Lateral Elbow Tendinopathy (Tennis Elbow)NCT07589725
Mulligan Mobilization in Lateral Elbow Tendinopathy
A study testing Mobilization with Movement (MWM) and Exercise in people with Lateral Elbow Tendinopathy (Tennis Elbow), run by Istanbul Kent University at 1 site in Turkey (Türkiye).
Trial summary
The aim of this randomized placebo-controlled trial is to investigate the effects of Mulligan Mobilization with Movement (MWM) combined with an exercise program in individuals with lateral elbow tendinopathy. The study will compare MWM plus exercise with sham MWM plus exercise and exercise alone. Read more about this study
- Who is it for?
- Ages 18 to 60 years
- Conditions the study is for
- Lateral Elbow Tendinopathy (Tennis Elbow)
- What is being tested?
- Mobilization with Movement (MWM) and Exercise
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 45 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 Oct 2026to 1 Oct 2027
- 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 18 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Age between 18 and 60 years
- Presence of unilateral lateral elbow pain and tenderness for at least 3 months
- Diagnosis of lateral elbow tendinopathy confirmed by the following four criteria:
- Local tenderness over the lateral epicondyle
- Positive Cozen's test
- Positive Maudsley's test
- Positive Mill's stretch test
Who cannot join
- History of surgery around the elbow
- History of elbow dislocation, fracture, or extensor tendon rupture
- History of fracture of the humerus, ulna, or radius within the past year
- Receipt of any treatment for LET within the past 6 months (e.g., physiotherapy, exercise, manual therapy, dry needling, orthosis)
- Presence of cervical referred pain and/or radiculopathy (positive Spurling test)
- Signs of peripheral nerve involvement
Show all 9Show fewer
- Corticosteroid injection within the past 6 months
- History of rheumatologic disease
- Presence of cancer or tumor
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Ipek Yeldan, Professor contact
Turkey (Türkiye)1 site
Istanbul Unıversity Cerrahpasa, Faculty of Health Sciences
Istanbul
Kubra Bali, Master Science Physiotherapist, 90+5449765584, kubra.tufekci@hotmail.com
Kubra Balı, Master Science
About this study
Official title: Effects of Mulligan Mobilization With Movement Technique on Pain, Muscle Stiffness, Grip Strength, and Function in Patients With Lateral Elbow Tendinopathy
The aim of this randomized placebo-controlled trial is to investigate the effects of Mulligan Mobilization with Movement (MWM) combined with an exercise program in individuals with lateral elbow tendinopathy. The study will compare MWM plus exercise with sham MWM plus exercise and exercise alone.
A total of 45 participants will be randomly allocated to one of the three intervention groups. The study will evaluate whether adding MWM to exercise provides greater improvements in pain, physical function, muscle performance, proprioception, and biomechanical outcomes than sham mobilization or exercise alone. Assessments will be performed at baseline, 2 days after completion of the 4-week intervention, and 24 weeks after completion of the intervention.
Read the detailed description
Lateral elbow tendinopathy (LET) is a common musculoskeletal condition characterized by pain and tenderness over the lateral epicondyle, particularly during gripping and resisted wrist or finger extension. The extensor carpi radialis brevis is frequently involved. Conservative management is generally recommended as the first-line approach, with exercise and manual therapy commonly used to reduce symptoms and improve function.
Mobilization with Movement (MWM), a manual therapy technique within the Mulligan Concept, combines a sustained accessory joint glide with active movement. Previous studies have reported improvements in pain and function following MWM in individuals with LET. However, contextual and placebo-related effects associated with manual therapy may contribute to observed clinical outcomes, and the specific contribution of MWM when added to exercise remains unclear. Placebo-controlled investigations are therefore needed to better distinguish the effects of MWM from nonspecific treatment effects.
In addition to conventional clinical outcomes, alterations in proprioception and the mechanical characteristics of the involved musculature may be relevant to LET. Wrist joint position sense and mechanical properties of the extensor carpi radialis brevis, including muscle tone, stiffness, elasticity, relaxation time, and creep, may provide additional information regarding neuromuscular and mechanical changes associated with treatment. These parameters have received comparatively limited attention in previous studies of conservative management for LET.
This study is a three-arm randomized, placebo-controlled trial designed to investigate the effects of adding MWM to an exercise program in individuals with LET. Participants will be allocated to an MWM plus exercise group, a sham MWM plus exercise group, or an exercise-only group. This design will allow the effects of MWM to be examined in comparison with both a sham manual therapy intervention and exercise alone.
