Efficacy of low-energy extracorporeal shockwave therapy and a supervised clinical exercise protocol for the treatment of chronic lateral epicondylitis: A randomised controlled study

AbstractThis randomised controlled trial was designed to evaluate the efficacy of low-energy extracorporeal shockwave therapy with a supervised exercise protocol for the treatment of chronic lateral epicondylitis. Thirty patients of lateral epicondylitis were randomly placed into two groups: an experimental group (n = 15) and a control group (n = 15). The experimental group received low-energy extracorporeal shockwave therapy and supervised exercise once a week for 3 weeks, whereas the control group received a supervised exercise protocol three times a week. Both the groups were instructed to carry out a home exercise programme twice daily for 4 weeks.Outcome parameters included in this study were pain intensity, pain-free grip strength, and the Disability of Arm, Shoulder, and Hand questionnaire. Data were collected at baseline and after the end of treatment (at 4th week). There was a decline in pain, and improvements in pain-free grip strength and limb function in both groups compared with the baseline values. At the end of the treatment period, the experimental group had greater reduction in pain intensity and better improvement in limb function (p < 0.01). It can be concluded that low-energy extracorporeal shockwave therapy, when combined with regular exercise, is an effective method for reducing pain and improving upper limb function in patients with chronic lateral epicondylitis

Effect of Treadmill Training on Gait and Functional Independence in Patients with Incomplete Spinal Cord Injury: A Case Series

Background and purpose: Many individuals with an incomplete spinal cord injury (SCI) have the potential to walk. The effectiveness of using a treadmill for gait training for these patients has been substantiated in the literature. This case series describes the effectiveness of incorporating gait training on a treadmill for two individuals with an incomplete SCI. Case Description: The treatments of two males each with an incomplete paraplegia were described. Subject 1 was 40 years old and was 14 months post injury at the time of the study. He had a T6 incomplete spinal cord injury classified as a D on the American Spinal Injury Association (ASIA) Impairment Scale and neurological classification standards. Subject 2 was 48 years old and was 10 months post injury. He had a T8 incomplete spinal cord injury classified as ASIA C. Intervention: Both subjects participated in gait training for a maximum of 10 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy programme.Results: An increase in step length, stride length, cadence, and comfortable walking speed were noted in both subjects. Both subjects improved their walking level as measured by the Walking Index for Spinal Cord Injury (WISCI II) and functional independence as measured by Spinal Cord Independent Measure (SCIM II). Conclusion: Gait training on a treadmill can improve gait parameters and functional independence in patients with incomplete paraplegia. Further research is needed to improve the generalizability of these findings and to identify which patients might benefit most from treadmill training

A comparative study on the effects of dextrose prolotherapy and local steroid injection in patients with lateral epicondylitis: A randomized controlled trial

Background Lateral epicondylitis (LE) is the most common condition of elbow pain. Multiple intralesional steroid injections help in the treatment. Prolotherapy is a traditional injection method recently categorized as regenerative treatment. However, there is scarcity of literature that compares its effectiveness with steroids. Objective The aim was to compare the effectiveness of dextrose prolotherapy (DP) against local steroid injection in patients with LE in relieving pain and improving dysfunction. Participants and methods This parallel, randomized controlled trial was conducted at Outpatient Department, National Institute for Locomotor Disabilities (Divyangjan), (erstwhile National Institute for the Orthopaedically Handicapped) Kolkata, from January 2016 to January 2017. Patients with the clinical diagnosis of LE (in clinical stages 2, 3, and 4) were allocated to receive either DP (group A) or local steroid injection (group B). A total of 34 participants aged between 18 and 60 years who had symptoms for greater than or equal to 4 weeks was included. Injections were given to each patient at 0, 4, and 8 weeks. Data were collected at baseline and followed up at the fourth, eighth, and 16th weeks. The two interventions' differential response was recorded in terms of pain [visual analog scale (VAS)], upper-extremity activities (DASH; disabilities of the arm, shoulder and hand scale), and the pain-free grip strength (PFGS). Results Both groups A and B showed significant improvement (P < 0.05) in VAS, DASH, and PFGS at follow-ups compared with baseline. Compared with group B, at 4 weeks, group A had no statistically significant differences in the VAS (53.6 ± 12.6 vs 51.3 ± 15.5, P = 0.65), DASH score (26.2 ± 14.6 vs 26.7 ± 15.6, P = 0.93), and PFGS (16.3 ± 8.7 vs 12.3 ± 5.4, P = 0.14). Compared with group B, at 8 weeks, no statistically significant differences in the VAS (n = 15, difference of mean 0.4, 95% confidence interval [−7.4 to 8.2], P = 0.9), DASH (n = 15, 3.5 [−5.2 to 12.2], P = 0.4), and PFGS (n = 15, 4.7 [−0.8 to 10.2], P = 0.1) were noted between two groups. However, at 16 weeks, compared with group B, group A patients showed significant better improvement in VAS (n = 15, 14.0 [7.0–20.9], P = 0.0001) and PFGS (n = 15, 8.4 [2.3–14.5], P = 0.009) but not in DASH (n = 15, 8.4 [2.3–14.5], P = 0.4). Conclusions DP showed superiority in reducing LE pain and improving the grip strength as compared with local steroid injection. However, prolotherapy was associated with increased pain around the injection site in the first 48 h and transient weakness of wrist extensors (about 10 min) because of local spread of lignocaine in the common extensor-origin muscles, which was conservatively managed