Gaps 08

Listen to the audio plenty of times and fill in the blanks with the exact words / phrases you hear.

The condition, commonly called tennis elbow, is a painful condition of the (2) ___________________ which interferes with tasks involving (2) ___________________ and manipulating objects. A recent trial led by Dr. Bob Dean has tried to see what type of therapy 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 industries where they do certain (3) ___________________, it’s surprisingly difficult for patients to (4) ___________________ the actual start of the pain. And even with those high risk activities, 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 (5) _____________ or the type of (6) ___________________ they were using, but nobody’s really researched that thoroughly. There are plenty of guidelines out there, but they’re not (7) ___________________. When somebody has pain, then modifying their tools, whether that’s a tennis racquet or something at work may well help, but that doesn’t necessarily mean there’s a (8) ___________________.

So what was your approach in the trial you conducted? 

Well, we divided our patients into three groups. One group followed a physiotherapy program. Another was asked to do (9) ___________________ 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 (10) ___________________. The physiotherapy we used was a specific (11) ___________________. The therapist applies manual force to the (12) ___________________, and at the same time, the patient actually performs the kind of task that causes the pain. The aim is to apply the force in a way that (13) ___________________ that particular pain. But just as important is the physical activity the therapy (14) ___________________, because in most tennis elbow patients, their muscle system is quite (15) ___________________. 

And I understand that complete rest wasn’t seen as an option. Instead, you describe something called smart rest. 

Resting is an interesting thing. (16) ___________________ the arm in a sling is probably the worst thing anyone with a tennis elbow can do. In fact, resting most (17) ___________________ pain isn’t good. What we advocate is something called (18) ___________________. And what this means is being as lively, as dynamic as possible, but not (19) ___________ the elbow. An example is where patients avoid picking things up with their (20) ___________________, which is classic advice given to anyone with a condition. But patients do need the (21) ___________________ of movement to help rehabilitation. And so, all our participants were given (22) ___________________ on how to manage their condition ergonomically, even the wait and see group. The difference was they didn’t get any other form of treatment, whereas our other two groups did. 

So what were the results? 

What we found was that steroid injections were more effective in the (23) ___________________, but not after that. The physiotherapy group also reported good results (24) ___________________, comparable to those for the injection group and much better than those reported by the wait and see group. But then, (25) ___________________, the situation had changed. The physiotherapy group was now reporting better results than the injection group. And remarkably, so was the (26) ___________________ and see group. Indeed, they were catching up all round. So much so that after six months, physiotherapy is no more effective than doing nothing at 12 months. And what’s fascinating is that with a second study to show this, the (27) ___________________ for people who do nothing was 70 to 80%. 

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 (28) ___________________. If it hasn’t resolved itself by then, they’re probably one of those (29) ___________________ who aren’t going to get better at that stage. I’d recommend they have some (30) ___________________ physiotherapy. I don’t think there’s much evidence to support the use of steroid injections until a really good attempt has been made with the (31) ___________________ backed up by physiotherapy. But it’s still (32) ___________________ at that stage because the alternative could be some quite (33) ___________________, even possibly surgery. 

I see. Now, it’s quite common for people to think that if something’s sore and swollen, they’ve got to take anti inflammatories like ibuprofen. Are they right? 

Well, there have been various studies about this and what they found is that there’s (34) ___________________ of inflammation in tennis elbow. So there’s no reason to think that (35) ___________________ are going to be very beneficial. So I suspect that just taking basic (36) ___________________ pain relief would be at least as successful as taking anti-inflammatory drugs in the case of tennis elbow.