1 Vol.:(0123456789) Scientific Reports | (2024) 14:16535 | https://doi.org/10.1038/s41598-024-67313-1 www.nature.com/scientificreports Effects of extracorporeal shockwave therapy versus ultrasonic therapy and deep friction massage in the management of lateral epicondylitis: a randomized clinical trial Wajida Perveen 1 , Sahreen Anwar 2 , Riaz Hashmi 3 , Misbah Amanat Ali 4 , Asim Raza 1 , Umer Ilyas 1 , Shibili Nuhmani 5 , Masood Khan 6* & Ahmad H. Alghadir 6 The study’s goal was to compare and evaluate the benefits of deep friction massage and ultrasonic therapy (US) vs extracorporeal shockwave therapy (ESWT) for people with lateral epicondylitis. This double-blind, parallel-arm randomized clinical trial was conducted after ethical approval on a sample of 80 subjects with lateral epicondylitis. Participants were enrolled based on predefined eligibility criteria. They were randomly allocated to groups A and B. Group A received ESWT, while Group B received the US combined with deep friction massage. Data was collected using the Numeric Pain Rating Score (NPRS) and Patient-rated tennis elbow evaluation questionnaire (PRTEE) at baseline, at 3rd, and at 7th week of treatment. On the basis of the normality of the data, a non-parametric test was applied to evaluate between-group and within-group differences. P value ≤ 0.05 was considered significant. There was a significant difference between groups (p < 0.001). Comparisons of PRTEE scores at 3rd week and 7th week of intervention were found significant for both groups (p < 0.001). While considering between-group comparisons based on percentile scores of PRTEE at baseline, 3rd and 7th week of intervention, in group A Median (IQR) at the baseline was 24.00 (5.00), at 3rd week, 10.00 (5.00) and 7th week was 1.50 (2.50) and in group B Median (IQR) at the baseline was 25.00 (4.00), at 3rd week 19.50 (4.50) and at 7th week was 11.50 (2.50). The results were significant in both groups (p = 0.000), but between-group analysis revealed that ESWT is more effective in patients with lateral epicondylitis. Keywords Tennis elbow, Pain, Physiotherapy, Patient-rated tennis elbow evaluation questionnaire Lateral epicondylitis is one of the common ailments in the elbow region, affecting 1–3% of the adult population every year 1 . e common presentation of epicondylitis is in the form of elbow pain caused by inflammation or degeneration of the Common extensor tendon, usually due to repeated activity. Female gender, smoking his- tory, repeated activity and ipsilateral scapulothoracic dysfunction are common associated factors 2,3 . e clinical examination, functional impairment, and positive provocation tests like Cozen’s test and Mills’s test form the OPEN 1 CMH Lahore Medical College & IOD (NUMS Rawalpindi), Lahore Cantt 54810, Pakistan. 2 Faculty of Rehabilitation Sciences, Lahore University of Biological and Applied Science, Lahore, Pakistan. 3 Department of Physical Therapy, Syed Medical Complex, Sialkot, Pakistan. 4 Department of Physical Therapy, Avicenna Medical College, Lahore, Pakistan. 5 Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. 6 Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia. * email: raomasood22@ gmail.com