Combination of manipulation, exercise, and physical therapy for the treatment of a 57-year-old woman with lateral epicondylitis.

OBJECTIVE: This case report presents a simple systematic approach consisting of a 10-week specific sequential multimodal conservative management approach to chronic lateral epicondylitis.

CLINICAL FEATURES: A 57-year-old female science teacher experiencing elbow pain for 5 months presented to our multidisciplinary clinic complaining of whole-arm pain extending to the wrist.

INTERVENTION AND OUTCOME: In the 10-week protocol, we used high-velocity and low-amplitude manipulation, high-voltage pulsed galvanic stimulation, a hard-padded elbow brace, ice, and exercise, along with restricted use of the affected elbow. The Patient-Rated Forearm Evaluation Questionnaire, currently named as the Patient-Rated Tennis Elbow Evaluation, was used for an outcome measurement. Overall, there was a systematic reduction of pain (92.86%), specific activity (100%), and usual activity (96.87%), and even after 3 weeks of follow-up, we did not notice significant changes in all of the data.

CONCLUSIONS: This case study showed the possible beneficial effects of the specific sequential multimodal treatment approach in a patient with resistant chronic lateral epicondylitis.