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Dr August A White, MD
professor at Harvard
Medical School... in the
July 1993issue of
American Health said;
"...only 3% of all back
surgeries can be
justified..." "97% are
unnecessary!"
professor at Harvard
Medical School... in the
July 1993issue of
American Health said;
"...only 3% of all back
surgeries can be
justified..." "97% are
unnecessary!"
Options for Tennis Elbow
Tennis elbow or lateral epicondylitis is a common condition that affects the outer part of the elbow;
commonly, it is a result of a specific strain, overuse, or directly hitting the area. The area becomes painful
and tender, and sometimes no specific cause is found. Researchers from Australia are looking for alternative
therapies for tennis elbow that don't involve regular injections.
In a study designed to evaluate the differences between a wait-and-see approach, physiotherapy and
corticosteroid injections, 198 men and women between the ages of 18 and 65, and who had not received any
other active treatment by a health care practitioner in the previous six months, were split into three groups:
wait and see, eight sessions of physiotherapy, or up to two corticosteroid injections within the first six weeks.
Participants were measured for global improvement, grip force, and assessor's rating of severity at baseline,
six weeks and 52 weeks.
Corticosteroid injection effectively relieved symptoms at six weeks, but there were high recurrence rates
thereafter (47 of the 65 patients regressed). There were significantly inferior outcomes in the long term
compared with physiotherapy. The physiotherapy sessions were superior to the wait-and-see approach in
the short term, but no difference was seen at 52 weeks, when most participants in both groups reported a
successful outcome. Patients in the physiotherapy group required less additional treatment, such as
nonsteroidal anti-inflammatory drugs, than the other two groups.
Results: The combination of elbow manipulation and exercise had a superior advantage to wait and see in
the first six weeks and to corticosteroid injections after six weeks. The researchers suggest this might be a
reasonable alternative to injections, since the short-term benefits of corticosteroid injection were reversed
after the initial six weeks.
Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and
see for tennis elbow: randomised trial. BMJ (online first), Sept. 29, 2006. (doi:10.1136/bmj.38961.584653.AE)
Tennis elbow or lateral epicondylitis is a common condition that affects the outer part of the elbow;
commonly, it is a result of a specific strain, overuse, or directly hitting the area. The area becomes painful
and tender, and sometimes no specific cause is found. Researchers from Australia are looking for alternative
therapies for tennis elbow that don't involve regular injections.
In a study designed to evaluate the differences between a wait-and-see approach, physiotherapy and
corticosteroid injections, 198 men and women between the ages of 18 and 65, and who had not received any
other active treatment by a health care practitioner in the previous six months, were split into three groups:
wait and see, eight sessions of physiotherapy, or up to two corticosteroid injections within the first six weeks.
Participants were measured for global improvement, grip force, and assessor's rating of severity at baseline,
six weeks and 52 weeks.
Corticosteroid injection effectively relieved symptoms at six weeks, but there were high recurrence rates
thereafter (47 of the 65 patients regressed). There were significantly inferior outcomes in the long term
compared with physiotherapy. The physiotherapy sessions were superior to the wait-and-see approach in
the short term, but no difference was seen at 52 weeks, when most participants in both groups reported a
successful outcome. Patients in the physiotherapy group required less additional treatment, such as
nonsteroidal anti-inflammatory drugs, than the other two groups.
Results: The combination of elbow manipulation and exercise had a superior advantage to wait and see in
the first six weeks and to corticosteroid injections after six weeks. The researchers suggest this might be a
reasonable alternative to injections, since the short-term benefits of corticosteroid injection were reversed
after the initial six weeks.
Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and
see for tennis elbow: randomised trial. BMJ (online first), Sept. 29, 2006. (doi:10.1136/bmj.38961.584653.AE)