Lateral EpicondylitisNCT07484516
Effects of Eccentric Exercises Along With Muscle Energy Technique in Lateral Epicondylitis
A study testing Eccentric exercise along with muscle energy technique, Muscle energy technique and Eccentric Exercise in people with Lateral Epicondylitis, run by Riphah International University at 1 site in Pakistan.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 20 to 50 years
- Conditions the study is for
- Lateral Epicondylitis
- What is being tested?
- Eccentric exercise along with muscle energy technique, Muscle energy technique and Eccentric Exercise
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 66 participants
- Where
- 1 sitePakistan
- Study dates
- 20 Mar 2026to 20 Jul 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 50 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- 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
- Patient's willingness in participation in this study.
Who cannot join
- Any recent history of fracture /surgery
- Acute patients
- Peripheral nerve entrapment like radial tunnel syndrome
- Cervical radiculopathy
- Instability of joint
- Corticosteroid injection within 3- 6 months
Show all 13Show fewer
- Neurological impairments
- Cardiovascular diseases
- Osteoporosis
- Local infection
- Malignancy
- Congenital /structural anomalies
- Systemic illness affecting joint function like Rheumatoid arthritis, psoriatic arthritis etc.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Jinnah Post Graduate Medical Center (Orthopedic Workshop)
Karachi, Sindh, 75510
Muhammad Amir PT, M.Phil, +92-334-316-7140, physioamirmalik@gmail.com
Saba Ramzan, MSPT*, +92-304-214-8750, ramzansaba371@gmail.com
About this study
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.
Read the detailed description
Lateral epicondylitis is one of the commonest reason of lateral elbow pain that affects 1-3% of the general population of middle-aged adults. A large population-based study of United States estimated its incidence as 3.4 cases per 1000 person annually with peak rates for 40-60 years old age group ranging between 7% and 10%.
Lateral epicondylitis (LE) or tennis elbow is simply a myotendinosis of the forearm extensor muscles that frequently associate with overuse injury due to repetitive strain by activities which impose excessive loads on common extensor tendinous origin at lateral epicondyle. Commonly this has been reported in those who engaged in activities which consist of repetitive wrist extension, radial deviation, gripping and/or forearm supination.
It leads to localized pain and tenderness at lateral epicondyle and along with the common extensor mass of the elbow making seemingly simple daily activities more difficult. This exaggerated with activities involving resisted wrist extension, middle finger extension, and forearm supination with extended elbow. The most common functional concern in LE is weak grip and restricted supination.
A vast number of physical therapy treatments such as different manual therapy techniques, exercise programs and modalities have been used. However eccentric training and manual therapy are the two most commonly used and beneficial physiotherapeutic treatment strategies.
Eccentric exercises have been suggested as first line treatment approach in conservative treatment as it improves overall function by lengthening the musculotendinous unit with low intensity load. It promotes healing and remodeling to increase collagen production and reduce pain by inhibiting pain neural pathways. Muscle energy technique (MET), a gentle manual therapy, is effective in addressing both myofascial issues and articular restrictions. It involves a patient's muscle contractions in a controlled position and direction against therapist's counterforce. Recently, international evidence supported its use in LE as a suitable intervention in this pathology and highlight its potential in reducing pain and improving grip and finger strength, and functionality in addition to home stretching and strengthening exercise.
Available literature in targeted population mainly evaluated effects of MET with other treatment techniques like corticosteroids, dry needling, movement with mobilization (MWM), friction massage etc. However, there is very limited literature available on using MET with eccentric exercise as a multimodal treatment for lateral epicondylitis which can point out whether using these two as a combination has better efficacy than alone. This manual therapy technique in combination of eccentric exercises, which has not been extensively studied in the context of lateral epicondylitis, can potentially enhance the therapeutic effects and provide new insights into the treatment and give more effective and tolerable strategy. So, the goal of this trial is to find effects of eccentric exercise along with MET as combined therapy in treating Lateral epicondylitis.
- Conditions
- Lateral Epicondylitis
- Being tested
- Eccentric exercise along with muscle energy technique, Muscle energy technique, Eccentric Exercise
- Keywords
- lateral epicondylitis, Muscle energy technique, eccentric exercise
- Medical subject headings
- Tennis Elbow
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Eccentric exercise along with muscle energy techniqueOther
For 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 techniqueOther
For 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 ExerciseOther
For 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.
| Study group | Role | What they receive |
|---|---|---|
| Group A: Eccentric exercise along with muscle energy technique | Experimental | Pulsed Ultrasound for 10 minutes, eccentric exercise and muscle energy technique for 8 sessions within 2 weeks. Receives: Other: Eccentric exercise along with muscle energy technique |
| Group B: Muscle energy technique | Experimental | Pulsed Ultrasound for 10 minutes and muscle energy technique for 8 sessions within 2 weeks. Receives: Other: Muscle energy technique |
| Group C: Eccentric exercise | Experimental | Pulsed Ultrasound for 10 minutes and eccentric exercise for 8 sessions within 2 weeks. Receives: Other: Eccentric Exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: 2nd Week
Secondary outcomes (3)
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.
Measured: 2nd Week
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.
Measured: 2nd Week
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.
