Mobilization With Movement Verses Cyriax Techniques Among Athletes With Lateral Epicondylitis

This study is a randomized controlled trial conducted at Sukkur Physiotherapy, Rehabilitation and Chiropractor Center and Hidayat Physiotherapy and Rehabilitation Center, Sukkur, over a period of nine months following ethical approval. Fifty-six clinically diagnosed lateral epicondylitis patients meeting inclusion criteria will be recruited using purposive sampling and randomly allocated into two groups using the sealed envelope method. Group A will receive Mobilization with Movement combined with progressive strengthening, proprioceptive training, and sport-specific exercises, while Group B will receive Cyriax techniques including deep transverse friction massage and Mill's manipulation along with strengthening and proprioceptive exercises. Both groups will undergo 16 treatment sessions over four weeks following standardized baseline care consisting of education, stretching, ice therapy, and light isometric exercises. Outcome measures include Joint Position Sense testing for proprioception (measuring absolute angular error), PRTEE questionnaire for pain and function, and grip strength measurement using a handheld dynamometer. Ethical guidelines will be strictly followed, informed consent will be obtained, confidentiality will be maintained, and participants will have the right to withdraw at any time without affecting their standard care.

• MWM (Behavioral): Mobilization with Movement (MWM) group will receive interventions five times per week. In the first week, the primary focus is on applying lateral glide mobilization to the elbow joint. The patient performs pain-free gripping or wrist extension activities while the therapist provides a sustained lateral glide, enhancing joint mechanics and reducing pain. This is complemented by isometric strengthening exercises for the wrist extensors (3 sets of 10 repetitions with 5-second holds) and proprioceptive neuromuscular facilitation (PNF) rhythmic stabilization techniques to begin improving joint position sense. Ice therapy may be used post-session to control inflammation. In the second week, the MWM technique is continued with increased repetitions and resistance based on patient tolerance. Eccentric wrist extensor strengthening using resistance bands is introduced, performed in 3 sets of 10 repetitions. Light sport-specific tasks such as racquet swings with minimal resistance are incorporat
• Cyriax techniques (Behavioral): Participants in the cyriax techniques group also receive treatment five times per week over four weeks. In the first week, the primary intervention is deep transverse friction massage (DTFM), applied for 10-15 minutes over the common extensor origin to break down adhesions and reduce localized pain. Isometric strengthening exercises for the wrist extensors are introduced with 3 sets of 10 repetitions, each held for 5 seconds. Ice therapy follows each session to reduce any post-treatment inflammation. Mill's manipulation is not used in the first week to allow tissue acclimatization to DTFM. In the second week, DTFM is continued on alternate days. Mill's manipulation, a high-velocity, low-amplitude technique that stretches the affected tendon, is introduced once per week immediately following DTFM. Resistance ball exercises are added for grip strengthening, encouraging the return of functional muscle performance. Isometric exercises are continued to maintain muscle recruitment without ag

Primary outcomes

• Elbow Proprioception Assessed by Joint Position Sense (JPS) Test [Baseline, Week 2, and Week 4]: Elbow proprioception will be assessed using the Joint Position Sense (JPS) test. Participants will be asked to actively reproduce a predetermined elbow flexion angle (e.g., 90°) with their eyes closed. The difference in degrees between the target angle and the reproduced angle (absolute error) will be recorded. Lower absolute error values indicate better proprioceptive accuracy. Three trials will be performed, and the average error will be calculated for analysis.

Sex: All, ages: 25 Years to 40 Years

Inclusion Criteria:

1. Both male and female population including sports persons(only throw ball players e.g racquet players)
2. Population with age range of 25 - 40 years.
3. Include only clinically diagnosed lateral epicondylitis patients
4. Patients with proprioception impairments in affected limb

Symptoms duration less than 3 months, not longer than 3 months

Exclusion Criteria:

1. Other Elbow Pathologies such as cubital tunnel syndrome, radial tunnel syndrome, or osteoarthritis of the elbow.
2. Recent Corticosteroid Injections in the affected elbow within the past 3 months.
3. Neurological conditions affecting proprioception (e.g., multiple sclerosis, peripheral neuropathy).
4. Autoimmune diseases, diabetes, or connective tissue disorders that may influence healing or proprioception.
5. History of surgical intervention in the affected upper limb.(Karthikeyan) Pregnant or planning to become pregnant during the study period

• Mohammad Affan, MSPTN, Principal investigator, The University of Lahore, Lahore