A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy. (2006)

Abstract
BACKGROUND: The use of ice as a supplement to an exercise programme has been recommended for the management of lateral elbow tendinopathy (LET). No studies have examined its effectiveness.

OBJECTIVES: To investigate whether an exercise programme supplemented with ice is more successful than the exercise programme alone in treating patients with LET.

METHODS: Patients with unilateral LET for at least four weeks were included in this pilot study. They were sequentially allocated to receive five times a week for four weeks either an exercise programme with ice or the exercise programme alone. The exercise programme consisted of slow progressive eccentric exercises of wrist extensors and static stretching of the extensor carpi radialis brevis tendon. In the exercise programme/ice group, the ice was applied after the exercise programme for 10 minutes in the form of an ice bag to the facet of the lateral epicondyle. Patients were evaluated at baseline, at the end of treatment, and three months after the end of treatment. Outcome measures used were the pain visual analogue scale and the dropout rate.

RESULTS: Forty patients met the inclusion criteria. At the end of treatment there was a decline in visual analogue scale of about 7 units in both groups compared with baseline (p<0.0005, paired t test). There were no significant differences in the magnitude of reduction between the groups at the end of treatment and at the three month follow up (p<0.0005, independent t test). There were no dropouts.

CONCLUSIONS: An exercise programme consisting of eccentric and static stretching exercises had reduced the pain in patients with LET at the end of the treatment and at the follow up whether or not ice was included. Further research to establish the relative, absolute, and cost effectiveness as well as the mechanism of action of the exercise programme is needed.

Diagnosis:  Lateral elbow tendinopathy

Outcome:  VAS over the previous 24 hours. VAS dropped 6.9 points at 4 weeks and 7.1 points (out of a 10 point scale) at 16 weeks in both groups.

When Assessed:  0, 4 and 16 weeks

Subjects:  40 subjects, mean age 40 years

Protocol:  Exercise group did 3 sets of 10 repetitions of slow (30 seconds) progressive eccentric reverse wrist curls with a 30 second rest interval between each repetition, increasing weight with free weights when they could do sets without pain. Performed static stretching in wrist flexion and ulnar deviation 3 times 30-45 seconds before and after eccentric exercise. Exercise performed 5 times per week for 4 weeks. The ICE group did the same exercise program above but applied a bag of ice to the lateral epicondyle for 10 minutes afterward.

Other Activity:  “All patients were instructed to use their arm during the course of the study but to avoid activities that irritated the elbow such as shaking hands, grasping, lifting, knitting, handwriting, driving a car and using a screwdriver.” No mention of exercise or sporting activity before, during or after the study.

Chad’s Comments:  Interesting in that this is the only study that has used ice as a variable (in tennis elbow or any form of tendinitis / tendinopathy) and found it had zero effect, good or bad on outcomes. Pain dropped considerably in a short time period which could be due to the effectiveness of the exercise protocol, which was novel (taking 30 seconds to lower the weight) or due to the avoidance of aggravating activities. The outcome measure (VAS over the prior 24 hours) perhaps does not take into account pain during activity and there were no functional measures.