The study will be conducted at the Laboratory of the Department of Physiotherapy and Rehabilitation at Istanbul University-Cerrahpasa. Participants will be randomly allocated in equal proportions to the three study groups using a computer-generated randomization sequence prepared by an independent researcher. Allocation concealment will be maintained using sequentially numbered, sealed, opaque envelopes that will be opened after completion of the baseline assessment.
The intervention period will last 4 weeks. Outcomes will be assessed at baseline, 2 days after completion of the 4-week intervention, and 24 weeks after completion of the intervention. The study will evaluate clinical outcomes together with measures of muscle performance, mechanical pain sensitivity, proprioception, and muscle mechanical properties to determine both the short- and long-term effects of the interventions.
The sample size was calculated using G*Power version 3.1. A medium effect size (f = 0.25), a Type I error rate of 0.05, and statistical power of 90% were used for the calculation. Allowing for an anticipated dropout rate of 15%, a total of 45 participants are planned to be included.
- Being tested
- Mobilization with Movement (MWM), Sham Mobilization with Movement (Sham MWM), Exercise
- Keywords
- mulligan mobilization, lateral elbow tendinopathy, placebo, exercise
- Medical subject headings
- Tennis Elbow, Motor Activity
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mobilization with Movement (MWM)Other
MWM is a manual therapy technique in which a therapist applies a sustained lateral glide to the radial head using a belt while the patient performs active gripping movements. The intervention is designed to restore pain-free movement by combining joint mobilization with functional activity.
Sham Mobilization with Movement (Sham MWM)Other
Sham MWM involves positioning the Mulligan belt in the same manner as the active intervention; however, no therapeutic joint mobilization force is applied. Participants perform active gripping movements while receiving a non-therapeutic simulation of mobilization.
ExerciseOther
The exercise program targets the extensor carpi radialis brevis muscle and includes isometric, concentric, and eccentric strengthening exercises. Exercises are performed in a structured manner and progressed according to a pain-monitoring model allowing mild tolerable pain.
| Study group | Role | What they receive |
|---|---|---|
| MWM + Exercise Group | Experimental | Participants will receive Mulligan Mobilization with Movement combined with a structured exercise program targeting the extensor muscles. Receives: Other: Mobilization with Movement (MWM); Other: Exercise |
| Sham MWM + Exercise Group | Sham comparator | Participants will receive sham Mulligan Mobilization combined with the same structured exercise program targeting the extensor muscles. Receives: Other: Sham Mobilization with Movement (Sham MWM); Other: Exercise |
| Exercise Group | Experimental | Participants will receive only a structured exercise program targeting the extensor muscles without any manual therapy intervention. Receives: Other: Exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain Intensity
Pain intensity was assessed using an 11-point Numeric Pain Rating Scale (NPRS), ranging from 0 (no pain) to 10 (worst imaginable pain), with higher scores indicating greater pain intensity.
Measured: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Secondary outcomes (9)
Pressure Pain Threshold
Pressure pain threshold was assessed using a pressure algometer. Pressure was gradually increased over the assessment site until the participant first reported that the sensation of pressure became painful. Higher values indicate a higher pressure pain threshold and lower pain sensitivity.
Measured: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Maximum Grip Strength
Maximum grip strength was assessed using a hand dynamometer. Participants were instructed to squeeze the dynamometer as strongly as possible, and the maximum force generated was recorded. Higher values indicate greater grip strength.
Measured: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Pain-free Grip Strength
Pain-free grip strength was assessed using a hand dynamometer. Participants were instructed to gradually increase their grip force and stop when pain was first experienced. The maximum force produced without pain was recorded. Higher values indicate greater pain-free grip strength.
Measured: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Functionality
Pain and functional disability were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE). The total score ranges from 0 to 100, with 0 indicating no pain or disability and 100 indicating the greatest pain and functional disability. Higher scores indicate a worse outcome.
Measured: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Kinesiophobia
Kinesiophobia was assessed using the 17-item Tampa Scale for Kinesiophobia (TSK-17). Total scores range from 17 to 68, with higher scores indicating greater fear of movement or reinjury and therefore a worse outcome.
