Both physiotherapy and a wait-and-see approach to treating tennis elbow outperformed corticosteroid injections over the course of a year, even though patients receiving the injections were experiencing less pain at 6 weeks, according to study findings.
Leanne Bisset, a PhD candidate at the School of Health and Rehabilitation Sciences at the University of Queensland, St. Lucia, Australia, and associates studied 198 adults with a history of tennis elbow for a minimum of 6 weeks; none of the patients had been treated for the condition in the previous 6 months. The patients were randomized into groups treated with one steroid injection followed by a second in 2 weeks if needed, physiotherapy (treatments of 30 minutes over 6 weeks, plus home exercises and elbow manipulation), or a “watch and wait” strategy that included modification of daily activities and treatment with analgesics, heat, cold, or braces (BMJ 2006; 333:939).
After 6 weeks, the average pain-free grip ratio of the unaffected arm to the affected arm was highest in the injection group at 84%. But at 12 weeks, it dropped to 64%, before rising again to 85% at 52 weeks. In the wait-and-see group, the pain-free grip ratio rose steadily from 52% at 6 weeks to 96% at 52 weeks.
In the physiotherapy group, it rose steadily also, from 70% at 6 weeks to 101% at 52 weeks. The steroid group had the most recurrences; 72% deteriorated after 3 or 6 weeks. Recurrence rates were 8% in the physiotherapy group and 9% in the wait-and-see group.