You hear an interview with Dr. Bob Dean, who's talking about a trial he conducted to assess different ways of treating the condition known as tennis elbow.
The condition commonly called tennis elbow is a painful condition of the which interferes with tasks involving gripping and manipulating objects. A recent trial led by Dr. Bob Dean has tried to see what type of works best. Bob, is there a typical way that tennis elbow starts?
It's a very common condition, but apart from tennis players themselves and people working in where they do certain manual tasks, it's surprisingly difficult for patients to pin down the actual start of the pain. And even with those high-risk , it's generally something that comes on over a period of time. In tennis, it used to be said it was down to the player's or the type of they were using, but nobody's really researched that thoroughly. There are plenty of guidelines out there, but they're not evidence-based. When somebody has pain, then modifying their , whether that's a tennis racket or something at work, may well help, but that doesn't necessarily mean there's a .
So what was your approach in the trial you conducted?
Well, we divided our patients into 3 groups. One group followed a program, another was asked to do nothing to see if the condition just went away by itself - the wait-and-see group, we called them - and people in the third group were given . The physiotherapy we used was a specific manipulation. The therapist applies manual force to the elbow joint, and at the same time, the patient actually performs the kind of task that causes the pain. The aim is to apply the in a way that relieves that particular pain. But just as important is the the therapy calls for. Because in most tennis elbow patients, their muscle system's quite .
And I understand that complete rest wasn't seen as an option. Instead, you describe something called smart rest.
Resting's an interesting thing. the arm in a sling is probably the worst thing anyone with a tennis elbow can do. In fact, resting most pain isn't good. What we advocate is something called smart rest.— and what this means is being as lively, as dynamic as possible, but not hurting the elbow. An example is where patients avoid things up with their palm facing down, which is classic advice given to anyone with a condition. But patients do need the of movement to help rehabilitation, and so all our participants were given advice on how to manage their condition , even the wait-and-see group. The difference was they didn't get any other form of , whereas our other two groups did.
So what were the results?
What we found was that steroid were more effective in the first 6 weeks, but not after that. The physiotherapy group also reported good results at 6 weeks, comparable to those for the , and much better than those reported by the wait-and-see group. But then, after 3 months, the situation had changed. The was now reporting better results than the injection group, and remarkably, so was the wait-and-see group. Indeed, they were all round, so much so that after 6 months, physiotherapy is no more effective than doing nothing. , and what's fascinating is that we're the second study to show this, the recovery rate for people who do nothing was .
So what does all this mean for patients? What advice would you give them on the strength of this trial?
I'd say in the first instance, rest the elbow and see how it is in 3 months. If it hasn't itself by then, they're probably one of those 20 to 30% who aren't going to get better. At that stage, I'd recommend they have some physiotherapy. I don't think there's much to support the use of steroid injections until a really good attempt's been made with the wait-and-see approach backed up by physiotherapy. But it's still worth trying at that stage because the could be some quite drastic measures, even possibly .
I see. Now it's quite common for people to think that if something's , they've got to take anti-inflammatories like ibuprofen. Are they right?
Well, there have been various studies about this, and what they've found is that there's little evidence of in tennis elbow. So there's no reason to think that anti-inflammatory drugs are going to be very beneficial. So I suspect that just taking basic pain relief would be at least as successful as taking anti-inflammatory drugs in the case of tennis elbow.
Now, go back to the previous task and Retake the Test.
