Patients in Group B received Cyriax physiotherapy, which consists of 10 minutes of deep transverse friction massage immediately followed by a single application of Mill’s manipulation. The hand placement is shown in Figure 1. Deep transverse friction for tennis elbow is applied as follows [34,39]. The patient should be positioned comfortably with the elbow fully supinated and in 90◦ of flexion. After palpating the anterolateral aspect of the lateral epicondyle of humerus,the area of tenderness was mapped. Deep transverse friction is applied with the side of the thumb tip. The pressure was applied in a posterior direction on the tenoosseous junction.It was applied for ten minutes after the numbing effect has been attained, to prepare the tendon for Mill’s manipulation
[33].For the technique of Mills manipulation, patients were positioned comfortably in the seating position with the affected extremity in 90◦ of abduction with internal rotation enough so that the olecranon faced up. The therapist stabilized the patient’s wrist in full flexion and pronation with one hand, while other hand was placed over the olecranon [14].While assuming full wrist flexion and pronation position, the therapist should apply a high-velocity low-amplitude thrust at the end range of elbow extension (Figure 2).
2.4. Outcome Measures. Outcome measures used in the study includes pain intensity and functional status which were recorded at base line (pretest) and at the end of 4 weeks. An independent observer, who was blinded to the patient group 3 allocation, assessed the outcome measures. Pain intensity was measured using the visual analogue scale (VAS). The VAS consists of a 10 cm horizontal line with two ends labelled as 0 cm representing the “least pain imaginable” and 10 cm the “worst pain imaginable”. Patients were given instructions to intersect this VAS scale with a vertical line depending on their current level of pain. The VAS assessment tool has been found to be a valid and also a reliable method of measuring patients perceived pain [40, 41].Patients functional status was assessed by completion of the Tennis Elbow Function Scale (TEFS) [42]. In TEFS scale,
the patients were instructed to perform certain set of task that can be difficult in performing as a result of their problem and were informed to accordingly rate the intensity of their pain.Higher scores are indicative of greater levels of disability.
The TEFS assessment tool has been found to have high testretest reliability (ICC 0.92) and moderate construct validity(Pearson’s correlation coefficient 0.47) [42].
Patients in Group B received Cyriax physiotherapy, which consists of 10 minutes of deep transverse friction massage immediately followed by a single application of Mill’s manipulation. The hand placement is shown in Figure 1. Deep transverse friction for tennis elbow is applied as follows [34,39]. The patient should be positioned comfortably with the elbow fully supinated and in 90◦ of flexion. After palpating the anterolateral aspect of the lateral epicondyle of humerus,the area of tenderness was mapped. Deep transverse friction is applied with the side of the thumb tip. The pressure was applied in a posterior direction on the tenoosseous junction.It was applied for ten minutes after the numbing effect has been attained, to prepare the tendon for Mill’s manipulation[33].For the technique of Mills manipulation, patients were positioned comfortably in the seating position with the affected extremity in 90◦ of abduction with internal rotation enough so that the olecranon faced up. The therapist stabilized the patient’s wrist in full flexion and pronation with one hand, while other hand was placed over the olecranon [14].While assuming full wrist flexion and pronation position, the therapist should apply a high-velocity low-amplitude thrust at the end range of elbow extension (Figure 2).2.4. Outcome Measures. Outcome measures used in the study includes pain intensity and functional status which were recorded at base line (pretest) and at the end of 4 weeks. An independent observer, who was blinded to the patient group 3 allocation, assessed the outcome measures. Pain intensity was measured using the visual analogue scale (VAS). The VAS consists of a 10 cm horizontal line with two ends labelled as 0 cm representing the “least pain imaginable” and 10 cm the “worst pain imaginable”. Patients were given instructions to intersect this VAS scale with a vertical line depending on their current level of pain. The VAS assessment tool has been found to be a valid and also a reliable method of measuring patients perceived pain [40, 41].Patients functional status was assessed by completion of the Tennis Elbow Function Scale (TEFS) [42]. In TEFS scale,the patients were instructed to perform certain set of task that can be difficult in performing as a result of their problem and were informed to accordingly rate the intensity of their pain.Higher scores are indicative of greater levels of disability.
The TEFS assessment tool has been found to have high testretest reliability (ICC 0.92) and moderate construct validity(Pearson’s correlation coefficient 0.47) [42].
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