Efficacy of Vitamin C Supplement vs Spinal Manipulation to Treatment in Lateral Epicondylitis

NCT ID: NCT04445727

Last Updated: 2020-06-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

130 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-05-21

Study Completion Date

2021-03-11

Brief Summary

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A randomized clinical trial will be conducted. 130 subjects diagnosed with lateral epicondylitis will be studied. 3 intervention groups will be formed. Experimental group 1 will receive a 1000mg daily vitamin C supplement along with the usual practice of manual therapy and TENS. Group 2 will undergo high-speed vertebral manipulations along with manual therapy and TENS. In group 3 or control, manual therapy and transcutaneous electrotherapy (TENS) will be applied. All groups will receive the same manual therapy program and TENS, one session per week for 6 consecutive weeks. Data analysis: The data will be entered in the SPSS statistical package (version 21.0) for analysis). Statistical analysis will be performed with a 95% confidence interval, meaning that those whose P is \<0.05 will be considered significant values.

Detailed Description

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The 130 subjects will be randomized into 3 groups: Experimental group 1 will receive a supplement of vitamin C (ascorbic complex) of the Bonusan brand, a daily dose of 1000mg should be consumed along with the usual practice of manual therapy and TENS. This group will maintain the daily intake of vitamin C for the 6 weeks that the treatment lasts, they will be informed of the possible side effects of adaptation to the supplement, such as, for example, diarrhea since excess vitamin C, in the case if there is, it lodges in the large intestine, which attracts fluid and produces osmotic diarrhea. This group will have direct communication with the doctor who collaborates in this investigation for any situation, query or unwanted symptom. Vitamin C has been used in other degenerative-type pathologies of collagen tissue such as Achilles tendinopathies and supraspinatus musculature. The investigators have also found references to the effect of vitamin C as pain treatment. Group 2 will undergo high-speed vertebral manipulations along with manual therapy and TENS. Vertebral manipulations would seek a reflexogenic effect through the sympathetic nerve pathway of the lower cervical ganglion. The transcutaneous TENS-type stimulation is evidenced to have an analgesic effect using self-adhesive patches placed longitudinally at the myo-junction. tendon with a size of 50X50 mm, a frequency of 100 Hz and a pulse duration of 200μs for 25 minutes. Both the vertebral manipulation intervention and the TENS placement will be performed by a professional health physiotherapist with 27 years of clinical experience in the application of the aforementioned techniques.

In group 3 or control, manual therapy and transcutaneous electrotherapy (TENS) will be applied. All groups will receive the same manual therapy program and TENS, one session per week for 6 consecutive weeks.

All the aforementioned interventions will be included in a 45 minute session for the 3 groups alike. They will be in charge of a highly qualified physiotherapist for all the therapies when carrying out which expresses his consent for the study in. Said professional uses all these therapies in consultation daily.

8 The aforementioned therapies can generate some adverse effects that the participants should be aware of and that is reflected in the informed consent that they must complete before the start of the evaluation and the interventions. In the first place, in the TENS, no bibliography has been found that warns of any unwanted effect, which it can refer to is an increase in skin tone under the patch due to the local effect and heat conduction of the same. which should disappear within 30 minutes after application.

In high-speed vertebral manipulation in the cervical region, in 6% of cases, post-manipulation dizziness may occur due to the local vascular change that occurs . The vitamin C supplement can produce some type of heartburn diarrhea, especially in the first days of taking, since this vitamin is absorbed in the intestine .

Alterations at the elbow can cause pain and functional limitation. To quantify these effects, there are different measurement scales. The evaluation to quantify the pain will be carried out with the numerical pain scale (0-10). The Disabilities of the Arm Shoulder and Hand (DASH) questionnaire will be used to determine the functionality of the upper limb, the Shoulder Pain and Disability Index SPADI will be used to assess shoulder function, Global perception of change will also be evaluated, Global Rating of Change Scale (GROC) a 15-point scale where -7 indicates much worse than before, 0 the same as before and +7 much better than before . Finally, the pressure pain threshold (PDU) will be evaluated using a digital algometer .

Measurement variables will be analyzed before treatment, after it, and at 3 and 6 months after the last treatment session.

Conditions

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Lateral Epicondylitis Tennis Elbow

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators

Study Groups

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vitamin c

daily dose of 1000 mg vitamin c in order to regenerate collagen

Group Type EXPERIMENTAL

Transcutaneous electrical nerve stimulation (TENS)

Intervention Type COMBINATION_PRODUCT

Received a manual therapy intervention and Tens. one session will be held per week for 6 weeks.

spinal manipulation

Spinal manipulation in cervical and dorsal with high speed and short amplitude techniques

Group Type EXPERIMENTAL

Transcutaneous electrical nerve stimulation (TENS)

Intervention Type COMBINATION_PRODUCT

Received a manual therapy intervention and Tens. one session will be held per week for 6 weeks.

Transcutaneous electrical nerve stimulation (TENS)

electrotherapy for an analgesic purpose

Group Type EXPERIMENTAL

Vitamin C

Intervention Type COMBINATION_PRODUCT

Will apply 1000mg of vitamin C, TENS and manual therapy. One session will be held per week for 6 weeks.

spinal manipulation

Intervention Type COMBINATION_PRODUCT

Applied spinal manipulations, tens and manual therapy.One session will be held per week for 6 weeks.

manual therapy

manual muscle treatment for epicondyl musculature

Group Type EXPERIMENTAL

Vitamin C

Intervention Type COMBINATION_PRODUCT

Will apply 1000mg of vitamin C, TENS and manual therapy. One session will be held per week for 6 weeks.

spinal manipulation

Intervention Type COMBINATION_PRODUCT

Applied spinal manipulations, tens and manual therapy.One session will be held per week for 6 weeks.

