Eccentric exercise therapy for medial epicondylitis: A systematic review of clinical outcomes

Medial epicondylitis, a tendinopathy of the flexor-pronator origin, remains less studied than lateral epicondylitis, especially regarding exercise-based interventions. Eccentric exercise has demonstrated benefits in other tendinopathies, but its role in medial epicondylitis has not been systematically evaluated.

To synthesize clinical evidence on the effectiveness of eccentric exercise in reducing pain and improving function in medial epicondylitis.

Following PRISMA guidelines, five databases (PubMed, Web of Science, Scopus, SPORTDiscus, Google Scholar) were searched from inception to January 2025. Clinical studies evaluating eccentric loading of the wrist flexor-pronator musculature as a primary intervention component for medial epicondylitis were included. Two reviewers independently screened the records, extracted the data, and assessed the risk of bias.

Five studies (n = 143 patients) were included, comprising randomized controlled trials (RCT), pre-post studies, and comparative analyses. Eccentric exercise was associated with significant within-group reductions in pain and improvements in functional outcomes across included studies. Between-group superiority was demonstrated in one RCT. Combined interventions showed superior outcomes compared with ultrasound in one trial, while other comparative studies demonstrated significant within-group improvements without clear between-group differences. Sustained pain relief and functional improvement at 11-year follow-up were reported in a single uncontrolled study. Heterogeneity in intervention protocols and small sample sizes precluded meta-analysis.

Current evidence suggests that eccentric exercise may reduce pain and improve function in medial epicondylitis, particularly when incorporated into multimodal conservative management. However, the overall certainty of evidence remains low, and larger high-quality randomized trials are required to confirm these findings.