This RCT compared the effectiveness of eccentric exercise, eccentric-concentric (isotonic) and combined isotonic-isometric exercise for treatment of lateral elbow tendinopathy (LET). The results found all exercise programs reduced pain and improved function with the combined isotonic-isometric group producing the largest effect.


Author took 34 amateur tennis players with a mean age of 43. They received 5 treatments per week for 4 weeks. In all groups 3 sets of 15 reps with 1-minute rest intervals were performed. The wrist extensor stretching before and after treatment.

The exercise start position was the elbow on the bed in full extension, forearm in pronation, wrist in an extended position and hand hanging over the edge. Eccentrics involved a count of 30 to full flexion. The combined isotonic-isometric group included a 45-second hold at the start positon. Load was increased using free weights when no pain during exercise was experienced.

Previous systematic reviews have favoured eccentrics exercise in the management of Lateral elbow tendinopathy. The authors hypothesized that Lateral elbow tendinopathy is often related to forceful grip activities which  requiring isometric contraction, which may be more beneficial than eccentric contraction. which  further enhance the analgesic effect.

Limitation of study :

A Small sample size, no placebo group, no long-term follow-up and problems with blinding and other possible treatments the patients may have received. More research is needed to confirm these results.

Clinical implication:

  1. The load of exercises was increased according to the patients’ symptoms otherwise, the results are poor.
  2. The simultaneous use of these 2 kinds of contractions (isotonic and isometric) and static stretching exercises will further enhance the analgesic effect of contractions in the treatment of LET which  increasing the arm function.
  3. Eccentric exercises were performed at a low speed in every treatment session because this allows tissue healing.
  4. The eccentric-concentric training combined with isometric contraction should be the first treatment
    option for therapists when they manage LET.


  1. Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy
    Dimitrios Stasinopoulos PhD a,*, Ioannis Stasinopoulos MDb
    a Department of Health Sciences, Physiotherapy Program, School of Sciences, European University Cyprus, Nicosia, Cyprus
    b Rheumatology and Rehabilitation Centre, Athens, Greece