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As a topic worthy of updating, it is disappointing to note
fundamental issues with both the methodology of this review as well as
errors in reporting of studies, leading to a limited perspective of the
role of exercise therapy and mobilisation techniques in treatment of
epicondylalgia. There are two major issues that readers ought to be made
aware of regarding this review.
Issue 1: A major issue is the lack of...
Issue 1: A major issue is the lack of a comprehensive search
strategy, with a simple pubmed search identifying several studies (Smidt
et al., 2002; Bisset et al., 2006; Croisier et al., 2007 ; Luginbuhl et
al., 2008; Nagrale et al., 2009) and at least two other systematic reviews
(Bisset et al., 2005; Herd et al., 2008) published within the author
specified census period. Stark omissions are two randomised trials, which
followed 185 (Smidt et al., 2002) and 198 (Bisset et al., 2006)
participants over one year. At least nine additional studies (Park et al.,
2010; Slater et al., 2010; Tyler et al., 2010; Peterson et al., 2011; Wen
et al., 2011; Fernandez-Carnero et al., 2012; Soderberg et al., 2012;
Viswas et al., 2012; Coombes et al., 2013) and a systematic review (Raman
et al., 2012) could be found beyond the census period, indicating that an
update is already timely.
The most noticeable gap in the literature presented by Hoogvliet, is
that in which exercise and manipulative treatments are included as a part
of a multimodal therapy program. Amongst missing evidence in this review,
is that which favours, in terms of speeding up resolution, the use of a
multimodal program including elbow mobilisation and concentric and
eccentric exercise compared to wait and see (Bisset et al., 2006) or
placebo intervention (Coombes et al., 2013). Given that combining exercise
and manual therapy reflects much of what occurs in clinical practice, its
absence is concerning.
Issue 2: There are errors in presentation of data from individual
studies. Readers might be better advised to refer to individual papers,
however, this in itself may be problematic given some studies were not
correctly referenced to the intended trials (e.g., #30(Cleland et al.,
2005), #11(Fernandez-Carnero et al., 2008)). That is, the study by Cleland
should refer to the pilot study of 10 participants (Cleland et al., 2005),
not the retrospective analysis of 112. There is misrepresentation of
studies, for example patient numbers, study design and results are ether
incorrect, incomplete or missing for #24 (Vicenzino et al., 1996) variably
so in Appendix 1 and text.
Bisset, L., Beller, E., Jull, G., Brooks, P., Darnell, R. &
Vicenzino, B. (2006) Mobilisation with movement and exercise,
corticosteroid injection, or wait and see for tennis elbow: randomised
trial. BMJ 333, 939.
Bisset, L., Paungmali, A., Vicenzino, B. & Beller, E. (2005) A
systematic review and meta-analysis of clinical trials on physical
interventions for lateral epicondylalgia. Br J Sports Med 39, 411-422;
Cleland, J., Flynn, T.W. & Palmer, J.A. (2005) Incorporation of
manual therapy directed at the cerviothoracic spine in patients with
lateral epicondylalgia. A pilot clinical trial. J Man Manip Ther 13, 143-
Coombes, B.K., Bisset, L., Brooks, P., Khan, A. & Vicenzino, B.
(2013) Effect of corticosteroid injection, physiotherapy or both on
clinical outcomes in patients with unilateral lateral epicondylalgia. A
randomized controlled trial. JAMA 309, 461-469.
Croisier, J.L., Foidart-Dessalle, M., Tinant, F., Crielaard, J.M.
& Forthomme, B. (2007) An isokinetic eccentric programme for the
management of chronic lateral epicondylar tendinopathy. Br J Sports Med
Fernandez-Carnero, J., Cleland, J.A. & Arbizu, R.L. (2012)
Examination of motor and hypoalgesic effects of cervical vs thoracic spine
manipulation in patients with lateral epicondylalgia: a clinical trial. J
Manipulative Physiol Ther 34, 432-440.
Fernandez-Carnero, J., Fernandez-de-las-Penas, C. & Cleland, J.A.
(2008) Immediate hypoalgesic and motor effects after a single cervical
spine manipulation in subjects with lateral epicondylalgia. J Manipulative
Physiol Ther 31, 675-681.
Herd, C.R. & Meserve, B.B. (2008) A systematic review of the
effectiveness of manipulative therapy in treating lateral epicondylalgia.
J Man Manip Ther 16, 225-237.
Luginbuhl, R., Brunner, F. & Schneeberger, A.G. (2008) No effect
of forearm band and extensor strengthening exercises for the treatment of
tennis elbow: a prospective randomised study. La Chirurgia degli organi di
movimento 91, 35-40.
Nagrale, A.V., Herd, C.R., Ganvir, S. & Ramteke, G. (2009) Cyriax
physiotherapy versus phonophoresis with supervised exercise in subjects
with lateral epicondylalgia: a randomized clinical trial. J Man Manip Ther
Park, J.Y., Park, H.K., Choi, J.H., Moon, E.S., Kim, B.S., Kim, W.S.
& Oh, K.S. (2010) Prospective evaluation of the effectiveness of a
home-based program of isometric strengthening exercises: 12-month follow-
up. Clinics in orthopedic surgery 2, 173-178.
Peterson, M., Butler, S., Eriksson, M. & Svardsudd, K. (2011) A
randomized controlled trial of exercise versus wait-list in chronic tennis
elbow (lateral epicondylosis). Upsala journal of medical sciences 116, 269
Raman, J., Macdermid, J.C. & Grewal, R. (2012) Effectiveness of
different methods of resistane exercses in lateral epicondylosis - a
systematic review. J Hand Ther 25, 5-25.
Slater, H., Theriault, E., Ronningen, B.O., Clark, R. & Nosaka,
K. (2010) Exercise-induced mechanical hypoalgesia in musculotendinous
tissues of the lateral elbow. Man Ther 15, 66-73.
Smidt, N., van der Windt, D.A., Assendelft, W.J., Deville, W.L.,
Korthals-de Bos, I.B. & Bouter, L.M. (2002) Corticosteroid injections,
physiotherapy, or a wait-and-see policy for lateral epicondylitis: a
randomised controlled trial. Lancet 359, 657-662.
Soderberg, J., Grooten, W.J. & Ang, B.O. (2012) Effects of
eccentric training on hand strength in subjects with lateral
epicondylalgia: a randomized-controlled trial. Scand J Med Sci Sports 22,
Tyler, T.F., Thomas, G.C., Nicholas, S.J. & McHugh, M.P. (2010)
Addition of isolated wrist extensor eccentric exercise to standard
treatment for chronic lateral epicondylosis: a prospective randomized
trial. J Shoulder Elbow Surg 19, 917-922.
Vicenzino, B., Collins, D. & Wright, A. (1996) The initial
effects of a cervical spine manipulative physiotherapy treatment on the
pain and dysfunction of lateral epicondylalgia. Pain 68, 69-74.
Viswas, R., Ramachandran, R. & Korde Anantkumar, P. (2012)
Comparison of effectiveness of supervised exercise program and Cyriax
physiotherapy in patients with tennis elbow (lateral epicondylitis): a
randomized clinical trial. TheScientificWorldJournal 2012, 939645.
Wen, D.Y., Schultz, B.J., Schaal, B., Graham, S.T. & Kim, B.S.
(2011) Eccentric strengthening for chronic lateral epicondylosis: a
prospective randomized study. Sports health 3, 500-503.