Muscle Energy Technique Combined With Mulligan Technique in Tennis Elbow

NCT07604454 | Completed DMC

• 1 other identifier: UOL/IREB/25/12/0027
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to evaluate the effectiveness of Muscle Energy Technique (MET) combined with Mulligan Mobilization With Movement (MWM) in patients with lateral epicondylitis (tennis elbow). The study compares the combined intervention with Mulligan technique and routine physical therapy alone. Outcomes including pain intensity, functional disability, and quality of life will be assessed using NPRS, PRTEE, and SF-8 questionnaires over a four-week treatment period.

Conditions

Lateral Epicondylitis; Tennis Elbow

Keywords

Tennis Elbow; Lateral Epicondylitis; Muscle Energy Technique; Mulligan Technique; Mobilization With Movement

Outcome Measures

Primary Outcomes (1)

• Pain Intensity Measured by Numeric Pain Rating Scale (NPRS)

  Pain intensity will be measured using the Numeric Pain Rating Scale (NPRS), an 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain).

  Baseline and after 4 weeks of intervention

Secondary Outcomes (2)

• Functional Disability Measured by PRTEE Questionnaire

  Baseline and after 4 weeks of intervention

• Quality of Life Measured by SF-8 Questionnaire

  Baseline and after 4 weeks of intervention

Study Arms (2)

Experimental Group (MET + MWM + Routine Physical Therapy)

EXPERIMENTAL

Participants in this group will receive Muscle Energy Technique combined with Mulligan Mobilization With Movement along with routine physical therapy including eccentric strengthening and stretching exercises for wrist extensors.

Procedure: Muscle Energy Technique Combined With Mulligan Technique

Control Group (MWM + Routine Physical Therapy)

ACTIVE COMPARATOR

Participants in this group will receive Mulligan Mobilization With Movement along with routine physical therapy including eccentric strengthening and stretching exercises.

Procedure: Mulligan Mobilization With Movement

Interventions

Muscle Energy Technique Combined With Mulligan Technique PROCEDURE

Muscle Energy Technique will be applied using resisted isometric contractions of forearm supination and pronation. Mulligan Mobilization With Movement will be applied using sustained lateral glide during pain-free gripping activity. Treatment sessions will be conducted five times weekly for four weeks.

Experimental Group (MET + MWM + Routine Physical Therapy)

Mulligan Mobilization With Movement PROCEDURE

Mulligan Mobilization With Movement technique will be applied using sustained glide of the forearm while participants perform pain-free gripping activities. Sessions will be conducted five times weekly for four weeks.

Control Group (MWM + Routine Physical Therapy)

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age between 18 and 45 years
• Both genders
• Unilateral lateral epicondylitis
• Diagnosed by senior physiotherapist
• Pain duration of at least 6 weeks
• Pain score ≥7 on NPRS/VAS
• Positive symptoms during extensor carpi radialis brevis and longus isometric contraction

You may not qualify if:

• Previous elbow or shoulder surgery
• Manual therapy within previous 6 months
• History of fracture, dislocation, or tendon tear
• Steroid or pain medication use
• Peripheral nerve entrapment
• Cervical radiculopathy
• Osteoporosis or metastasis involving elbow

Sponsors & Collaborators

• University of Lahore: lead
• University of Lahore Hospital (ULH): collaborator

Study Sites (1)

University of Lahore Teaching Hospital, Lahore

Lahore, Punjab Province, Pakistan

Location

Related Publications (10)

• Bowman EN. Current concepts: pathology in the overhead athlete's lateral elbow. J Shoulder Elbow Surg. 2024 Feb;33(2):507-511. doi: 10.1016/j.jse.2023.08.017. Epub 2023 Sep 27.

  PMID: 37774828 BACKGROUND

• Blanchette MA, Normand MC. Augmented soft tissue mobilization vs natural history in the treatment of lateral epicondylitis: a pilot study. J Manipulative Physiol Ther. 2011 Feb;34(2):123-30. doi: 10.1016/j.jmpt.2010.12.001.

  PMID: 21334545 BACKGROUND

• Bazancir Z, Firat T. A potential factor in the pathophysiology of lateral epicondylitis: The long sarcomere length of the extensor carpi radialis brevis muscle and implications for physiotherapy. Med Hypotheses. 2019 Sep;130:109278. doi: 10.1016/j.mehy.2019.109278. Epub 2019 Jun 12.

  PMID: 31383324 BACKGROUND

• Bagcaci S, Unuvar BS, Gercek H, Ugurlu I, Sert OA, Yilmaz K. A randomized controlled trial on pain, grip strength, and functionality in lateral elbow pain: Mulligan vs muscle energy techniques. J Back Musculoskelet Rehabil. 2023;36(2):419-427. doi: 10.3233/BMR-220061.

  PMID: 36120766 BACKGROUND

• Alagaesan, J., & Nirmala, J. G. (2024). Effectiveness of Mulligan Mobilization Technique Versus Cyriax Technique for Lateral Epicondylitis: A Pilot Study. Indian Journal of Physiotherapy & Occupational Therapy, 18.

  BACKGROUND

• Akbar H, Akbar S, Saddique MN, Sarfraz MS. Prevalence of lateral epicondylitis among housewives in Lahore: a cross-sectional study. BMC Musculoskelet Disord. 2024 Oct 15;25(1):815. doi: 10.1186/s12891-024-07889-x.

  PMID: 39407258 BACKGROUND

• Ahmed A, Ibrar M, Arsh A, Wali S, Hayat S, Abass S. Comparing the effectiveness of Mulligan mobilization versus Cyriax approach in the management of patients with subacute lateral epicondylitis. J Pak Med Assoc. 2021 Jan;71(1(A)):12-15. doi: 10.47391/JPMA.186.

  PMID: 33484510 BACKGROUND

• Afzal, M., Zakaullah, S., Memon, S. I., Nisar, A., Touqeer, H., & Shabir, H. (2021). Prevalence and risk factors of lateral epicondylitis among restaurant cooks at district Gujranwala: A cross-sectional study. Rawal Medical Journal, 46(2), 338.

  BACKGROUND

• Aben A, De Wilde L, Hollevoet N, Henriquez C, Vandeweerdt M, Ponnet K, Van Tongel A. Tennis elbow: associated psychological factors. J Shoulder Elbow Surg. 2018 Mar;27(3):387-392. doi: 10.1016/j.jse.2017.11.033.

  PMID: 29433642 BACKGROUND

• Abd Elrahim, R. M., Ali, M. F., Elwerdany, S. H., Salama, A. M., & Elsayed, M. (2022). Mulligan mobilisation with movement versus deep friction massage in patients with lateral epicondylitis. J Pharm Negat Results, 13, 5184-5192.

  BACKGROUND

MeSH Terms

Conditions

Tennis Elbow

Interventions

Movement

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

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The study is single-blinded. The outcome assessor was blinded to the group allocation and intervention details to minimize assessment bias. Participants and treating physiotherapists were aware of the interventions being administered.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Doctor of Physical Therapy Student

Model Details: Participants will be randomly assigned into two parallel groups. One group will receive Muscle Energy Technique combined with Mulligan Mobilization With Movement and routine physical therapy, while the control group will receive Mulligan Mobilization With Movement with routine physical therapy alone.

Study Record Dates

• First Submitted: May 17, 2026
• First Posted: May 22, 2026
• Study Start: September 26, 2025
• Primary Completion: October 28, 2025
• Study Completion: January 25, 2026
• Last Updated: May 22, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)