Effects of adding sustained natural apophyseal glides on neuropathic pain-related symptoms and clinical outcomes in patients with lateral elbow tendinopathy: A randomized controlled trial

Background Cervical spine dysfunction and neural mechano-sensitivity may contribute to persistent symptoms in lateral elbow tendinopathy (LET), suggesting a potential role for cervical intervention such as sustained natural apophyseal glides (SNAGS) as an adjunct to rehabilitation.Purpose To investigate whether adding cervical SNAGS to a conventional rehabilitation program (CRP) improves neuropathic pain-related symptoms and signs, pain intensity, handgrip strength, pinch strength, and disability in individuals with LET.Methods Arandomized controlled trial was conducted on52 participantswith unilateral LET, randomlyassigned toa study grouporcontrol group. The control group received aCRP, whereas the study group received the same program plus cervical SNAGS.Both groups were treated twice weekly for 4 weeks. Outcomes includedLeeds Assessment of Neuropathic Symptoms and Signs(LANSS), handgrip strength (HGS),lateral pinch strength, fingertip pinch strength, Numeric Pain Rating Scale (NPRS) at rest and during activity, and Patient-Rated Tennis Elbow Evaluation (PRTEE). Outcomes were assessed before and after treatment.Results Both groups demonstrated significant pre-to-post improvements across all outcomes (p < .001). Between-group analysis of change scores favored the study group for LANSS (p = .049, r_rb = 0.314), HGS (p < .001, r_rb = 1.000), lateral pinch strength (p < .001, r_rb = 1.000), and PRTEE (p = .001, r_rb = 0.521). No significant between-group differences were found for fingertip pinch strength (p = .343, r_rb = 0.152), NPRS at rest (p = .089, r_rb = 0.277), or NPRS during activity (p = .067, r_rb = 0.283). Baseline-adjusted analysis favored the study group for LANSS (p = .008), HGS (p < .001), lateral pinch strength (p < .001), fingertip pinch strength (p = .001), NPRS during activity (p = .034), and PRTEE (p = .001), whereas NPRS at rest did not differ significantly between groups (p = .105).Conclusion Adding cervical SNAGS to a CRP resulted in greater short-term improvement in several clinically relevant outcomes in individuals with LET.These findings support cervical SNAGS as a useful adjunct within a multimodal rehabilitation approach for LET.Clinical Trial Registry number: Prospectively registered at ClinicalTrials.gov (NCT06271915).