Comparison of Muscle Energy Technique and Oscillating Energy Manual Therapy in Chronic Lateral Epicondylitis
Condition: Lateral Epicondylitis
MeSH terms: Tennis Elbow
Study type: Interventional

Summary: 
      Lateral epicondylitis (LE) is a painful musculoskeletal condition caused by overuse. The
      condition is also called tennis elbow because it affects 50% of tennis players, notably
      beginners learning the one-handed backhand. Nonetheless, only 10% of all patients with LE
      play tennis. Lateral Epicondylitis (LE) or tennis elbow affects about 1-3% of general
      population.

      Muscle energy technique was developed by osteopathic physician, Fred Mitchell, Sr. It was
      refined and systematized by Fred Mitchell, Jr., and has continued to evolve with
      contributions from many individuals.
    

Detailed description: 
      Lateral epicondylitis (LE) is a painful musculoskeletal condition caused by overuse. The
      condition is also called tennis elbow because it affects 50% of tennis players, notably
      beginners learning the one-handed backhand. Nonetheless, only 10% of all patients with LE
      play tennis. Lateral Epicondylitis (LE) or tennis elbow affects about 1-3% of general
      population.

      patients with Lateral Epicondylitis complains of pain, functional difficulty affecting
      activities of daily living related to wrist and forearm movements . The grip strength is
      affected due to voluntary decline of effort to avoid pain and due to wasting of affecting
      muscles seen in long standing conditions. The symptoms exacerbate with stressful activities
      in overuse syndromes but pain may persist even at rest as the condition progress.

      Muscle energy technique was developed by osteopathic physician, Fred Mitchell, Sr. It was
      refined and systematized by Fred Mitchell, Jr., and has continued to evolve with
      contributions from many individuals. Muscle energy technique (MET) is used by practitioners
      from different professions and has been advocated for the treatment of shortened muscles,
      weakened muscles, restricted joints, and lymphatic drainage. In addition to using muscle
      effort to mobilize joints and tissues, MET is considered by some to be a biomechanics-based
      analytic diagnostic system that uses precise physical diagnosis evaluation procedures to
      identify and qualify articular range of motion restriction. MET are defined as a manual
      treatment in which a patient produces a contraction in a precisely controlled position and
      direction against a counterforce applied by a manual therapist. MET have been also used in
      asymptomatic subjects in order to increase mobility. There is varying evidence that when a
      joint has a functional limitation, the application of a MET can increase its Range of Motion.

      A comparative study concluded that oscillating energy manual therapy and muscle energy
      technique had shown the improvement in Numeric Rating Scale, grip strength and PRTEE in
      lateral epicondylitis subjects, but more significant improvement was observed in the subjects
      who were treated with muscle energy technique than oscillating energy manual therapy.
    

Intervention name(s): muscle energy technique; oscillating manual energy therapy
Intervention type(s): Other; Other
Intervention description(s): the subject to sit comfortably and then stabilize the subject's distal humerus with one hand, then the forearm was supinated with the therapist another hand until resistance appeared. Holding the position the subject was asked to slowly pronate the forearm that is Isometric contraction against resistance for a period of 6-10 seconds with inhale and exhale, followed by slightly increasing supination until resistance was met once again. After 5 seconds of relaxation, the procedure was repeated 5 times during a single treatment session; this technique was applied in 2 sessions for a week for 4 weeks.; It is also known as V-spread .The subject was asked to sit on a chair with the affected painful arm resting on the treatment table. Tender points were palpated. Then the therapist places the index and middle fingers of one hand in a V-shape around the tender point and placed the index finger of the other hand in the medial side of the elbow, diagonally across the located tender point. Gentle pressure was applied a few times using fingertips to the tissues alternatively from the medial and lateral sides to start the oscillations. On the initiation of oscillations, the application of pressure should be stopped and allow the oscillations to continue between the two points of contact on the subject's elbow.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: lateral epicondylitis; Muscle energy technique; Oscillating manual energy therapy; grip strength; pain