Comparision of Paraffin Wax Therapy Versus Low Level Laser Therapy in Patients with Trigger Point in Tennis Elbow-A Pilot Study
Corresponding Author(s) : Chinmayi Kavatkar
chinmayi622@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 6 No. 1 (2018): 2018 Volume 6- Issue -1
Abstract
Background Lateral Epicondylitis also known as tennis elbow affects the wrist extensor muscles .Pain occurs due to repetitive microtrauma between 30 and 55 years. It affects 1%-3% of the population and mostly involves the dominant hand with no gender predisposition.
Aim The purpose of the study is to compare Paraffin Wax Therapy (PWT) and Low Level Laser Therapy (LLLT) on pain and grip strength in patients with trigger point in tennis elbow. Method 20 subjects randomly recruited into 2 groups,Group1 given PWT and group 2 given LLLT and both groups also received supervised exercise protocol for 5 days .Pre - Post assessment was carried .Pain and grip strength were assessed using NRS and Hand held Dynamometer . Results Wicoxon test was used to find pre- post treatment values of NRS. NRS at rest for both the groups p=0.0078 and NRS on activity for group1 was p=0.0039, group 2 p=0.0078 showing significant results .Paired t test assessed pre- post treatment values of grip strength with p=0.2668 of group1 showing no significant results and 0.0009 of group2 suggesting significant results .Mann-Whitney U test compared NRS between the groups with p=0.4401NRS at rest p=0.3236NRS on activity with no significant results .Unpaired t test compared grip strength between the groups with p=0.0432 giving significant results .Conclusion-PWT and LLLT both are equally effective in reducing pain and LLLT alone is effective in improving grip strength in patients with trigger point in tennis elbow.
Keywords
Numerical Rating Scale (NRS)
Hand Held Dynamometer
Lateral epicondylitis
Grip strength
1.
Chinmayi Kavatkar. Comparision of Paraffin Wax Therapy Versus Low Level Laser Therapy in Patients with Trigger Point in Tennis Elbow-A Pilot Study. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2020 Aug. 10 [cited 2025 Sep. 26];6(1):138-49. Available from: https://ijamscr.com/ijamscr/article/view/492
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References
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Thomas De Smedt, Andy de Jong, Wim Van Leemput, ‘et al’.Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment .British journal of sports medicine. [2]. Leanne M Bisset a, Bill Vicenzino .Physiotherapy management of lateral epicondylalgia. Journal of Australia. [3]. Akram Amro, MPH a,b,Ina Diener et’al. The effects of Mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis .Hongkong journal of physiotherapy. [4]. Brent Brotzman and Kevin Wilk Clinical Orthopaedic Rehabiliatation – second edition [5]. Alfonso Vaquero-Picado, Raul Barco, Samuel A. Lateral epicondylitis of the elbow.EFORT. EFORT. 1(1), 2016. [6]. Carol J Manheim, MS, Med ,PT, LPC .The Myofascial Release Manual fourth edition- [7]. DAVID J. ALVAREZ, D.O., and PAMELA G. ROCKWELL, D.O., University of Michigan Medical School, Ann Arbor, Michigan. Am Fam Physician. 65(4), 2012, 653-661. Trigger Points: Diagnosis and Management. Am Fam Physician. 65(4), 2012, 653-661. [8]. Travell and Simons Myofascial Pain and Dysfunction: The Trigger Point Manual 1(2). [9]. LIZ KIT YIN LAM, M.Sc 1 and GLADYS LAI YING CHEING, Ph.D.2. Effects of 904-nm Low-Level Laser Therapy in the Management of Lateral Epicondylitis: A Randomized Controlled Trial Photomedicine and Laser Surgery 25(2), 2007. [10]. Rick Tosti, John Jennings, Milo Sewards. Lateral epicondylitis of the elbow.The American journal of medicine. 126, 2013. [11]. Maheshwari and Mhaskar. Essential Othopaedics (including clinical methods) fifth edition. [12]. David J. Magee Orthopaedic Physical Assessment sixth edition. [13]. Jennifer L. Wuori, MSc, Thomas J. Overend, PhD, John F. Kramer, PhD, ‘et al’. Strength and Pain Measures Associated With Lateral Epicondylitis Bracing.
[14]. Arti S Bhargava, 1 Charu Eapen, 2 and Senthil P Kumar, Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis-comparison of involved vs. uninvolved side in athletes and non athletes a case-control study.
