The effect of a combination of Mulligan mobilisation (a manual therapy approach) and ultrasound therapy is compared with that of ultrasound therapy alone. In both cases, a progressive exercise programme followed ten sessions of therapy to improve strength and facilitate return to work. Sixty-six patients (male:female ratio 6:5, mean age 41 years) were recruited. Of these patients, 46 were randomised into two treatment groups by a random draw of chits. The remaining 20, who could not be randomised, comprised the control group, The first (MM) group was treated with a combination of ultrasound therapy and Mulligan mobilisation while the second group was treated with ultrasound therapy alone for ten sessions (completed within three weeks). Both groups then followed a progressive exercise regime for a further nine weeks. They were evaluated at weekly intervals from the time of selection until the third week and finally at the 12th week with four outcome measures: visual analogue scale (VAS), isometric grip strength, weight test and patient assessment test. In the follow-up visit after 12 weeks of therapy, there was improvement in VAS, weight test and grip strength in both the MM (p < 0.01, 0.01, 0.01) and ultrasound groups (p < 0.01, 0.05, 0.05). The MM group showed a greater improvement than both the ultrasound group and the control group on VAS (p < 0.05, 0.05); weight test (p < 0.01, 0.001) and grip strength (NS, p < 0.05). The ultrasound group was superior to the control group on VAS (p < 0.05); weight test (p < 0.01), but the difference from the control group in grip strength was not significant. The MM group showed improvement on most parameters from the first week onwards whereas the ultrasound group improved only from the second week. Also the patient assessment score improved for the MM group (p < 0.05) and for the ultrasound group improvement was significant at three weeks of therapy (p < 0.05), but the difference was not statistically significant at 12 weeks. CONCLUSION: The addition of Mulligan mobilisation to a regimen comprising ultrasound therapy and progressive exercises brings about increased and faster recovery in patients with tennis elbow.

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