Mobilization With Movement Verses Cyriax Techniques Among Athletes With Lateral Epicondylitis

NCT07424794 | Completed DMC

• 1 other identifier: UOL/IREB/25/15/03/24
• Study Type: interventional
• Target: 56
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Lateral Epicondylitis

Keywords

Mobilization with Movement (MWM); Cyriax Technique; Deep Transverse Friction Massage; Mill's Manipulation

Outcome Measures

Primary Outcomes (1)

• Elbow 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.

  Baseline, Week 2, and Week 4

Study Arms (2)

interventional group Mobilization with Movement (MWM)

EXPERIMENTAL

Participants in this group will receive Mobilization with Movement (MWM) techniques applied to the elbow joint along with progressive wrist extensor strengthening, proprioceptive training, and sport-specific functional exercises. Treatment will be administered five times per week for four weeks (total 16 sessions). Ice therapy may be applied post-session as needed. Standardized baseline education, stretching, and isometric exercises will be provided before the intervention phase.

Behavioral: MWM

interventional group Cyriax Technique

EXPERIMENTAL

Participants in this group will receive Cyriax techniques including deep transverse friction massage (DTFM) and Mill's manipulation, combined with progressive wrist extensor strengthening, grip exercises, proprioceptive drills, and sport-specific activities. Treatment will be delivered five times per week for four weeks (total 16 sessions). Ice therapy may be applied post-session. Standardized baseline education, stretching, and light isometric exercises will be provided prior to the intervention phase.

Behavioral: Cyriax techniques

Interventions

MWM BEHAVIORAL

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

interventional group Mobilization with Movement (MWM)

Cyriax techniques BEHAVIORAL

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

interventional group Cyriax Technique

Eligibility Criteria

• Age: 25 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Both male and female population including sports persons(only throw ball players e.g racquet players)
• Population with age range of 25 - 40 years.
• Include only clinically diagnosed lateral epicondylitis patients
• Patients with proprioception impairments in affected limb
• Symptoms duration less than 3 months, not longer than 3 months

You may not qualify if:

• Other Elbow Pathologies such as cubital tunnel syndrome, radial tunnel syndrome, or osteoarthritis of the elbow.
• Recent Corticosteroid Injections in the affected elbow within the past 3 months.
• Neurological conditions affecting proprioception (e.g., multiple sclerosis, peripheral neuropathy).
• Autoimmune diseases, diabetes, or connective tissue disorders that may influence healing or proprioception.
• History of surgical intervention in the affected upper limb.(Karthikeyan) Pregnant or planning to become pregnant during the study period

Sponsors & Collaborators

• Mohammad Affan: lead

Study Sites (1)

University of Lahore Teaching Hospital, Lahore

Lahore, Punjab Province, 54000, Pakistan

Location

MeSH Terms

Conditions

Tennis Elbow

Condition Hierarchy (Ancestors)

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

Study Officials

• Mohammad Affan, MSPTN

  The University of Lahore, Lahore

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: principal investigator

Study Record Dates

• First Submitted: February 14, 2026
• First Posted: February 20, 2026
• Study Start: February 25, 2026
• Primary Completion: March 26, 2026
• Study Completion: March 27, 2026
• Last Updated: June 10, 2026

Record last verified: 2026-02

Locations

PA (1)