This study is intended to find the effects of Eccentric exercises along with muscle energy technique (MET) on pain, functional disability, range of motion and grip strength in Lateral Epicondylitis. For this trial, participants will be enrolled with their consent after assessing on basis of inclusion \& exclusion criteria from orthopedic workshop, Jinnah post graduate medical center Karachi. Total of 66 participants will be recruited and will be equally randomized into three groups consisting of 22 participants in each group. They would recruit into either Eccentric exercise (EE) along with MET group (group A) or MET group (group B) or EE group (group C). Participants will be allocated to intervention by sealed envelope method and will undergo a total of 8 treatment sessions within 2 weeks. Baseline assessment will carry out before treatment on 1st session and follow-up assessment on 8th session after treatment through tool named as Numeric Pain-Rating Scale (NPRS), Patient Rated Tennis Elbow Evaluation (PRTEE), Goniometer and Handheld dynamometer.
Subacute & chronic patients
Participants diagnosed with lateral epicondylitis based on
Pain local to the lateral epicondyle reproduced with palpation.
Positive Mill's test and Cozen's test and/or Maudsley's test
Any recent history of fracture /surgery
Acute patients
Peripheral nerve entrapment like radial tunnel syndrome
Cervical radiculopathy
Parallel
Eccentric exercise along with muscle energy technique
Other interventionFor Eccentric Exercise, patient be in sitting position with full elbow extension, forearm pronation, and maximum wrist extension. The patient will be asked to slowly lower the wrist with 0.5 or 1 kg weight into flexion for a count of 30. Non-affected hand will be used to return the wrist to maximum extension again. 3 sets of 10 repetitions / session and 1 minute rest/set For MET, patient's affected forearm will be stabilized with 90 degrees flexed elbow. The mobilizing hand will hold the wrist and move into the supination until resistance or discomfort is detected. Then the patient will gently pronate against resistance for 5 seconds. Then with a relaxation phase of 5 seconds the therapist will stretch gently to re-position the forearm into a new supination barrier or until resistance will be met for several seconds (20-30 sec). No. of each isometric contraction in a single session will be 5 times. Pulsed mode ultrasound therapy will be given at frequency of I MHz for 10 minutes.
Muscle energy technique
Other interventionFor MET, patient's affected forearm will be stabilized with elbow 90 degrees flexed. The mobilizing hand will hold the wrist and move into the supination until resistance or discomfort is detected. Then the patient will gently pronate against resistance for 5 seconds. Then with a relaxation phase of 5 seconds the therapist will stretch gently to re-position the forearm into a new supination barrier or until resistance will be met for several seconds (20-30 sec). No of each isometric contraction in a single session will be 5 times. Pulsed mode ultrasound therapy will be given at frequency of I MHz for 10 minutes.
Eccentric Exercise
Other interventionFor Eccentric Exercise Patient will be in sitting position with full elbow extension, forearm pronation, and maximum wrist extension. Then the patient will be asked to slowly lower wrist with 0.5 or 1 kg weight into flexion for a count of 30. Then they will use the non-affected hand to return the wrist to maximum extension again. 3 sets of 10 repetitions / session and 1 minute rest/set. Pulsed mode ultrasound therapy will be given at frequency of I MHz for 10 minutes.
Numeric Pain Rating Scale
Changes from Baseline pain values will be taken with the help of Numeric Pain Rating Scale measures level of pain. Scoring is done by selecting a point from zero to ten as the current level of pain. Zero means minimum pain and 10 denotes maximum pain.
Patient Rated Tennis Elbow Evaluation Scale
Changes from Baseline functional disability value will be taken with the help of Patient Rated Tennis Elbow Evaluation Scale. The PRTEE, a 15-item self-reported questionnaire, designed to measure patient's perceived pain and disability in Lower Extremity. It consists of 5 items on pain scale, 10 items on function scale.
Pain-free grip strength
Changes from Baseline pain-free grip strength will be measured by hand-held dynamometer (in Kg). The amount of force that a patient can generate before any pain will be measured using a handgrip dynamometer and the mean of 3 successive trials will be used.
Range of Motion
Changes from Baseline range of motion of wrist extension /flexion and forearm pronation/ supination will be taken with the help of universal goniometer.
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