Comparison of Muscle Energy Technique and Oscillating Energy Manual Therapy in Chronic Lateral Epicondylitis

Lateral epicondylitis (LE) is a painful musculoskeletal condition caused by overuse. The condition is also called tennis elbow because it affects 50% of tennis players, notably beginners learning the one-handed backhand. Nonetheless, only 10% of all patients with LE play tennis. Lateral Epicondylitis (LE) or tennis elbow affects about 1-3% of general population.

Muscle energy technique was developed by osteopathic physician, Fred Mitchell, Sr. It was refined and systematized by Fred Mitchell, Jr., and has continued to evolve with contributions from many individuals.

Study Overview

• Status: Completed
• Conditions: Lateral Epicondylitis
• Intervention / Treatment: Other: muscle energy technique; Other: oscillating manual energy therapy

Detailed Description

Lateral epicondylitis (LE) is a painful musculoskeletal condition caused by overuse. The condition is also called tennis elbow because it affects 50% of tennis players, notably beginners learning the one-handed backhand. Nonetheless, only 10% of all patients with LE play tennis. Lateral Epicondylitis (LE) or tennis elbow affects about 1-3% of general population.

patients with Lateral Epicondylitis complains of pain, functional difficulty affecting activities of daily living related to wrist and forearm movements . The grip strength is affected due to voluntary decline of effort to avoid pain and due to wasting of affecting muscles seen in long standing conditions. The symptoms exacerbate with stressful activities in overuse syndromes but pain may persist even at rest as the condition progress.

Muscle energy technique was developed by osteopathic physician, Fred Mitchell, Sr. It was refined and systematized by Fred Mitchell, Jr., and has continued to evolve with contributions from many individuals. Muscle energy technique (MET) is used by practitioners from different professions and has been advocated for the treatment of shortened muscles, weakened muscles, restricted joints, and lymphatic drainage. In addition to using muscle effort to mobilize joints and tissues, MET is considered by some to be a biomechanics-based analytic diagnostic system that uses precise physical diagnosis evaluation procedures to identify and qualify articular range of motion restriction. MET are defined as a manual treatment in which a patient produces a contraction in a precisely controlled position and direction against a counterforce applied by a manual therapist. MET have been also used in asymptomatic subjects in order to increase mobility. There is varying evidence that when a joint has a functional limitation, the application of a MET can increase its Range of Motion.

A comparative study concluded that oscillating energy manual therapy and muscle energy technique had shown the improvement in Numeric Rating Scale, grip strength and PRTEE in lateral epicondylitis subjects, but more significant improvement was observed in the subjects who were treated with muscle energy technique than oscillating energy manual therapy.

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Islamabad, Punjab, Pakistan, 46000
      • National Institute of Rehabilitation Medicine,

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 25 years to 45 years (ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Presence of tenderness point on lateral epicondyle.
• Positive cozen test, mills test, Maudsley's test
• Negative Radial nerve test

Exclusion Criteria:

• Cervical spine disorder
• Peripheral neuropathy
• Fractures
• Major upper limb surgery
• Steroid injections in last 6 months
• Tumor or wound
• take any kind of physiotherapy treatment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: muscle energy technique; the subject to sit comfortably and then stabilize the subject's distal humerus with one hand, then the forearm was supinated with the therapist another hand until resistance appeared. Holding the position the subject was asked to slowly pronate the forearm that is Isometric contraction against resistance for a period of 6-10 seconds with inhale and exhale, followed by slightly increasing supination until resistance was met once again. After 5 seconds of relaxation, the procedure was repeated 5 times during a single treatment session.	Other: muscle energy technique; the subject to sit comfortably and then stabilize the subject's distal humerus with one hand, then the forearm was supinated with the therapist another hand until resistance appeared. Holding the position the subject was asked to slowly pronate the forearm that is Isometric contraction against resistance for a period of 6-10 seconds with inhale and exhale, followed by slightly increasing supination until resistance was met once again. After 5 seconds of relaxation, the procedure was repeated 5 times during a single treatment session; this technique was applied in 2 sessions for a week for 4 weeks.
EXPERIMENTAL: oscillating manual energy therapy; It is also known as V-spread .The subject was asked to sit on a chair with the affected painful arm resting on the treatment table. Tender points were palpated. Then the therapist places the index and middle fingers of one hand in a V-shape around the tender point and placed the index finger of the other hand in the medial side of the elbow, diagonally across the located tender point. Gentle pressure was applied a few times using fingertips to the tissues alternatively from the medial and lateral sides to start the oscillations. On the initiation of oscillations, the application of pressure should be stopped and allow the oscillations to continue between the two points of contact on the subject's elbow. This technique was repeated until there were no tender points on palpation. The duration varied from 30 seconds to 2 minutes.	Other: oscillating manual energy therapy; It is also known as V-spread .The subject was asked to sit on a chair with the affected painful arm resting on the treatment table. Tender points were palpated. Then the therapist places the index and middle fingers of one hand in a V-shape around the tender point and placed the index finger of the other hand in the medial side of the elbow, diagonally across the located tender point. Gentle pressure was applied a few times using fingertips to the tissues alternatively from the medial and lateral sides to start the oscillations. On the initiation of oscillations, the application of pressure should be stopped and allow the oscillations to continue between the two points of contact on the subject's elbow.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numerical rating scale	The Verbal Numerical Rating Scale is the most commonly used self-report measure of pain intensity. Patients are instructed to choose a single number from the scale that best indicates their level of pain.1-4 Mild pain,5-6 Moderate,7-10 severe. assessment to be done on baseline and after every week	four weeks
Hand dynamometer(Grip strength)	Grip strength is a measure of muscular strength or the maximum force/tension generated by one's forearm muscles. It can be used as a screening tool for the measurement of upper body strength and overall strength. Assessment to be done on baseline and after every week.	for four weeks
Patient rated tennis elbow evaluation (functional status)	The Patient-rated Tennis Elbow Evaluation (PRTEE) enables quantitative rating by the patient of pain and functional impairment associated with tennis elbow or lateral elbow tendinopathy. It takes the form of a 15-item questionnaire, with five items addressing pain and 10 concerned with functional deficit. Assessment to be done on baseline and after every week.	for four weeks

Collaborators and Investigators

• Sponsor: Riphah International University

Study record dates

Study Major Dates

• Study Start (ACTUAL): April 1, 2022
• Primary Completion (ACTUAL): August 1, 2022
• Study Completion (ACTUAL): August 5, 2022

Study Registration Dates

• First Submitted: April 25, 2022
• First Submitted That Met QC Criteria: April 25, 2022
• First Posted (ACTUAL): April 29, 2022

Study Record Updates

• Last Update Posted (ACTUAL): September 16, 2022
• Last Update Submitted That Met QC Criteria: September 15, 2022
• Last Verified: September 1, 2022

More Information

Terms related to this study

• Keywords: pain; grip strength; lateral epicondylitis; Muscle energy technique; Oscillating manual energy therapy
• Additional Relevant MeSH Terms: Wounds and Injuries; Musculoskeletal Diseases; Muscular Diseases; Tendon Injuries; Tendinopathy; Arm Injuries; Elbow Tendinopathy; Tennis Elbow
• Other Study ID Numbers: REC 01053 Huma mehrin

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No