INTEGRATING SCAPULAR STRENGTHENING EXERCISES INTO REHABILITATION OF LATERAL EPICONDYLITIS: A NARRATIVE REVIEW

Abstract

Background: Lateral epicondylitis (LE), or tennis elbow, is an overuse tendinopathy characterized by lateral elbow pain and weakened grip strength. Emerging evidence suggests that scapular and shoulder girdle muscle weakness may contribute to distal overload and symptom persistence.

Objective: To analyse  evidence on effectiveness of integrating scapular strengthening into LE rehabilitation, assessing impacts on pain, function, and grip strength.

Methods: conducted a comprehensive search of MEDLINE (PubMed), Scopus, CINAHL, PEDro, EMBASE, Web of Science, CENTRAL, and SPORT Discus for studies published between January 2018 and June 2025. Randomized controlled trials, pre–post intervention studies, and cohort research examining scapular or shoulder girdle strengthening in patients with lateral epicondylitis or lateral elbow tendinopathy were included.

Results: In pre–post study of 65 participants, patients achieved ~31‑point reductions in PRTEE and a 33.6 % increase in grip strength at one year (P < 0.001). A RCT (n = 26) found that adding lower/middle trapezius and serratus anterior strengthening to conventional physiotherapy resulted in significant improvements in pain (VAS), PRTEE, pain‑free grip force, EMG activity, and scapular muscle strength (time group P < 0.05), though scapular positioning did not change significantly. A 2025 systematic review and meta-analysis (six RCTs) reported mean gains of +7.6 points in elbow/wrist function, +15.4 % in grip strength, and increases in serratus anterior and trapezius strength (p ≤ 0.04), although many effects did not reach clinical significance.

Conclusion: Overall, evidence consistently supports that adding scapular strengthening to standard LE rehabilitation enhances pain relief, functional status, and grip strength, addressing proximal dysfunction and kinetic chain impairment. The variability in clinical significance and protocol heterogeneity underscores the need for high‑quality trials to establish standardized dosing and assess long‑term benefits.