Adding Neural Mobilization to Mulligan Technique for Treatment of Patients With Chronic Tennis Elbow

NCT ID: NCT06765798

Last Updated: 2025-12-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-01-01

Study Completion Date

2025-06-01

Brief Summary

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The study aimed to assess the combined effect of neural mobilization and mulligan technique on pain ,functional disability and grip strength in patients with tennis elbow

Detailed Description

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Tennis elbow, known as lateral epicondylitis (LE) describes an overuse injury secondary to an eccentric overload of the common extensor tendon at the origin of the extensor carpi radialis brevis (ECRB) tendon. Tennis elbow primarily results from the repetitive strain caused by activities that involve loaded and repeated gripping and/or wrist extension. It is common in individuals who play tennis, squash, badminton, or any activity involving repetitive wrist extension, radial deviation, and/or forearm supination.

Patients with tennis elbow usually report pain or tenderness at the lateral epicondyle of the humerus, decreased gripping strength, and weakness when turning their palms up and straightening their wrists. Pain and inflammation of make it difficult to move the elbow joint through its full range of motion because of the pain and affect function of joint (ECRB)

Radial nerve mobilization exercises, has been used to treat musculoskeletal problems, including LE. Nerve mobilization or neurodynamic mobilization, defined by David Butler, is aimed at restoring homeostasis in and around the nervous system through facilitating movement between neural structures and their surroundings. It is stated that neural shifting reduces adhesions between the nerve and surrounding tissue, improves neural vascularity, and improves the axoplasmic flow Mulligan mobilization with movement (MWM) is a form of manual therapy that includes a sustained lateral glide to the elbow joint with concurrent physiological movement. This mobilization technique is often used to correct the faulty position of the elbow joint. It is the primary modality for the correction of positional fault of the elbow joint complex mimicking a contractile element pathology of the common extensor bundle." Which result in reducing pain, improvement of pain-free grip strength (PFGS), and increased ability to tolerate resisted isometric wrist extension

Conditions

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Tennis Elbow

Keywords

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Tennis Elbow Mulligan mobilization with movement Neural Mobilization

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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group A

Group A received neural mobilization for radial nerve, mulligan mobilization with movement and conventional therapy

Group Type EXPERIMENTAL

Group A : receive neural mobilization for radial nerve , mulligan mobilization with movement and conventional Therapy

Intervention Type OTHER

Group A :Neural Mobilization for radial nerve, Mulligan Mobilization with Movement and Conventional neural mobilization for radial nerve: The physiotherapist holds the patient's arm and wrist while the patient reclined on his side then depress the shoulder, extend the elbow and then internally rotated the patient's arm. The patient's wrist, thumb, and fingers were all flexed, and the patient's ulnar was brought to deviation. While the patient's position was maintained, and the arm was abducted and then contralateral cervical side bending Mulligan mobilization with movement manual lateral glide MWM with gripping: Patient: Supine with upper limb fully supported on a treatment table. Treated body part: Relaxed extension of the elbow, shoulder internal rotation, with pronation of the forearm. Hands loosely around the grip dynamometer handles. Apply 6-10 repetitions in a set, with 3-5 sets in a treatment session, conventional ; Ultrasound therapy , stretching and strengthening for

group B

Group B received neural mobilization for radial nerve and conventional therapy

Group Type EXPERIMENTAL

Group B receive neural mobilization for radial nerve and conventional

Intervention Type OTHER

Group B receive neural mobilization for radial nerve and conventional neural mobilization for radial nerve: The physiotherapist holds the patient's arm and wrist while the patient reclined on his side then depress the shoulder, extend the elbow and then internally rotated the patient's arm. The patient's wrist, thumb, and fingers were all flexed, and the patient's ulnar was brought to deviation. While the patient's position was maintained, and the arm was abducted and then contralateral cervical side bending conventional ; Ultrasound therapy , stretching and strengthening for wrist flexors and extensors

Group C

Group C received mulligan mobilization with movement and conventional therapy

Group Type EXPERIMENTAL

Group C receive Mulligan mobilization with movement and conventional

Intervention Type OTHER

Group C receive Mulligan mobilization with movement and conventional

Mulligan mobilization with movement manual lateral glide MWM with gripping: Patient: Supine with upper limb fully supported on a treatment table. Treated body part: Relaxed extension of the elbow, shoulder internal rotation, with pronation of the forearm. Hands loosely around the grip dynamometer handles. Apply 6-10 repetitions in a set, with 3-5 sets in a treatment session, conventional ; Ultrasound therapy , stretching and strengthening for wrist flexors and extensors

