COMPARATIVE EFFECTS OF DRY NEEDLING AND NEURAL MOBILIZATION ON PAIN, STRENGTH AND RANGE OF MOTION IN PATIENTS WITH GOLFER'S ELBOW

Golfer's Elbow (Medial Epicondylitis) is a common musculoskeletal disorder characterized by pain and tenderness over the medial epicondyle of the elbow, often associated with repetitive wrist flexion and forearm pronation activities. The condition can lead to decreased grip strength, restricted range of motion, and impaired functional performance, affecting daily activities and quality of life.

Various physiotherapy interventions have been used for the management of Golfer's Elbow, including Dry Needling and Neural Mobilization. Dry Needling is a technique that targets myofascial trigger points to reduce pain, improve blood flow, and restore muscle function. Neural Mobilization aims to restore the normal mobility and physiological function of peripheral nerves by reducing neural tension and improving neural mechanics.

The purpose of this randomized clinical trial is to compare the effectiveness of Dry Needling and Neural Mobilization in reducing pain, improving grip strength, and increasing range of motion in patients with Golfer's Elbow. Eligible participants will be randomly assigned to one of two intervention groups. Baseline assessments will be conducted before treatment, followed by post-intervention assessments after completion of the treatment protocol.

Primary outcome measures will include pain intensity, assessed using a validated pain scale, while secondary outcomes will include grip strength and elbow/wrist range of motion. Data collected will be analyzed to determine whether one intervention demonstrates superior clinical outcomes compared to the other.

The findings of this study are expected to provide evidence regarding the comparative effectiveness of these commonly used physiotherapy interventions and may assist clinicians in selecting appropriate treatment strategies for patients with Golfer's Elbow.

• Dry needling (Procedure): Participants will receive dry needling to the affected forearm muscles along with conventional physiotherapy. Treatment will be administered twice weekly for 6 weeks, totaling 12 sessions. Outcomes will include pain, grip strength, and range of motion
• Neural mobilization (Procedure): Participants will receive neural mobilization techniques along with conventional physiotherapy. Treatment will be administered twice weekly for 6 weeks, totaling 12 sessions. Outcomes will include pain, grip strength, and range of motion.

Primary outcomes

• Pain intensity [Baseline and at 6 weeks post-intervention]: Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS). The scale ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores represent greater pain intensity.

Secondary outcomes

• Grip strength [Baseline and at 6 weeks post-intervention]: Grip strength will be measured using a hand dynamometer. Higher values indicate greater muscle strength.
• Range of motion [Baseline and at 6 weeks post-intervention]: Elbow and wrist range of motion will be measured using a standard goniometer. Higher values indicate improved joint mobility.

Sex: All, ages: 18 Years to 40 Years

Inclusion Criteria:

* • Both male and female patients were included.

  * Diagnosis of Medial Epicondylitis by spiral test clinically confirmed by orthopaedic.

pain is limited on medial epicondyle

* Pain reproduced with resisted wrist flexion and/or forearm pronation.
* Aged between 18-40 years
* Acute to Subacute stage (≥ 6 weeks and ≤ 12 months
* NPRS score ≥ 4/10 at baseline

Exclusion Criteria:

* • History of Other elbow pathologies e.g (Lateral epicondylitis , Olecranon bursitis ,Ligament injuries)

  * Radial or ulnar neuropathies not associated with medial epicondylitis.
  * Systemic or inflammatory conditions affecting tendons, such as rheumatoid arthritis
  * Diabetes with neuropathy (unless controlled and neuropathy absent)
  * Previous surgical procedures around the elbow or wrist within the past 6 months
  * Corticosteroid injection, PRP or shockwave therapy within the last 3 months

• Prof Dr Fahad Tanveer, Principal investigator, Green international University lahore