Exercise Therapy and Orthoses in Lateral Elbow Tendinopathy: Comparative Effects

Investigation of the Effects of Different Types of Orthoses Used in Addition to Exercise Therapy in Lateral Elbow Tendinopathy

The aim of this study was to investigate whether adding a forearm counterforce brace or a wrist orthosis to exercise therapy provided additional benefits in pain, functional status, grip strength, and perceived recovery in individuals with lateral elbow tendinopathy, compared with exercise therapy alone.

This study was conducted under the supervision of Istanbul University-Cerrahpasa, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation. It was designed as a single-centre, three-arm randomized controlled trial and included adults with unilateral lateral elbow tendinopathy who met the eligibility criteria and provided written informed consent. Participants were recruited from the Orthopedics and Traumatology Clinic of Basaksehir Cam and Sakura City Hospital. Participants were informed about the purpose, procedures, and potential risks of the study, and written informed consent was obtained from all participants. Following informed consent, 45 participants were randomly allocated in a 1:1:1 ratio to three groups:

1. Exercise-Only Group
2. Exercise + Counterforce Forearm Brace Group
3. Exercise + Wrist Orthosis Group

All participants received education, activity modification, and the same physiotherapist-led progressive exercise program. Supervised exercise sessions were conducted twice weekly for 6 weeks, followed by a 6-week home exercise program. The exercise program consisted of wrist isometric, concentric, and eccentric exercises. Free-weight exercises were initiated with 0.5-1 kg weights according to individual tolerance, with progression achieved through 0.5-1 kg increments. For exercises using resistance bands, resistance was progressed by advancing to the next resistance level. Participants in Group 2 additionally used a counterforce forearm brace, whereas participants in Group 3 additionally used a wrist orthosis.

Participants were assessed at baseline, week 6, and week 12. The primary outcome was the Patient-Rated Tennis Elbow Evaluation (PRTEE). Secondary outcomes included resting and activity pain assessed using the Numeric Pain Rating Scale (NPRS), pain-free and maximum grip strength measured using a digital hand dynamometer, and perceived recovery assessed using the Global Rating of Change (GRC) scale. Sociodemographic and clinical characteristics were recorded using a case assessment form.

The collected data were analyzed using the Statistical Package for the Social Sciences (SPSS).

Inclusion Criteria:

• Being between the ages of 18 and 65,
• Having a diagnosis of unilateral lateral elbow tendinopathy,
• Having at least two of the Thomsen, Maudsley, Mill's, or Cozen's tests positive during clinical examination,
• Experiencing symptoms for at least 3 months,
• Not having a systemic or chronic illness that would prevent participation in the treatment program.

Exclusion Criteria:

• A history of trauma or surgery in the relevant elbow and/or wrist,
• The presence of orthopedic and/or neurological problems in the cervical spine, shoulder joint, or wrist,
• Participation in a physiotherapy and rehabilitation program for lateral elbow tendinopathy within the last 6 months,
• Receiving any injections within the last 6 months,
• Systemic inflammatory disease.