Measured: 2nd Week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Mar 2026
- Study start20 Mar 2026
- Primary completion15 Jul 2026 (estimated)
- Study completion20 Jul 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Lateral EpicondylitisStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 66 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Dr. Muhammad Affan Iqbal, PT, PhD*, Principal investigator, Riphah International university, IslamabadDr. Saba Ramzan, PT, MSPT, Principal investigator, Riphah International University, Islamabad
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07484516
- Sponsor's protocol ID
- RIPHAH/FR&AHS/Letter-014373
- Status last verified
- Jul 2026
- First submitted
- 16 Mar 2026
- Last updated
- 20 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 20 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Eccentric Exercises Along With Muscle Energy Technique in Lateral Epicondylitis
- ClinicalTrials.gov ID
- NCT07484516
- Acronym / sponsor ID
- RIPHAH/FR&AHS/Letter-014373
- Conditions
- Lateral Epicondylitis
- Keywords
- lateral epicondylitis, Muscle energy technique, eccentric exercise
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 66 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 20 Mar 2026 (actual)
- Primary completion
- 15 Jul 2026 (estimated)
- Study completion
- 20 Jul 2026 (estimated)
- First posted
- 20 Mar 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
Lateral epicondylitis is one of the commonest reason of lateral elbow pain that affects 1-3% of the general population of middle-aged adults. A large population-based study of United States estimated its incidence as 3.4 cases per 1000 person annually with peak rates for 40-60 years old age group ranging between 7% and 10%.
Lateral epicondylitis (LE) or tennis elbow is simply a myotendinosis of the forearm extensor muscles that frequently associate with overuse injury due to repetitive strain by activities which impose excessive loads on common extensor tendinous origin at lateral epicondyle. Commonly this has been reported in those who engaged in activities which consist of repetitive wrist extension, radial deviation, gripping and/or forearm supination.
It leads to localized pain and tenderness at lateral epicondyle and along with the common extensor mass of the elbow making seemingly simple daily activities more difficult. This exaggerated with activities involving resisted wrist extension, middle finger extension, and forearm supination with extended elbow. The most common functional concern in LE is weak grip and restricted supination.
A vast number of physical therapy treatments such as different manual therapy techniques, exercise programs and modalities have been used. However eccentric training and manual therapy are the two most commonly used and beneficial physiotherapeutic treatment strategies.
Eccentric exercises have been suggested as first line treatment approach in conservative treatment as it improves overall function by lengthening the musculotendinous unit with low intensity load. It promotes healing and remodeling to increase collagen production and reduce pain by inhibiting pain neural pathways. Muscle energy technique (MET), a gentle manual therapy, is effective in addressing both myofascial issues and articular restrictions. It involves a patient's muscle contractions in a controlled position and direction against therapist's counterforce. Recently, international evidence supported its use in LE as a suitable intervention in this pathology and highlight its potential in reducing pain and improving grip and finger strength, and functionality in addition to home stretching and strengthening exercise.
Available literature in targeted population mainly evaluated effects of MET with other treatment techniques like corticosteroids, dry needling, movement with mobilization (MWM), friction massage etc. However, there is very limited literature available on using MET with eccentric exercise as a multimodal treatment for lateral epicondylitis which can point out whether using these two as a combination has better efficacy than alone. This manual therapy technique in combination of eccentric exercises, which has not been extensively studied in the context of lateral epicondylitis, can potentially enhance the therapeutic effects and provide new insights into the treatment and give more effective and tolerable strategy. So, the goal of this trial is to find effects of eccentric exercise along with MET as combined therapy in treating Lateral epicondylitis.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Group A: Eccentric exercise along with muscle energy technique | Experimental | Other: Eccentric exercise along with muscle energy techniquePulsed Ultrasound for 10 minutes, eccentric exercise and muscle energy technique for 8 sessions within 2 weeks. |
| Group B: Muscle energy technique | Experimental | Other: Muscle energy techniquePulsed Ultrasound for 10 minutes and muscle energy technique for 8 sessions within 2 weeks. |
| Group C: Eccentric exercise | Experimental | Other: Eccentric ExercisePulsed Ultrasound for 10 minutes and eccentric exercise for 8 sessions within 2 weeks. |
Who may qualify
- Ages
- 20 to 50 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- 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
- Patient's willingness in participation in this study.
Key exclusion criteria (13 listed)
- Any recent history of fracture /surgery
- Acute patients
- Peripheral nerve entrapment like radial tunnel syndrome
- Cervical radiculopathy
- Instability of joint
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Eccentric exercise along with muscle energy techniqueFor 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. | Other | Group A: Eccentric exercise along with muscle energy technique |
| Muscle energy techniqueFor 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. | Other | Group B: Muscle energy technique |
| Eccentric ExerciseFor 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. | Other | Group C: Eccentric exercise |
Primary outcome
Numeric Pain Rating Scale
Time frame: 2nd Week
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.
3 secondary outcomes
Patient Rated Tennis Elbow Evaluation Scale
Time frame: 2nd Week
Pain-free grip strength
Time frame: 2nd Week
Range of Motion
Time frame: 2nd Week
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Jul 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Dr. Muhammad Affan Iqbal, PT, PhD* principal investigator
Riphah International university, Islamabad
Dr. Saba Ramzan, PT, MSPT principal investigator
Riphah International University, Islamabad
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Eccentric exercise along with muscle energy technique, Muscle energy technique and Eccentric Exercise in people with Lateral Epicondylitis, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 20 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Dr. Imran Amjad, PT, PhD (03324390125, imran.amjad@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Numeric Pain Rating Scale (time frame: 2nd Week). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Jul 2026.