Chronic lateral epicondylitis of the elbow: a prospective study of low‐energy shockwave therapy and low‐energy shockwave therapy plus manual therapy of the cervical spine. (Johannes Gutenberg University School of Medicine, Mainz, Germany). Arch Phys Med Rehabil. 2001;82:578–582.

This prospective, matched single‐blinded control trial compared the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine in treating chronic tennis elbow. Thirty patients with unilateral chronic tennis elbow, an unsuccessful conservative therapy during the 6 months before referral, and clinical signs of cervical dysfunction were studied. Three times at weekly intervals all patients received 1000 shockwave impulses of an energy flux density of 0.16J/mm 2 at the lateral elbow. Additionally, they underwent manual therapy of the cervical spine and the cervicothoracic junction 10 times (Group I). For each patient, a control matched by age and gender at first conservative treatment was drawn at random from 127 patients who had undergone low‐energy shockwave therapy in the same unit in the past 3 years (Group II). Follow‐up examinations took place at 12 weeks and at 12 months. Neither group differed statistically before the study, with a poor rating for all patients. At 12 months, there was still no significant difference, with the outcome being excellent or good in 56% in Group I and 60% in Group II. Each group showed significant improvement compared with the respective prestudy evaluation. Conclude ESWT may be an effective conservative treatment method for unilateral chronic tennis elbow. The efficacy of additional cervical manual therapy for lateral epicondylitis remains questionable.