Tennis Elbow Treatment: Efficaciousness of Kinesio tape and Therapeutic Ultrasonography

Tennis elbow, sometimes called lateral epicondylitis, is often brought on by overstress or repeated motions, such as those involved in manual labor or sports like tennis. Tennis elbow is present in around 2% of people [1]. People between the ages of 40 and 60 are more likely to experience the symptoms, most likely due to the fact that middle-aged and older muscles are more prone to overuse. Men and women both experience tennis elbow [2]. Where the tendons connect to the muscles on the outside of the elbow is where tennis elbow discomfort originates. The tendons in question are engaged in wrist extension motions. Those who typically don't utilize their forearm muscles much and then abruptly overdo them are often affected. However, there is more to the symptoms than just temporary abuse. Tennis elbow may develop as a consequence of frequent repetitive strain. Although it may potentially affect the whole arm, discomfort in the outer elbow is the primary symptom [3, 4]. Usually only felt when the elbow is moved or touched, the pain in the outer elbow may also radiate to the upper arm, forearm, or hand. Even seemingly basic actions, such as turning the bottle's lid off to get a firm grasp, might cause discomfort. Also, it becomes more flexible than it was before. If the arm is not resting as much, the soreness may subside. The inability to fall asleep brought on by these symptoms is another possibility [5]. Possible causes include:

• Heavy lifting Ÿ Playing musical instruments, such as the piano

• Manual labour like painting, carpentry or turning screws

• Sports like tennis, rowing or strength training

• Working at a computer or a supermarket cash register

Tennis elbow most often results from overusing or misusing muscles, which wears down and irritates the base of the tendons that connect to the muscles and causes minor injuries. To determine if a patient has tennis elbow, a physical examination is performed [6, 7]. Doctors often only investigate X-rays, ultrasound scans, or magnetic resonance imaging (MRI) when they suspect a patient may have a more serious condition. Reducing or eliminating activities that aggravate the symptoms may be helpful in avoiding or lessening the symptoms. Pain relief may be achieved with "eccentric exercises," which are specialized movements designed to strengthen the wrist and forearm [8]. A

Lateral epicondylitis, the clinical term for tennis elbow, is a common ailment that affects a large number of people, particularly those who play sports or participate in repetitive arm motions. Tennis elbow is characterized by discomfort and soreness on the outside of the elbow, which may significantly lower quality of life and make it difficult to carry out daily activities. This article explores the effectiveness of two widely used modalities—kinesio tape and therapeutic ultrasound—in the search for efficient treatment choices. By delving into their mechanics, application techniques, and study results, we want to provide a thorough grasp of how these therapies might ease the pain related to tennis elbow [9].

Elastic therapeutic tape known as kinesio tape has become more well-known in recent years due to its use in the treatment of a variety of musculoskeletal disorders, including tennis elbow. The main purpose of the tape is to support muscles and joints structurally without limiting their range of motion. Kinesio tape is thought to work in a number of ways to lessen tennis elbow discomfort and enhance function. [10]:

• Pain Modulation: Kinesio tape has the potential to reduce pain by enhancing proprioception and reducing the feeling of pain by activating the skin's sensory receptors. Additionally, it may gently raise the skin, freeing up space to lessen the pressure on pain receptors.

• Support for Muscles: The elastic qualities of the tape provide support for strained or injured muscles, lessening the tension on the forearm's extensor tendons and the lateral epicondyle.

• Enhanced Circulation: According to some hypotheses, using kinesio tape may improve lymphatic and blood circulation, which would aid in the elimination of waste products from metabolism and aid in tissue regeneration.

and temporary pain alleviation. Its long-term effectiveness, however, is still up for discussion, with conflicting results in the literature [11-16].

