2.3.2 Physical therapy
pain
A week after the injection the participants started with the physical therapy interventions. All participants received the respective physical therapy for 3 sessions per week for 4 weeks, each session lasted for 30 to 40 minutes.All the participants underwent baseline evaluation of variables before the administration of injection. To avoid intervention bias, a fixed physical therapy protocol was prepared on the basis of recent evidence with the objectives of ameliorating pain, increasing functional activity and soft tissue healing. A holistic approach consisting of physical modalities, exercise protocols and patient education were used to obtain these objectives. Participants in active MM group underwent deep transverse friction massage (DTFM) and Mill’s manipulation. Deep transverse friction massage (DTFM) is a specific type of connective tissue massage applied precisely to the soft tissues around the elbow. It is important that the depth of friction applied is tolerable to the patient. It was applied transversely to the specific tissue involved and applied for 5 minutes. This technique is applied to prepare the structures for the manipulation.For manipulation, the participant was asked to sit comfortably with proper backrest. The treating therapist stands behind the patient and grasp the patient’s arm under the crook of the elbow with the shoulder joint abducted to 90° and medially rotated. Therefore, the patient’s forearm is pronated. Place the thumb of other hand in the web space between the patient’s thumb and index finger and fully flex the patient’s wrist and pronate the forearm. Move the hand supporting the crook of the elbow on to the posterior surface of the elbow joint and, while maintaining full wrist flexion and pronation, extend the patient’s elbow until that all the slack has been taken up in the tendon. Apply a high velocity low amplitude thrust (HVLAT) by side flexing the body away from the arms and pushing downwards with the hand over the patient’s elbow. This procedure is conducted only once at each session because it is an uncomfortable procedure for the patient [Progressive resistance exercises (PRE) and home exercises were applied to both the treatment groups. The progressive resistance exercises were prescribed to the wrist joint with Thera-band based on the assessment of individual muscles, which was shown as an appendix-A (