Research Protocol
Volume 11 Issue 4 - 2020
448 khz Capacitive Resistive Monopolar Radiofrequency and a Supervised Exercise Programme in Patients with Lateral Elbow Tendinopathy? A Research Protocol
Dimitrios Stasinopoulos1*, Antonis Constantinou2, Areti-Zoi Cheimonidou3 and Dimitrios Lamnisos4
1Assistant Professor of Physiotherapy, Department of Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Member of Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Athens, Greece
2Physical Therapist/Clinical Trainer, Cyprus Musculoskeletal and Sports Trauma Research Centre (CYMUSTREC), Department of Health Sciences, Physiotherapy Program, School of Sciences, European University of Cyprus, Nicosia, Cyprus
3Physical Therapist/Clinical Trainer, Department of Health Sciences, Physiotherapy Program, School of Sciences, European University of Cyprus, Nicosia, Cyprus
4Chairperson/Assistant Professor of Biostatistics, Co-ordinator of Msc in Public health, Department of Health Sciences, Cyprus Musculoskeletal and Sports Trauma Research Centre (CYMUSTREC) Physiotherapy Program, School of Sciences, European University of Cyprus, Nicosia, Cyprus
*Corresponding Author: Dimitrios Stasinopoulos, Assistant Professor of Physiotherapy, Department of Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Member of Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), Athens, Greece.
Received: February 27, 2020; Published: March 27, 2020




Abstract

Background: One of the two most common tendinopathies of the upper limb is Lateral elbow Tendinopathy (LET). An exercise programme consisting of static stretching exercises of wrist extensors, isometric of wrist extensors, concentric - eccentric training of wrist extensors, Tendon Neuroplastic Training (TNT) of wrist extensors, and strengthening of rotator cuff, scapula muscles exercises and supinator has been recommended for the management of LET. 448 kHz Capacitive Resistive Monopolar Radiofrequency (CRMRF) is usually used as a supplement to exercise programme. The purpose of the present article will be to make a comparison of the effects of an exercise programme consisting of TNT of wrist extensors, static stretching exercises of wrist extensors, isometric of wrist extensors, concentric - eccentric training of wrist extensors and strengthening of supinator, rotator cuff and scapula muscles exercises and an exercise programme consisting of TNT of wrist extensors, static stretching exercises of wrist extensors, isometric of wrist extensors, concentric - eccentric training of wrist extensors and strengthening of supinator, rotator cuff and scapula muscles exercises and 448 kHz CRMRF for the treatment of LET.

Methods/Design: LET patients will participate in this randomized clinical trial (RCT). Patients will be allocated to two groups randomly. Group A will be treated with TNT of wrist extensors, static stretching exercises of wrist extensors, isometric of wrist extensors, concentric - eccentric training of wrist extensors and strengthening of supinator, rotator cuff and scapula muscles exercises and group B will be treated with TNT of wrist extensors, static stretching exercises of wrist extensors, isometric of wrist extensors, concentric - eccentric training of wrist extensors and strengthening of supinator, rotator cuff and scapula muscles exercises and 448 kHz CRMRF. All patients will receive 20 treatments totally (5 treatments/week for 4 weeks). Pain (visual analogue scale), function (visual analogue scale) and pain-free grip strength will be evaluated at the end of treatment, at 3 months follow-up and at 6 months follow up. The independent t test will be used to determine the differences between groups. A paired t test will be used to determine the difference within groups. The level for statistical significance will be 5% level of probability. SPSS 21.00 will be used for the statistical analysis

Discussion: The present RCT will be evaluate the effectiveness of 448 kHz CRMRF as a supplement to exercise programme in patients with LET.

Trial Registration: The Cyprus Ethics Committee will approve the study.

Keywords: Monopolar Radiofrequency; Lateral Elbow Tendinopathy (LET); Extensor Carpi Radialis Brevis (ECRB)

