Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial

J Shoulder Elbow Surg. 2019 Feb;28(2):288-295. doi: 10.1016/j.jse.2018.10.002.


Background: Counterforce bracing is one of the common treatment modalities for tennis elbow. The objective of this study was to determine whether counterforce bracing offers any additional benefit over placebo bracing in the treatment of tennis elbow.

Methods: This prospective, randomized, double-blinded, placebo-controlled clinical trial investigated the use of counterforce bracing (n = 17) compared with placebo bracing (n = 14) in the management of acute tennis elbow. Outcome measures included patient-rated pain and functional outcomes, epicondyle tenderness, and strength at 6 months and long term. Follow-up occurred at 2, 6, 12, and 26 weeks, as well as long term (mean follow-up, 3 years). The study duration was 5 years.

Results: The 2 groups, counterforce and placebo, were similar in age, sex, hand dominance, and duration of symptoms. Both braces improved patient-rated pain frequency and severity (P < .01), difficulty with picking up objects and twisting motions, and overall elbow function (P < .001) at 6 months and 3 years. Both braces also improved lateral epicondyle tenderness, grip strength (P < .01), and modified ORI-TETS (Orthopaedic Research Institute-Tennis Elbow Testing System) force (P < .05) at 6 months. Significant intergroup differences were detected for frequency of pain at rest at 6 and 12 weeks (P < .05), level of pain at rest at 2 weeks (P < .001), and patient-rated overall elbow function at 26 weeks (P = .041).

Conclusion: The counterforce brace provides significant reduction in the frequency and severity of pain in the short term (2-12 weeks), as well as overall elbow function at 26 weeks, compared with the placebo brace.

Keywords: Tennis elbow; brace; counterforce; lateral epicondylitis; placebo; sham; splint.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Braces*
  • Double-Blind Method
  • Elbow Joint / physiopathology*
  • Female
  • Follow-Up Studies
  • Hand Strength
  • Humans
  • Male
  • Middle Aged
  • Musculoskeletal Pain / etiology*
  • Pain Measurement
  • Prospective Studies
  • Rest
  • Tennis Elbow / complications
  • Tennis Elbow / physiopathology*
  • Tennis Elbow / therapy*
  • Treatment Outcome