Background: Lateral epicondylitis (LE) often benefits from eccentric training exercises, but combining them with deep friction massage (DFM) might enhance outcomes.
Objective: To evaluate if adding DFM to eccentric training improves pain, function, wrist extensor strength, and hand grip strength more than eccentric training alone.
Design: A triple-blinded, randomized controlled trial involving 46 participants aged 16-30 with unilateral LE. Participants will be randomly assigned to receive either eccentric training plus sham massage (Control Group) or eccentric training plus DFM (Experimental Group) over 4 weeks.
Methods: Outcomes will be measured using the Visual Analogue Scale (VAS) for pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire for function, a hand-held dynamometer for wrist extensor strength, and a grip dynamometer for hand grip strength.
Blinding: The study is triple-blinded-assessors, statisticians, and participants are unaware of group allocations.
Significance: This study aims to determine if DFM enhances the effectiveness of eccentric training in LE rehabilitation, potentially leading to improved treatment protocols.
Both gender male and female
Age from 16 to 30
Unilateral elbow pain
Body mass index ranges from 18.5 to 29.9
Any injury or disease around the shoulder, elbow and wrist on the affected side
Any b local intervention such as injection of steroids 6 month prior to the intervention
Cervical radiculopathy
History of fracture of radius, ulna and humerus with resultant deformity of the affected extremity
Parallel
Eccentric Training
Other interventionExercise 1: Eccentric Wrist Extension with Dumbbell Position: Seated, elbow extended, wrist maximally extended. Action: Lower: Slowly flex the wrist for 30 seconds. Return: Use the opposite hand to bring wrist back to extension. Load: Increase weight based on 10 Repetition Maximum (10RM). Exercise 2: Eccentric Wrist Extension with Twist-Bar Position: Hold Flex Bar with involved hand in extension. Action: Twist: Rotate the bar with the non-involved hand while keeping the involved wrist extended. Untwist: Allow the wrist to flex slowly. Exercise 3: Eccentric Supination with Elastic Band Position: Anchor band, elbow flexed to 90°. Action: Supinate: Rotate forearm with palm up. Flex: Slowly rotate to palm down, then return
Deep Friction Massage
Other interventionThe patient will sit on a chair while holding a pillow. DFM will be performed in perpendicular direction to the Extensor carpi radialis brevis tendon the site of the application will be on the upper attachment of the common extensor origin (palpated one cm distal to the lateral epicondyle of the humerus) for 5 minutes. Using the thumb, Firm pressure will be applied to compress the extensor tendons, their origins, and the musculotendinous junctions between the underlying bone and the fingertips. This pressure will be maintained while the therapist applies DFM in the direction of their fingers,
Visual Analogue Scale
is used to measure the pain which is represented from (0) grade to (10) grade, with zero means no pain and ten means intolerable pain, The subjects were asked to indicate the level of pain by placing a dash at the appropriate level on the 10 cm horizontal line
-Disability of the Arm, Shoulder and Hand questionnaire Arabic version
It is a 30-item; self-report questionnaire designed to assess the patient's health status. The items indicate the degree of difficulty in performing different physical activities (21 items), the severity of each of the symptoms of pain, activity-related pain, tingling, weakness and stiffness (5 items) and the impact of the problem on social, work, sleep and self-image (4 items). Each item has 5 response options. Scores range from 0 (no disability) to 100 (most severe disability)
Hand-held Dynamometer
for measuring wrist extensor strength, it is a sensitive, objective and affordable device
-Jamar grip dynamometer
for measuring hand grip strength, it is an accurate and quantifiable assessment tool
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