Comparative Effects of Mulligan Mobilization With and Without Myofascial Release Technique in Management of Post Traumatic Elbow Stiffness

N/ANot Yet RecruitingNCT07598526

University of Faisalabad30 enrolled

Overview

The Randomize Clinical Trial will involve 30 participants with post traumatic elbow stiffness recruited from Madinah Teaching Hospital and Chiniot General hospital Faisalabad. Consecutive sampling technique will be used. Study will include individuals with \>30° extension loss and \<120° flexion, 50° in both directions for pronation-supination, who are 3-6 weeks post-POP removal from radiograph confirmation of skeletal/bone healing will be insured, who have elbow pain from 3 to 5/10 on NPRS and have fully healed fractures. Both intra-articular and extra-articular injuries will be accepted. DASH Score with 45 to 50 points. Study will exclude pathological or acute fractures, burns, brain trauma, neurological or psychological disorders, history of pre-operative osteoarthritis. Consent will be taken written and verbal from participants before including into study. Patients will be allocated with online randomization generator method into 2 groups. Group A will receive Mulligan Mobilization with Myofascial release technique, while Group B will receive Mulligan Mobilization alone. Hot pack for 20 minutes before treatment and static stretching after treatment will apply in both groups. Each stretch is performed 10 repetition with hold duration of 30 sec and rest period 15 sec between each stretch. Total 3 sessions per week for 4 weeks (12 sessions) on alternative days will be given. Outcome of study will be elbow pain, elbow range of motion (flexion and extension) and functional disability will be measure by using Numerical Pain Rating Scale, Universal Goniometer and Dash Questionnaire Score respectively. Data will be investigated by using SPSS version 2023.

Elbow stiffness is a disabling condition that interferes in daily living activities after trauma. The study's goal is to compare the results of Mulligan Mobilization with and without Myofascial Release Technique in management of post traumatic elbow stiffness. The Randomize Clinical Trial will involve 30 participants with post traumatic elbow stiffness recruited from Madinah Teaching Hospital and Chiniot General hospital Faisalabad. Consecutive sampling technique will be used. Study will include individuals with \>30° extension loss and \<120° flexion, 50° in both directions for pronation-supination, who are 3-6 weeks post-POP removal from radiograph confirmation of skeletal/bone healing will be insured, who have elbow pain from 3 to 5/10 on NPRS and have fully healed fractures. Both intra-articular and extra-articular injuries will be accepted. DASH Score with 45 to 50 points. Study will exclude pathological or acute fractures, burns, brain trauma, neurological or psychological disorders, history of pre-operative osteoarthritis. Consent will be taken written and verbal from participants before including into study. Patients will be allocated with online randomization generator method into 2 groups. Group A will receive Mulligan Mobilization with Myofascial release technique, while Group B will receive Mulligan Mobilization alone. Hot pack for 20 minutes before treatment and static stretching after treatment will apply in both groups. Each stretch is performed 10 repetition with hold duration of 30 sec and rest period 15 sec between each stretch. Total 3 sessions per week for 4 weeks (12 sessions) on alternative days will be given. Outcome of study will be elbow pain, elbow range of motion (flexion and extension) and functional disability will be measure by using Numerical Pain Rating Scale, Universal Goniometer and Dash Questionnaire Score respectively. Data will be investigated by using SPSS version 2023.

Interventions

Group A (Mulligan Mobilization with Myofascial Release Technique)OTHER

The patient will be positioned supine at the edge of the table with the shoulder abducted to 90°, elbow flexed, and forearm supinated. The therapist will stabilize the distal humerus and use a belt around the pelvis while applying a sustained glide through the forearm. Active elbow flexion/extension will be performed with gentle, pain-free overpressure at end range. The technique will be repeated 6-10 times for 1-3 sets with 15-second rest intervals. Myofascial release will be applied with the patient supine, elbow slightly flexed and forearm pronated. The therapist will treat from lateral epicondyle to wrist extensors while the patient performs small elbow movements. Both groups will receive a hot pack application for 20 minutes as a baseline treatment prior to the intervention, followed by static stretching after the session. Each stretch will be performed for 10 repetitions, with a 30-second hold and a 15-second rest interval between stretches.

Group B (Mulligan Mobilization alone)OTHER

The patient will be positioned supine at the edge of the table with the shoulder abducted to 90°, elbow flexed, and forearm supinated. The therapist will stabilize the distal humerus and use a belt around the pelvis while applying a sustained glide through the forearm. Active elbow flexion/extension will be performed with gentle, pain-free overpressure at end range. The technique will be repeated 6-10 times for 1-3 sets with 15-second rest intervals. Both groups will receive a hot pack application for 20 minutes as a baseline treatment prior to the intervention, followed by static stretching after the session. Each stretch will be performed for 10 repetitions, with a 30-second hold and a 15-second rest interval between stretches.

Eligibility

Sex: ALLMin age: 17 YearsMax age: 44 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Participants aged between 17 and 44 years will be included in the study (Sun et al., 2025). * Both male and female patients experiencing mild to moderate elbow pain (3/10 to 5/10 on NPRS) along with restricted range of motion will be eligible (Zulfqar et al., 2021). * Subjects having elbow movement limitation of more than 30° in extension, flexion less than 120°, and 50° restriction in both pronation and supination will be included (Masci et al., 2020). * Participants will be recruited 3 to 6 weeks after POP removal, and radiographic confirmation of bone/skeletal healing will be ensured before inclusion (Morrey et al., 2017). * Patients with both intra-articular and extra-articular fractures will be considered eligible. * Individuals with DASH scores ranging from 45 to 50 points will be included. * Only patients willing to participate in the study will be enrolled. Exclusion Criteria: * Patients with a history of previous surgical excision will be excluded from the study (Zheng et al., 2018). * Participants presenting with pathological fractures will not be included (Zulfqar et al., 2021). * Patients in the acute stage of fracture will be excluded from participation (Zulfqar et al., 2021). * Individuals with metabolic or malignant conditions causing elbow stiffness, such as gout or osteosarcoma, will not be eligible (Fusaro et al., 2014). * Patients with elbow fractures associated with a history of metal implants will be excluded (Zheng et al., 2018). * Individuals who have already received physiotherapy treatment or medication for the condition will not be included. * Patients diagnosed with psychological illnesses that may interfere with following instructions will be excluded. * Participants with brain trauma or referred neurological symptoms, including numbness, dizziness, or hyperesthesia, will not be considered (Fusaro et al., 2014). * Patients with structural or postural abnormalities involving the shoulder or wrist will be excluded. * Individuals with open skin wounds or burn injuries around the affected area will not be included. * Patients with a pre-operative history of arthritis will also be excluded from the study.

Outcomes

Primary Outcomes

Elbow pain

The Numeric Pain Rating Scale (NPRS) is an 11-point scale used to assess pain intensity. The scale ranges from 0, indicating no pain, to 10, representing the worst imaginable pain. It is considered a reliable and valid tool for evaluating changes in pain severity over time

Time frame: Baseline and week 4

Elbow range of motion

The universal goniometer is a reliable and effective instrument commonly used to assess elbow joint range of motion

Time frame: Baseline and week 4

Secondary Outcomes

Functional disability

The DASH questionnaire is designed to evaluate upper limb function and related symptoms. It assesses the level of difficulty an individual experiences while performing daily activities involving the arm, shoulder, and hand due to pain, weakness, or movement limitations. The questionnaire contains 30 items, and scores range from 0 (no disability) to 100 (maximum disability), with higher scores indicating greater functional impairment

Time frame: Baseline and Week 4