Combined Physiotherapy in the Approach to Work-Related Epicondylalgia

INTERVENTION: We will compare two highly popular electrotherapy treatments in physiotherapy: electrolysis and peripheral magnetic stimulation. The duration of the intervention will be 6 weeks. For this purpose, three groups will be established: Control Group: Gold standard treatment. Exercise plus diathermy. Exercise Protocol: ‐Isometric exercises: On alternate days, 4‐5 repetitions of 30 seconds with 1‐2 minutes of rest between repetitions, progressively increasing the time up to 45 seconds, at 70% of their calculated maximum voluntary contraction using a dynamometer. ‐Eccentric exercises: 3 sets of 10 repetitions on alternate days, gradually increasing the load (2.5‐5%), aiming for slight discomfort not exceeding 4‐5/10 on the pain visual analog scale (EVA). Starting position will be wrist extension, finishing in wrist palmar flexion. ‐Shoulder muscle strengthening: 3 sets of 15 repetitions, 2‐3 days per week, depending on the worker's capacity (sedentary or active individual). This exercise targets the rotator cuff muscles. Patients will work on external and internal rotation, followed by shoulder flexion, shoulder abduction, and shoulder extension exercises with the same parameters (3 sets of 15 repetitions). ‐Scapula and neck motor control: 3 basic exercises for each area, performing 3 sets of 10 repetitions with a focus on proper execution rather than load. Voluntary contraction of rhomboids, inferior trapezius, and serratus for shoulder stability, and deep flexors and extensors for the neck. They will perform a 10‐second contraction with 25% of strength intensity during each 10‐second contraction. ‐Forearm and shoulder muscle stretches: Hold each stretch for 10 seconds and repeat 3 times daily during the treatment period. Diathermy: 60 watts fo CONDITION: Injuries and Accidents ‐ Other injuries and accidents Musculoskeletal ‐ Other muscular and skeletal disorders Physical Medicine / Rehabilitation ‐ Physiotherapy Work‐Related Epicondylalgias;tendinopathies ; ; Work‐Related Epicondylalgias ; tendinopathies; INCLUSION CRITERIA: Workers covered by Umivale (Worker's Mutual Insurance Company) with the epicondylitis therapy plan (ICD‐10 code M77.1): Confirmed by magnetic resonance imaging to have medial epicondylalgia. Currently on sick leave due to medial epicondylalgia. Who sign the informed consent to participate in the study. PRIMARY OUTCOME: Algometry: to calculate the pressure pain threshold measurement of the common extensor carpi radialis, extensor carpi radialis brevis, and extensor carpi radialis longus muscles in both elbows, using the algometer (Wagner instruments, Greenwich, USA). all measures will be assessed as a composite primary outcome[ before the first day of treatment; after the last day of treatment (normally 6 weeks, primary outcome); 6 months after the end of the treatment] Dynamometry: Measurement of isometric strength in the flexor muscles of the wrist, using the ActiveForce 2 dynamometer (Activbody, San Diego, CA).[ before the first day of treatment ; after the last day of treatment (normally 6 weeks, primary tmepoint)); 6 months after the end of the treatment] Goniometry: Measurement of elbow flexion, extension, and pronosupination using an universal goniometer. all measures will be assessed as a composite primary outcome[ before the first day of treatment; after the last day of treatment (normally 6 weeks, primary timepoint); 6 months after the end of the treatment] SECONDARY OUTCOME: "Ultrasound imaging:to assess the thickness of the common wrist extensor tendon and the presence of hypervascularization. It will be performed using a Mindray M8 ultrasound system.:both measures will be assessed as a composite secondary outcome[ before the first day of treatment ; after the last day of treatment (normally 6 weeks) ; 6 months after the end of the treatment] Days of work absenteeism: number of days the patients would not be able to work due to the pathology. The days of sick leave will be counted from the time the doctor grants you sick leave, until you are discharged from work and are fit to work. An excel will be kept with the data provided by the doctor from the mutual insurance company.[ the day they go back to work. ] Dynamometry: Measurement of isometric strength in the extensor muscles of the wrist, using the ActiveForce 2 dynamometer (Activbody, San Diego, CA).[ before the first day of treatment ; after the last day of treatment (normally 6 weeks,primary timepoint) ; 6 months after the end of the treatment] Dynamometry: Measurement of isometric strength ratio between flexors and extensor muscles of the wrist, using the ActiveForce 2 dynamometer (Activbody, San Diego, CA).[ before the first day of treatment ; after the last day of treatment (normally 6 weeks,primary timepoint) ; 6 months after the end of the treatment ; ] VAS Scale: Numeric ruler from 0 to 100.(primary outcome) to assess pain.[ before the first day of treatment ; after the last day of treatment (normally 6 weeks,primary timepoint) ; 6 months after the end of the treatment]