Background: Tennis elbow is defined as a painful condition affecting the tendinous tissue of the lateral condyle of the humerus leading to loss of functional efficiency of the affected upper limb. Mainly the inflammation occurs in the origin of the extensor muscles (mainly extensor carpi radialis affected more). Prevalence of the tennis elbow is approximately 1% to 3% in general population and it rises 19% to 50% among the tennis player and it is equally affected in men and women and mainly occurs in the dominant arm and increased with age peak in between the age of 30 to 50 years. Tennis elbow is diagnosed by special test such as Mill’s test or cozen’s test. Mainly the sign and symptoms including the pain, swelling, ecchymosis, increased tenderness on palpation over lateral epicondyle and reduced grip strength and functionality. Primary outcomes were pain and functionality. Secondary outcome was grip strength. In this study pain was measured by VAS, functional performance was measured by PRTEEQ and grip strength was measured by JAMAR handheld dynamometer and. In this experimental study conventional treatment was same in both groups. Additionally, Group A received the Mill’s Manipulation and Group B received the Tyler’s Twist exercises. As there is a lack of evidence available comparing the Mill’s Manipulation and Tyler’s Twist exercise for subacute and chronic tennis elbow, by conducting this study we focused over additional techniques to a conventional protocol, which could be more beneficial from clinical context.

Objective: To evaluate the effectiveness of the Mill’s Manipulation and Tyler’s Twist exercises combined with conventional treatment for improving pain by using VAS, grip strength by using hand held dynamometer and functional performance by using PRTEEQ in patients with subacute and chronic tennis elbow.

Methods: In the present experimental study, total thirty-two patients with subacute and chronic tennis elbow with age between 20-50 years were included.16 patients were included in each group. Both groups received conventional treatment, in addition group A received Mill’s manipulation and group B received Tyler’s twist exercises. Patients were evaluated pre- intervention (0 week) and post- intervention (4 week) for Pain (by means of VAS), grip strength (by means of JAMAR handheld dynamometer) and functional performance (by means of patient rated tennis elbow evaluation questionnaire (PRTEEQ) Gujarati Version). Statistical analysis was done by using SPSS 20 version. Significance level was set at p≤0.05.

Result: 32 patients were enrolled in study and randomized in group A and group B. Mean age of patients in group A was 40.25 and group B 46.68. The sample size of this study was small (n < 50). So, the Shapiro wilk test was applied to check the normality of data. Based on the normality testing of the baseline of VAS, grip strength and PRTEEQ was measured by parametric test (Independent t test). Based on results of normality of within group comparison was done by parametric test (Paired t test) and based on normality of post-pre scores, between group analysis for VAS and PRTEEQ was done by parametric test (independent t test) and between group analysis of grip strength was measured by non-parametric test (Mann Whitney U test). The result of this study states that there is improvement in VAS, grip strength and PRTEEQ after and before treatment in both groups. But there are no significant differences between both groups for VAS, grip strength and PRTEEQ after treatment.