References

  1. Stasinopoulos D and Johnson MI. “Lateral elbow tendinopathy is the most appropriate diagnostic term for the condition commonly referred to as lateral epicondylitis”. Medical Hypotheses 67 (2006): 1399-1401.
  2. Bisset LM and Vicenzino B. “Physiotherapy management of lateral epicondylalgia”. Journal of Physiotherapy 61 (2015): 174-181.
  3. Coombes BK., et al. “Management of Lateral Elbow Tendinopathy-One Size Does Not Fit All”. Journal of Orthopaedic and Sports Physical Therapy 17 (2015): 1-38.
  4. Kraushaar B and Nirschl R. “Current concepts review - tendinosis of the elbow (tennis elbow). Clinical features and findings of histological immunohistochemical and electron microscopy studies”. Journal of Bone and Joint Surgery America 81 (1999): 259-285. 
  5. Vicenzino B and Wright A. “Lateral epicondylalgia I: epidemiology, pathophysiology, aetiology and natural history”. Physical Therapy Reviews 1 (1996): 23-34.
  6. Waugh E., et al. “ Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy”. Archives of Physical Medicine and Rehabilitation 85 (2004): 308-318. 
  7. Haker E. “Lateral epicondylalgia: diagnosis, treatment and evaluation”. Critical Reviews in Physical and Rehabilitation Medicine 5 (1993): 129-154.
  8. Hong QN., et al. “Treatment of lateral epicondylitis where is the evidence? ” Joint Bone Spine 71 (2004): 369-373.
  9. Stasinopoulos D and Johnson MI. “Physiotherapy and tennis elbow/lateral epicondylitis”. Letter. Rapid response to Assendelft., et al. (2003) article Tennis elbow: BMJ (2004).
  10. Trudel D., et al. “Rehabilitations for patients with lateral epicondylitis: a systematic review”. Journal of Hand Therapy 17 (2004): 243-266.
  11. Smidt N., et al. “Effectiveness of physiotherapy for lateral epicondylitis: a systematic review”. Annals of Medicine 35 (2003): 51-62.
  12. Labelle H., et al. “Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow: an attempted meta-analysis”. Journal of Bone and Joint Surgery 74 (1992): 646-651.
  13. Wright A and Vicenzino B. “Lateral epicondylalgia II: therapeutic management”. Physical Therapy Reviews 2 (1997): 39-48.
  14. Bisset L., et al. “A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia”. British Journal of Sports Medicine 39 (2005): 411-422.
  15. Stasinopoulos D and Johnson MI. “Treatment- management for tendinopathy”. Rapid response to Khan., et al. (2002) article Time to abandon the ‘tendinitis’ myth. BMJ (2004).
  16. Johannsen F., et al. “Rebox: an adjunct in physical medicine?” Archives of Physical Medicine and Rehabilitation 74 (1993): 438 -440. 
  17. Manias P and Stasinopoulos D. “A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy”. British Journal of Sports Medicine 40 (2006): 81-85.
  18. Pienimaki T., et al. “Progressive strengthening and stretching exercises and ultrasound for chronic lateral epicondylitis”. Physiotherapy 82 (1996): 522-530.
  19. Stasinopoulos D and Stasinopoulos I. “Comparison of effects of Cyriax physiotherapy, a supervised exercise programme and polarized polychromatic non-coherent light (Bioptron light) for the treatment of lateral epicondylitis”. Clinical Rehabilitation 20 (2006): 12-23.
  20. Stasinopoulos D., et al. “Comparison of effects of a home exercise programme and a supervised exercise programme for the management of lateral elbow tendinopathy”. British Journal of Sports Medicine 44 (2010): 579-583.
  21. Vicenzino B., et al. “The initials effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia”. Pain 68 (2013): 69-74.
  22. Welsh P. “Tendon neuroplastic training for lateral elbow tendinopathy: 2 case reports”. Journal of the Canadian Chiropractic Association 62.2 (2018): 98-104.
  23. Bhatt JB., et al. “Middle and lower trapezius strengthening for the management of lateral epicondylalgia: a case report”. Journal of Orthopaedic and Sports Physical Therapy 43.11 (2013): 841-7.15.   
  24. Raman Sharma M., et al. “Effect of adding rotator cuff strengthening to therapeutic ultrasound and wrist extensor eccentric exercise for lateral epicondylalgia - a randomized clinical trial”. Journal of Health Sciences and Research 5.7 (2015): 250-257.
  25. Stasinopoulos D., et al. “A pilot trial to study the effectiveness of an exercise programme in the treatment of rotator cuff tendinopathy”. Journal of Biology of Exercise 10.2 (2014): 69-77.
  26. Demosthenous M., et al. “The effectiveness of eccentric - concentric training of wrist extensors and eccentric – concentric training combined with supinator strengthening in healthy population”. Journal of Orthopaedics and Physiotherapy 3 (2017): 036.
  27. Stratford P., et al. “Extensor carpi radialis tendonitis: a validation of selected outcome measures”. Physiotherapy Canada 39 (1987): 250-255.
  28. Raman J., et al. “Effectiveness of different methods of resistance exercises in lateral epicondylosis-a systematic review”. Journal of Hand Therapy 25 (2012): 5-25.
  29. Peterson M., et al. “A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy) ”. Clinical Rehabilitation 28 (2014): 862-872. 
  30. Malliaras P., et al. “Achilles and patellar tendinopathy loading programmes. a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness”. Sports Medicine 43 (2013): 267-286.
  31. Martinez-Silvestrini JA., et al. “Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening”. Journal of Hand Therapy 18 (2005): 411-419.
  32. Malliaras P., et al. “Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations”. Journal of Orthopaedic and Sports Physical Therapy 21 (2015): 1-33.
  33. Stasinopoulos D. “Strengthening of supinator in the management of Lateral Elbow Tendinopathy”. AMJ 10 (2017a): 373-374. 
  34. Stasinopoulos D. “Scapular and rotator cuff strengthening in patients with lateral elbow tendinopathy”. Hong Kong Physiotherapy Journal 37 (2017b): 25-26.
  35. Juul-Kristensen B., et al. “Poorer elbow proprioception in patients with lateral epicondylitis than in healthy controls: a cross-sectional study”. Journal of Shoulder and Elbow Surgery 17 (2008): 72S-81S.
  36. Rio, E., et al. “Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review”. British Journal of Sports Medicine 50 (2015): 209-215.
  37. Alfredson H., et al. “Heavy load eccentric calf muscle training for the treatment of chronic Achilles tendinosis”. American Journal of Sports Medicine 26 (1998): 360-366.
  38. Stanish WD., et al. “Eccentric exercise in chronic tendinitis”. Clinical Orthopaedics and Related Research 1986 (2008): 65-68.
  39. Scattone Silva R., et al. “Lower limb strength and flexibility in athletes with and without patellar tendinopathy”. Physical Therapy in Sport 20 (2016): 19-25.
  40. Kumaran B and Watson T. “Treatment using 448kHz capacitive resistive monopolar radiofrequency improves pain and function in patients with osteoarthritis of the knee joint: a randomised controlled trial”. Physiotherapy 105.1 (2019): 98-107.
Citation: Dimitrios Stasinopoulos., et al. “448 khz Capacitive Resistive Monopolar Radiofrequency and a Supervised Exercise Programme in Patients with Lateral Elbow Tendinopathy? A Research Protocol”. EC Orthopaedics 11.4 (2020): 98-106.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


December Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 20, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.