Comparison of Mulligan Technique and Muscle Energy Technique in Lateral Epicondylitis
Condition: Tennis Elbow
MeSH terms: Tennis Elbow
Study type: Interventional

Summary: 
      In this study, the effects of mulligan and muscle energy techniques on pain, grip strength
      and functionality will be investigated in a randomized controlled manner in individuals with
      lateral epicondylitis. Various treatments have been tried in patients with lateral
      epicondylitis whose daily activities are restricted in order to reduce pain and increase
      functions. Among them, conservative and physical therapy agents have an important place.
      There are many studies in the literature evaluating the effects of mobilization in LE
      treatment. However, there are no definitive data on the long-term efficacy and benefits of
      all these treatment methods. Mulligan and muscle energy techniques can be used in lateral
      epicondylitis due to many positive reasons such as being effective in a short time, giving
      fast results, high success rate, risk-free and painless in the case of specialists. Thanks to
      the findings obtained from our study, it is aimed to contribute to the literature with
      objective, evidence-based results in this field.
    

Detailed description: 
      Lateral epicondylitis (LE); It is one of the most common lesions of the upper limb,
      originating from the wrist and wrist extensor muscles, characterized by pain in the lateral
      epicondyle and extensor muscle surface of the forearm. LE was first described by Runge in
      1873 and was named tennis elbow by Morris in 1882. It is thought that the cause of LE is
      caused by repetitive stresses, direct traumas, repetitive contractions, degeneration, micro
      tears, immature repair and tendinosis at the adhesion of the extensor carpi radialis brevis
      and extensor digitorum communis muscles. It is mostly seen in 4-6 decades. More dominant
      upper limb is affected. Its annual incidence has been determined between 1-3%. It has been
      shown that it can cause a significant loss of labor due to pain in patients.

      The Mulligan Concept is a new approach in Manual Therapy. It was started to be developed by
      New Zealand physiotherapist Brian Mulligan in the 1980s, and its popularity and awareness has
      increased in the last 10 years. The concept-specific techniques called NAGS, SNAGS and MWMs
      are applied safely and effectively in musculoskeletal-nervous system diseases. The concept is
      suitable for biomechanics, arthrokinematic kinesiological principles, which are the common
      knowledge of the known Manual Therapy approaches, and techniques and application principles
      are important with other approaches. show differences.

      Manual therapy and forearm extensor muscle strengthening are used together with MWM
      (mobilization with movement) technique. MWM eliminates elbow pain by reducing abnormal
      facilitations and creates some tactile and compressive stimuli in soft tissue. Afferent nerve
      activity results in these tactile and compressive stimuli inhibiting spinal cord neurons.
      Force is applied at long load at low load. Increases the harmony and mobility of connective
      tissue layers.

      Mulligan concept; It can be defined as a combination of passive mobilization concepts such as
      Kaltenborn, Maitland Cyriax, and active methods such as Pilates, PNF and Kinetic Control. The
      distinctive feature of this approach is that, when the right case is chosen, the pain can be
      achieved, functional gains can be achieved in a very short time and in the long term.

      Postisometric reconstruction: muscle energy technique (MET) is a manual therapy that uses
      muscle's own energy in the form of mild isometric contractions to relax and lengthen muscles
      through autogenic or mutual inhibition. Compared to static stretching, a passive technique in
      which the therapist does all the work, MET is an active technique in which the patient is
      also an active participant. BAT is based on the concepts of Autogenic Inhibition and Mutual
      Inhibition. If a maximum contraction of the muscle is followed by the stretching of the same
      muscle, Autogenic Inhibition is known as MET, and if the opposite muscle following a maximum
      contraction of the muscle is stretched, it is known as Mutual Inhibition MET.

      The manipulative treatment acts directly on the joint structures and creates a nociceptive
      afferent stimulation by providing physiological effect on the central nervous system. Such
      findings emphasize the appropriateness of the local movements of mobilization. Such a
      mechanism may include intranoral circulation, axoplasmic flow, or neural connective tissue
      viscoelasticity. However, an increasing number of studies have shown that passive joint
      movements can activate many areas.

      Exercise programs are the most common physiotherapy treatments for LE. There are many studies
      examining the effects of exercise programs in LE. Stretching and strengthening exercises are
      at the core of the exercise program. Because the tendon should not only be strengthened, it
      should be flexible. Home exercises should usually be done once or twice a day.
    

Intervention name(s): Mulligan Technique; Muscle Energy Technique; Only Exercise (Control)
Intervention type(s): Other; Other; Other
Intervention description(s): First, the painless application angle was determined for each patient. The lateral condyle of the humerus was fixed by the web range of the physiotherapist. The elbow joint was glided until the elbow joint and the hand tightening position were not able to cause pain.
The patients were asked to repeat the motion of the elbow joint and the ball squeezing motion given to their hands 10 times without pain. For pain control, the same procedure was performed with three sets, each containing 10 repetitions of the exercise. The interval between sets was 15 to 20 seconds, and the interval between repetitions within each set was 30 seconds.; Firstly, 5-7 sec opposite isometric muscle contraction was requested from the patient in the barrier by passively stretching by the physiotherapist until the barrier of the related muscle or dysfunctional joint. After a short rest period of 2-3 seconds, the physiotherapist continued to stretch passively until the second barrier. The application continued until the tension of the muscle or dysfunction of the joint disappeared.; Eccentric training for the extensor Carpi Radialis Brevis (ECRB) muscle, the most affected wrist extensor tendon, and static stretching exercise for the EKRB muscle were given as home exercise program. The best stretching position for the EKRB tendon is provided when the elbow joint is in extension, forearm pronation, when the wrist is flexed with ulnar deviation (Mills maneuver). Each exercise was taught to patients in 10 repetitions and 10 seconds, and one day of the week, participants in the control group performed their exercises under the supervision of a physiotherapist.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Tennis Elbow; Exercise; Musculoskeletal Manipulations