Measured: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Mechanical Properties of the Extensor Carpi Radialis Brevis Muscle
Mechanical properties of the extensor carpi radialis brevis muscle were assessed non-invasively using the MyotonPRO device. The device provides quantitative measurements of muscle mechanical properties, including muscle tone, stiffness, elasticity, relaxation time, and creep.
Measured: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Wrist Joint Position Sense
Wrist joint position sense was assessed using a digital goniometer. Participants were asked to actively reproduce a predetermined target wrist position without visual feedback. The absolute difference between the target angle and the reproduced angle was recorded in degrees as the joint position error. Lower error values indicate better wrist joint position sense.
Measured: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Upper Extremity Movement Strategy During Maximum Voluntary Grip
Upper extremity movement strategies during maximum voluntary grip will be assessed using two-dimensional video analysis with Kinovea software. Shoulder flexion, shoulder abduction, elbow flexion, and wrist extension angles will be measured during a 5-second maximum voluntary grip performed with a Jamar hand dynamometer. For each joint, the angular change from the initial position to the maximum angle reached during gripping will be calculated in degrees (Δ angle = maximum angle - initial angle). Greater angular changes indicate greater use of the corresponding movement strategy during maximum voluntary grip.
Measured: Baseline, 2 days after completion of the 4-week intervention, and 24 weeks after completion of the intervention
Isometric Wrist Extensor Muscle Strength
Isometric wrist extensor muscle strength will be assessed using a Lafayette handheld digital dynamometer during maximum voluntary isometric contraction. Participants will perform wrist extension against the stationary dynamometer using a make-test procedure. Three 5-second maximal contractions will be performed, and the mean of the three measurements will be used for analysis. Higher values indicate greater wrist extensor muscle strength.
Measured: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 May 2026
- Study start1 Oct 2026 (estimated)
- Primary completion15 May 2027 (estimated)
- Study completion1 Oct 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (18)Papers the sponsor has linked to this study.
- Other trials for Lateral Elbow Tendinopathy (Tennis Elbow)Studies of the same condition, open and under way.
- 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
- Model description
- Three-arm randomized placebo-controlled trial
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 45 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Istanbul Kent University
- Sponsor type
- University, hospital or other
- Collaborators
- Istanbul University - Cerrahpasa
- Responsible party
- Principal investigator, KubraBali, Istanbul Kent University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07589725
- Sponsor's protocol ID
- E-83460662-050.04-1627561
- Status last verified
- Aug 2026
- First submitted
- 11 May 2026
- Last updated
- 19 Aug 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Hing W, Bigelow R, Bremner T. Mulligan's mobilization with movement: A systematic review. J Man Manip Ther. 2009;17(2). doi:10.1179/jmt.2009.17.2.39e
Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018 Feb 2;15(1):107-110. doi: 10.1016/j.jor.2018.01.040. eCollection 2018 Mar.
PubMed 29657450Wallis JA, Bourne AM, Jessup RL, Johnston RV, Frydman A, Cyril S, Buchbinder R. Manual therapy and exercise for lateral elbow pain. Cochrane Database Syst Rev. 2024 May 28;5(5):CD013042. doi: 10.1002/14651858.CD013042.pub2.
PubMed 38802121Bisset L, Coombes B, Vicenzino B. Tennis elbow. BMJ Clin Evid. 2011 Jun 27;2011:1117.
PubMed 21708051Sanders TL Jr, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015 May;43(5):1066-71. doi: 10.1177/0363546514568087. Epub 2015 Feb 5.
PubMed 25656546Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Occupation and epicondylitis: a population-based study. Rheumatology (Oxford). 2012 Feb;51(2):305-10. doi: 10.1093/rheumatology/ker228. Epub 2011 Oct 22.
PubMed 22019808Martinez-Cervera FV, Olteanu TE, Gil-Martinez A, Diaz-Pulido B, Ferrer-Pena R. Influence of expectations plus mobilization with movement in patient with lateral epicondylalgia: a pilot randomized controlled trial. J Exerc Rehabil. 2017 Feb 28;13(1):101-109. doi: 10.12965/jer.1732848.424. eCollection 2017 Feb.
PubMed 28349041Zhu B, You Y, Xiang X, Wang L, Qiu L. Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography. Quant Imaging Med Surg. 2020 Jan;10(1):211-219. doi: 10.21037/qims.2019.10.07.