[15]. Val Robertson, Alex ward, Low and Reed. Electrotherapy Explained Principles and Practice Fourth Edition.
[16]. Dilpreet Kaur Reena Arora Lalit Arora ‘et al’. A Randomized Controlled Trial to Study the Efficacy of Low Level Laser Therapy Combined with Ischemic Compression in the Treatment of Latent Myofascial Trigger Points .International Journal of Innovative Research and Development 3(7), 2014.
[17]. Priya Kannan1.Management of Myofascial Pain of Upper Trapezius: A Three Group Comparison Study Global Journal of Health Science; 4(5), 2012.
Chinmayi K et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-6(1) 2018 [138-149]
149
[18]. Abeer A. Yamany and Samir Elsaid Salim. Efficacy of Low Level Laser Therapy for Treatment Myofascial Trigger Points of Shoulder Pain .World Applied Sciences Journal 12 (6), 2011, 758-764
[19]. Peeyoosha Gurudut *1, Esha Bhadauria 2Comparative Effectiveness of low level laser therapy, ultrasound therapy and combined effect of both on trigger points. International Journal of Physiotherapy and Research, Int J Physiother Res 4(5), 2016, 2321-1822
[20]. Parisa Taheri, Babak Vahdatpour, Somayeh Andalib. Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius. Advanced Biomedical Research. 5, 2016.
[21]. Jan M Bjordal, corresponding author1, 2 Rodrigo AB Lopes-Martins, 3 Jon Joensen ‘et al’. A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008, 9- 75.
[22]. Mohamed Faisal C.K., Mary Sumila, Lawrence Mathias, ’et al’.Comparative Study on the effectiveness of Low Level Laser Therapy versus Phonophoresis in the management of lateral epicondylitis Nitte University Journal of Health Science 2013.
[23]. Manpreet Kaur, Reena Arora, Lalit Arora, ‘et al’. . Efficacy of Laser Therapy in Lateral Epicondylitis: A RCT. International Journal of Recent Research and Review. 2, 2014.
[24]. Wen-Dien Chang, M.S.12 Jih-Huah Wu, Ph.D. 3 Wen-Ju Yang, M.S, ‘et al’. Therapeutic Effects of Low-Level Laser on Lateral Epicondylitis from Differential Interventions of Chinese-Western Medicine: 0Systematic Review. Photomedicine and Laser Surgery 28(3), 2010.
[25]. Forster and Palastanga Clayton’s Electrotherapy Theory and practice Eighth Edition.
[26]. Trial Banu Dilek, MD,a Mehtap Go¨zu¨m ‘et al’. Efficacy of Paraffin Bath Therapy in Hand Osteoarthritis: A Single-Blinded Randomized Controlled. Archives of Physical Medicine and Rehabilitation 94, 2013, 642-9.
[27]. Recommended treatment doses for Low Level Laser Therapy Laser class 3B, 904 nm GaAs Lasers(Peak pulse output >1 Watt, mean output >5 mW and power density > 5mW/cm2).Irradiation times should range between 30 and 600 seconds
[28]. Jayant Joshi, Prakash Kotwal. Orthopaedics and Applied Physiotherapy third edition
[29]. Muhammad Zeeshan Khalid1 Mechanism of Laser/light beam interaction at cellular and tissue level and study of the influential factors for the application of low level laser therapy. Department of Basic sciences, University of Engineering and Technology, 47050 Taxila, Pakistan. Physics.med-ph
[30]. Virendra Khokkhar Electrotherapy for Physiotherapists second edition.
