A Comparison of the Effects of Combining ESWT With Blood Flow Restriction Therapy in Patients Diagnosed With Lateral Epicondylitis: a Randomized Controlled Trial

Lateral epicondylitis is a form of tendinitis characterized by pain at the attachmentsite of the common extensor tendons of the wrist to the lateral epicondyle, resultingfrom inflammation and degeneration (Kraushaar & Nirschl, 1999). It is most commonly seenin individuals aged 40‐59, with a prevalence of 1.3% (Zhang et al., 2024). Common riskfactors include female gender, obesity, a history of smoking, repetitive activities, andipsilateral rotator cuff dysfunction (Shiri et al., 2006). Typically, pain on the lateralaspect of the elbow and forearm, restricted range of motion in the elbow and wristjoints, decreased muscle strength, and loss of function may be observed due to repetitiveforearm supination/pronation and wrist extension (Shiri & Viikari‐Juntura, 2011; G etal., 2024).Treatment options include medical (oral and topical nonsteroidal anti‐inflammatory drugs,local corticosteroid injections), conservative (cryotherapy, orthoses, electrotherapy,etc.), and surgical methods. Among conservative methods, Extracorporeal Shock WaveTherapy (ESWT) is frequently preferred (Lai et al., 2018). ESWT is a non‐invasive methodthat utilizes high‐frequency acoustic waves for therapeutic purposes in target tissues.This method supports tissue regeneration by enhancing angiogenesis at the tendon‐bonejunction through the stimulation of vascular endothelial growth factors and nitric oxidesynthesis, and reduces pain by inhibiting pain receptors (Yoon et al., 2020).Additionally, it triggers the release of lubricin, which facilitates tendon repair andgliding by stimulating tenocyte proliferation through increased expression of TGFβ1 andIGF‐1 (Zhang et al., 2011). The literature has demonstrated that ESWT has effects onlateral epicondylitis, such as alleviating pain, shortening recovery time, increasinggrip strength, and enabling patients to return to their daily activities (Murat et al.,2024; Pettrone & McCall, 2005).Another conservative method used in the treatment of lateral epicondylitis is Blood FlowRestriction Therapy (BFR). In this method, arterial blood flow is partially restrictedand venous return is blocked by applying an external device (tourniquet oradjustable‐pressure cuff) to the proximal part of the extremity (Patterson et al., 2019).This causes the targeted muscle group to work in an ischemic, hypoxic environment,triggering a significant increase in muscle mass and strength by activating fast‐twitchmuscle fibers (Gorgey et al., 2016; Scott et al., 2014). Studies investigating theeffects of BFR on lateral epicondylitis have shown that it reduces pain, increases gripstrength, and contributes to functional improvement (Karanasios et al., 2022; Kinandanaet al., 2023).In the literature, the effects of both methods on lateral epicondylitis have beenexamined separately, but their efficacy has not been compared. Therefore, the aim of ourstudy is to compare the efficacy of extracorporeal shock wave therapy (ESWT) and bloodflow restriction therapy (BFR) in patients with lateral epicondylitis. By comparingdifferent treatment methods that can be used in the management of lateral epicondylitissymptoms, our study will contribute to the use of more personalized and effectivetreatment strategies by healthcare professionals and will serve as a guide for futureresearch.