This randomized controlled trial aims to compare the effectiveness of Mobilization with Movement (MWM) and Cyriax techniques in athletes diagnosed with lateral epicondylitis (tennis elbow). Lateral epicondylitis commonly causes pain, reduced grip strength, and impaired proprioception, particularly in racquet and throwing sports players. A total of 56 participants aged 25-40 years with symptoms of less than three months will be randomly assigned to either the MWM group or the Cyriax group. Both groups will receive treatment five times per week for four weeks. Outcomes including elbow proprioception (Joint Position Sense test), pain and functional disability (Patient-Rated Tennis Elbow Evaluation), and grip strength (Handheld Dynamometer) will be assessed at baseline, at 2 weeks, and at 4 weeks. The study aims to determine which treatment method provides superior improvement in pain reduction, functional recovery, and proprioceptive enhancement.
This study is a randomized controlled trial conducted at Sukkur Physiotherapy, Rehabilitation and Chiropractor Center and Hidayat Physiotherapy and Rehabilitation Center, Sukkur, over a period of nine months following ethical approval. Fifty-six clinically diagnosed lateral epicondylitis patients meeting inclusion criteria will be recruited using purposive sampling and randomly allocated into two groups using the sealed envelope method. Group A will receive Mobilization with Movement combined with progressive strengthening, proprioceptive training, and sport-specific exercises, while Group B will receive Cyriax techniques including deep transverse friction massage and Mill's manipulation along with strengthening and proprioceptive exercises. Both groups will undergo 16 treatment sessions over four weeks following standardized baseline care consisting of education, stretching, ice therapy, and light isometric exercises. Outcome measures include Joint Position Sense testing for proprioception (measuring absolute angular error), PRTEE questionnaire for pain and function, and grip strength measurement using a handheld dynamometer. Ethical guidelines will be strictly followed, informed consent will be obtained, confidentiality will be maintained, and participants will have the right to withdraw at any time without affecting their standard care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
56
Mobilization with Movement (MWM) group will receive interventions five times per week. In the first week, the primary focus is on applying lateral glide mobilization to the elbow joint. The patient performs pain-free gripping or wrist extension activities while the therapist provides a sustained lateral glide, enhancing joint mechanics and reducing pain. This is complemented by isometric strengthening exercises for the wrist extensors (3 sets of 10 repetitions with 5-second holds) and proprioceptive neuromuscular facilitation (PNF) rhythmic stabilization techniques to begin improving joint position sense. Ice therapy may be used post-session to control inflammation. In the second week, the MWM technique is continued with increased repetitions and resistance based on patient tolerance. Eccentric wrist extensor strengthening using resistance bands is introduced, performed in 3 sets of 10 repetitions. Light sport-specific tasks such as racquet swings with minimal resistance are incorporat
Participants in the cyriax techniques group also receive treatment five times per week over four weeks. In the first week, the primary intervention is deep transverse friction massage (DTFM), applied for 10-15 minutes over the common extensor origin to break down adhesions and reduce localized pain. Isometric strengthening exercises for the wrist extensors are introduced with 3 sets of 10 repetitions, each held for 5 seconds. Ice therapy follows each session to reduce any post-treatment inflammation. Mill's manipulation is not used in the first week to allow tissue acclimatization to DTFM. In the second week, DTFM is continued on alternate days. Mill's manipulation, a high-velocity, low-amplitude technique that stretches the affected tendon, is introduced once per week immediately following DTFM. Resistance ball exercises are added for grip strengthening, encouraging the return of functional muscle performance. Isometric exercises are continued to maintain muscle recruitment without ag
University of Lahore Teaching Hospital, Lahore
Lahore, Punjab Province, Pakistan
RECRUITINGElbow Proprioception Assessed by Joint Position Sense (JPS) Test
Elbow proprioception will be assessed using the Joint Position Sense (JPS) test. Participants will be asked to actively reproduce a predetermined elbow flexion angle (e.g., 90°) with their eyes closed. The difference in degrees between the target angle and the reproduced angle (absolute error) will be recorded. Lower absolute error values indicate better proprioceptive accuracy. Three trials will be performed, and the average error will be calculated for analysis.
Time frame: Baseline, Week 2, and Week 4
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