References
Thomas De Smedt, Andy de Jong, Wim Van Leemput, ‘et al’.Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment .British journal of sports medicine. [2]. Leanne M Bisset a, Bill Vicenzino .Physiotherapy management of lateral epicondylalgia. Journal of Australia. [3]. Akram Amro, MPH a,b,Ina Diener et’al. The effects of Mulligan mobilisation with movement and taping techniques on pain, grip strength, and function in patients with lateral epicondylitis .Hongkong journal of physiotherapy. [4]. Brent Brotzman and Kevin Wilk Clinical Orthopaedic Rehabiliatation – second edition [5]. Alfonso Vaquero-Picado, Raul Barco, Samuel A. Lateral epicondylitis of the elbow.EFORT. EFORT. 1(1), 2016. [6]. Carol J Manheim, MS, Med ,PT, LPC .The Myofascial Release Manual fourth edition- [7]. DAVID J. ALVAREZ, D.O., and PAMELA G. ROCKWELL, D.O., University of Michigan Medical School, Ann Arbor, Michigan. Am Fam Physician. 65(4), 2012, 653-661. Trigger Points: Diagnosis and Management. Am Fam Physician. 65(4), 2012, 653-661. [8]. Travell and Simons Myofascial Pain and Dysfunction: The Trigger Point Manual 1(2). [9]. LIZ KIT YIN LAM, M.Sc 1 and GLADYS LAI YING CHEING, Ph.D.2. Effects of 904-nm Low-Level Laser Therapy in the Management of Lateral Epicondylitis: A Randomized Controlled Trial Photomedicine and Laser Surgery 25(2), 2007. [10]. Rick Tosti, John Jennings, Milo Sewards. Lateral epicondylitis of the elbow.The American journal of medicine. 126, 2013. [11]. Maheshwari and Mhaskar. Essential Othopaedics (including clinical methods) fifth edition. [12]. David J. Magee Orthopaedic Physical Assessment sixth edition. [13]. Jennifer L. Wuori, MSc, Thomas J. Overend, PhD, John F. Kramer, PhD, ‘et al’. Strength and Pain Measures Associated With Lateral Epicondylitis Bracing.
[14]. Arti S Bhargava, 1 Charu Eapen, 2 and Senthil P Kumar, Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis-comparison of involved vs. uninvolved side in athletes and non athletes a case-control study.
[15]. Val Robertson, Alex ward, Low and Reed. Electrotherapy Explained Principles and Practice Fourth Edition.
[16]. Dilpreet Kaur Reena Arora Lalit Arora ‘et al’. A Randomized Controlled Trial to Study the Efficacy of Low Level Laser Therapy Combined with Ischemic Compression in the Treatment of Latent Myofascial Trigger Points .International Journal of Innovative Research and Development 3(7), 2014.
[17]. Priya Kannan1.Management of Myofascial Pain of Upper Trapezius: A Three Group Comparison Study Global Journal of Health Science; 4(5), 2012.
Chinmayi K et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-6(1) 2018 [138-149]
149
[18]. Abeer A. Yamany and Samir Elsaid Salim. Efficacy of Low Level Laser Therapy for Treatment Myofascial Trigger Points of Shoulder Pain .World Applied Sciences Journal 12 (6), 2011, 758-764
[19]. Peeyoosha Gurudut *1, Esha Bhadauria 2Comparative Effectiveness of low level laser therapy, ultrasound therapy and combined effect of both on trigger points. International Journal of Physiotherapy and Research, Int J Physiother Res 4(5), 2016, 2321-1822
[20]. Parisa Taheri, Babak Vahdatpour, Somayeh Andalib. Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius. Advanced Biomedical Research. 5, 2016.
[21]. Jan M Bjordal, corresponding author1, 2 Rodrigo AB Lopes-Martins, 3 Jon Joensen ‘et al’. A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008, 9- 75.
[22]. Mohamed Faisal C.K., Mary Sumila, Lawrence Mathias, ’et al’.Comparative Study on the effectiveness of Low Level Laser Therapy versus Phonophoresis in the management of lateral epicondylitis Nitte University Journal of Health Science 2013.
[23]. Manpreet Kaur, Reena Arora, Lalit Arora, ‘et al’. . Efficacy of Laser Therapy in Lateral Epicondylitis: A RCT. International Journal of Recent Research and Review. 2, 2014.
[24]. Wen-Dien Chang, M.S.12 Jih-Huah Wu, Ph.D. 3 Wen-Ju Yang, M.S, ‘et al’. Therapeutic Effects of Low-Level Laser on Lateral Epicondylitis from Differential Interventions of Chinese-Western Medicine: 0Systematic Review. Photomedicine and Laser Surgery 28(3), 2010.
[25]. Forster and Palastanga Clayton’s Electrotherapy Theory and practice Eighth Edition.
[26]. Trial Banu Dilek, MD,a Mehtap Go¨zu¨m ‘et al’. Efficacy of Paraffin Bath Therapy in Hand Osteoarthritis: A Single-Blinded Randomized Controlled. Archives of Physical Medicine and Rehabilitation 94, 2013, 642-9.
