Mulligan Mobilization in Lateral Elbow Tendinopathy

NCT07589725 | Not Yet Recruiting DMC

• 1 other identifier: E-83460662-050.04-1627561
• Study Type: interventional
• Target: 45
• Locations: 1 country
• Sites: 1

Brief Summary

The aim of this study is to investigate the short-, medium-, and long-term effects of Mulligan Mobilization with Movement (MWM) added to an exercise program on pain, functionality, and biomechanical parameters in individuals with lateral elbow tendinopathy, compared to sham mobilization and exercise-only interventions. The primary hypothesis is that the addition of true MWM to exercise will result in greater improvements in pain intensity, grip strength, pressure pain threshold, kinesiophobia, wrist joint position sense, and the mechanical properties of the extensor muscles compared to placebo (sham MWM) and exercise alone. This study is designed as a three-arm randomized placebo-controlled trial. A total of 45 participants will be allocated to one of three groups: MWM plus exercise, sham MWM plus exercise, and exercise alone. Assessments will be conducted at baseline, immediately post-intervention, and at 3- and 6-month follow-ups. The primary outcome measure is pain intensity. Secondary outcomes include functionality, grip strength, pressure pain threshold, kinesiophobia, wrist proprioception, and the mechanical properties of the extensor carpi radialis brevis muscle assessed using Myoton. This study aims to determine the effects of manual therapy independent of placebo and to evaluate the sustainability of these effects over time. Additionally, by objectively assessing the mechanical and proprioceptive characteristics of the muscle-tendon unit alongside clinical outcomes, the study is expected to provide a novel contribution to the literature. The findings are anticipated to enhance the understanding of the mechanisms underlying conservative treatment approaches in lateral elbow tendinopathy and to support evidence-based clinical decision-making.

Conditions

Lateral Elbow Tendinopathy (Tennis Elbow)

Keywords

mulligan mobilization; lateral elbow tendinopathy; placebo; exercise

Outcome Measures

Primary Outcomes (1)

• Pain Intensity

  Numeric Pain Rating Scale

  1 minute

Secondary Outcomes (7)

• Pressure Pain Threshold

  1 minute

• Maximum Grip Strength

  1 minute

• Pain-free Grip Strength

  1 minute

• Functionality

  5 minute

• Kinesiophobia

  5 minute

Study Arms (3)

MWM + Exercise Group

EXPERIMENTAL

Participants will receive Mulligan Mobilization with Movement combined with a structured exercise program targeting the extensor muscles.

Other: Mobilization with Movement (MWM); Other: Exercise

Sham MWM + Exercise Group

SHAM COMPARATOR

Participants will receive sham Mulligan Mobilization combined with the same structured exercise program targeting the extensor muscles.

Other: Sham Mobilization with Movement (Sham MWM); Other: Exercise

Exercise Group

EXPERIMENTAL

Participants will receive only a structured exercise program targeting the extensor muscles without any manual therapy intervention.

Other: Exercise

Interventions

Mobilization with Movement (MWM) OTHER

MWM is a manual therapy technique in which a therapist applies a sustained lateral glide to the radial head using a belt while the patient performs active gripping movements. The intervention is designed to restore pain-free movement by combining joint mobilization with functional activity.

MWM + Exercise Group

Sham Mobilization with Movement (Sham MWM) OTHER

Sham MWM involves positioning the Mulligan belt in the same manner as the active intervention; however, no therapeutic joint mobilization force is applied. Participants perform active gripping movements while receiving a non-therapeutic simulation of mobilization.

Sham MWM + Exercise Group

Exercise OTHER

The exercise program targets the extensor carpi radialis brevis muscle and includes isometric, concentric, and eccentric strengthening exercises. Exercises are performed in a structured manner and progressed according to a pain-monitoring model allowing mild tolerable pain.

Exercise Group; MWM + Exercise Group; Sham MWM + Exercise Group

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age between 18 and 60 years
• Presence of unilateral lateral elbow pain and tenderness for at least 3 months
• Diagnosis of lateral elbow tendinopathy confirmed by the following four criteria:
• Local tenderness over the lateral epicondyle
• Positive Cozen's test
• Positive Maudsley's test
• Positive Mill's stretch test

You may not qualify if:

• History of surgery around the elbow
• History of elbow dislocation, fracture, or extensor tendon rupture
• History of fracture of the humerus, ulna, or radius within the past year
• Receipt of any treatment for LET within the past 6 months (e.g., physiotherapy, exercise, manual therapy, dry needling, orthosis)
• Presence of cervical referred pain and/or radiculopathy (positive Spurling test)
• Signs of peripheral nerve involvement
• Corticosteroid injection within the past 6 months
• History of rheumatologic disease
• Presence of cancer or tumor

Sponsors & Collaborators

• Istanbul Kent University: lead
• Istanbul University - Cerrahpasa: collaborator

Study Sites (1)

Istanbul Unıversity Cerrahpasa, Faculty of Health Sciences

Istanbul, Turkey (Türkiye)

Location

Related Publications (18)

• Hing W, Bigelow R, Bremner T. Mulligan's mobilization with movement: A systematic review. J Man Manip Ther. 2009;17(2). doi:10.1179/jmt.2009.17.2.39e

  BACKGROUND

• Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018 Feb 2;15(1):107-110. doi: 10.1016/j.jor.2018.01.040. eCollection 2018 Mar.

