Adding Neural Mobilization to Mulligan Technique for Treatment of Patients With Chronic Tennis Elbow

NCT06765798 | Completed

• 1 other identifier: P.T.REC/012/005457
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

The study aimed to assess the combined effect of neural mobilization and mulligan technique on pain ,functional disability and grip strength in patients with tennis elbow

Conditions

Tennis Elbow

Keywords

Tennis Elbow; Mulligan mobilization with movement; Neural Mobilization

Outcome Measures

Primary Outcomes (3)

• pain by visual analgue scale

  pain will be assessed by visual analogue scale (VAS) which involves having them mark along a 10 cm-long line with a number ranging from 0 to 10. "0" denotes no discomfort, and "10" denotes the most agonizing pain possible They are generally completed by patients themselves. The patients marks on the line the point that they feel represents their perception of their current state of pain.

  from enrollment to the end of treatment at 4 weeks , assessment will be done pre and post treatment

• Functional disability

  Functional Disability will be assessed by Arabic version of DASH Questionnaire DASH Arabic contains 30 items, like the original DASH, each item has five response choices that range from 1, ''without any difficulty or no symptoms exist'' to 5, ''unable to engage in activity or very severe symptoms''. In order for a score to be calculated, a minimum of 27 of the 30 items must be completed. The assigned values for all completed responses are added and averaged to yield a score of 5 or less; this value is then transformed to 100 by subtracting 1 and multiplying by 25, to make it easy to compare with other measures that are scaled from 0 to 100: the higher the score, the greater the disability

  from enrollment to the end of treatment at 4 weeks , assessment will be done pre and post treatment

• Maximum grip strength

  Maximum grip strength by Jamer hand dynamometer The gold standard for measuring grip strength is the JAMAR® Hydraulic Hand Dynamometer. Where possible, participants were positioned sitting upright in a chair, with their knees and hips at 90° and with back support. For those unable to mobilize out of bed, the head of the bed was raised as far as possible, ensuring an upright long-sitting position. The shoulder on the dominant side was adducted against the body, the elbow positioned in 90° flexion (unsupported) and the wrist in a neutral position. Participants were then instructed to grip the dynamometer as strongly as they possibly could, using their dominant hand .The measurements of both extremities were repeated 3 times with resting interval of 30 s between each measurement. The average of the three trials was recorded in kilograms (kg).

  from enrollment to the end of treatment at 4 weeks , assessment will be done pre and post treatment

Study Arms (4)

group A

EXPERIMENTAL

Group A received neural mobilization for radial nerve, mulligan mobilization with movement and conventional therapy

Other: Group A : receive neural mobilization for radial nerve , mulligan mobilization with movement and conventional Therapy

group B

EXPERIMENTAL

Group B received neural mobilization for radial nerve and conventional therapy

Other: Group B receive neural mobilization for radial nerve and conventional

Group C

EXPERIMENTAL

Group C received mulligan mobilization with movement and conventional therapy

Other: Group C receive Mulligan mobilization with movement and conventional

Group D

ACTIVE COMPARATOR

Group D received conventional therapy

Other: Group D receive conventional

Interventions

Group B receive neural mobilization for radial nerve and conventional OTHER

Group B receive neural mobilization for radial nerve and conventional neural mobilization for radial nerve: The physiotherapist holds the patient's arm and wrist while the patient reclined on his side then depress the shoulder, extend the elbow and then internally rotated the patient's arm. The patient's wrist, thumb, and fingers were all flexed, and the patient's ulnar was brought to deviation. While the patient's position was maintained, and the arm was abducted and then contralateral cervical side bending conventional ; Ultrasound therapy , stretching and strengthening for wrist flexors and extensors

group B

Group C receive Mulligan mobilization with movement and conventional OTHER

Group C receive Mulligan mobilization with movement and conventional Mulligan mobilization with movement manual lateral glide MWM with gripping: Patient: Supine with upper limb fully supported on a treatment table. Treated body part: Relaxed extension of the elbow, shoulder internal rotation, with pronation of the forearm. Hands loosely around the grip dynamometer handles. Apply 6-10 repetitions in a set, with 3-5 sets in a treatment session, conventional ; Ultrasound therapy , stretching and strengthening for wrist flexors and extensors

