In this arm, the subjects will receive the intervention of FSN on Day1, Day2 and Day4, in total 3 treatments and will be arrange to take efficacy two assessment on Day8 and Day15, separately.

In this arm, the subjects will receive the intervention of TENS on Day1, Day2 and Day4, in total 3 treatments and will be arrange to take efficacy two assessment on Day8 and Day15, separately.

Lateral Epicondylitis

Fu's Subcutaneous Needle (FSN), is an innovation for the treatment of myofascial pain and trigger points. The needle is a non-injection needle, and the fact that both needles are manipulated and act on soft connective tissue.
FSN abstains from the muscle and deep fascia layers and is confined to only the subcutaneous layer where collagen fibers are most abundant. As the subcutaneous layer is poorly innervated, pain is less than other needling therapies.
FSN is also currently being used successfully to treat non-musculoskeletal conditions.

Fu's subcutaneous needling

Transcutaneous electrical nerve stimulation (TENS or TNS) is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes.
TENS, by definition, covers the complete range of transcutaneously applied currents used for nerve excitation although the term is often used with a more restrictive intent, namely to describe the kind of pulses produced by portable stimulators used to treat pain. The unit is usually connected to the skin using two or more electrodes. A typical batteryoperated TENS unit is able to modulate pulse width, frequency and intensity. Generally TENS is applied at high frequency (>50 Hz) with an intensity below motor contraction (sensory intensity) or low frequency (<10 Hz) with an intensity that produces motor contraction.

Transcutaneous electrical nerve stimulation

China Medical University Hospital

Fu's Subcutaneous Needling on the Myofascial Trigger Points: Lateral Epicondylitis

Changes in the Muscle Tone of Affected Muscle After Fu's Subcutaneous Needling on the Myofascial Trigger Points - a Sample of Lateral Epicondylitis

The visual analogue scale or visual analog scale (VAS) is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end-points.

Pressure pain threshold (PPT) is defined as the minimum force applied which induces pain. This measure has proven to be commonly useful in evaluating tenderness symptom.

Muscle tone is the muscle's resistance to passive stretch during resting state. Myotone will help the investigators to get muscle parameters such as tone, elasticity and stiffness.

The pain-free grip (PFG) test is used to measure the amount of force that the patient generates to the onset of pain; when there is no pain the test result could be regarded as maximum grip strength. It is commonly performed in patients with lateral epicondylalgia (LE). LE is characterised by the presence of pain over the lateral humeral epicondyle which is provoked by at least two of: gripping, resisted wrist or middle finger extension, or palpation (Stratford et al 1993) in conjunction with reduced PFG over the affected side (Stratford et al 1993; Vicenzino et al 1996; Vicenzino et al 1998).

Li-Wei Chou

Minister of Rehabilitation

Athletic Injuries

rESWT will be performed as follows:
Nine rESWT sessions
Three sessions per week
rESWT device: Swiss DolorClast (Electro Medical Systems, Nyon Switzerland), EvoBlue handpiece, 15 mm applicator
2500 rESWs per session, with energy density between 0.12 and 0.16 mJ/mm^2, depending on what the patient tolerates
rESWs applied at 15 Hz
Application of rESWs in prone position, with the patient lying on an examination table
Exact location of the application of rESWs determined by clinical and ultrasonographic examinations
Treatment of both the side of injury and the entire affected muscle (from distal to proximal in order to relax the affected muscle)
No use of local anesthesia.
In addition, patients will receive a specific rehabilitation program.

rESWT

Sham-rESWT will be performed as rESWT described in Arm rESWT + RP, but with a specially designed placebo EvoBlue handpiece that looks and sounds like the EvoBlue handpiece of the Swiss DolorClast, but does not generate radial shock waves. This is achieved by blocking the projectile shortly before it strikes the metal applicator. The placebo EvoBlue handpiece will not emit any radial shock wave energy.
In addition, patients will receive a specific rehabilitation program.

