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Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: a single-blinded randomised clinical trial


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Yelland, M, Rabago, D, Ryan, M, Ng, S-K, Vitanachchi, D, Manickaraj, N and Bisset, L 2019 , 'Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: a single-blinded randomised clinical trial' , BMC Musculoskeletal Disorders, vol. 20 , pp. 1-10 , doi: 10.1186/s12891-019-2905-5.

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BackgroundLateral epicondylalgia (tennis elbow) is a common, debilitating and often treatment-resistant condition. Two treatments thought to address the pathology of lateral epicondylalgia are hypertonic glucose plus lignocaine injections (prolotherapy) and a physiotherapist guided manual therapy/exercise program (physiotherapy). This trial aimed to compare the short- and long-term clinical effectiveness, cost effectiveness, and safety of prolotherapy used singly and in combination with physiotherapy.MethodsUsing a single-blinded randomised clinical trial design, 120 participants with lateral epicondylalgia of at least 6 weeks’ duration were randomly assigned to prolotherapy (4 sessions, monthly intervals), physiotherapy (weekly for 4 sessions) or combined (prolotherapy+physiotherapy). The Patient-Rated Tennis Elbow Evaluation (PRTEE) and participant global impression of change scores were assessed by blinded evaluators at baseline, 6, 12, 26 and 52 weeks. Success rate was defined as the percentage of participants indicating elbow condition was either ‘much improved’ or ‘completely recovered.’ Analysis was by intention-to-treat.ResultsEighty-eight percent completed the 12-month assessment. At 52 weeks, there were substantial, significant improvements compared with baseline status for all outcomes and groups, but no significant differences between groups. The physiotherapy group exhibited greater reductions in PRTEE at 12 weeks than the prolotherapy group (p = 0.014).ConclusionThere were no significant differences amongst the Physiotherapy, Prolotherapy and Combined groups in PRTEE and global impression of change measures over the course of the 12-month trial.

Item Type: Article
Authors/Creators:Yelland, M and Rabago, D and Ryan, M and Ng, S-K and Vitanachchi, D and Manickaraj, N and Bisset, L
Keywords: elbow, tendinopathy, physiotherapy, prolotherapy, tennis elbow, injection, lateral epicondylalgia
Journal or Publication Title: BMC Musculoskeletal Disorders
Publisher: Biomed Central Ltd
ISSN: 1471-2474
DOI / ID Number: 10.1186/s12891-019-2905-5
Copyright Information:

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, ( which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

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