Evaluating the impact of NSAIDs and exercise therapy versus sole exercise therapy on joint mobility, pain levels, grip strength, and muscle activity in lateral epicondylitis patients

Authors

  • Junaid Ahmad Parrey Dept of Physical Education, Aligarh Muslim University, Aligarh India https://orcid.org/0000-0002-0762-3038
  • Mohd Arshad Bari Dept of Physical Education, Aligarh Muslim University, Aligarh India
  • Abdul Qayyum Khan Dept of orthopedic surgery, Aligarh Muslim University, Aligarh India
  • Arish Ajhar Dept of Physical Education, Aligarh Muslim university, Aigarh India
  • Shivani Singh Dept of Physical Education, Aligarh Muslim University, Aligarh India

DOI:

https://doi.org/10.47197/retos.v69.113131

Keywords:

Electromyography, exercise therapy, forearm extensor muscles, hand grip strength, NSAIDs, lateral epicondylitis

Abstract

Aim and Background: Lateral epicondylitis (LE), or tennis elbow, is a common musculoskeletal disorder causing pain, reduced grip strength, and limited wrist range of motion (ROM). This study aimed to compare the effects of NSAIDs combined with exercise therapy versus exercise therapy alone on wrist ROM, pain, grip strength, and electromyographic (EMG) activity of the extensor digitorum communis (EDC) muscle in LE patients. Material and Method: Eighty participants were randomized into two groups: the standard care group (n=40) and the intervention group (n=40). Both groups followed a 12-week program, with the intervention group performing additional eccentric and concentric exercises. Results: The intervention group showed greater improvements than the standard care group. Pain, measured by the Visual Analogue Scale (VAS), decreased from 7.30 ± 0.68 to 2.12 ± 0.56 in the intervention group, compared to a decrease from 7.02 ± 0.69 to 3.32 ± 0.65 in the standard care group. Grip strength increased by 13.37 kg in the intervention group (from 25.25 ± 2.39 to 38.62 ± 3.42 kg), while the standard care group saw an increase of 2.63 kg (from 24.79 ± 2.80 to 27.42 ± 3.13 kg). ROM in wrist flexion improved from 34.69 ± 2.43 to 59.47 ± 4.31 degrees in the intervention group, and from 32.93 ± 1.90 to 49.54 ± 3.50 degrees in the standard care group. Wrist extension ROM increased from 32.95 ± 1.94 to 53.19 ± 2.49 degrees in the intervention group, versus 30.66 ± 2.72 to 47.23 ± 3.52 degrees in the standard care group. EMG analysis revealed a significant reduction in EDC RMS amplitude in the intervention group from 575.53 ± 18.93 µV to 474.73 ± 22.70 µV.

Conclusion: Combining NSAIDs with exercise therapy resulted in more significant improvements in pain, grip strength, and ROM than NSAIDs alone, highlighting the added benefits of structured exercise therapy for Lateral epicondylitis.

Author Biographies

Junaid Ahmad Parrey, Dept of Physical Education, Aligarh Muslim University, Aligarh India

Research scholar,  Dept of Physical Education, Aligarh Muslim University, Aligarh India

Mohd Arshad Bari, Dept of Physical Education, Aligarh Muslim University, Aligarh India

Assistant Professor, Dept of Physical Education, Aligarh Muslim University, Aligarh India

Abdul Qayyum Khan, Dept of orthopedic surgery, Aligarh Muslim University, Aligarh India

Professor, Dept of orthopedic surgery, Aligarh Muslim University, Aligarh India

Arish Ajhar, Dept of Physical Education, Aligarh Muslim university, Aigarh India

Reserach scholar, Dept of Physical Education, Aligarh Muslim University, Aigarh India

Shivani Singh, Dept of Physical Education, Aligarh Muslim University, Aligarh India

Reserach Scholar , Dept of Physical Education, Aligarh Muslim University, Aligarh India

References

Abbas, L., Leiros-Rodríguez, R., Marques-Sanchez, M. P., de Carvalho, F. O., & Maciel, L. Y. (2023). Efficacy of percutaneous electrolysis for the treatment of tendinopathies: A systematic review and meta-analysis. Clinical Rehabilitation,37(6), 747–759. https://doi.org/10.1177/02692155221147781

Alizadehkhaiyat, O., Fisher, A. C., Kemp, G. J., Vishwanathan, K., & Frostick, S. P. (2007). Upper limb muscle imbalance in tennis elbow: A functional and electromyographic assessment. Journal of Orthopaedic Research, 25(12), 1651–1657. https://doi.org/10.1002/jor.20468

Almquist, E. E., Necking, L., & Bach, A. W. (1998). Epicondylar resection with anconeus muscle transfer for chronic lateral epicondylitis. The Journal of Hand Surgery, 23(5), 723–731. https://doi.org/10.1016/S0363-5023(98)80061-0

Balk, M. L., Hagberg, W. C., Buterbaugh, G. A., & Imbriglia, J. E. (2005). Outcome of surgery for lateral epicondylitis (tennis elbow): Effect of worker's compensation. American Journal of Orthopedics, 34(3), 122–126.

