Muscle Energy Technique Combined With Mulligan Technique in Tennis Elbow

May 17, 2026 updated by: Aman Zahra, University of Lahore

Effectiveness of Muscle Energy Technique Combined With Mulligan Mobilization Among Patients With Lateral Epicondylitis: A Randomized Controlled Trial

This randomized controlled trial aims to evaluate the effectiveness of Muscle Energy Technique (MET) combined with Mulligan Mobilization With Movement (MWM) in patients with lateral epicondylitis (tennis elbow). The study compares the combined intervention with Mulligan technique and routine physical therapy alone. Outcomes including pain intensity, functional disability, and quality of life will be assessed using NPRS, PRTEE, and SF-8 questionnaires over a four-week treatment period.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Lateral epicondylitis, commonly known as tennis elbow, is a musculoskeletal disorder characterized by pain and reduced functional ability affecting the lateral aspect of the elbow. It commonly results from repetitive wrist extension and forearm movements leading to overuse of the extensor tendons.

Conservative physiotherapy management including manual therapy and therapeutic exercises is widely used for the treatment of lateral epicondylitis. Mulligan Mobilization With Movement (MWM) has shown beneficial effects in reducing pain and improving grip strength and functional mobility. Muscle Energy Technique (MET) is another manual therapy approach that may help improve joint mobility, muscle flexibility, and pain reduction through controlled isometric contractions.

This study aims to determine whether combining MET with Mulligan technique provides superior clinical outcomes compared to Mulligan technique alone in patients with tennis elbow.

Participants will be randomly allocated into two groups:

Experimental Group: MET + MWM + Routine Physical Therapy Control Group: MWM + Routine Physical Therapy

Treatment will be provided five sessions per week for four weeks. Outcomes will be assessed at baseline and after completion of the intervention period.

Study Type

Interventional

Enrollment (Actual)

40

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 Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan
        • University of Lahore Teaching Hospital, Lahore

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:

  • Age between 18 and 45 years
  • Both genders
  • Unilateral lateral epicondylitis
  • Diagnosed by senior physiotherapist
  • Pain duration of at least 6 weeks
  • Pain score ≥7 on NPRS/VAS
  • Positive symptoms during extensor carpi radialis brevis and longus isometric contraction

Exclusion Criteria:

  • Previous elbow or shoulder surgery
  • Manual therapy within previous 6 months
  • History of fracture, dislocation, or tendon tear
  • Steroid or pain medication use
  • Peripheral nerve entrapment
  • Cervical radiculopathy
  • Osteoporosis or metastasis involving elbow

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: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental Group (MET + MWM + Routine Physical Therapy)
Participants in this group will receive Muscle Energy Technique combined with Mulligan Mobilization With Movement along with routine physical therapy including eccentric strengthening and stretching exercises for wrist extensors.
Procedure: Muscle Energy Technique Combined With Mulligan Technique
Muscle Energy Technique will be applied using resisted isometric contractions of forearm supination and pronation. Mulligan Mobilization With Movement will be applied using sustained lateral glide during pain-free gripping activity. Treatment sessions will be conducted five times weekly for four weeks.
Active Comparator: Control Group (MWM + Routine Physical Therapy)
Participants in this group will receive Mulligan Mobilization With Movement along with routine physical therapy including eccentric strengthening and stretching exercises.
Procedure: Mulligan Mobilization With Movement
Mulligan Mobilization With Movement technique will be applied using sustained glide of the forearm while participants perform pain-free gripping activities. Sessions will be conducted five times weekly for four weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pain Intensity Measured by Numeric Pain Rating Scale (NPRS)
Time Frame: Baseline and after 4 weeks of intervention
Pain intensity will be measured using the Numeric Pain Rating Scale (NPRS), an 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain).
Baseline and after 4 weeks of intervention

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Functional Disability Measured by PRTEE Questionnaire
Time Frame: Baseline and after 4 weeks of intervention
Functional disability will be assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire.
Baseline and after 4 weeks of intervention
Quality of Life Measured by SF-8 Questionnaire
Time Frame: Baseline and after 4 weeks of intervention
Quality of life will be assessed using the Short Form-8 (SF-8) questionnaire. The SF-8 is an 8-item questionnaire that evaluates physical functioning, general health, pain, vitality, social functioning, emotional role, mental health, and physical role limitations. Higher scores indicate better quality of life.
Baseline and after 4 weeks of intervention

Collaborators and Investigators

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

Sponsor

University of Lahore

Collaborators

University of Lahore Hospital (ULH)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Actual)

September 26, 2025

Primary Completion (Actual)

October 28, 2025

Study Completion (Actual)

January 25, 2026

Study Registration Dates

First Submitted

May 17, 2026

First Submitted That Met QC Criteria

May 17, 2026

First Posted (Actual)

May 22, 2026

Study Record Updates

Last Update Posted (Actual)

May 22, 2026

Last Update Submitted That Met QC Criteria

May 17, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • UOL/IREB/25/12/0027

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared because this study was conducted as an academic research project. The informed consent obtained from participants did not include provisions for public data sharing, and the dataset contains sensitive personal health information. Data will be stored securely and used only for academic and research purposes in accordance with institutional ethics approval.

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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