Sham-rESWT

KinEf Kinesiología Deportiva

Radial Extracorporeal Shock Wave Therapy for Acute Hamstring Muscle Complex Injury Type 3b in Athletes

A Prospective, Randomized, Double-blind, Placebo Controlled Single Centre Trial to Assess the Efficacy and Safety of rESWT Combined With a Specific Rehabilitation Program for Acute Hamstring Muscle Complex Injury Type 3b in Athletes

Individual treatment success is defined as the possibility to return to play, fulfilling all criteria specified by Van de Horst et al. (Sports Med 2016;46(6):899-912). Accodingly, the primary outcome measure is the number of days until "yes" (return to play possible according to the criteria established by Van de Horst et al., 2016) will be achieved.

Individual patient's satisfaction will be assessed using a scale ranging from 0 (maximum dissatisfaction) to 10 (maximum satisfaction)

Re-injury is defined as sudden, sharp pain in the posterior aspect of the thigh that was initially injured, accompanied by the same objective criteria initially used for the diagnosis of acute HMC injury Type 3b

Individual participant data (IPD) will not be shared with other researchers.

Kinef Kinesiología Deportiva

Ludwig-Maximilians - University of Munich

A medical assistant at the clinic of the Principal Investigator will allocate interventions by means of opaque sealed envelopes that will be marked according to the allocation schedule. The medical assistant will be unaware of the size of the blocks.
The randomized intervention assignment as outlined above will be concealed from both patients and health care staff until recruitment will be complete and irrevocable.
Patients will be blinded in this study. The assessor will be blinded in this study. The assessor is the person who will assess the outcome of treatment during follow up. In this study, the assessor will be a medical assistant at the clinic of the Principal Investigator.
The therapist will not be blinded in this study. The therapist is the person who will administer either rESWT or sham-rESWT to the patient. In this study, the therapist will be the Principal Investigator.

Kinesio taping by using space correction and fascia correction techniques every 3 days for 2 weeks in addition to exercises

Sham taping without using any techniques every 3 days for 2 weeks in addition to exercises

Stretching and strengthening exercises of wrist

Kinesio taping by using space and fascia correction techniques on forearm of the patients for lateral epicondylitis treatment will be applied every 3 days for 2 weeks in addition to exercises.
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series.

Kinesiotaping

Sham taping without using any techniques every 3 days for 2 weeks in addition to exercises
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series.

Sham Taping

Only-exercises group: Stretching and strengthening exercises of wrist
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series.

Control

Total

Sex: Female, Male

Ethnicity (NIH/OMB)

Region of Enrollment

Duration of Symptoms

Nirschl Scoring is a Likert scale ranging from 1 to 7 and classifying LE by the pain phase as a guide to the severity of the problem. Phase 1: Mild pain with exercise, resolves in 24 hours; Phase 2: Pain with exercise, exceeds 48 hours; Phase 3: Pain with exercise, does not alter activity; Phase 4: Pain with exercise, alters activity; Phase 5: Pain with heavy activities of daily living; Phase 6: Pain with light activities of daily living, intermitten pain at rest; Phase 7: Constant pain at rest, disrupts sleep.

Nirschl Score

PRTEE is a 15-item questionnaire designed tomeasure the forearm pain and disability in patients with LET. PRTEE allows patients to rate their levels of elbow pain and disability from 0 to 10 and consists of 2 subscales: 1) Pain subscale [5 items] (0 = no pain, 10 = worst imaginable) 2) Function subscale [Specific activities – 6 items, Usual activities – 4 items] (0 = no difficulty, 10 = unable to do). A total score can be computed on a scale of 100 (0 = no disability).

PRTEE (Patient rated tennis elbow evaluation)

PRTEE is a 15-item questionnaire designed to measure the forearm pain and disability in patients with LE. PRTEE allows patients to rate their levels of elbow pain and disability from 0 to 10. Test consists of 2 subscales: 1) Pain subscale [5 items] (0 = no pain, 10 = worst imaginable) 2) Function subscale [Specific activities - 6 items, Usual activities - 4 items] (0 = no difficulty, 10 = unable to do). A total score can be computed on a scale of 100 (0 = no disability).

