Effects of Non-Immersive Virtual Reality and Conventional Physical Therapy in Patients with Tennis Elbow

Background: Lateral epicondylitis, or tennis elbow, is a common musculoskeletal disorder marked by pain and tenderness along the lateral elbow. It is frequently caused by repetitive forearm and wrist movements, affecting athletes and individuals in occupations with similar strain. Objective: To compare the effects of non-immersive virtual reality therapy with conventional physiotherapy in patients with tennis elbow. Methodology: A randomised controlled trial was conducted at SARAM Hospital, Azad Kashmir, Pakistan. Forty participants aged 18 to 45 years with a diagnosis of tennis elbow lasting at least six weeks and no prior active treatment in the past six months were included. Participants were randomly assigned to a virtual reality-based intervention group (n=21) or a conventional physiotherapy group (n=19). The virtual reality group performed structured exercises designed to reduce pain and improve function, while the control group received standard physiotherapy. Outcomes included pain intensity, grip strength, functional status, and assessor-rated improvement, measured at baseline and after intervention. Results: Both groups demonstrated significant pain reduction. Paired sample t-test showed notable improvements within the conventional group (p<0.00). An independent sample t-test revealed superior results in the virtual reality group compared to controls (p=0.000). The negative mean differences for virtual reality activities like bicep curls (-3.23), shoulder presses (-2.81), and wrist curls/extensions (-3.42) indicated greater pain reduction. Functional assessment with the Disabilities of the Arm, Shoulder, and Hand and patient-rated tennis elbow evaluation questionnaires showed larger mean improvement in the virtual reality group, reflecting enhanced arm function and decreased disability relative to standard therapy. Conclusion: Non-immersive virtual reality therapy was more effective than conventional physiotherapy in alleviating pain and improving function in patients with tennis elbow. Better compliance and engagement with virtual reality exercises may account for the enhanced outcomes. Younger participants benefited most, suggesting virtual reality can be a valuable addition to rehabilitation programs, pending confirmation from long-term studies.