The Research Question Lateral epicondylosis (tennis elbow) is common, debilitating and often refractory to routine care. Prolotherapy, an injection-based “regenerative” therapy, and guided physical therapy (PT) are safe, evidence-based modalities, but have not been compared. Study question: Among adults with tennis elbow, what is the effect of prolotherapy, PT and the two combined on disease- specific quality of life as assessed by a validated questionnaire?

Research Design and Method Design: 12 month randomized controlled trial (N=120). Participants: Adults with chronic tennis elbow. Intervention: Participants were allocated to: 4 monthly sessions of prolotherapy with hypertonic dextrose, OR… 4 weekly sessions of PT, OR… Prolotherapy and PT combined. Assessment: Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. The outcomes assessor was blinded to group.

What the Research Found 120 participants Adherence to treatment and 12-month questionnaire adherence were high: 93% and 88% respectively. All groups reported PRTEE score improvements of approximately 28 points on this 100-point scale. Meets clinical importance standard. There was not a difference between groups at 12 months; combined care did not improve outcomes. Participants in all groups were satisfied. There were no adverse events.

What this means for Clinical Practice Prolotherapy, PT and combined therapy resulted in safe, significant, substantial and sustained improvement of PRTEE- based elbow pain and function by 52 weeks. Clinicians can feel comfortable recommending prolotherapy and supervised PT to patients who are refractory to other non- surgical care. Combination therapy did not add improvement to either therapy alone.