The Effect of Adding Deep Friction Massage to Eccentric Training Exercises in Lateral Epicondylitis

"Exercise 1: Eccentric Wrist Extension with Dumbbell~Position: Seated, elbow extended, wrist maximally extended.~Action:~Lower: Slowly flex the wrist for 30 seconds. Return: Use the opposite hand to bring wrist back to extension. Load: Increase weight based on 10 Repetition Maximum (10RM). Exercise 2: Eccentric Wrist Extension with Twist-Bar~Position: Hold Flex Bar with involved hand in extension.~Action:~Twist: Rotate the bar with the non-involved hand while keeping the involved wrist extended.~Untwist: Allow the wrist to flex slowly. Exercise 3: Eccentric Supination with Elastic Band~Position: Anchor band, elbow flexed to 90°.~Action:~Supinate: Rotate forearm with palm up. Flex: Slowly rotate to palm down, then return"

The patient will sit on a chair while holding a pillow. DFM will be performed in perpendicular direction to the Extensor carpi radialis brevis tendon the site of the application will be on the upper attachment of the common extensor origin (palpated one cm distal to the lateral epicondyle of the humerus) for 5 minutes. Using the thumb, Firm pressure will be applied to compress the extensor tendons, their origins, and the musculotendinous junctions between the underlying bone and the fingertips. This pressure will be maintained while the therapist applies DFM in the direction of their fingers,