Transcutaneous electrical nerve stimulation (TENS)

Intervention Type COMBINATION_PRODUCT

Received a manual therapy intervention and Tens. one session will be held per week for 6 weeks.

Interventions

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Vitamin C

Will apply 1000mg of vitamin C, TENS and manual therapy. One session will be held per week for 6 weeks.

Intervention Type COMBINATION_PRODUCT

spinal manipulation

Applied spinal manipulations, tens and manual therapy.One session will be held per week for 6 weeks.

Intervention Type COMBINATION_PRODUCT

Transcutaneous electrical nerve stimulation (TENS)

Received a manual therapy intervention and Tens. one session will be held per week for 6 weeks.

Intervention Type COMBINATION_PRODUCT

Other Intervention Names

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tens manual therapy tens manual therapy manual therapy

Eligibility Criteria

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Inclusion Criteria

* Elbow pain patients medically diagnosed with epicondylitis by ultrasound of more than 4 weeks of evolution.
* Age between 35 and 55 years (both inclusive).
* Have signed the informed consent.

Exclusion Criteria

* Have received corticosteroid infiltrations in the previous 3 months. Having received physical therapy treatment for the same reason in last 3 months.
* Bilateral symptoms.
* Fibromyalgia syndrome.
* Previous trauma to the upper limb.
* Fractures or prior dislocation of the shoulder or elbow.
* Previous surgeries on the shoulder or elbow.
* Psychiatric treatment.
* Cognitive deficit.
* Owning defibrillator or pacemaker.
* Acute infectious diseases.
* Uncontrolled systemic pathologies (heart disease, pacemaker, coagulation disorders).
* Pregnant women.
* History of rheumatic disease affecting the elbow such as rheumatoid arthritis, gout, reflex sympathetic dystrophy, plaque psoriasis. • Oncological processes.
* Aversion or fear of the application of currents.
Minimum Eligible Age

35 Years

Maximum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Universidad Rey Juan Carlos

OTHER

Sponsor Role lead

Responsible Party

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Pablo Federico Scillone Tessore

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ana I de la Llave Rincón

Role: STUDY_DIRECTOR

Universidad Rey Juan Carlos

José J Arias Buría

Role: STUDY_DIRECTOR

Universidad Rey Juan Carlos

Locations

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Pablo Federico Scillone Tessore

San Sebastián de los Reyes, Madrid, Spain

Site Status

Countries

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Spain

References

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Notarnicola A, Pesce V, Vicenti G, Tafuri S, Forcignano M, Moretti B. SWAAT study: extracorporeal shock wave therapy and arginine supplementation and other nutraceuticals for insertional Achilles tendinopathy. Adv Ther. 2012 Sep;29(9):799-814. doi: 10.1007/s12325-012-0046-4. Epub 2012 Aug 24.

Reference Type RESULT
PMID: 22923162 (View on PubMed)

Leijn E, Monnens LA, Cornelissen EA. Intravenous iron supplementation in children on hemodialysis. J Nephrol. 2004 May-Jun;17(3):423-6.

Reference Type RESULT
PMID: 15365964 (View on PubMed)

Passerieux E, Hayot M, Jaussent A, Carnac G, Gouzi F, Pillard F, Picot MC, Bocker K, Hugon G, Pincemail J, Defraigne JO, Verrips T, Mercier J, Laoudj-Chenivesse D. Effects of vitamin C, vitamin E, zinc gluconate, and selenomethionine supplementation on muscle function and oxidative stress biomarkers in patients with facioscapulohumeral dystrophy: a double-blind randomized controlled clinical trial. Free Radic Biol Med. 2015 Apr;81:158-69. doi: 10.1016/j.freeradbiomed.2014.09.014. Epub 2014 Sep 20.

Reference Type RESULT
PMID: 25246239 (View on PubMed)

Malek Mahdavi A, Mahdavi R, Kolahi S, Zemestani M, Vatankhah AM. L-Carnitine supplementation improved clinical status without changing oxidative stress and lipid profile in women with knee osteoarthritis. Nutr Res. 2015 Aug;35(8):707-15. doi: 10.1016/j.nutres.2015.06.003. Epub 2015 Jun 16.

Reference Type RESULT
PMID: 26149189 (View on PubMed)

Lee GW, Yang HS, Yeom JS, Ahn MW. The Efficacy of Vitamin C on Postoperative Outcomes after Posterior Lumbar Interbody Fusion: A Randomized, Placebo-Controlled Trial. Clin Orthop Surg. 2017 Sep;9(3):317-324. doi: 10.4055/cios.2017.9.3.317. Epub 2017 Aug 4.

Reference Type RESULT
PMID: 28861199 (View on PubMed)

Coombes BK, Bisset L, Vicenzino B. Bilateral cervical dysfunction in patients with unilateral lateral epicondylalgia without concomitant cervical or upper limb symptoms: a cross-sectional case-control study. J Manipulative Physiol Ther. 2014 Feb;37(2):79-86. doi: 10.1016/j.jmpt.2013.12.005. Epub 2013 Dec 28.

Reference Type RESULT
PMID: 24378321 (View on PubMed)

Fernandez-Carnero J, Fernandez-de-las-Penas C, Cleland JA. Immediate hypoalgesic and motor effects after a single cervical spine manipulation in subjects with lateral epicondylalgia. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):675-81. doi: 10.1016/j.jmpt.2008.10.005.

Reference Type RESULT
PMID: 19028251 (View on PubMed)

Study Documents

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Document Type: Clinical Study Report

View Document

Other Identifiers

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PScillone

Identifier Type: -

Identifier Source: org_study_id

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