Comparison of Mulligan Mobilization with Movement and Progressive Strengthening Exercises in Patient with Lateral Epicondylitis

Main Article Content

Amman Ullah Nazir
Zulekha Nasar
Muhammad Adnan
Salman Khan
Ijaz Ul Haq
Rashid Naeem
Lal Gul Khan


Background: Lateral epicondylitis, commonly known as tennis elbow, is the most prevalent cause of elbow pain. Both Mulligan Mobilization with Movement (MWM) and Progressive Resistive Exercises (PRE) have shown effectiveness in treating lateral epicondylitis individually. This study aims to compare the effects of these two interventions to determine which is more effective in managing lateral epicondylitis.

Objective: To compare the effects of Mulligan Mobilization with Movement and Progressive Resistive Exercises in relieving pain, improving functional disability, and enhancing pain-free grip strength in patients with lateral epicondylitis.

Methods: A randomized clinical trial was conducted on 33 patients with symptomatic tennis elbow from July 2020 to January 2021 at the Bone and Joint Center and Khyaban Medical Center. Participants were randomly assigned to Group A (n=16) receiving Mulligan Mobilization with Movement and conventional physiotherapy, and Group B (n=17) receiving Progressive Resistive Exercises and conventional therapy. Patients were assessed using the Visual Analogue Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and hand dynamometer to measure pain intensity, functional status, and grip strength at baseline, after 5 sessions, 10 sessions, and at a 6-week follow-up. Data were analyzed using SPSS version 25.

Results: Both groups showed significant improvements within group analyses. Group A showed a more substantial reduction in VAS scores and PRTEE scores, with median VAS scores decreasing from 7 to 2 (p=0.001) and PRTEE scores improving from 41 to 8 (p=0.001). Group B demonstrated greater improvements in pain-free grip strength, with median values increasing significantly at all time points (p<0.05). Between-group analysis revealed that Group A had more significant improvements in VAS and PRTEE scores, while Group B had more significant improvements in pain-free grip strength.

Conclusion: Mulligan Mobilization with Movement was more effective in reducing pain and improving functional status in patients with lateral epicondylitis compared to Progressive Resistive Exercises. However, Progressive Resistive Exercises were more effective in enhancing pain-free grip strength. These findings suggest the importance of tailored treatment approaches based on individual patient needs.

Article Details

How to Cite
Nazir, A. U., Nasar, Z., Adnan, M., Khan, S., Haq, I. U., Naeem, R., & Lal Gul Khan. (2024). Comparison of Mulligan Mobilization with Movement and Progressive Strengthening Exercises in Patient with Lateral Epicondylitis. Journal of Health and Rehabilitation Research, 4(2), 1639–1643.
Author Biographies

Amman Ullah Nazir, Riphah International University Islamabad Pakistan.

Senior Lecturer Faculty of Rehabilitation and Allied Health Science, Riphah International University Islamabad, Pakistan.

Zulekha Nasar, National Health Service Foundation Trust UK.

Community Therapist, South Warwickshire, National Health Service Foundation Trust, UK.

Muhammad Adnan, City University Peshawar Pakistan.

Director/Senior Lecturer, Department of Allied Health Sciences, City University Peshawar, Pakistan.

Salman Khan, Akbar Medical Center Lahore Pakistan.

Physiotherapist, Physiotherapy Department, Akbar Medical Center Lahore, Pakistan.

Ijaz Ul Haq, Paraplegic Centre Peshawar Pakistan.

Physical Therapist, Paraplegic Centre Peshawar, Pakistan.

Rashid Naeem, Cantonment General Hospital Rawalpindi Pakistan.

HOD Physiotherapy Department, Cantonment General Hospital Rawalpindi, Pakistan.

Lal Gul Khan, Riphah International University Islamabad Pakistan.

Senior Lecturer Faculty of Rehabilitation and Allied health Science, Riphah International University Islamabad, Pakistan.


Greenberg JA. Endobutton Repair of Distal Biceps Tendon Ruptures. J Hand Surg. 2009;34(8):1541-8.

Manias P, Stasinopoulos D. A Controlled Clinical Pilot Trial to Study the Effectiveness of Ice as a Supplement to the Exercise Programme for the Management of Lateral Elbow Tendinopathy. Br J Sports Med. 2006;40(1):81-5.

Kwapisz A, Prabhakar S, Compagnoni R, Sibilska A, Randelli P. Platelet-Rich Plasma for Elbow Pathologies: A Descriptive Review of Current Literature. Curr Rev Musculoskelet Med. 2018;11(4):598-606.

