Muscle Energy Technique Combined With Mulligan Technique in Tennis Elbow

Effectiveness of Muscle Energy Technique Combined With Mulligan Mobilization Among Patients With Lateral Epicondylitis: A Randomized Controlled Trial

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.

Lateral epicondylitis, commonly known as tennis elbow, is a musculoskeletal disorder characterized by pain and reduced functional ability affecting the lateral aspect of the elbow. It commonly results from repetitive wrist extension and forearm movements leading to overuse of the extensor tendons.

Conservative physiotherapy management including manual therapy and therapeutic exercises is widely used for the treatment of lateral epicondylitis. Mulligan Mobilization With Movement (MWM) has shown beneficial effects in reducing pain and improving grip strength and functional mobility. Muscle Energy Technique (MET) is another manual therapy approach that may help improve joint mobility, muscle flexibility, and pain reduction through controlled isometric contractions.

This study aims to determine whether combining MET with Mulligan technique provides superior clinical outcomes compared to Mulligan technique alone in patients with tennis elbow.

Participants will be randomly allocated into two groups:

Experimental Group: MET + MWM + Routine Physical Therapy Control Group: MWM + Routine Physical Therapy

Treatment will be provided five sessions per week for four weeks. Outcomes will be assessed at baseline and after completion of the intervention period.

Inclusion Criteria:

• 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

Exclusion Criteria:

• 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