PubMed 31956543Sevik Kacmaz K, Unver B. Immediate Effects of Mulligan Mobilization on Elbow Proprioception in Healthy Individuals: A Randomized Placebo-Controlled Single-Blind Study. J Manipulative Physiol Ther. 2023 Jan;46(1):59-64. doi: 10.1016/j.jmpt.2023.05.001. Epub 2023 Jul 7.
PubMed 37422752Bialosky JE, Bishop MD, Penza CW. Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing? J Orthop Sports Phys Ther. 2017 May;47(5):301-304. doi: 10.2519/jospt.2017.0604.
PubMed 28459190Syed AU, Darain H, Rana M. The effects of the addition of Mulligan mobilization with movement to exercise on elbow pain and function associated with lateral elbow tendinopathy. J Bodyw Mov Ther. 2024 Oct;40:872-879. doi: 10.1016/j.jbmt.2024.06.007. Epub 2024 Jun 13.
PubMed 39593689Reyhan 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):99-107. doi: 10.3233/BMR-181135.
PubMed 31104005Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan's mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis between 2008-2017. Physiotherapy. 2019 Mar;105(1):1-9. doi: 10.1016/j.physio.2018.10.001. Epub 2018 Oct 15.
PubMed 30630623Lucado 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 Apr-Jun;32(2):262-276.e1. doi: 10.1016/j.jht.2018.01.010. Epub 2018 Apr 26.
PubMed 29705077Coombes BK, Connelly L, Bisset L, Vicenzino B. Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial. Br J Sports Med. 2016 Nov;50(22):1400-1405. doi: 10.1136/bjsports-2015-094729. Epub 2015 Jun 2.
PubMed 26036675
Study at a glance
From the registry record, last updated by the sponsor on 19 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Mulligan Mobilization With Movement Technique on Pain, Muscle Stiffness, Grip Strength, and Function in Patients With Lateral Elbow Tendinopathy
- ClinicalTrials.gov ID
- NCT07589725
- Acronym / sponsor ID
- E-83460662-050.04-1627561
- Keywords
- mulligan mobilization, lateral elbow tendinopathy, placebo, exercise
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 45 participants (estimated)
- Lead sponsor
- Istanbul Kent UniversityUniversity, hospital or other
- Collaborators
- Istanbul University - Cerrahpasa
- Study start
- 1 Oct 2026 (estimated)
- Primary completion
- 15 May 2027 (estimated)
- Study completion
- 1 Oct 2027 (estimated)
- First posted
- 15 May 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.
The aim of this randomized placebo-controlled trial is to investigate the effects of Mulligan Mobilization with Movement (MWM) combined with an exercise program in individuals with lateral elbow tendinopathy. The study will compare MWM plus exercise with sham MWM plus exercise and exercise alone.
A total of 45 participants will be randomly allocated to one of the three intervention groups. The study will evaluate whether adding MWM to exercise provides greater improvements in pain, physical function, muscle performance, proprioception, and biomechanical outcomes than sham mobilization or exercise alone. Assessments will be performed at baseline, 2 days after completion of the 4-week intervention, and 24 weeks after completion of the intervention.
Detailed description
Lateral elbow tendinopathy (LET) is a common musculoskeletal condition characterized by pain and tenderness over the lateral epicondyle, particularly during gripping and resisted wrist or finger extension. The extensor carpi radialis brevis is frequently involved. Conservative management is generally recommended as the first-line approach, with exercise and manual therapy commonly used to reduce symptoms and improve function.
Mobilization with Movement (MWM), a manual therapy technique within the Mulligan Concept, combines a sustained accessory joint glide with active movement. Previous studies have reported improvements in pain and function following MWM in individuals with LET. However, contextual and placebo-related effects associated with manual therapy may contribute to observed clinical outcomes, and the specific contribution of MWM when added to exercise remains unclear. Placebo-controlled investigations are therefore needed to better distinguish the effects of MWM from nonspecific treatment effects.
In addition to conventional clinical outcomes, alterations in proprioception and the mechanical characteristics of the involved musculature may be relevant to LET. Wrist joint position sense and mechanical properties of the extensor carpi radialis brevis, including muscle tone, stiffness, elasticity, relaxation time, and creep, may provide additional information regarding neuromuscular and mechanical changes associated with treatment. These parameters have received comparatively limited attention in previous studies of conservative management for LET.