Tennis elbow, also known as lateral epicondylitis (LE), is the most prevalent cause of elbow discomfort. According to reports, the general population has a 3% incidence of LE; it is anticipated that this percentage will rise among manufacturing employees and paddle sportsmen. LE often affects people in their middle age (40–54), with equal effects on males and women. More often, the dominant upper limb is impacted. Firm hand grips at a forearm pronation of > 45° and challenging or repeated wrist or forearm actions have been identified as risk factors for LE. Clinically, the discomfort is located around the lateral epicondyle and causes a considerable wrist extension. The etiopathogenesis of LE is thought to be caused by degenerative angiofibroblastic hyperplasia of the wrist extensor tendons as a result of repeated microtraumas. Neuromuscular insufficiency and changes in the sensory system have also been seen in LE patients [17]. Several therapies for LE have been shown to have inadequate evidence, despite the fact that these treatments are often conservative (e.g., oral medications, steroid injections, physiotherapy, and orthoses) [17, 18]. Use of Kinesio Taping (KT) to treat a range of musculoskeletal issues is common. The tape was created in the 1970s by Japanese chiropractor Kenzo Kase and consists of an elastic cotton weave with a maximum useable tension of around 40–60% of its whole length, combined with a heat-sensitive acrylic glue. Numerous physiological benefits are expected by KT, including as reduced pain, restored muscle function, enhanced proprioceptive input, repaired joint incompatibility, and increased circulation of lymph and blood under the skin [19]. Regarding the best sort of tape to use and how to apply it, there is no agreement [20]. Furthermore, there is conflicting data on the immediate and short-term follow-up effects of KT, and not many research have looked at the efficacy of KT as a short-term therapy [5]. According to [21], after using KT, patients with LE reported much improved grip strength and reduced discomfort. A placebo-controlled research found that although genuine pain alleviation and painless grip strength had similar benefits to a placebo, KT seemed to have extra effects in reducing the pain associated with elbow wrist extensions [7]. An orthosis that is often used to treat LE is forearm bandaging (FB). Under the elbow, they are worn. By lowering strain on the common origin of the wrist extensors, FB primarily aims to address the source of a lesion [22, 23]. Studies have shown that compared

beneficial for their everyday activities [24]. While FB's impact on handgrip strength and discomfort was not noted in some research involving individuals with LE, other studies' findings indicated that FB enhances handgrip strength and decreases pain [25, 26]. Numerous controversies have been raised by the literature about the relative merits of these two therapy modalities (KT and FB), offering both good and negative results. Nevertheless, we were unable to locate enough information contrasting the efficacy of various strategies.

To find out how kinesio tape and therapeutic ultrasound affect tennis elbow discomfort and hand grip strength.

Over the course of four weeks, 25 patients in the 40–50 age range who met the inclusion and exclusion criteria were part of an experimental research design at the Physiotherapy Center in Saudi.

Inclusion Criteria:  25 Subjects  Subject wrist.  Voluntary participants Exclusion Criteria:  Those that suffer from clinical disorders  Injectable corticosteroids or use oral NSAIDs earlier were not among the subjects.  The individuals without any elbow deformity and those with deformities in the afflicted lateral elbow and wrist.  Individuals who declined to take part Kinesio Tape  Apply the tape directly over the painful area, using multiple strips if necessary, generally along the muscle fibers. the tape.  Use scissors to round the edges of the tape to avoid early lifting off skin.  The tape can be worn for up to three days, though exposure to water may shorten that time.  Use about 25% tension but no more than 50% to avoid skin irritation. After application, gently rub the tape to activate the adhesive.  If skin becomes red and irritated, remove it immediately (it may be an allergic reaction).

To evaluate the impact of the counterforce forearm brace, mean scores were compared before and after the intervention, and a paired-sample t-test was used to see whether any significant changes existed. SPSS (version 15.0) was used for the statistical analysis, and P-values of less than 0.05 were regarded as statistically significant.

The individuals' pre- and post-test information has been gathered. The paired t test and the basic t test must be used to analyze the data in statistics.

The medication has resulted in a noteworthy improvement in pain reduction (t value = 2.21, p < 0.05). The SD has dropped from 0.879 to 0.689, and the mean value of the VAS has dropped from 150 to 111.

