An investigation of the effectiveness of a Mobilisation with Movement (MWM) technique for lateral epicondylagia on pain and function in clinical practice

INTERVENTION: Participants will be selected from a population of all patients referred to the Physiotherapy Department at Solihull Hospital with a diagnosis of lateral epicondylagia, lateral epincondylitis, tennis elbow or lateral elbow pain. In order to assess the effectiveness of the technique, a randomised controlled trial is proposed. This will involve randomly putting patients into two groups, i.e. a treatment group and a control group. All patients will receive a thorough assessment of their elbow problem and asked to answer questions which will both evaluate their suitability for inclusion or need for exclusion from the trial and provide descriptive information allowing for comparison of the characteristics of the two groups. Baseline values for pain‐free grip strength and the Patient‐Rated Forearm Evaluation Questionnaire (PRFEQ) will be collected. Both pain‐free grip strength and the PRFEQ are assessment tools which have been shown to be valid and reliable in assessing pain and function in patients with lateral epicondylagia (tennis elbow). Pain‐free grip strength will be measured using a hand grip dynamometer with a digital display. The value on the display will be read by a physiotherapy assistant in order to prevent bias by the researcher. Patients will be asked to fill out the questionnaire (PRFEQ) themselves. This is a 15‐item questionnaire which takes about 5 minutes to complete. In order to prevent bias by the researcher, the randomisation process will be carried out by reception staff at Solihull Hospital, who will select a sealed envelope from a box. In the envelopes there will be equal numbers of cards stating 'group 1' and 'group 2'. The randomisation process should maximise the likelihood of the two groups being equal, e.g. age, gender, hand dominance, duration of symptoms. Group 1 will be the treatment group. They will asked to attend the physiotherapy department twice a week for three weeks. Group 2 will be the control group. They will simply be giv CONDITION: Musculoskeletal diseases: tennis elbow ; Musculoskeletal Diseases ; Tennis elbow PRIMARY OUTCOME: Outcome measures for the study are pain‐free grip strength and the Patient‐Related Forearm Evaluation Questionnaire (PRFEQ). Each of these outcome measures has been shown to be a valid and reliable method of both pain and function. SECONDARY OUTCOME: Not provided at time of registration INCLUSION CRITERIA: 1. Patients diagnosed with chronic lateral epicondylagia (this is a clinical diagnosis based on previously established criteria, i.e. pain over the lateral side of the elbow provoked by palpitation of the lateral epicondyle region and gripping tasks, pain over the lateral epicondyle during either resisted static contraction or stretching of the forearm extensor muscles, and symptoms of greater than 6 weeks duration) 2. Both male and female patients 3. Adults, i.e. patients over 18 years old