Kongmalai P, Chanlalit C. Demographic Causes of Chronic Lateral Elbow Pain Along Arthroscopic Criteria. J Med Assoc Thai. 2016;99(8).

Coombes BK, Bisset L, Vicenzino B. Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. J Orthop Sports Phys Ther. 2015;45(11):938-49.

Soonsuwan W, Rangkla S. Comparison Between Effects of Radial Extracorporeal Shock Wave Therapy and Progressive Resistive Exercise in Treatments of Chronic Lateral Elbow Tendinosis. Chulalongkorn Med J. 2017;61(2):193-204.

Ahmad Z, Siddiqui N, Malik S, Abdus-Samee M, Tytherleigh-Strong G, Rushton N. Lateral Epicondylitis: A Review of Pathology and Management. Bone Joint J. 2013;95(9):1158-64.

Reyhan AC, Sindel D, Dereli EE. The Effects of Mulligan’s Mobilization With Movement Technique in Patients With Lateral Epicondylitis. J Back Musculoskelet Rehabil. 2020;33(1):1-9.

Upadhyay S, Shukla Y, Patel KK. Effects of Progressive Strengthening Exercises in Chronic Lateral Epicondylitis. Int J Health Sci Res. 2017;7(4):244-57.

Lucado AM, Dale RB, Vincent J, Day JM. Do Joint Mobilizations Assist in the Recovery of Lateral Elbow Tendinopathy? A Systematic Review and Meta-Analysis. J Hand Ther. 2019;32(2):262-76.e1.

Basak T, Pal TK, Saha MB, Agarwal S, Das T. Comparative Efficacy of Wrist Manipulation, Progressive Exercises and Both Treatments in Patients With Tennis Elbow. Int J Health Sci Res. 2018;8(4):87-94.

Amro A, Diener I, Isra’M H, Shalabi AI, Dua’I I. The Effects of Mulligan Mobilisation With Movement and Taping Techniques on Pain, Grip Strength, and Function in Patients With Lateral Epicondylitis. Hong Kong Physiother J. 2010;28(1):19-23.

Lee JH, Kim TH, Lim KB. Effects of Eccentric Control Wrist Exercises on the Pain and Functions of Tennis Elbow. J Phys Ther Sci. 2018;30(4):590-4.

Uttamchandani SR, Phansopkar P. Efficacy of PowerBall Versus Mulligan Mobilization With Movement on Pain and Function in Patients With Lateral Epicondylitis: A Randomized Clinical Trial. Cureus. 2024 Mar;16(3).

Alagaesan J, Nirmala JG. Effectiveness of Mulligan Mobilization Technique Versus Cyriax Technique for Lateral Epicondylitis: A Pilot Study. Indian Journal of Physiotherapy & Occupational Therapy. 2024 Jan 2;18.

Kamayoga ID, Adyasputri AA, Adhitya IP, Prianthara IM, Widnyana M, Utama AA, Putra IP. The potential of Mulligan mobilization with movement and blood flow restriction training for lateral epicondylitis. Physical Therapy Journal of Indonesia. 2023 Jun 2;4(1):76-9.

Eapen C, Rosita R, Sohani MS, Patel VD. A systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis. Journal of Hand Therapy. 2023 Mar 12.

Sonone SV, Patil D. Effect of Maitland and Mulligan mobilization on pain, range of motion and disability in patients with rotator cuff syndrome: a randomized clinical trial protocol. F1000Research. 2023 Aug 23;12:1027.

Ceylan İ, Büyükturan Ö, Aykanat Ö, Büyükturan B, Şaş S, Ceylan MF. The effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study. Journal of Hand Therapy. 2023 Oct 1;36(4):773-85.

Patel R, Contractor ES. To Study the Effectiveness of Cyriax Mill’s Manipulation and Deep Transverse Friction Versus Myofascial Release Technique on Pain, Grip Strength and Functional Disability in Subjects with Lateral Epicondylitis: An Experimental Study.

Jalil R, gul Khan L, Afzal MF. Effects of eccentric Tyler twist extensor-strengthening exercises in lateral epicondylitis. Journal Riphah College of Rehabilitation Sciences. 2024 Mar 31;12(1).

Pathan AF, Sharath HV. A review of physiotherapy techniques used in the treatment of tennis elbow. Cureus. 2023 Oct;15(10).