Comparing the Effects of Manual Cross Friction Massage Versus Instrument-Assisted Soft Tissue Mobilization on Pain, Range of Motion, And Functional Disability in Patients With Chronic Lateral Epicondylitis

Group A received Manual cross friction massage . Group B received Instrument assisted soft tissue mobilization . Visual analog scale, goniometer, Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire was used as outcome tools. This was a single blinded study. Outcome assessor was blind. Data analysis was done at Baseline and post treatment at 6 weeks.

• Manual Cross Friction Massage (CFM) (Other): Patient seated , elbow flexed \~90 degree , forearm pronated , extensor tendon exposed and released. Thumb / index finger applies firm transverse pressure . Short , deep ,rhythmic strokes perpendicular to ECRB tendon fibers (5 to 10 min ).Total duration 35 - 40 mins. 3 sessions per week for 6 weeks.
• Instrument-Assisted Soft Tissue Mobilization (IASTM) (Other): Seated,Elbow flexed \~ 90 degree , forearm pronated, extensor tendon exposed and relaxed. Stainless steel IASTMCurve bar S shape , dual grip tool was used with moderate ,tolerable pressure . Longitudinal sweeping (1-2 min ) , Cross fiber stokes (1-2 min), Fanning over tender point ( 1- 2min). Flushing stokes (1min).40 -45 mins total time . 3 sessions per week for 6 weeks.

Primary outcomes

• Visual Analog Scale. [Assessments were performed at baseline (week 0) and post intervention (week 6).]: A Visual Analogue Scale (VAS) was used to measure pain intensity during rest. The level of pain was recorded on a 10 cm line where 0 was classified as "no pain" and 10 was classified as "worst possible pain". Subjects were asked to indicate their pain level by placing a mark along this horizontal line
• Goniometer [Assessments was performed at baseline (week 0) and post intervention (week 6).]: ROM measured was used a standard universal goniometer, which is considered a valid, reliable, and widely accepted clinical tool for assessing joint angles in musculoskeletal conditions. Measurements were taken for wrist flexion, wrist extension, and elbow movements, following standardized positioning and landmark alignment to ensure consistency and accuracy.
• Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire [Assessments was performed at baseline (week 0) and post intervention (week 6).]: Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire The Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire is an instrument that has been developed specifically for use with this disorder \[16\]. It takes the form of a 15-item questionnaire, with five items addressing pain and 10 concerned with functional deficit. For each item, the respondent uses a 0- 10 numerical scale to rate the average pain or difficulty they have experienced over the previous week while carrying out various activities that are commonly painful in tennis elbow. The marking system ensures that pain and function are weighted equally in the total score. Higher scores represent greater se- verity and the maximum score is 100

Sex: All, ages: 18 Years to 60 Years

Inclusion Criteria:

* Both male and female aged between 18 to 60 years with a clinical diagnosis of lateral elbow pain lasting for≥ 6 months duration
* VAS score ≥ 4 during resisted wrist extension or grip activity

  ≥1 of the following tests being positive .
* Mill's test pain on passive wrist flexion and elbow extension
* Cozen's test pain on resisted wrist extension, elbow extended, wrist in flexion and medial deviation .
* Painful palpation at the origin of the ECRB or lateral epicondyle

Exclusion Criteria:

* History of recent fracture, dislocation, or surgery near the elbow joint in the last 3 month
* Neurological or systemic inflammatory conditions (e.g., rheumatoid arthritis)
* Current use of corticosteroid injections in the elbow region within the past 6 weeks
* Previous physiotherapy interventions for the same complaint in the last 3 months.
* Skin disorders or open wounds near the treatment area.