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: A Randomized Controlled Trial

This was a randomized controlled trial done to to compare the effect of manual Cross Friction Massage and IASTM in reducing pain , range of motion and functional disability in patients with chronic lateral epicondylitis

Study Overview

• Status: Completed
• Conditions: Chronic Lateral Epicondylitis
• Intervention / Treatment: Other: Manual Cross Friction Massage (CFM); Other: Instrument-Assisted Soft Tissue Mobilization (IASTM)

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • KPK
    • Peshawar, KPK, Pakistan, 25000
      • Ibadat International University, Islamabad

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

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:

• Participants will be excluded as:

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.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Manual Cross Friction Massage (CFM); Arm Description: Patient seated , elbow flexed ~90 degree , forearm pronated , extensor tendon exposed and released. Thumb / index finger applies firm transverse pressure .	Other: Manual Cross Friction Massage (CFM); 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.
Active Comparator: Group B: Instrument-Assisted Soft Tissue Mobilization (IASTM); 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 .	Other: Instrument-Assisted Soft Tissue Mobilization (IASTM); 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Scale.	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	Assessments were performed at baseline (week 0) and post intervention (week 6).
Goniometer	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.	Assessments was performed at baseline (week 0) and post intervention (week 6).
Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire	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	Assessments was performed at baseline (week 0) and post intervention (week 6).

Collaborators and Investigators

• Sponsor: Ibadat International University, Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): January 11, 2026
• Primary Completion (Actual): June 28, 2026
• Study Completion (Actual): July 2, 2026

Study Registration Dates

• First Submitted: July 6, 2026
• First Submitted That Met QC Criteria: July 6, 2026
• First Posted (Actual): July 10, 2026

Study Record Updates

• Last Update Posted (Actual): July 10, 2026
• Last Update Submitted That Met QC Criteria: July 6, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: IIUI/RERC/ADT/2026/01/206

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