ESWT vs HILT in Chronic Lateral Epicondylitis

The Group will receive ESWT plus conventional physiotherapy treatment program. Regarding ESWT protocol, the group will receive 1,000, 1,500, and 2,000 pulses during the first, second, and third through fifth treatments, respectively (pressure, 2.5 bar; frequency, 8 Hz; energy density, 0.4 mJ/mm2). The patients received 5 ESWT treatments once per week. The treatments were performed using a Rosetta ESWT (CR Technology, Korea). Ultrasound gel was applied between the apparatus head and skin. The procedure was performed in the area with the most intense pain. Treatment was administered at the anterior aspect of the LE and three points around it at a radius of 1.5-2 cm. The treatment time did not exceed 10 minutes. During the treatments, the patients did not receive any drugs (Lizis, 2015).

The conventional program will include TENS for twenty minutes in elbow region; the use of pulse ultrasound with duty cycle 80% on the lateral epicondyle for five minutes with an intensity of 0.8 W per every cm'; the use of ice for ten minutes; training for correcting the daily activities to minimize pressure on the elbow (preferentially, holding, lifting and pressing the objects will be asked to be carried out in supination); and, stretch and strain wrist muscle strengthening exercises (Fekri et al., 2019). The exercise therapy method involved six elbow joint exercises. They are a total of six exercises (Fig. 2) for patients with tennis elbow. Each exercise will be performed three times a day, with each session involving five repetitions of the movement, over four weeks, gradually increasing weight until the movement is effective but below the pain threshold. Painful movements will be avoided, and exercises causing pain or discomfort will be discontinued following consultation from a p

The Group will receive HILT plus conventional physiotherapy treatment program. High-power laser used in the present research paper was MLS Laser, Model M6 (ASA), that will be included in class four lasers device, with maximum 25-Watt power, average power of 3.3 Watts, wavelength of 808 nm in a continuous state. The target region diameter in this device will be 5 cm and the energy used for treating the patients will be 272.4 Jules, and the energy density will be 13.89 Jules per cm' with a 700-hertz frequency for a period of three minutes on the lateral epicondyle and the origin of the wrist's extensor muscles (Fekri et al., 2019).