Comparison of Mulligan Technique and Muscle Energy Technique in Lateral Epicondylitis

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Diagnosing lateral epicondylitis
* Age between 30 and 60 years
* Willingness to comply with treatment and follow-up assessments

Exclusion Criteria:

* Treatment of elbow complaints with surgical intervention
* Physiotherapy or CSIs in the past 6 months
* Duration of \<3 months
* Severe neck or shoulder problems likely to cause or maintain the elbow complaints
* Posterior interosseous nerve compression
* Congenital or acquired deformities of the elbow
* Systemic musculoskeletal or neurologic disorders