Lateral epicondylitis is the most common lesion of the elbow complex. Despite also being
referred to as "tennis elbow", lateral epicondylitis is present in less than 5-10 % of
players and can appear in various tasks of excessive and repetitive effort involving
movements gripping or pronation-supination.These specific patterned movements put manual
laborers at the highest risk of developing lateral epicondylitis. Magnetic Resonance
Imaging studies done to evaluate the prevalence of lateral epicondylitis suggest signal
changes in the Extensor Carpi Radialis Brevis tendon consistent with lateral
epicondylitis increase with age, with the incidence starting after 18 years of age and
the peak prevalence in the subsequent decades of life. The cadaveric studies have
established the direct contact of Extensor Carpi Radialis Brevis tendon with the elbow
joint capsule, making it the epicondylar tendon bearing the greatest load in executing a
backhand while playing tennis. Another study observed friction between the ECRB tendon
and capitellum during flexion extension at the elbow joint. The Extensor Carpi Radialis
Longus is the next most affected muscle in lateral epicondylitis since it has a tendon
footprint 13 times greater than the Extensor Carpi Radialis Brevis on the epicondyle. As
per the natural history of the lateral epicondylitis, it resolves spontaneously in 1-2
years without treatment. However, very few studies have compared outcomes with and
without treatment. In a meta-analysis, no difference between nonoperative versus no
treatment group was found for patients with lateral epicondylitis. One study reported no
difference for the physiotherapy and corticosteroid groups compared to the wait-and-see
group at 1 year against outcomes, while in another study the outcomes in the
physiotherapy group were only slightly better. There are a number of different
physiotherapy treatment options are available for lateral epicondylitis. However,
literature is scarce for established efficacy of these treatments, largely due to lack of
homogeneity as well as varied protocols of dosage and frequency. Nevertheless, these
treatment options include but are not limited to stretching exercises, mobilization,
electrotherapeutic modalities, deep transverse massage, orthoses, acupuncture, eccentric
exercises and neuromuscular rehabilitation excercises etc. Neuromuscular rehabilitation
can enhance grip strength by targeting both the muscles and the nervous system. It
involves exercises that improve muscle coordination, motor control, and strength, which
are crucial for a strong grip. Additionally, neuromuscular training can help re-establish
proper firing patterns between the brain and muscles, leading to more efficient muscle
recruitment and ultimately, improved grip strength. The treatment principle in most of
these options is to reduce the force acting at the origin of the extensor muscles of the
wrist allowing time for recovery to occur. The outcome reported as a result of the
intervention is an improvement in pain, function and grip strength. As already stated,
the available literature for the efficacy of conservative management of lateral
epicondylitis cites lack of uniform results and therefore advocates for further research
to establish the effect of these interventions. One such study by Marcolino et. al
employed a multimodal rehabilitation protocol for lateral epicondylitis in a form of case
series. This aim study aim at verifying "the efficiency of the multimodal treatment with
mobilization with movement associated with eccentric strengthening, transverse massage
and stretching in the treatment of eight volunteers with symptoms of lateral
epicondylitis". According to this study, the results showed statistical differences in
pain symptoms before and after treatment, in the analysis and functional assessment.
However, lack of control group as well as the study design and the small sample size
serve as confounding variables thereby limiting the ability of this study to generalize
their findings. Furthermore, the study lacked objective evaluation for the assessment of
grip strength. Therefore, the current study aims to work on the limitations of the study
done by Marcolino et. al, by reducing the risk of biasness and eliminating the
confounding variables. This will be done by conducting a randomized controlled trial in a
larger sample size and comparing the suggested multimodal approach to the conventional
protocol followed for lateral epicondylitis. Furthermore, in order to accurately measure
the change in grip strength following the treatment protocol, dynamometer will be used.