Due to the therapy, there has been a noticeable improvement in the reduction of handicap (t value=9.89, p=0.9). The UEFI mean value improved from 615 to 795, indicating a significant improvement in the reduction of handicap. The impairment lessens as the scores rise.

The pain strength findings for are shown in Figure 2, which demonstrates that there are substantial variations between the pre and post tests. Specifically, the post test reveals reduced pine by a mean of 3, compared to the pre-test (8.1). The statistical analysis has shown the critical effect that therapeutic ultrasonography and kinesio taping have had in lowering pain and impairment. The VAS mean ratings showed a drop from the pre-test to the post-test, suggesting a more significant reduction in pain. In a similar vein, the UEFI scores rose between the pre- and post-test, indicating a decrease in the degree of impairment. The disability decreases as the mean scores rise.

The results of this research indicate that, although their modes of action and results may vary, kinesio tape and therapeutic ultrasound may both be effective in the treatment of tennis elbow. It was discovered that kinesio tape immediately relieved pain and, in the short term, improved functional results. The use of the tape seems to relieve tension on the lateral epicondyle and support the injured muscles. Conversely, during an extended course of therapy, therapeutic ultrasonography shown encouraging outcomes in lowering inflammation and accelerating tissue recovery. It's crucial to remember that each participant's reaction to these therapies differed, and not everyone saw appreciable progress. Furthermore, even greater outcomes might be obtained by treatment plans for tennis elbow, further study is required. In clinical practice, while deciding between kinesio tape and therapeutic ultrasound as part of an all-encompassing treatment strategy for tennis elbow, medical professionals should take the patient's preferences, the severity of the problem, and the availability of resources into account.

1. Boyer MI. Lateral tennis elbow:” Is there any science out there?.”Journal of Shoulder and Elbow Surgery. 2013;8(5):481-91. 2. Sghir M, Elhersi T, Abdallah A, Salah AH, Khemiri NE, Dammak N, Kessomtini W. Epidemiological profile of lateral epicondylitis in the rehabilitation department. The Pan African Medical Journal. 2020 Aug 11;36:265-. 3. Lai WC, Erickson BJ, Mlynarek RA, Wang D. Chronic lateral epicondylitis: challenges and solutions. Open access journal of sports medicine. 2018;9:243. 4. Au IP, Fan PC, Lee WY, Leong MW, Tang OY, An WW, Cheung RT. Effects of Kinesio tape in individuals with lateral epicondylitis: a deceptive crossover trial. Physiotherapy theory and practice. 2017 Dec 2;33(12):914-9. 5. Cho YT, Hsu WY, Lin LF, Lin YN. Kinesio taping reduces elbow pain during resisted wrist extension in patients with chronic lateral epicondylitis: a randomized, double-blinded, cross-over study. BMC musculoskeletal disorders. 2018 Dec;19(1):193. 6. Giray E, Bingul DK, Akyuz G. The effectiveness of kinesiotaping, sham taping or exercises only in the treatment of lateral epicondylitis: A randomized controlled study. PM&R. 2019 Jan 4. 7. Özmen T, Koparal SS, KarataŞ Ö, Eser F, Özkurt B, GafuroĞlu TÜ. Comparison of the clinical and sonographic effects of ultrasound therapy, extracorporeal shock wave therapy and kinesio taping in lateral epicondylitis [published online ahead of print, 2020 Jul 19]. Turk J Med Sci. 2020;10.3906/sag-2001-79. 8. Shahabi S, Bagheri Lankarani K, Heydari ST, Jalali M, Ghahramani S, Kamyab M, Tabrizi R, Hosseinabadi M. The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials. Prosthetics and Orthotics International. 2020 Jul 8:0309364620930618. 9. Matache BA, Berdusco R, Momoli F, Lapner PLC, Pollock JW. A randomized, double-blind sham-controlled trial on the efficacy of