Bisset, L., Paungmali, A., Vicenzino, B., & Beller, E. (2005). A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. British Journal of Sports Medicine, 39(7), 411–422. https://doi.org/10.1136/bjsm.2004.016170

Calvert, P. T., Macpherson, I. S., Allum, R. L., & Bentley, G. (1985). Simple lateral release in treatment of tennis elbow. Journal of the Royal Society of Medicine, 78(11), 912–915. https://doi.org/10.1177/014107688507801106

Croisier, J. L., Foidart-Dessalle, M., Tinant, F., Crielaard, J. M., & Forthomme, B. (2007). An isokinetic eccentric program for the management of chronic lateral epicondylar tendinopathy. British Journal of Sports Medicine, 41(4), 269–275. https://doi.org/10.1136/bjsm.2006.033334

Cullinane, F. L., Boocock, M. G., & Trevelyan, F. C. (2014). Is eccentric exercise an effective treatment for lateral epicondylitis? A systematic review. Clinical Rehabilitation, 28(1), 3–19. https://doi.org/10.1177/0269215513491597

Cummins, C. A. (2006). Lateral epicondylitis: In vivo assessment of arthroscopic debridement and correlation with patient outcomes. The American Journal of Sports Medicine, 34(9), 1486–1491. https://doi.org/10.1177/0363546506288016

Dunkow, P. D., Jatti, M., & Muddu, B. N. (2004). A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow. The Journal of Bone and Joint Surgery. British Volume, 86(5), 701–704. https://doi.org/10.1302/0301-620X.86B5.14

Garg, R., Adamson, G. J., Dawson, P. A., Shankwiler, J. A., & Pink, M. M. (2010). A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. Journal of Shoulder and Elbow Surgery, 19(4), 508–512. https://doi.org/10.1016/j.jse.2009.08.006

Sánchez-Gómez, Ángela., Domínguez, R., Sañudo, B., & San Juan, A. F. (2023). Efectos de 8 semanas de ejercicio excéntrico y terapia de ondas de choque extracorpóreas sobre el tejido tendinoso, dolor percibido, potencia y fuerza muscular en atletas diagnosticados con tendinopatía rotuliana: un estudio longitudinal (Effects of 8 weeks of eccentric exercise and extracorporeal shockwave therapy on tendon tissue, perceived pain, and muscle power and strength in athletes diagnosed with patellar tendinopathy: A longitudinal study). Retos, 47, 1–11. https://doi.org/10.47197/retos.v47.93378

Gongora-Rodriguez, J., Rosety-Rodriguez, M. A., Rodriguez-Almagro, D., Martin-Valero, R., Gongora-Rodriguez, P., & Rodriguez-Huguet, M. (2024). Structural and functional changes in supraspinatus tendinopathy through percutaneous electrolysis, percutaneous peripheral nerve stimulation, and eccentric exercise combined therapy: A single-blinded randomized clinical trial. Biomedicines, 12(4), Article 771. https://doi.org/10.3390/biomedicines12040771

Green, S., Buchbinder, R., Barnsley, L., Hall, S., White, M., & Smidt, N. (2002). Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database of Systematic Reviews, 2002(2), Article CD003686. https://doi.org/10.1002/14651858.CD003686

Irie, K., Yokota, J., Takeda, M., Mukaiyama, K., Nishida, Y., Sato, M., & Aoyama, T. (2022). Comparison of forearm muscle activation and relationship with pressure distribution in various grip patterns. Asian Journal of Occupational Therapy, 18(1), 31–37. https://doi.org/10.11596/ajot.2021-0021

Khan, K. M., Cook, J. L., Bonar, F., Harcourt, P., & Astrom, M. (2000). Overuse tendinosis, not tendinitis: A new paradigm for a difficult clinical problem. The Physician and Sportsmedicine, 28(5), 38–48. https://doi.org/10.3810/psm.2000.05.890

Luginbühl, R., Brunner, F., & Schneeberger, A. G. (2008). No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: A prospective randomised study. Chirurgia degli Organi di Movimento, 91(1), 35–40. https://doi.org/10.1007/s12306-007-0007-1