  PMID: 29657450 BACKGROUND

• Wallis JA, Bourne AM, Jessup RL, Johnston RV, Frydman A, Cyril S, Buchbinder R. Manual therapy and exercise for lateral elbow pain. Cochrane Database Syst Rev. 2024 May 28;5(5):CD013042. doi: 10.1002/14651858.CD013042.pub2.

  PMID: 38802121 BACKGROUND

• Bisset L, Coombes B, Vicenzino B. Tennis elbow. BMJ Clin Evid. 2011 Jun 27;2011:1117.

  PMID: 21708051 BACKGROUND

• Sanders TL Jr, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015 May;43(5):1066-71. doi: 10.1177/0363546514568087. Epub 2015 Feb 5.

  PMID: 25656546 BACKGROUND

• Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Occupation and epicondylitis: a population-based study. Rheumatology (Oxford). 2012 Feb;51(2):305-10. doi: 10.1093/rheumatology/ker228. Epub 2011 Oct 22.

  PMID: 22019808 BACKGROUND

• Martinez-Cervera FV, Olteanu TE, Gil-Martinez A, Diaz-Pulido B, Ferrer-Pena R. Influence of expectations plus mobilization with movement in patient with lateral epicondylalgia: a pilot randomized controlled trial. J Exerc Rehabil. 2017 Feb 28;13(1):101-109. doi: 10.12965/jer.1732848.424. eCollection 2017 Feb.

  PMID: 28349041 BACKGROUND

• Zhu B, You Y, Xiang X, Wang L, Qiu L. Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography. Quant Imaging Med Surg. 2020 Jan;10(1):211-219. doi: 10.21037/qims.2019.10.07.

  PMID: 31956543 BACKGROUND

• Sevik Kacmaz K, Unver B. Immediate Effects of Mulligan Mobilization on Elbow Proprioception in Healthy Individuals: A Randomized Placebo-Controlled Single-Blind Study. J Manipulative Physiol Ther. 2023 Jan;46(1):59-64. doi: 10.1016/j.jmpt.2023.05.001. Epub 2023 Jul 7.

  PMID: 37422752 BACKGROUND

• Bialosky JE, Bishop MD, Penza CW. Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing? J Orthop Sports Phys Ther. 2017 May;47(5):301-304. doi: 10.2519/jospt.2017.0604.

  PMID: 28459190 BACKGROUND

• Syed AU, Darain H, Rana M. The effects of the addition of Mulligan mobilization with movement to exercise on elbow pain and function associated with lateral elbow tendinopathy. J Bodyw Mov Ther. 2024 Oct;40:872-879. doi: 10.1016/j.jbmt.2024.06.007. Epub 2024 Jun 13.

  PMID: 39593689 BACKGROUND

• Reyhan AC, Sindel D, Dereli EE. The effects of Mulligan's mobilization with movement technique in patients with lateral epicondylitis. J Back Musculoskelet Rehabil. 2020;33(1):99-107. doi: 10.3233/BMR-181135.

  PMID: 31104005 BACKGROUND

• Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan's mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis between 2008-2017. Physiotherapy. 2019 Mar;105(1):1-9. doi: 10.1016/j.physio.2018.10.001. Epub 2018 Oct 15.

  PMID: 30630623 BACKGROUND

• Lucado AM, Dale RB, Vincent J, Day JM. Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. J Hand Ther. 2019 Apr-Jun;32(2):262-276.e1. doi: 10.1016/j.jht.2018.01.010. Epub 2018 Apr 26.

  PMID: 29705077 BACKGROUND

• Coombes BK, Connelly L, Bisset L, Vicenzino B. Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial. Br J Sports Med. 2016 Nov;50(22):1400-1405. doi: 10.1136/bjsports-2015-094729. Epub 2015 Jun 2.

  PMID: 26036675 BACKGROUND

• Landesa-Pineiro L, Leiros-Rodriguez R. Physiotherapy treatment of lateral epicondylitis: A systematic review. J Back Musculoskelet Rehabil. 2022;35(3):463-477. doi: 10.3233/BMR-210053.

  PMID: 34397403 BACKGROUND

• Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011 Feb;25(1):43-57. doi: 10.1016/j.berh.2011.01.013.

  PMID: 21663849 BACKGROUND

• Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. J Physiother. 2015 Oct;61(4):174-81. doi: 10.1016/j.jphys.2015.07.015. Epub 2015 Sep 8. No abstract available.

  PMID: 26361816 BACKGROUND

MeSH Terms

Conditions

Tennis Elbow; Motor Activity

Interventions

Movement; Exercise

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Physiological Phenomena; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Motor Activity

Central Study Contacts

Kubra Bali, Master Science

CONTACT

90+5449765584; kubra.tufekci@hotmail.com

Ipek Yeldan, Professor

CONTACT

ipek.yeldan@iuc.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: Participants were blinded to group allocation through the use of a sham intervention
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Lecturer

Model Details: Three-arm randomized placebo-controlled trial

Study Record Dates

• First Submitted: May 11, 2026
• First Posted: May 15, 2026
• Study Start: May 15, 2026
• Primary Completion (Estimated): May 15, 2027
• Study Completion (Estimated): October 1, 2027
• Last Updated: May 15, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)