2016;17:239. doi:10.1186/s12891-016-1093-9 10. Kroslak M, Murrell GAC. Surgical Treatment of Lateral Epicondylitis: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. Am J Sports Med. 2018 Mar 1:363546517753385. doi: 10.1177/0363546517753385. 11. Millar NL, Murrell GA, Kirwan P. Time to put down the scalpel? The role of surgery in tendinopathy. 12. Arrigoni P, Cucchi D, Menon A, Randelli P. It’s time to change perspective! New diagnostic tools for lateral elbow pain. Musculoskeletal surgery. 2017 Aug 2:1-5. 13. Hauser RA, Blakemore PJ, Wang J, Steilen D. Structural basis of joint instability as cause for chronic musculoskeletal pain and its successful treatment with regenerative injection therapy (prolotherapy). The Open Pain Journal. 2014 Sep 9;7(1). 14. Rabago D, Lee KS, Ryan M, Chourasia AO, Sesto ME, Zgierska A, Kijowski R, Grettie J, Wilson J, Miller D. Hypertonic Dextrose and Morrhuate Sodium Injections (Prolotherapy) for Lateral Epicondylosis (Tennis Elbow): Results of a Single-blind, Pilot-Level, Randomized Controlled Trial. Am J Phys Med Rehabil. 2013 Jan 3 15. Yelland M, Rabago D, Ryan M, Ng SK, Vithanachchi D, Manickaraj N, Bisset L. Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: a single-blinded randomised clinical trial. BMC musculoskeletal disorders. 2019 Dec 1;20(1):509. 16. Hauser RA, Hauser MA, Baird NM. Evidence-Based use of dextrose Prolotherapy for musculoskeletal pain: a scientific literature review. Journal of Prolotherapy. 2011;3(4):765-789. 17. Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2016 Jan;9:CMAMD-S39160. 18. Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med. 2008;18(3):248–54. 19. Shin J, Seo K-M, Kim D-K, Kim B-K, Kang SH. The effect of prolotherapy on lateral epicondylitis of elbow. J Korean Acad Rehabil Med. 2002;26:764– 20. Park JH, Song IS, Lee JB, et al. Ultrasonographic findings of healing of torn tendon in the patients with lateral epicondylitis after prolotherapy. J Korean Soc Med Ultrasound. 2003;22(3):177–83. Lateral Epicondylopathy: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. 2020 Sep 28. 22. Uygur E, AktaŞ B, Yilmazoglu EG. The use of dry needling versus corticosteroid injection to treat lateral epicondylitis: a prospective, randomized, controlled study. Journal of Shoulder and Elbow Surgery. 2020 Sep 17. 23. Bayat M, Raeissadat SA, Babaki MM, Rahimi-Dehgolan S. Is Dextrose Prolotherapy Superior To Corticosteroid Injection In Patients With Chronic Lateral Epicondylitis?: A Randomized Clinical Trial. Orthopedic Research and Reviews. 2019;11:167. 24. Apaydin H, Bazancir Z, Altay Z. Injection Therapy in Patients with Lateral Epicondylalgia: Hyaluronic Acid or Dextrose Prolotherapy? A Single-Blind, Randomized Clinical Trial [published online ahead of print, 2020 Sep 15]. J Altern Complement Med. 2020;10.1089/acm.2020.0188. doi:10.1089/acm.2020.0188 25. Evans JP, Maffulli N, Smith C, Watts A, Valderas J, Goodwin V. Even experts cannot agree on the optimal use of platelet-rich plasma in lateral elbow tendinopathy: an international Delphi study. Journal of Orthopaedics and Traumatology. 2021 Dec;22(1):1-0. 26. Brkljac M, Conville J, Sonar U, Kumar S. Long-term follow-up of platelet-rich plasma injections for refractory lateral epicondylitis. J Orthop. 2019 Aug 14;16(6):496-499. doi: 10.1016/j.jor.2019.08.023. PMID: 31680739; PMCID: PMC6818374.

Physiotherapist, Prince Sultan Military Medical City - Riyadh KSA