one session per week (weeks 5-8). Pain at rest, at palpation on the lateral epicondyle, during resisted wrist extension, middle finger test, and strength testing was evaluated using Visual Analogue Scales. Also it was evaluated the grip strength, the range of motion and weight test. Parameters were determined before the treatment, at the end of the eighth week course of treatment (week 8), and eighth (week
after the end of treatment. RESULTS: Relative to the group B, the group A had (1) a significant decrease of pain at rest at the end of 8 weeks of the treatment (p < 0.005) and at the end of following up period (p < 0.05), (2) a significant decrease in pain at palpation and pain on isometric testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (3) a significant decrease in pain during middle finger test at the end of 8 weeks of treatment (p < 0.01), and at the end of the follow-up period (p < 0.05), (4) a significant decrease of pain during grip strength testing at 8 weeks of treatment (p < 0.05), and at 8 weeks follow-up (p < 0.001), (5) a significant increase in the wrist range of motion at 8 weeks follow-up (p < 0.01), (6) an increase in grip strength at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.01), and (7) a significant increase in weight-test at 8 weeks of treatment (p < 0.05) and at 8 weeks follow-up (p < 0.005). CONCLUSION: The results suggested that the combination of laser with plyometric exercises was more effective treatment than placebo laser with the same plyometric exercises at the end of the treatment as well as at the follow-up. Future studies are needed to establish the relative and absolute effectiveness of the above protocol.PMID: 17603862 [PubMed - indexed for MEDLINE]
Ankara Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Division of Hand Rehabilitation, Ankara, Turkey. okenoznur@yahoo.com
The aims of this study were to evaluate the effects of low-level laser therapy (LLLT) and to compare these with the effects of brace or ultrasound (US) treatment in tennis elbow. The study design used was a prospective and randomized, controlled, single-blind trial. Fifty-eight outpatients with lateral epicondylitis (9 men, 49 women) were included in the trial. The patients were divided into three groups: 1) brace group-brace plus exercise, 2) ultrasound group-US plus exercise, and 3) laser group-LLLT plus exercise. Patients in the brace group used a lateral counterforce brace for three weeks, US plus hot pack in the ultrasound group, and laser plus hot pack in the LLLT group. In addition, all patients were given progressive stretching and strengthening exercise programs. Grip strength and pain severity were evaluated with visual analog scale (VAS) at baseline, at the second week of treatment, and at the sixth week of treatment. VAS improved significantly in all groups after the treatment and in the ultrasound and laser groups at the sixth week (p<0.05). Grip strength of the affected hand increased only in the laser group after treatment, but was not changed at the sixth week. There were no significant differences between the groups on VAS and grip strength at baseline and at follow-up assessments. The results show that, in patients with lateral epicondylitis, a brace has a shorter beneficial effect than US and laser therapy in reducing pain and that laser therapy is more effective than the brace and US treatment in improving grip strength.
The advantage of High Power Laser Therapy over cold or low level laser is that High Power Laser Therapy provides more power which allows the physician to reach deeper (target) tissues. This permits saturation of the injured tissue with the light energy which creates the healing effect.
Dr. Mane offers one on one consultation for those who suffer from Tennis Elbow/ lateral epicondylitis /tendonitis. If you are interested in scheduling a consultation please call 813-935-4744.
For more information about Dr. Nelson Mane, D.C. and his treatment approach go to http://www.manecenter.com
By: Nelson Mane
About the Author:
Having Fun With Tennis
Above a life, a person could find much inspirations which influence their decision to play tennis. Some of these inspirations could come from a relative at a young age because they are concentrated on their children keeping the adjustment. When the children show a talent to strike a ball of tennis with a racquet, the parents are inspired to make sure that their child succeeds with their talent and is registered them in the formal classes of formation which they can go at each week.
The young players of tennis could obtain more inspiration of a player of the high row of tennis than of any conference of motivation than their parents could give. When they follow the career of a player, they can easily say how much hard work enters creating such a champion. They could be inspired to gain more energy by certain words spoken by such a player on the importance of the good nutrition.
A set of tennis can be very exhausting and a player of tennis could be very inspired by the quantity of effort which enters being used for each match. The hard musculeux bodies of other players of tennis could inspire aspiring tennis hold the first role to go in a room of gymnastics and to establish with some weights. While on the machines being exerted for the size, they can receive more stimulation to play the game correctly by observing a match of tennis to television.
The majority of the players of tennis will obtain much inspiration of the inbox on their micro-computer. They could have been committed to form part of a group of bulletin and obtaining inspired by the contents which it contains each week. They could realize that the players of tennis play tennis on exhausting programs and must travel to the foreign countries halfway around the world, but always find the hour to remain in contact with ventilators by the blogs which are installed with the addresses of sequence which bear their names.
The majority of the ventilators carry out that which keeps that the kind of step upwards on a basis of day in day requires professional players of tennis to be in physical state higher all time. These players of tennis which do not play on professional level obtain inspired while thinking just of the way in which made their idols of tennis are with the play of tennis. That the kind of attachment requires the nerve of steel and a heart made gold. It is probably why the majority of the ventilators of tennis have much respect for the people which they observe with television playing tennis in such hard conditions.
The young people can also buy video games for tennis and play them with children with the same system of play by a connection of Internet. They can obtain very inspired by seeing their character pass by the action exhausting on the court. They can see first hand what it takes to obtain with the ball above the net, and the noises which come from the players on the court of tennis are so intense that the player of play will know that playing tennis requires much effort. They could be even inspired to play more tennis when they firmly have successfully the beat their adversary during the play.
By: Jennifer Seaton
About the Author:
The young players of tennis could obtain more inspiration of a player of the high row of tennis than of any conference of motivation than their parents could give. When they follow the career of a player, they can easily say how much hard work enters creating such a champion. They could be inspired to gain more energy by certain words spoken by such a player on the importance of the good nutrition.
A set of tennis can be very exhausting and a player of tennis could be very inspired by the quantity of effort which enters being used for each match. The hard musculeux bodies of other players of tennis could inspire aspiring tennis hold the first role to go in a room of gymnastics and to establish with some weights. While on the machines being exerted for the size, they can receive more stimulation to play the game correctly by observing a match of tennis to television.
The majority of the players of tennis will obtain much inspiration of the inbox on their micro-computer. They could have been committed to form part of a group of bulletin and obtaining inspired by the contents which it contains each week. They could realize that the players of tennis play tennis on exhausting programs and must travel to the foreign countries halfway around the world, but always find the hour to remain in contact with ventilators by the blogs which are installed with the addresses of sequence which bear their names.
The majority of the ventilators carry out that which keeps that the kind of step upwards on a basis of day in day requires professional players of tennis to be in physical state higher all time. These players of tennis which do not play on professional level obtain inspired while thinking just of the way in which made their idols of tennis are with the play of tennis. That the kind of attachment requires the nerve of steel and a heart made gold. It is probably why the majority of the ventilators of tennis have much respect for the people which they observe with television playing tennis in such hard conditions.
The young people can also buy video games for tennis and play them with children with the same system of play by a connection of Internet. They can obtain very inspired by seeing their character pass by the action exhausting on the court. They can see first hand what it takes to obtain with the ball above the net, and the noises which come from the players on the court of tennis are so intense that the player of play will know that playing tennis requires much effort. They could be even inspired to play more tennis when they firmly have successfully the beat their adversary during the play.
By: Jennifer Seaton
About the Author:
To read about tennis racquets and the history of tennis, visit the Tennis Rules website.
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