Kinesio taping by using space correction and fascia correction techniques every 3 days for 2 weeks in addition to exercises
Kinesio taping: Kinesio tape will be applied by using space correction and fascia correction technique on forearm of the patients for the treatment of lateral epicondylitis
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series.

Sham taping without using any techniques every 3 days for 2 weeks in addition to exercises
Sham taping: Sham taping will be performed without using any technique
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series.

Stretching and strengthening exercises of wrist
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series. .

Patient Rated Tennis Elbow Evaluation (PRTEE)

The patients will be requested to score from 1 to 5 points any difficulty experienced during different daily activities related to the upper extremity. Test has 1 module of compulsory items and two optional modules: work module (4 items) and sport/performing arts module (4 items). Scores range from 0 to 100, where higher scores indicate more disability.

Kinesio taping by using space correction and fascia correction techniques every 3 days for 2 weeks in addition to exercises
Kinesio taping: Kinesio tape will be applied by using space correction and fascia correction technique on forearm of the patients for the treatment of lateral epicondylitis
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series. .

Sham taping without using any techniques every 3 days for 2 weeks in addition to exercises
Sham taping: Sham taping will be performed without using any technique
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series. .

The Disabilities of the Arm, Shoulder and Hand Score (QuickDash)

Pain on lateral epicondyle at rest during the day was evaluated with the visual analog scale (VAS 0-10 cm). Higher score indicates more pain.

Visual Analogue Scale (VAS) at Rest

Pain on lateral epicondyle during daily activity was evaluated with the visual analog scale (VAS 0-10 cm). Higher score indicates more pain.

Visual Analogue Scale (VAS) at Daily Activity

Pain on lateral epicondyle at night was evaluated with the visual analog scale (VAS 0-10 cm). Higher score indicates more pain.

Visual Analogue Scale (VAS) at Night

Grip strength will be measured using a hand held dynamometer (JAMAR, Sammons Preston, Inc., Bolingbrook, IL). Patients will be asked to grip the dynamometer until (s)he feel pain in elbow. Three evaluations will be made with resting periods in between and average scores will be recorded.

Painless Grip Strength

Grip strength will be measured using a hand held dynamometer (JAMAR, Sammons Preston, Inc., Bolingbrook, IL). Patients will be asked to grip with maximum strength. Three evaluations will be made with resting periods in between and average scores will be recorded.

Grip Strength

Overall Study

Gulseren Derya Akyuz

Kinesio taping by using space correction and fascia correction techniques every 3 days for 2 weeks in addition to exercises
Kinesio taping: Kinesio tape will be applied by using space correction and fascia correction technique on forearm of the patients for the treatment of lateral epicondylitis
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series.
No adverse effect occured.

Sham taping without using any techniques every 3 days for 2 weeks in addition to exercises
Sham taping: Sham taping will be performed without using any technique
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series.
No adverse effect occured.

Stretching and strengthening exercises of wrist
Exercise: Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series.
No adverse effect occured.

Kinesio tape will be applied by using space correction and fascia correction technique on forearm of the patients for the treatment of lateral epicondylitis

Sham taping will be performed without using any technique

Sham taping

Stretching exercises of wrist 30 seconds to one minute, twice a day and strengthening exercises will performed be 10 repetitions in 2 or 3 series. .

Exercise

Marmara University School of Medicine Department of Physical Medicine and Rehabilitation

Kinesiotaping in Lateral Epicondylitis

A Randomized Controlled Trial Comparing the Effects of Kinesiology Taping With Exercise, Sham Taping With Exercise and Exercise Alone for Lateral Epicondylitis

Marmara University

To ensure group concealment, randomization will be done by using opaque, sealed envelopes which the assessors will be blinded to

tennis elbow/asthenia

Fu's Subcutaneous Needling on the Myofascial Trigger Points: Lateral Epicondylitis

Radial Extracorporeal Shock Wave Therapy for Acute Hamstring Muscle Complex Injury Type 3b in Athletes

Kinesiotaping in Lateral Epicondylitis

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