Effect of Extra Corporeal Shockwave Therapy with Conventional Therapy on Pain Quality of Life in Subjects with Lateral Epicondylalgia

Abstract

Tennis elbow, or lateral epicondylalgia, is one of the more frequent causes of pain and limitation around the elbow. Extracorporeal Shockwave Therapy (ESWT) combined with standard rehabilitation could provide greater relief of pain and functional improvement than standard therapy alone. To compare the effect of ESWT combined with conventional therapy versus conventional therapy alone on pain and quality of life (functional status) in adults with lateral epicondylalgia. Randomized, pre–post experimental study in outpatient rehabilitation clinics. Participants (n = 30) 18–65 years with clinically diagnosed lateral epicondylalgia were randomly assigned to:

- Group A: Conventional therapy + ESWT (intervention) (15 subjects)

- Group B: Standard therapy alone (control) (15 subjects)

Standard treatment for both groups consisted of rest and activity modification, cryotherapy, TENS and ultrasound, wrist extensor stretching, and isometric strengthening. The ESWT protocol (Group A) employed radial or focused ESWT 0.08–0.25 mJ/mm², 8–15 Hz, 1500–2500 shocks per treatment, 24 treatments total, administered once a week for 4 weeks. Post-treatment management consisted of NSAID avoidance for 48 hours and progressive return to loading exercises. Outcome measures were measured at baseline and post-treatment (4 weeks) and consisted of pain severity (Numeric Pain Rating Scale, NPRS) and function (Patient-Rated Tennis Elbow Evaluation, PRTEE). Follow-up assessments were taken at 6 weeks post-treatment. Group A showed highly significant decrease in pain as compared to Group B (NPRS: t = 9.04, p = 3.20 × 10⁻⁷) and highly significant improvement in function (PRTEE: t = 11.01, p = 2.81 × 10⁻⁸). Group B also demonstrated considerable reduction in pain (NPRS: t = 8.36, p = 8.16 × 10⁻⁷) and enhancement of function (PRTEE: t = 11.24, p = 2.15 × 10⁻⁸); however, the amount of improvement was in favor of ESWT. Between-group analysis was in favor of Group A, showing an additive or synergistic effect of ESWT with standard therapy in pain relief and improvement of elbow function after a 4-week course of treatment. Combination with conventional rehabilitation of ESWT offers greater short-term pain reduction and functional gain than alone conventional therapy in adults with lateral epicondylalgia. The results support the addition of ESWT to multimodal treatment, with care regarding treatment parameters and patient tolerance. Follow-up for longer intervals and reporting of effect sizes according to standard is indicated.