Review of selected physical therapy methods used in the rehabilitation of the tennis elbow in the framework of evidence-based medicine principles

Introduction
Tennis elbow (TE) is a term widely used to describe an injury of wrist extensors enthesopathy known as lateral epicondylitis. Many serious constraints are being caused by this syndrome, emerging as a socioeconomic problem affecting patients of working age. The aetiology is still unknown, but it was proven that repetitive gripping, wrist extension, radial deviation, and/or forearm supination are the main factors influencing the development of the syndrome. There are many surgical and non-surgical treatment methods, but current scientific literature does not identify significant differences in their outcomes. Despite this, rehabilitation, yielding similar results to other methods, was still considered a supportive method after a surgical procedure. Three methods of extracorporeal shockwave therapy (ESWT), ultrasounds (US), and laser therapy are thoroughly described further down in the review.

Aims: This paper aimed to review current scientific literature and investigate possible non-surgical treatment methods for the TE syndrome.

Material and methods
The scientific literature review was conducted between June and September of 2021. The review was carried out by searching scientifically recognised medical databases, including PubMed, MEDLINE and PEDro. The scientific literature was not limited to articles no older than five years, counting from the start of the study conduction. In addition, articles written in a language other than English were excluded.

Results
All three methods were very simple yet popular and widely available. They seem suitable for patients diagnosed with TE as the main treatment with long-term effects. ESWT approach was proven to be the most prognostic, also having the highest research rate. Ultrasounds used small frequency penetration and did not produce long-term pain relief compared to laser treatment, which claimed to be safe and produce long-term benefits.

Conclusions
This review is meant to bring awareness and popularise the significance of non-surgical treatment. These studies raised the need for more randomised trials, with a larger number of subjects and considering high methodological standards.