This study is a three-arm randomized, placebo-controlled trial designed to investigate the effects of adding MWM to an exercise program in individuals with LET. Participants will be allocated to an MWM plus exercise group, a sham MWM plus exercise group, or an exercise-only group. This design will allow the effects of MWM to be examined in comparison with both a sham manual therapy intervention and exercise alone.
The study will be conducted at the Laboratory of the Department of Physiotherapy and Rehabilitation at Istanbul University-Cerrahpasa. Participants will be randomly allocated in equal proportions to the three study groups using a computer-generated randomization sequence prepared by an independent researcher. Allocation concealment will be maintained using sequentially numbered, sealed, opaque envelopes that will be opened after completion of the baseline assessment.
The intervention period will last 4 weeks. Outcomes will be assessed at baseline, 2 days after completion of the 4-week intervention, and 24 weeks after completion of the intervention. The study will evaluate clinical outcomes together with measures of muscle performance, mechanical pain sensitivity, proprioception, and muscle mechanical properties to determine both the short- and long-term effects of the interventions.
The sample size was calculated using G*Power version 3.1. A medium effect size (f = 0.25), a Type I error rate of 0.05, and statistical power of 90% were used for the calculation. Allowing for an anticipated dropout rate of 15%, a total of 45 participants are planned to be included.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 3
- Model description
- Three-arm randomized placebo-controlled trial
| Arm | Type | Receives |
|---|---|---|
| MWM + Exercise Group | Experimental | Other: Mobilization with Movement (MWM), Other: ExerciseParticipants will receive Mulligan Mobilization with Movement combined with a structured exercise program targeting the extensor muscles. |
| Sham MWM + Exercise Group | Sham comparator | Other: Sham Mobilization with Movement (Sham MWM), Other: ExerciseParticipants will receive sham Mulligan Mobilization combined with the same structured exercise program targeting the extensor muscles. |
| Exercise Group | Experimental | Other: ExerciseParticipants will receive only a structured exercise program targeting the extensor muscles without any manual therapy intervention. |
Who may qualify
- Ages
- 18 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (7 listed)
- Age between 18 and 60 years
- Presence of unilateral lateral elbow pain and tenderness for at least 3 months
- Diagnosis of lateral elbow tendinopathy confirmed by the following four criteria:
- Local tenderness over the lateral epicondyle
- Positive Cozen's test
Key exclusion criteria (9 listed)
- History of surgery around the elbow
- History of elbow dislocation, fracture, or extensor tendon rupture
- History of fracture of the humerus, ulna, or radius within the past year
- Receipt of any treatment for LET within the past 6 months (e.g., physiotherapy, exercise, manual therapy, dry needling, orthosis)
- Presence of cervical referred pain and/or radiculopathy (positive Spurling test)
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 |
|---|---|---|
| Mobilization with Movement (MWM)MWM is a manual therapy technique in which a therapist applies a sustained lateral glide to the radial head using a belt while the patient performs active gripping movements. The intervention is designed to restore pain-free movement by combining joint mobilization with functional activity. | Other | MWM + Exercise Group |
| Sham Mobilization with Movement (Sham MWM)Sham MWM involves positioning the Mulligan belt in the same manner as the active intervention; however, no therapeutic joint mobilization force is applied. Participants perform active gripping movements while receiving a non-therapeutic simulation of mobilization. | Other | Sham MWM + Exercise Group |
| ExerciseThe exercise program targets the extensor carpi radialis brevis muscle and includes isometric, concentric, and eccentric strengthening exercises. Exercises are performed in a structured manner and progressed according to a pain-monitoring model allowing mild tolerable pain. | Other | Exercise Group, MWM + Exercise Group, Sham MWM + Exercise Group |
Primary outcome
Pain Intensity
Time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Pain intensity was assessed using an 11-point Numeric Pain Rating Scale (NPRS), ranging from 0 (no pain) to 10 (worst imaginable pain), with higher scores indicating greater pain intensity.
9 secondary outcomes
Pressure Pain Threshold
Time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Maximum Grip Strength
Time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Pain-free Grip Strength
Time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Functionality
Time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Kinesiophobia
Time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Mechanical Properties of the Extensor Carpi Radialis Brevis Muscle
Time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Wrist Joint Position Sense
Time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.
