#013- Articles on Lateral Elbow Tendinopathy and Low Back Pain

Covered Topics:

1. Unsupervised isometric exercise for lateral elbow tendinopathy (Tennis Elbow).

2. Adding hip strengthening exercise to your low back pain treatment plan might improve pain and disability.

Estimated reading time: 4 minutes, 21 seconds.


Unsupervised isometric exercise for lateral elbow tendinopathy (Tennis Elbow)

Isometric exercise effect on tendinopathies has been conflicting, where some found to decrease pain such as in patellar tendinopathy, while others found it increases pain immediately after exercise for lateral elbow tendinopathy.

This clinical trial (PEDro Score 8/10) investigated an unsupervised isometric program against no treatment or as they called it wait-and-see.


  • Affected arm resting on a table edge, elbow 90 degrees flexed and wrist at 30 degrees extension, using a water container with a handle for load management.
  • Initial load was determined using 20% of maximal voluntary contraction (MVC) of the unaffected arm, load increased by 5% each week.
  • 1 set daily for 8 weeks.

Repetitions and Isometric hold altered between weeks:

  • Week 1, 3, 5, 7: 4 repetitions/ 30 seconds hold/ 1 set
  • Week 2, 4, 6, 8: 3 repetitions/ 45 seconds hold/ 1 set


  • 20 participant in the exercise group and 19 in the wait-and-see group.
  • Patient-Rated Tennis Elbow Evaluation (PRTEE): Exercise group had better results.
  • Global rating of change (GROC): No significant difference between groups.
  • Pain free grip strength: No significant difference between groups.
  • Worst pain: Lower in the exercise group.
  • Pain at rest: No significant difference between groups.
  • Pressure pain threshold: No significant difference between groups.
  • Cold/heat pain threshold: No significant difference between groups.
  • Adherence to exercise: 18 out of the 20 participant completed 5 out of 7 sessions per week on average.

What we learned:

  • Unsupervised isometric exercise should not be used alone. (Probably knew that already)
  • Unsupervised isometric exercise can improve pain and disability compared to no treatment (small effect size).
  • The program used in this trial was easy, time conservative and cost effective, which is why the adherence rate was high.

When to use this program:

  • If you work in a place where you can see patients once every few days or weeks (better add different types of exercise).
  • If your patient can’t adhere to a regularly planned sessions and do not have the time to do a long home-based program.

Adding hip strengthening exercise to your low back pain treatment plan might improve pain and disability

Recently, studies has indicated that patients with low back pain exhibit hip muscles weakness compared to healthy population.

This systematic review and meta analysis aimed to investigate the effect of hip muscles strengthening exercise on patients with low back pain.

Hip Strengthening Exercise (HSE):

HSE in general consisted of strengthening exercise for hip flexors, extensors, abductors and adductors using elastic resistance/bands.

Exercise dose ranged from 2 to 3 sets of 10 to 15 repetitions for 1 to 7 sessions/week for 6 weeks (one study did not report duration), all supervised (except for 1 did not report).

Conventional Physiotherapy used by the included studies:

  1. Lumbar segmental stabilization exercise. (50 minutes/session, 3 sessions/week)
  2. Lumbar stabilization exercises. (4 sets/4 reps, 10s hold for 6 weeks)
  3. In one study, the control group intervention was based on the therapist’s selection for each participant.
  4. Lumbopelvic motor control exercise program that focused on the performance of the motor skill of co-contracting the transversus abdominus, multifidus, and pelvic floor musculature with the progression of this skill to performance during increasingly functional tasks.
  5. Stretching for hip medial and lateral rotation or multi-directional hip stretching. (3 times/session, 30s hold, 5 session/week for 6 weeks).


5 RCTs including 309 participant with chronic low back pain or non-specific chronic low back pain.

  • HSE was effective in reducing pain for more than 25%.
    • Compared to conventional physiotherapy alone
    • As measured by Numeric pain rating scale or visual analogue scale.
    • Moderate quality evidence.
  • HSE was effective in reducing self-reported disability for an average of 12.1 points as measured by Oswestry index disability score.
    • Compared to conventional physiotherapy alone.
    • Low quality evidence.

Learned from this article:

  • Hip muscle strength decrease in patients with low back pain.
  • Adding hip strengthening exercise to your treatment plan can reduce pain and disability.

As discussed by the authors, the “best” type of exercise for low back pain is still unclear, as with any other condition, individualized and a combination of different interventions still the way to go.

Final Note

  • The two articles in this report prove that going with solo interventions is not the best, adding and tailoring treatment plans is the way to go.


  • The term “Tennis elbow” is way more popular than “lateral elbow tendinopathy”

Recommended reads:


  1. Unsupervised Isometric Exercise versus Wait-and-See for Lateral Elbow Tendinopathy. (Restricted Access)
  2. Addition of specific hip strengthening exercises to conventional rehabilitation therapy for low back pain: a systematic review and meta-analysis. (Restricted Access)

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