EFFECTS OF MULLIGAN AND CYRIAX APPROACH IN PATIENTS WITH SUBACUTE LATERAL EPICONDYLITIS.
Objective: To determine and compare the effects of Deep Transverse Friction (DTF) massage and Mill’s manipulation (Cyriax) with Mobilization with movement (MWM) and Taping (Mulligan) in lateral epicondylitis patients. Material & Methods: A Randomized Control Trial (NCT03848117) was conducted in Physiotherapy Department of DHQ Hospital Bahawalnagar after the approval from the competent authority. Non-probability convenient sampling technique was used to collect sample. The n=30 sample size was randomly allocated in two groups as Group A i.e. the Cyriax group (DTF Massage & Mill’s Manipulation) and Group B i.e. the Mulligan group (Taping & MWM), with 15 participants in each group having sub acute lateral epicondylitis. Data was collected in terms of age, gender, BMI and occupation. Patient related tennis elbow evaluation (PRTEE) questionnaire was used to determine the level of pain, functional disability and hand grip strength. Patients were evaluated on 0, 1st, 2nd, 3rd, and 4th week respectively. Mann Whitney U statistics test was used for between the group analysis and Friedman with Wilcoxon signed ranks test was used for within the group analysis. The significance level was set at p<0.05. Results: The mean±SD age of subjects in Group A i.e. the Cyriax group (DTF Massage & Mill’s Manipulation) was 33.60±6.864 years and in Group B i.e. the Mulligan group(Taping & MWM) was 36.93±7.741 years. Among the study participants, Males were 19 and females were 11. A total of n=19 were male and remaining n=11 were female. MWM with taping and Mill’s manipulation with deep transverse friction massage both showed significant improvement (p<0.001) in pain, function ability and handgrip strength throughout the treatment duration. When comparing the both group regarding pain, Cyriax approach showed significant improvement after 2nd week while mulligan’s approach showed more improvement than Cyriax approach (p<0.001) in functional ability from 2ndto 3rd week. Hand grip strength in both groups did not show any significant difference (p≥0.05). Conclusion: Mobilization with movement& taping (Mulligan) and mill’s manipulation with deep transverse friction massage (Cyriax), both are effective in improving pain, functional ability and handgrip strength in lateral epicondylitis. Cyriax approach is more effective in relieving pain in lateral epicondylitis as compare to Mulligan’s approach. On the other hand, functional ability, more improve with Mulligan’s approach. But both treatments are equally effective in improving hand grip strength in lateral epicondylitis.