Mobilization With Movement and Progressive Strengthening Exercises in Lateral Epicondylitis
Condition: Lateral Epicondylitis
MeSH terms: Tennis Elbow
Study type: Interventional

Summary: 
      The purpose of the study is to compare the mobilization with movement and progressive
      strengthening exercises in individuals with lateral epicondylitis on VAS, PRTEE and Hand Grip
      strength . A randomized clinical trial was conducted at Bone and Joint center and Khyaban
      medical center, Rawalpindi. The sample size was 40 calculated through open-epi tool . The
      participants were divided into two groups each having 20 participants. The study duration was
      six months. Sampling technique applied was Purposive sampling for recruitment and group
      randomization using enveloped sealed. Only 20 to 60 years participants with chronic lateral
      epicondylitis included in that study . Tools used in this study are SELF STRUCTURE
      QUESTIONNAIRE, VAS visual analogue scale range is 0 TO 10 O is no pain 10 is unbearable pain
      , PRTEE patient ratted tennis elbow evaluation 15 questionnaire form 3 sub-scale total 100
      scores 0 is best 100 is worst, hand held Dynamo-meter , Data was collected before and
      immediately after the application of interventions. Data analyzed through SPSS version 21.
    

Detailed description: 
      Epicondylitis is common in persons who frequently overuse the upper arm, particularly with
      activities that involve rotation of the arm with flexion and extension.

      Anyone who performs repetitive movements involving extension of the wrist or hand for at
      least two hours a day, which can include anyone sitting at a computer and using a mouse.
      Professional who are commonly effected are Tennis Players, Squash Players, Badminton Players
      ,Painters, Plumbers, Computer user and Musician.

      Lateral Epicondylitis affect the extensor muscle around elbow also common for extensor type
      pathology.

      Evidence suggests that Prevalence of Tennis elbow generally affects about 1 to 3 % general
      population from 35 to 50 years .

      Lateral epicondylitis of young age around 20 years is usually due to overused sustained
      pressure during laptop working and it mainly effect the dominant hand usually right hand.

      The condition tends to affect men and women equally. The annual incidence is one to three
      percent in the United States. Despite the condition being commonly referred to as tennis
      elbow, tennis players make up only 10% of the patient population. Half of the tennis players
      develop pain around the elbow, of which 75% represent true tennis elbow.

      Diagnosis of Lateral Epicondylitis is based on the palpation around lateral elbow region ,
      found local tenderness around lateral epicondyle region and Cozen test , Mill,s test.

      Literature review: A systematic and evidence based search of relevant literature was
      performed by utilizing PubMed and Google Scholar as search engines and the key words used
      were Lateral Epicondylitis , Tennis Elbow, PRE, Strengthening exercises ,VAS, exercises
      programme for tennis elbow, .The purpose of the literature review is to find out the
      pre-existing literature regarding the mobilization with movement and PRE interventions for
      Lateral Epicondylitis .

      In 2020, The Effects of Mulligan's Mobilization with movement technique in patients with
      lateral epicondylitis. MWM is secure and shows efficacy in terms of outcomes at elbow pain
      (VAS) , Functional Capacity( FC) PRTEE, and Pain less maximized grip strength, these all
      parameters showed significant improvement.

      An experimental study was conducted in 2017 Effects of progressive strengthening exercises in
      chronic lateral epicondylitis. The group receiving PRE showed significant improvement in
      study variables (VAS, PRTEE, Grip Strength). The group which performed PRE and conventional
      physiotherapy showed greater improvement than alone conventional treatment for lateral
      epicondylitis .

      RCT was conducted in 2016 MWM compared to supervised exercises in patients with lateral
      epicondylitis. This study showed that the group with mulligan technique's showed
      effectiveness in term of reduction of pain and improved Grip Hand Strength (GHS) as compared
      with supervised exercise program group.

      An Intervention Comparative study was conducted in 2013 Effectiveness of MWM compared with
      manipulation of wrist in lateral epicondylitis . The variables were pain , Functional
      disability recorded by VAS, PRTEE, and Hand Dynamo-meter .This study showed that mulligan
      mobilization plus conventional treatment was much more effective in treatment of tennis elbow
      .

      RCT was conducted in 2012 MWM as adjunct to conventional physiotherapy in treatment of
      chronic lateral epicondylitis stated that Mobilization with movement group showed significant
      improvement in pain reduction at VAS and improved Pain Free Grip Strength .
    

Intervention name(s): Mobilization with movement lateral Glides and Conventional Physiotherapy; Progressive Resistance Exercises and Conventional Physiotherapy
Intervention type(s): Other; Other
Intervention description(s): (The Mobilization with movement technique is(lateral glide) applied to the patient by a physiotherapist to patients at supine level position.
First we identify pain free region each patients. The lateral humerus above the condyle of elbow joint are fixed by therapist. Then therapist ask to patients perform the active movement ten times. The same procedure repeats number of 3 sets, 10 number of repetition. The rest of interval fifteen to twenty seconds with in the sets Grip strength (pain Free Strength ) was evaluated in kilogram using a dynamometer. The measurements using dynamometer patients posture is erect sit position , the elbow at 90 degree flexion , shoulder would be abducted , rest of joint forearm and wrist in neutral during measurements.
conventional therapy list of conventional physiotherapy are therapeutic ultrasound , deep transverse friction massage and stretching; 4 STEPS Progressive resistive EXERCISES have a 4 step to application Step 1 Clenching fist strongly, resisted wrist Flexion, Extension, wrist rotation with a stick) Step 2 The therapeutic band exercised performed at wrist Flexion(WF), Wrist Extension(WE), Wrist Ulnar Deviation(WED) , and Wrist Radial Deviation(WRD).Step 3 Patient asked to perform combined wrist rotatory movements using e.g. table top as a support. Step 4 Soft ball compressing exercises, Transferring buttons from cup into another, Twisting a towel into the roll, Hand Rotating both directions at table AND CONVENTIONAL PHYSIOTHERAPY and list of conventional physiotherapy are therapeutic ultrasound , deep transverse friction massage and stretching
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: RCT
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Mobilization with movement, PRE, PRTEE, VAS, HD.