The Elbow-EpiTrainer : A method of delivering graded resistance to the extensor carpi radialis brevis. Effectiveness of a prototype device in a healthy population

This document is the Accepted Manuscript version of the following article: Navsaria R, Ryder DM, Lewis JS, et al, 'The Elbow-EpiTrainer: a method of delivering graded resistance to the extensor carpi radialis brevi:. Effectiveness of a prototype device in a healthy population', British Journal of Sports Medicine, Vol. 49(5):318-322, March 2015, available online at: http://bjsm.bmj.com/content/49/5/318. Published by the BMJ Publishing Group Limited.Background: Tennis elbow or lateral epicondylopathy (LE) is experienced as the lateral elbow has a reported prevalence of 1.3%, with symptoms lasting up to 18 months. LE is most commonly attributed to tendinopathy involving the extensor carpi radialis brevis (ECRB) tendon. The aim of tendinopathy management is to alleviate symptoms and restore function that initially involves relative rest followed by progressive therapeutic exercise. Objective: To assess the effectiveness of two prototype exercises using commonly available clinical equipment to progressively increase resistance and activity of the ECRB. Method: Eighteen healthy participants undertook two exercise progressions. Surface electromyography was used to record ECRB activity during the two progressions, involving eccentric exercises of the wrist extensors and elbow pronation exercises using a prototype device. The two progressions were assessed for their linearity of progression using repeated ANOVA and linear regression analysis. Five participants repeated the study to assess reliability. Results: The exercise progressions led to an increase in ECRB electromyographic (EMG) activity (p0.7) between the first and second tests for five participants. Conclusions: Manipulation of resistance and leverage with the prototype exercises was effective in creating significant increases of ECRB normalised EMG activity in a linear manner that may, with future research, become useful to clinicians treating LE. In addition, between trial reliability for the device to generate a consistent load was acceptable.Peer reviewe

Description of the vegetation zones investigated in this study.

<p>Each zone is classified as Unmanaged (U), managed (M), or degraded (D), and individually identified by the prominent features of the zone. Photographs of each zone are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.g001" target="_blank">Fig 1</a>, and site photographs are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s009" target="_blank">S4</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s010" target="_blank">S5</a> Figs.</p><p>Description of the vegetation zones investigated in this study.</p

Six vegetation zones investigated in this study at Holme Moss, with identifying name and abbreviation.

<p>Further information about each zone is provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.t001" target="_blank">Table 1</a>. Site photographs are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s009" target="_blank">S4</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s010" target="_blank">S5</a> Figs.</p

Correspondence analysis of bacterial and fungal communities, constrained by vegetation zone.

<p>Analysis is based on relative abundance of 354 bacterial OTUS and 273 fungal OTUs across six zone classifications. Markers indicate individual samples (three per zone type), and dispersion ellipses show the 99% standard deviation confidence interval for each zone. Environmental variables with significance p < 0.05, are shown as biplotted vectors (based on permutation tests; n = 1000). Unconstrained ordinations and scree plots are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s006" target="_blank">S1 Fig</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s007" target="_blank">S2 Fig</a>.</p

Rank abundance of bacterial and fungal OTUs in bare peat and vegetated zones.

<p>Descriptions of the zones are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.t001" target="_blank">Table 1</a>.</p

Relative abundance of bacterial and fungal phyla (within each kingdom) in the six zones.

<p>The mean of 3 samples for each zone is shown and full results are given in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s003" target="_blank">S2 Table</a>. Taxonomic affiliations of all OTUs are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s001" target="_blank">S1 Protocol</a>, and descriptions of the zones are given in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.t001" target="_blank">Table 1</a>.</p

Soil physico-chemical properties in bare peat and vegetated zones (see Table 1) at Holme Moss.

<p>All values are expressed in mg kg^-1 dry soil except for organic matter (OM; %), moisture (%), and pH. Bars indicate the standard error of the mean (n = 3). Different markers and colours are provided to facilitate comparison with other figures. Statistical comparisons are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s005" target="_blank">S4 Table</a>.</p

Cultivable bacteria and fungi in bare peat and vegetated zones at Holme Moss.

<p>Results are expressed as colony forming units (CFU g^-1) with bars indicating the standard error of the mean (n = 3). Information about the zones can be found in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.t001" target="_blank">Table 1</a> and statistical comparisons are provided in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124726#pone.0124726.s005" target="_blank">S4 Table</a>.</p

ITS2_basi

ITS2 sequences of basidiomycetous fungi from INSD database

ITS2_asco

ITS2 sequences of ascomycetous fungi from INSD database