Group D

Group D received conventional therapy

Group Type ACTIVE_COMPARATOR

Group D receive conventional

Intervention Type OTHER

Group D receive conventional :

Ultrasound therapy , stretching and strengthening for wrist flexors and extensors

Interventions

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Group A : receive neural mobilization for radial nerve , mulligan mobilization with movement and conventional Therapy

Group A :Neural Mobilization for radial nerve, Mulligan Mobilization with Movement and Conventional neural mobilization for radial nerve: The physiotherapist holds the patient's arm and wrist while the patient reclined on his side then depress the shoulder, extend the elbow and then internally rotated the patient's arm. The patient's wrist, thumb, and fingers were all flexed, and the patient's ulnar was brought to deviation. While the patient's position was maintained, and the arm was abducted and then contralateral cervical side bending Mulligan mobilization with movement manual lateral glide MWM with gripping: Patient: Supine with upper limb fully supported on a treatment table. Treated body part: Relaxed extension of the elbow, shoulder internal rotation, with pronation of the forearm. Hands loosely around the grip dynamometer handles. Apply 6-10 repetitions in a set, with 3-5 sets in a treatment session, conventional ; Ultrasound therapy , stretching and strengthening for

Intervention Type OTHER

Group B receive neural mobilization for radial nerve and conventional

Group B receive neural mobilization for radial nerve and conventional neural mobilization for radial nerve: The physiotherapist holds the patient's arm and wrist while the patient reclined on his side then depress the shoulder, extend the elbow and then internally rotated the patient's arm. The patient's wrist, thumb, and fingers were all flexed, and the patient's ulnar was brought to deviation. While the patient's position was maintained, and the arm was abducted and then contralateral cervical side bending conventional ; Ultrasound therapy , stretching and strengthening for wrist flexors and extensors

Intervention Type OTHER

Group C receive Mulligan mobilization with movement and conventional

Group C receive Mulligan mobilization with movement and conventional

Mulligan mobilization with movement manual lateral glide MWM with gripping: Patient: Supine with upper limb fully supported on a treatment table. Treated body part: Relaxed extension of the elbow, shoulder internal rotation, with pronation of the forearm. Hands loosely around the grip dynamometer handles. Apply 6-10 repetitions in a set, with 3-5 sets in a treatment session, conventional ; Ultrasound therapy , stretching and strengthening for wrist flexors and extensors

Intervention Type OTHER

Group D receive conventional

Group D receive conventional :

Ultrasound therapy , stretching and strengthening for wrist flexors and extensors

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patient aged 20-60 years old

* . Diagnosed with chronic tennis elbow
* experienced discomfort in their dominant arm, tenderness over the lateral epicondyle of the elbow joint, and exhibited signs and symptoms of tennis elbow persisting for three months
* Increased pain with resistant elbow extension, wrist extension, gripping, and supination
* ULTT 2 b (radial nerve) should be positive ) pain referral throughout the dorsal and radial aspect of the forearm and, sometimes, an "electrical shock-like" pain on the radial side of the right wrist (

Exclusion Criteria

* patients who had a history of or were suffering from psychogenic stress

* acute strain, fractures of the humerus, radius, and ulna,
* History of Rheumatoid diseases
* Subjects on steroids or any other medications for pain at present were excluded
* severe edema, infection
* malignancy
* osteoporosis
* unstable joints
* severe neck or shoulder pain, neurological conditions \\ impacting the upper extremity Cervical radiculopathy
* Bilateral Symptoms of Tennis elbow
Minimum Eligible Age

20 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Safaa Radi Saber

OTHER

Sponsor Role lead

Responsible Party

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Safaa Radi Saber

Master degree student .Basic Science . Physical therapy . Cairo university

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Maher Ahmed Elkeblawy Professor of physical Therapy,Department of Basic Science, Professor of physical Therapy

Role: STUDY_DIRECTOR

Professor of physical Therapy ,Department of Basic Science , Faculty of Physical Therapy Cairo University

Mariam Omran Grace Lecturer of Physical Therapy .Basic Science . cairo university, Lecturer of Physical Therapy .

Role: STUDY_DIRECTOR

Lecturer of Physical Therapy .Basic Science . cairo university

Mohamed Ali Hashish Lecturer of orthopedic and spine surgery, Cairo university,, Lecturer

Role: STUDY_DIRECTOR

Lecturer of orthopedic and spine surgery , Cairo university ,kasr Al-ainy

Locations

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Delta University

Gamasa, , Egypt

Site Status

Countries

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Egypt

Other Identifiers

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P.T.REC/012/005457

Identifier Type: -

Identifier Source: org_study_id