Comprehensive and Progressive Evidence-Based Physiotherapy for Lateral Epicondylitis in a Female Domestic Worker: A Case Report

Abstract

Background: Lateral epicondylitis, commonly known as the tennis elbow, is one of the most frequent overuse injuries affecting the forearm muscle’ extensor tendons, particularly the extensor carpi radialis brevis (ECRB). It is characterized by pain and tenderness over the lateral epicondyle, reduced grip strength, and functional limitations during activities requiring repetitive wrist extension or gripping. Although often self-limiting, chronic cases can significantly impair daily activities and functioning, especially in individuals engaged in repetitive upper-limb activities such as household work. Conservative physiotherapy remains the primary and most effective mode of treatment, involving pain-relieving modalities, strengthening, stretching, and ergonomic modification. Evidence-based physiotherapy (C-EB-PT) is a desirable exploration. We present a case of a 43-year-old housewife with chronic right lateral elbow pain managed conservatively with physiotherapy. Case Presentation: A 43-year-old right-hand–dominant married female from Greater Noida, engaged in domestic work, presented with an 8-month history of progressive right lateral elbow pain, aggravated by household tasks involving gripping and wrist activity. On examination, there was swelling on the right elbow lateral side, warmth also present, tenderness (grade 2), pain rated 8/10 on the NPRS, limited grip strength, and mildly reduced wrist strength. Special tests (Cozen’s, Maudsley’s, Mill’s manuvers) were positive. Range of motion (ROM) of the wrist and muscle strength (MMT) of the wrist were decreased. She underwent comprehensive evidence-based physiotherapy, including ultrasound therapy, laser therapy, icing and progressive therapeutic exercises. Over the course of treatment, pain, swelling, grip strength, and functional use improved. Results: After the (C-EB-PT) physiotherapy protocol, the patient reported a significant reduction of pain. Pain decreased from 8 to 2 on a scale of 0-10. Decreased swelling, improved grip strength from 7 kg to 18 kg in the affected upper extremity, and forearm muscle strength (5/5), and restoration of the ability to perform duties (household tasks) without aggravation. Range of motion ROM remained full. Conclusion: This case illustrates that a structured physiotherapy program combining modalities for the acute phase (ultrasound, laser, cryotherapy) with progressive exercise (isometric → isotonic strengthening, grip, wrist, and forearm training) can result in symptomatic relief and functional recovery in lateral epicondylitis in a non-sport, domestic work–related context in women.