Effect of Rotator Cuff Strengthening Exercises Combined with Myofascial Release on Pain and Function in Patients with Tennis Elbow: A Single-Group Pre–Post Interventional Study
Abstract
Background: Tennis elbow (lateral epicondylitis) is a common overuse tendinopathy of the extensor carpi radialis brevis (ECRB) that causes lateral elbow pain, reduced grip strength, and functional limitation. Conventional treatment directed at the forearm alone often produces incomplete or short-lived relief. Weakness of the rotator cuff and scapular stabilisers may alter upper-limb biomechanics and increase load on the forearm extensors, providing a rationale for combining proximal strengthening with local soft-tissue treatment. Objective: To evaluate the effect of rotator cuff strengthening exercises combined with myofascial release on pain and function in patients with tennis elbow. Materials and Methods: Twenty patients (10 male, 10 female; mean age 29.55 ± 3.53 years) with unilateral lateral epicondylitis of at least four weeks' duration and a positive Cozen's test were recruited from Narinder Mohan Hospital & Heart Centre, Ghaziabad, using convenience sampling. In this single-group pre–post design, all participants received rotator cuff and scapular strengthening using elastic resistance together with instrument-assisted myofascial release of the wrist extensors, three times per week for four weeks. Pain was assessed with the Visual Analogue Scale (VAS) and pain provoked on Cozen's test; function was assessed with the Patient-Rated Tennis Elbow Evaluation (PRTEE). Outcomes were recorded at baseline and after four weeks and compared using a paired t-test (α = 0.05). Results: All outcomes improved significantly from baseline to post-intervention. Mean VAS fell from 7.3 ± 1.14 to 2.8 ± 0.75, PRTEE from 61.55 ± 6.69 to 19.85 ± 6.28, and Cozen's test pain from 7.6 ± 1.1 to 2.8 ± 0.77 (all p < 0.001). Conclusion: A four-week programme combining rotator cuff strengthening with myofascial release produced clinically and statistically significant reductions in pain and disability in patients with tennis elbow. Targeting proximal muscle weakness alongside local fascial restriction may offer a more comprehensive management strategy. Randomised controlled trials with a comparison group and longer follow-up are recommended.