Group C

Group D receive conventional OTHER

Group D receive conventional : Ultrasound therapy , stretching and strengthening for wrist flexors and extensors

Group D

Group A : receive neural mobilization for radial nerve , mulligan mobilization with movement and conventional Therapy OTHER

Group A :Neural Mobilization for radial nerve, Mulligan Mobilization with Movement and Conventional neural mobilization for radial nerve: The physiotherapist holds the patient's arm and wrist while the patient reclined on his side then depress the shoulder, extend the elbow and then internally rotated the patient's arm. The patient's wrist, thumb, and fingers were all flexed, and the patient's ulnar was brought to deviation. While the patient's position was maintained, and the arm was abducted and then contralateral cervical side bending Mulligan mobilization with movement manual lateral glide MWM with gripping: Patient: Supine with upper limb fully supported on a treatment table. Treated body part: Relaxed extension of the elbow, shoulder internal rotation, with pronation of the forearm. Hands loosely around the grip dynamometer handles. Apply 6-10 repetitions in a set, with 3-5 sets in a treatment session, conventional ; Ultrasound therapy , stretching and strengthening for

group A

Eligibility Criteria

• Age: 20 Years - 60 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Patient aged 20-60 years old
• Diagnosed with chronic tennis elbow
• experienced discomfort in their dominant arm, tenderness over the lateral epicondyle of the elbow joint, and exhibited signs and symptoms of tennis elbow persisting for three months
• Increased pain with resistant elbow extension, wrist extension, gripping, and supination
• ULTT 2 b (radial nerve) should be positive ) pain referral throughout the dorsal and radial aspect of the forearm and, sometimes, an "electrical shock-like" pain on the radial side of the right wrist (

You may not qualify if:

• patients who had a history of or were suffering from psychogenic stress
• acute strain, fractures of the humerus, radius, and ulna,
• History of Rheumatoid diseases
• Subjects on steroids or any other medications for pain at present were excluded
• severe edema, infection
• malignancy
• osteoporosis
• unstable joints
• severe neck or shoulder pain, neurological conditions \\ impacting the upper extremity Cervical radiculopathy
• Bilateral Symptoms of Tennis elbow

Sponsors & Collaborators

• Safaa Radi Saber: lead

Study Sites (1)

Delta University

Gamasa, Egypt

Location

MeSH Terms

Conditions

Tennis Elbow

Interventions

Movement; Congresses as Topic

Condition Hierarchy (Ancestors)

Elbow Tendinopathy; Tendinopathy; Muscular Diseases; Musculoskeletal Diseases; Elbow Injuries; Arm Injuries; Wounds and Injuries; Tendon Injuries

Intervention Hierarchy (Ancestors)

Physiological Phenomena; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Organizations; Health Care Economics and Organizations

Study Officials

• Maher Ahmed Elkeblawy Professor of physical Therapy,Department of Basic Science, Professor of physical Therapy

  Professor of physical Therapy ,Department of Basic Science , Faculty of Physical Therapy Cairo University

  STUDY DIRECTOR

• Mariam Omran Grace Lecturer of Physical Therapy .Basic Science . cairo university, Lecturer of Physical Therapy .

  Lecturer of Physical Therapy .Basic Science . cairo university

  STUDY DIRECTOR

• Mohamed Ali Hashish Lecturer of orthopedic and spine surgery, Cairo university,, Lecturer

  Lecturer of orthopedic and spine surgery , Cairo university ,kasr Al-ainy

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Master degree student .Basic Science . Physical therapy . Cairo university

Study Record Dates

• First Submitted: December 27, 2024
• First Posted: January 9, 2025
• Study Start: January 1, 2025
• Primary Completion: June 1, 2025
• Study Completion: June 1, 2025
• Last Updated: December 19, 2025

Record last verified: 2024-12

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)