Mobilization With Movement Verses Cyriax Techniques Among Athletes With Lateral Epicondylitis (MWM-CYR-LE)

February 14, 2026 updated by: Mohammad Affan
This randomized controlled trial aims to compare the effectiveness of Mobilization with Movement (MWM) and Cyriax techniques in athletes diagnosed with lateral epicondylitis (tennis elbow). Lateral epicondylitis commonly causes pain, reduced grip strength, and impaired proprioception, particularly in racquet and throwing sports players. A total of 56 participants aged 25-40 years with symptoms of less than three months will be randomly assigned to either the MWM group or the Cyriax group. Both groups will receive treatment five times per week for four weeks. Outcomes including elbow proprioception (Joint Position Sense test), pain and functional disability (Patient-Rated Tennis Elbow Evaluation), and grip strength (Handheld Dynamometer) will be assessed at baseline, at 2 weeks, and at 4 weeks. The study aims to determine which treatment method provides superior improvement in pain reduction, functional recovery, and proprioceptive enhancement.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

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.

Study Type

Interventional

Enrollment (Estimated)

56

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan, 54000
        • Recruiting
        • University of Lahore Teaching Hospital, Lahore
        • Contact:
        • Contact:
        • Principal Investigator:
          • Mohammad Affan, MSPTN

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: interventional group Mobilization with Movement (MWM)
Participants in this group will receive Mobilization with Movement (MWM) techniques applied to the elbow joint along with progressive wrist extensor strengthening, proprioceptive training, and sport-specific functional exercises. Treatment will be administered five times per week for four weeks (total 16 sessions). Ice therapy may be applied post-session as needed. Standardized baseline education, stretching, and isometric exercises will be provided before the intervention phase.
Behavioral: MWM

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
Experimental: interventional group Cyriax Technique
Participants in this group will receive Cyriax techniques including deep transverse friction massage (DTFM) and Mill's manipulation, combined with progressive wrist extensor strengthening, grip exercises, proprioceptive drills, and sport-specific activities. Treatment will be delivered five times per week for four weeks (total 16 sessions). Ice therapy may be applied post-session. Standardized baseline education, stretching, and light isometric exercises will be provided prior to the intervention phase.
Behavioral: Cyriax techniques

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

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Elbow Proprioception Assessed by Joint Position Sense (JPS) Test
Time Frame: 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.
Baseline, Week 2, and Week 4

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Mohammad Affan

Investigators

  • Principal Investigator: Mohammad Affan, MSPTN, The University of Lahore, Lahore

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

February 25, 2026

Primary Completion (Estimated)

March 26, 2026

Study Completion (Estimated)

March 27, 2026

Study Registration Dates

First Submitted

February 14, 2026

First Submitted That Met QC Criteria

February 14, 2026

First Posted (Actual)

February 20, 2026

Study Record Updates

Last Update Posted (Actual)

February 20, 2026

Last Update Submitted That Met QC Criteria

February 14, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • UOL/IREB/25/15/03/24

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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