Molaee, F., Shahmir, M., Oliveira, R., Nia Samakosh, H. M., Hajrezaee, B., Sarvari Far, B., & Badicu, G. (2024). ¿Puede el entrenamiento de oscilación y movilización aguda beneficiar el sentido de la posición articular y la fuerza de los músculos del manguito rotador en jugadores de tenis jóvenes? Retos, 58, 271-280. https://doi.org/10.47197/retos.v58.106208

Nilsson, P., Thom, E., Baigi, A., Marklund, B., & Mansson, J. (2007). A prospective pilot study of a multidisciplinary home training programme for lateral epicondylitis. Musculoskeletal Care, 5(1), 36–50. https://doi.org/10.1002/msc.117

Nirschl, R. P., & Ashman, E. S. (2003). Elbow tendinopathy: Tennis elbow. Clinics in Sports Medicine, 22(4), 813–836. https://doi.org/10.1016/S0278-5919(03)00016-5

Ohberg, L., Lorentzon, R., & Alfredson, H. (2001). Neovascularisation in Achilles tendon with painful tendinitis but normal tendon: An ultrasonographic investigation. Knee Surgery, Sports Traumatology, Arthroscopy, 9(4), 233–238. https://doi.org/10.1007/s001670000189

Pérez Espallargas, L., Ayuso Pablo, A., Abdelkader Mohamed, K., Pinto Redondo, A., & López González, L. (2024). Efectos del ejercicio de fuerza escapular para pacientes con epicondilalgia lateral: Ensayo clínico aleatorizado. Retos, 56, 357–364. https://doi.org/10.47197/retos.v56.103988

Peterson, M., Butler, S., Eriksson, M., & Svardsudd, K. (2011). A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Upsala Journal of Medical Sciences, 116(4), 269–279. https://doi.org/10.3109/03009734.2011.600476

Rodriguez-Huguet, M., Cabrera-Martos, I., Valenza, M. C., Pastor-Moreno, G., Calvo-Lobo, C., & Romero-Garcia, M. (2022). Current trends of dry needling for tendinopathy: A systematic review and meta-analysis. Journal of Clinical Medicine, 11(6), Article 1674. https://doi.org/10.3390/jcm11061674

Shiri, R., Viikari-Juntura, E., Varonen, H., & Heliövaara, M. (2006). Prevalence and determinants of lateral and medial epicondylitis: A population study. American Journal of Epidemiology, 164(11), 1065–1074. https://doi.org/10.1093/aje/kwj316

Smidt, N., Lewis, M., Van Der Windt, D. A., Hay, E. M., Bouter, L. M., & Croft, P. R. (2002). Lateral epicondylitis in general practice: Course and prognosis. The Clinical Journal of Pain, 18(2), 92–97. https://doi.org/10.1097/00002508-200203000-00003

Smidt, N., Van Der Windt, D. A., Hay, E. M., Bouter, L. M., & Croft, P. R. (2006). Lateral epicondylitis in general practice: Course and prognostic indicators of outcome. The Journal of Rheumatology, 33(10), 2053–2059.

Söderberg, J., Grooten, W. J., & Äng, B. O. (2012). Effects of eccentric training on hand strength in subjects with lateral epicondylalgia: A randomized-controlled trial. Scandinavian Journal of Medicine & Science in Sports, 22(6), 797–803. https://doi.org/10.1111/j.1600-0838.2011.01323.x

Stasinopoulos, D., & Johnson, M. I. (2005). "Physiotherapy and rehabilitation for lateral epicondylitis: A systematic review." British Journal of Sports Medicine has been removed as it was a duplicate of Bisset et al. with incorrect author attribution.

Tyler, T. F., Thomas, G. C., Nicholas, S. J., & McHugh, M. P. (2010). Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: A prospective randomized trial. Journal of Shoulder and Elbow Surgery, 19(6), 917–922. https://doi.org/10.1016/j.jse.2010.04.041

Downloads

Published

2025-06-18

How to Cite

Parrey, J. A., Bari, M. A., Khan, A. Q., Ajhar, A., & Singh, S. (2025). Evaluating the impact of NSAIDs and exercise therapy versus sole exercise therapy on joint mobility, pain levels, grip strength, and muscle activity in lateral epicondylitis patients. Retos, 69, 512–526. https://doi.org/10.47197/retos.v69.113131

Issue

Vol. 69 (2025)

Section

Original Research Article

License

Copyright (c) 2025 Junaid Ahmad Parrey, Mohd Arshad Bari, Abdul Qayyum Khan, Arish Ajhar, Shivani Singh

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
  2. Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
  3. Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).

This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.