Lateral Epicondylitis — Instrument-Assisted vs Exercise
What comparative research suggests for chronic elbow pain.
TL;DR
- Some trials show added benefit of instrument‑assisted techniques alongside tendon‑focused exercise; effects vary by protocol and chronicity.
- Progressive loading (isometric → isotonic → energy‑storage drills) remains the cornerstone. Tools can help tolerance and ROM.
Evidence snapshot
- Studies comparing Astym/IASTM + exercise vs exercise alone report improvements in pain/function in selected cohorts; risk of bias and sample sizes limit certainty.
- Best outcomes occur when programs include education, activity modification, and graded loading.
Dosing with exercise
- IASTM: 30–60s over wrist extensors and proximal common extensor origin; light–moderate pressure; reassess grip pain.
- Exercise: start with isometrics (e.g., wrist extension holds 5×45s), progress to slow eccentrics/concentrics, then to faster energy‑storage tasks as pain allows.
Bracing/taping (optional)
- Counterforce strap during provocative tasks can reduce tendon load; avoid over‑tightening.
- Kinesio‑taping may offer short‑term comfort for training adherence.
Progression
- Pain during/after should be tolerable (≤ 3–4/10) and settle within 24h. If not, reduce volume or intensity.
- Advance load by range (wrist extension ROM), tempo control, then load; finally add energy‑storage (e.g., ball throws) for return to sport.
Safety
- Avoid aggressive pressure at the lateral epicondyle, radial tunnel, or where paresthesia appears.
- Screen for cervical/radial nerve contributions if symptoms radiate.
FAQs
Can IASTM replace eccentric training?
No. Use it to improve tolerance and motion, then load the tendon progressively.
How long until improvement?
2–6 weeks for meaningful symptom changes; return‑to‑sport takes longer depending on chronicity and workload.
Reference
- Astym vs eccentric loading context: https://pmc.ncbi.nlm.nih.gov/articles/PMC4451036/