Tennis Elbow (or Lateral Epicondylalgia) is one of the most common overload injuries that it is the most frequent cause of lateral elbow pain, occurring to people between 40-60 years of age. It is characterized by pain on the outside of the elbow, usually near the lateral epicondyle bone where the extensor carpi Brevis tendon attaches, aggravated by gripping or wringing activities During menopause period, declining estrogen levels can negatively impact tendon health. Estrogen plays a protective role in tendons, contributing to their strength and ability to withstand load.
None
Patients with cervical radiculopathy ,thoracic outlet syndrome ,
dysfunction in shoulder or elbow with corticosteroid injection in previous three months.
Their BMI more than 25 kg/m2.
Unrelated to any traumatic conditions
Single group
multimodal electrotherapy
Other interventionsubjects will receive multimodal approach of electrotherapy (LLLT , and IFC) with conventional physical therapy modalities in the form of (stretch and strengthen exercises ) 3 sessions every week for 6 weeks
shock wave therapy
Other interventionsubjects will receive shock wave therapy with conventional physical therapy modalities 3 sessions every week for 6 weeks.
exercise
Other interventionsubjects will receive with conventional physical therapy modalities only in the form of (stretching and strengthening therapeutic exercises ) 3 sessions every week for 6 weeks.
Visual analogue scale
The VAS consists of a 10-cm line, with the left extremity indicating ''no pain'' and the right extremity indicating ''unbearable pain.'' Participants asked to use the scale to indicate their current level of pain Higher values suggest more intense pain ,It was found that VAS provide valid and reliable assessments for the affective magnitude, as well as the sensation intensity of pain.
hand grip
Grip hand strength will be assessed by hand held dynamometer
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