Comparison of the effects of trigger point ischemic compression massage and focused extracorporeal shock wave therapy on pain level, muscle strength, joint range of motion, functionality and quality of life in patients with lateral epicondylitis: A randomized controlled trial

Purpose: To compare the effects of Trigger Point Ischemic Compression Massage (TPICM) and Focused Extracorporeal Shock Wave Therapy (focused ESWT) on pain level, muscle strength, joint range of motion, functionality and quality of life in patients with lateral epicondylitis (LE) in a randomised controlled trial. Method: The study included 85 patients with LE. The patients were divided into the TPICM group (n=24, age=43.59±10.94 years, BMI= 25.48±4.25 kg/m2), Focused ESWT group (n=25, age=44.14±11.77 years, BMI= 26.06±3.81 kg/m2) and Control group (n=26, age=46.03±9.03, BMI= 26.25±3.17 kg/m2). Before and after treatment, pain intensity was assessed with The Visual Analogue Scale (VAS), joint range of motion was assessed with the universal standard manual goniometer, hand grip strength was assessed with The Jamar hand dynamometer, wrist muscle strength was assessed with The Biodex System 3 Isokinetic, function was assessed with The Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and Patient Based Lateral Epicondylitis Evaluation Questionnaire (PRETEE-T), quality of life was assessed with The Short Form-36. Results: After the treatment, rest, activity and nighttime pain level were found to decrease in all 3 groups (p<0.05). Hand grip strength increased in the focused ESWT and TPICM groups (p=0.016, p=0.001). Isokinetic strength of the wrist flexor and extensor group muscles increased at 60°/sec and 180°/sec angular velocities in all groups (all p<0.001). The wrist extension angle increased in the focused ESWT group (p = 0.036). The DASH symptom score increased in the TPICM group (p=0.001), and in all groups PRETEE-T scores increased (p<0.05), physical role limitation decreased in health-related quality of life parameters, and physical function increased (all p<0.05). No difference was found between the groups in terms of pain level, muscle strength, joint range of motion, functionality and quality of life measurements (p>0.05). Conclusion: As a result of the study, it is thought that TPICM applied in combination with exercise or exercise alone may be a treatment option in terms of pain control and strength gain in cases where focused ESWT application is not possible in the treatment of LE. Keywords: Exercise, extracarporeal shock wave therapy, ischemic compression massage, lateral epicondylitis, pain.