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Acupuncture combined with manipulation significantly improves clinical effectiveness and function in lateral epicondylitisCombining acupuncture and joint manipulation improves elbow pain and function

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Key Takeaway
Consider acupuncture combined with manipulation to improve function and pain in lateral epicondylitis, though evidence is low certainty.

This meta-analysis evaluates the clinical effectiveness of acupuncture combined with manipulation for patients with lateral epicondylitis. The authors synthesized data comparing combined therapy against acupuncture alone or manipulation alone. The analysis found that combined therapy significantly improved clinical effectiveness (OR = 4.47; 95% CI: 2.8 to 7.14, p < 0.00001). Specifically, compared to acupuncture alone, the odds ratio was 3.88 (95% CI: 1.95 to 7.73, p = 0.0001), and compared to manipulation alone, the odds ratio was 4.94 (95% CI: 1.89 to 12.9, p = 0.001).

Secondary outcomes also showed significant improvements. Mayo elbow function scores improved by a mean difference of 7.51 (95% CI: 5.98 to 9.05, p < 0.00001), and pain-free grip strength improved by a mean difference of 2.88 (95% CI: 1.69 to 4.07, p < 0.00001). Additionally, patients receiving combined therapy showed reduced pain scores, including a mean difference of -1.38 for acupuncture combined with joint mobilization and -0.88 for conventional acupuncture combined with manipulation.

The authors note several limitations, including a high risk of bias, substantial heterogeneity, and potential publication bias. Due to these factors, the certainty of the evidence is low. While the results suggest that combined therapy may improve clinical outcomes and function, high-quality RCTs are needed to confirm these findings.

How this fits prior evidence

This meta-analysis addresses a gap in non-pharmacological management for lateral epicondylitis. It complements existing evidence regarding percutaneous electrolysis for rapid pain reduction and the use of combined celecoxib and flurbiprofen hydrogel patches for improved outcomes. While the current meta-analysis suggests acupuncture combined with manipulation improves clinical effectiveness and function, the evidence is of low certainty due to high risk of bias and heterogeneity.

Living with a painful elbow can make simple tasks, like gripping a handle or lifting a cup, feel like a constant struggle. This condition, known as lateral epicondylitis, often requires a multi-pronged approach to manage the discomfort and regain strength.

Research suggests that combining acupuncture with joint manipulation—a physical therapy technique to move the joint—works better than using either treatment alone. This combined approach showed significant improvements in clinical effectiveness, elbow function, and pain-free grip strength. Specifically, patients using both methods saw lower pain scores and better ability to use their hands without discomfort.

While these results are promising, the evidence comes with some caution. The study noted a high risk of bias and significant differences in how various studies were conducted. Because of these factors, the certainty of the findings is currently low. More high-quality trials are needed to confirm exactly how well this combination works for everyone.

What this means for you:
Combining acupuncture and joint manipulation may improve pain and grip strength for those with lateral epicondylitis.

Common questions

Does combining acupuncture and manipulation work better than just one treatment?

Yes, the data shows that combining acupuncture with joint manipulation provides higher clinical effectiveness than using acupuncture alone or manipulation alone. Patients who received both treatments showed significant improvements in elbow function and pain-free grip strength compared to those who received only one of the treatments.

How does this treatment affect elbow pain and grip strength?

The combination of acupuncture and manipulation was shown to reduce pain scores and improve pain-free grip strength. Specifically, the study found significant improvements in the Mayo elbow function score and a reduction in pain scores across different types of acupuncture when combined with manipulation.

Is this treatment certain to work for everyone?

The evidence is currently not certain. Because the study involved a high risk of bias and a lot of variation between different trials, the results are not definitive. You should talk to your doctor to see if this specific combination is right for your personal situation.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
ObjectiveTo systematically evaluate the efficacy of acupuncture combined with manipulation for relieving pain and improving function in patients with lateral epicondylitis (LE).MethodsRandomized controlled trials (RCTs) involving patients with LE were retrieved from eight Chinese and English databases from inception to January 1, 2026. The risk of bias of the included studies was assessed using the Cochrane Risk of Bias tool. Meta-analysis was performed using RevMan 5.4.1 software. The main outcomes included clinical effectiveness, visual analog scale (VAS) score, Mayo elbow function score, and pain-free grip strength (PFG).ResultsFourteen studies met the inclusion criteria. Meta-analysis showed that acupuncture combined with manipulation significantly improved clinical effectiveness (OR = 4.47, 95% CI: 2.8 to 7.14, p < 0.00001), Mayo elbow function score (MD = 7.51, 95% CI: 5.98 to 9.05, p < 0.00001), and PFG (MD = 2.88, 95% CI: 1.69 to 4.07, p < 0.00001). Compared with acupuncture alone (OR = 3.88, 95% CI: 1.95 to 7.73, p = 0.0001) or manipulation alone (OR = 4.94, 95% CI: 1.89 to 12.9, p = 0.001), the combined intervention was associated with higher clinical effectiveness. Subgroup analyses indicated that acupuncture combined with joint mobilization reduced pain (MD = −1.38, 95% CI: −1.63 to −1.13, p < 0.00001). Conventional acupuncture (MD = −0.88, 95% CI: −1.21 to −0.54, p < 0.00001) or moxibustion acupuncture (MD = −1.39, 95% CI: −1.65 to −1.12, p < 0.00001) combined with manipulation, as well as a 2-week treatment duration (MD = −1.31, 95% CI: −1.55 to −1.08, p < 0.00001), was associated with reduced VAS scores. Sensitivity analyses supported robustness of the pooled estimates, whereas funnel plots suggested potential publication bias. The certainty of the evidence was limited by risk of bias and substantial heterogeneity.ConclusionCurrent evidence suggests that acupuncture combined with manipulation may improve clinical effectiveness, elbow function, and pain-free grip strength in patients with lateral epicondylitis. However, the certainty of evidence is low due to high risk of bias and heterogeneity in the included studies. High-quality RCTs are needed to confirm these findings.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42024572260.
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