Regenerative Rehabilitation for Lateral Epicondylalgia

Abstract

Lateral epicondylalgia (LE) is a common condition of the elbow that causes significant pain and disability resulting in economic burden and loss of function. Causes of LE include overuse leading to local tendinopathy, neuropathic mechanisms, and impairments in regions proximal and distal to the elbow such as the wrist, cervical spine, and shoulder girdle. Physical therapy and other forms of conservative rehabilitation are often utilized successfully and include interventions such as exercise, joint, and soft tissue manipulation, and various modalities such as ultrasound and extracorporeal shockwave therapy. However, despite the reported benefits of exercise and other rehabilitative interventions, most research regarding treatment efficacy has focused on functional outcomes without understanding the cellular and molecular effects. Moreover, inconsistencies in the literature remain regarding best-practice management for LE. Nevertheless, recent investigations have provided insight into the corrective processes that may occur with commonly employed rehabilitative procedures. This article will give an overview of the pathophysiological process associated with LE followed by a detailed discussion of the current understanding of the cellular and molecular mechanisms that may occur with conservative rehabilitation. The purpose of this paper is to present the current evidence regarding conservative rehabilitation to exemplify how these interventions may serve as an adjunct to biological therapies.