[27]. Recommended treatment doses for Low Level Laser Therapy Laser class 3B, 904 nm GaAs Lasers(Peak pulse output >1 Watt, mean output >5 mW and power density > 5mW/cm2).Irradiation times should range between 30 and 600 seconds
[28]. Jayant Joshi, Prakash Kotwal. Orthopaedics and Applied Physiotherapy third edition
[29]. Muhammad Zeeshan Khalid1 Mechanism of Laser/light beam interaction at cellular and tissue level and study of the influential factors for the application of low level laser therapy. Department of Basic sciences, University of Engineering and Technology, 47050 Taxila, Pakistan. Physics.med-ph
[30]. Virendra Khokkhar Electrotherapy for Physiotherapists second edition.
[14]. Arti S Bhargava, 1 Charu Eapen, 2 and Senthil P Kumar, Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis-comparison of involved vs. uninvolved side in athletes and non athletes a case-control study.
[15]. Val Robertson, Alex ward, Low and Reed. Electrotherapy Explained Principles and Practice Fourth Edition.
[16]. Dilpreet Kaur Reena Arora Lalit Arora ‘et al’. A Randomized Controlled Trial to Study the Efficacy of Low Level Laser Therapy Combined with Ischemic Compression in the Treatment of Latent Myofascial Trigger Points .International Journal of Innovative Research and Development 3(7), 2014.
[17]. Priya Kannan1.Management of Myofascial Pain of Upper Trapezius: A Three Group Comparison Study Global Journal of Health Science; 4(5), 2012.
Chinmayi K et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-6(1) 2018 [138-149]
149
[18]. Abeer A. Yamany and Samir Elsaid Salim. Efficacy of Low Level Laser Therapy for Treatment Myofascial Trigger Points of Shoulder Pain .World Applied Sciences Journal 12 (6), 2011, 758-764
[19]. Peeyoosha Gurudut *1, Esha Bhadauria 2Comparative Effectiveness of low level laser therapy, ultrasound therapy and combined effect of both on trigger points. International Journal of Physiotherapy and Research, Int J Physiother Res 4(5), 2016, 2321-1822
[20]. Parisa Taheri, Babak Vahdatpour, Somayeh Andalib. Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius. Advanced Biomedical Research. 5, 2016.
[21]. Jan M Bjordal, corresponding author1, 2 Rodrigo AB Lopes-Martins, 3 Jon Joensen ‘et al’. A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008, 9- 75.
[22]. Mohamed Faisal C.K., Mary Sumila, Lawrence Mathias, ’et al’.Comparative Study on the effectiveness of Low Level Laser Therapy versus Phonophoresis in the management of lateral epicondylitis Nitte University Journal of Health Science 2013.
[23]. Manpreet Kaur, Reena Arora, Lalit Arora, ‘et al’. . Efficacy of Laser Therapy in Lateral Epicondylitis: A RCT. International Journal of Recent Research and Review. 2, 2014.
[24]. Wen-Dien Chang, M.S.12 Jih-Huah Wu, Ph.D. 3 Wen-Ju Yang, M.S, ‘et al’. Therapeutic Effects of Low-Level Laser on Lateral Epicondylitis from Differential Interventions of Chinese-Western Medicine: 0Systematic Review. Photomedicine and Laser Surgery 28(3), 2010.
[25]. Forster and Palastanga Clayton’s Electrotherapy Theory and practice Eighth Edition.
[26]. Trial Banu Dilek, MD,a Mehtap Go¨zu¨m ‘et al’. Efficacy of Paraffin Bath Therapy in Hand Osteoarthritis: A Single-Blinded Randomized Controlled. Archives of Physical Medicine and Rehabilitation 94, 2013, 642-9.
[27]. Recommended treatment doses for Low Level Laser Therapy Laser class 3B, 904 nm GaAs Lasers(Peak pulse output >1 Watt, mean output >5 mW and power density > 5mW/cm2).Irradiation times should range between 30 and 600 seconds
[28]. Jayant Joshi, Prakash Kotwal. Orthopaedics and Applied Physiotherapy third edition
[29]. Muhammad Zeeshan Khalid1 Mechanism of Laser/light beam interaction at cellular and tissue level and study of the influential factors for the application of low level laser therapy. Department of Basic sciences, University of Engineering and Technology, 47050 Taxila, Pakistan. Physics.med-ph
[30]. Virendra Khokkhar Electrotherapy for Physiotherapists second edition.