Response letter to the role of proprioception of lateral elbow tendinopathy

[...]joint proprioception retraining has been established as an evidence-based intervention for a variety of neurologic and musculoskeletal disorders.3 Stasinopoulous puts forth an important commentary regarding the need to further examine the role of proprioception in the development or perpetuation of lateral elbow tendinopathy (LET). When compared with control groups, patients with LET demonstrate cervical thoracic impairments,11-13 diminished scapular muscle performance,14,15 rotator cuff dysfunction,16 and shoulder, scapular, and wrist stabilizer imbalances.14,16 It has been hypothesized that these dysfunctions, abnormal activation patterns, and deficits in regional muscle performance contribute to the development of high recurrence rates of the condition.9,10,16 Coombes et al17 have proposed an integrative model of LET that considers tendon pathology, motor system impairments, and pain system changes. Preliminary evidence supports an integrative sensorimotor approach for treating patients with various forms of shoulder impingement.18-20 Dilek et al21 examined the effectiveness of upper extremity loading in attempts to stimulate joint proprioceptors in patients with shoulder impingement syndrome, finding improved proprioceptive acuity but no differences in functional outcomes when compared with traditional therapy. [...]it may be prudent to also explore the combined effects of sensorimotor retraining in the context of specific tasks, in addition to closed kinetic chain exercises as Stasinopoulos suggests.