Physiotherapy or a “wait and see” approach are both more effective in tackling tennis elbow than corticosteroid (steroid) injections, according to a UQ study published today in the British Medical Journal.

Dr Bill Vicenzino of the University of Queensland (UQ)'s School of Health and Rehabilitation Sciences said the study tested different treatments on three separate groups of patients with tennis elbow (pain on the outside of the elbow).

The study was conducted by UQ researchers including Ms Elaine Beller, Professor Gwendolen Jull, Professor Peter Brooks, Dr Ross Darnell, Dr Vicenzino and UQ PhD student Leanne Bisset.

The researchers allocated the “wait and see” approach to one group of participants. Group members were reassured that the condition would eventually settle down and encouraged to wait. They were also given specific instructions on modifying their daily activities to avoid aggravating their pain.

A second group was given a local corticosteroid injection and advised to gradually return to normal activities.

The final group received eight treatments of physiotherapy of 30 minutes over six weeks and taught home exercises and self-manipulation. The physiotherapy group also received a resistant exercise band and exercise instruction booklet.

Each group's progress was measured at six weeks, and again after a year.

“ Initially, corticosteroid injections were the most successful treatment, with 78% of those in the group reporting improvements, followed closely by physiotherapy with a 65% success rate when compared to just 27% in the ‘wait and see' group,” Dr Vicenzino said.

“ However, after 52 weeks the injection group rates of improvement were significantly worse than those of the physiotherapy group.

_ The injection group also had the most reported recurrences, with 72% of participants' condition deteriorating after three or six weeks – which could be due, in part, to a quicker initial recovery leading to greater use and over-taxing of the elbow.”

The study also found that the superior long-term effects of physiotherapy were replicated by the wait and see approach – at the end of the study participants in both the physiotherapy and wait and see group had either much improved or completely recovered.

The British Medical Journal article said that

“ the…poor overall performance of corticosteroid injections should be taken under consideration by both the patient and their doctor in management of tennis elbow.”

Dr Vicenzino said the study findings also supported the idea that tennis elbow is, in most cases, a self-limiting condition. He said the researchers concluded that

“ patients with tennis elbow can be reassured that, in the majority of cases, they will improve in the long-term when given information and ergonomic advice about their condition.”

UQ is currently seeking further people with tennis elbow to participate in ongoing studies. Volunteers need to be 18–65 years old with pain in one elbow, aggravated by activities such as gripping, squeezing, lifting objects or playing sports.

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