L2: What the patient can expect

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What the patient can expect

This progressive exercise series has been used in a number of studies – albeit most of low quality (small sample sizes, short duration). We have included the exercises for completeness as it involves movements in all directions; however, some practitioners argue that current approaches to tendinopathy favour eccentric exercises and stretching. In addition, this exercise protocol is time-consuming and cumbersome which could hamper compliance. It also requires considerable monitoring by the practitioner.

These exercises were used in a small 1996 study by Pienimaki et al. who found this progressive exercise regime more effective than ultrasound for improving pain and the patient’s ability to work.4 In 2004 Struijs et al. used the same protocol following initial ultrasound and friction massage treatment. This was compared to use of a brace. Initially the brace was more effective in the short term (six weeks) whereas a combination of brace and ultrasound/massage/exercise protocol was more effective after six weeks follow-up. This advantage disappeared at 26 weeks and 52 weeks suggesting that this exercise regime may not be any more beneficial in the longterm.5 In Oken et al.’s 2008 study each of the interventions (brace, ultrasound, low-level laser) were provided in conjunction with this exercise protocol making it impossible to determine its effectiveness alone.6 All groups improved on a visual analog scale at two and six weeks.

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