Upper Extremity Movement Strategy During Maximum Voluntary Grip
Time frame: Baseline, 2 days after completion of the 4-week intervention, and 24 weeks after completion of the intervention
Isometric Wrist Extensor Muscle Strength
Time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention
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 19 Aug 2026.
- BackgroundHing W, Bigelow R, Bremner T. Mulligan's mobilization with movement: A systematic review. J Man Manip Ther. 2009;17(2). doi:10.1179/jmt.2009.17.2.39e
- Background: PubMed 29657450Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018 Feb 2;15(1):107-110. doi: 10.1016/j.jor.2018.01.040. eCollection 2018 Mar.
- Background: PubMed 38802121Wallis JA, Bourne AM, Jessup RL, Johnston RV, Frydman A, Cyril S, Buchbinder R. Manual therapy and exercise for lateral elbow pain. Cochrane Database Syst Rev. 2024 May 28;5(5):CD013042. doi: 10.1002/14651858.CD013042.pub2.
- Background: PubMed 21708051Bisset L, Coombes B, Vicenzino B. Tennis elbow. BMJ Clin Evid. 2011 Jun 27;2011:1117.
- Background: PubMed 25656546Sanders TL Jr, Maradit Kremers H, Bryan AJ, Ransom JE, Smith J, Morrey BF. The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015 May;43(5):1066-71. doi: 10.1177/0363546514568087. Epub 2015 Feb 5.
- Background: PubMed 22019808Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Occupation and epicondylitis: a population-based study. Rheumatology (Oxford). 2012 Feb;51(2):305-10. doi: 10.1093/rheumatology/ker228. Epub 2011 Oct 22.
- Background: PubMed 28349041Martinez-Cervera FV, Olteanu TE, Gil-Martinez A, Diaz-Pulido B, Ferrer-Pena R. Influence of expectations plus mobilization with movement in patient with lateral epicondylalgia: a pilot randomized controlled trial. J Exerc Rehabil. 2017 Feb 28;13(1):101-109. doi: 10.12965/jer.1732848.424. eCollection 2017 Feb.
- Background: PubMed 31956543Zhu B, You Y, Xiang X, Wang L, Qiu L. Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography. Quant Imaging Med Surg. 2020 Jan;10(1):211-219. doi: 10.21037/qims.2019.10.07.
- Background: PubMed 37422752Sevik Kacmaz K, Unver B. Immediate Effects of Mulligan Mobilization on Elbow Proprioception in Healthy Individuals: A Randomized Placebo-Controlled Single-Blind Study. J Manipulative Physiol Ther. 2023 Jan;46(1):59-64. doi: 10.1016/j.jmpt.2023.05.001. Epub 2023 Jul 7.
- Background: PubMed 28459190Bialosky JE, Bishop MD, Penza CW. Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing? J Orthop Sports Phys Ther. 2017 May;47(5):301-304. doi: 10.2519/jospt.2017.0604.
- Background: PubMed 39593689Syed AU, Darain H, Rana M. The effects of the addition of Mulligan mobilization with movement to exercise on elbow pain and function associated with lateral elbow tendinopathy. J Bodyw Mov Ther. 2024 Oct;40:872-879. doi: 10.1016/j.jbmt.2024.06.007. Epub 2024 Jun 13.
- Background: PubMed 31104005Reyhan 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):99-107. doi: 10.3233/BMR-181135.
- Individual participant dataSharing planned: No
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Lateral Epicondylitis
Not yet recruiting
Comparing Surgical and Nonsurgical Outcomes of Tennis Elbow
Lateral Epicondylitis
Not yet recruiting
Comparative Effectiveness of Ultrasound-Guided Tenoxicam and Corticosteroid Injections for Lateral Epicondylitis
Lateral Epicondylitis
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.
Ipek Yeldan, Professor contact
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mobilization with Movement (MWM) and Exercise in people with Lateral Elbow Tendinopathy (Tennis Elbow), run by Istanbul Kent University at 1 site in Turkey (Türkiye).
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 7 inclusion and 9 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: opening soon, as of the sponsor's last update on 19 Aug 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 Turkey (Türkiye). 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. Some participants in this study may receive a placebo. 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 Kubra Bali, Master Science (90+5449765584, kubra.tufekci@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain Intensity (time frame: Baseline, 2 days after completion of the 4-week intervention, 12 weeks after completion of the intervention, and 24 weeks after completion of the intervention.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07589725, which also lists 18 linked publications.
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 19 Aug 2026.