Pan African Clinical Trials Registry
South African Medical Research Council, South African Cochrane Centre
PO Box 19070, Tygerberg, 7505, South Africa
Telephone: +27 21 938 0506 / +27 21 938 0834 Fax: +27 21 938 0836
Email: pactradmin@mrc.ac.za Website: pactr.samrc.ac.za
Trial no.: PACTR202602776509124 Date of Registration: 26/02/2026
Trial Status: Retrospective registration - This trial was registered after enrolment of the first participant
TRIAL DESCRIPTION
Public title Isokinetic Strength Training to Improve Elbow Pain and Arm Function in Swimmers with Long‑Standing Tennis Elbow
Official scientific title Efficacy of Eccentric Isokinetic Training in Chronic Lateral Epicondylitis: A Randomized Controlled Trial in Swimmers
Brief summary describing the background and objectives of the trial Background: Chronic lateral epicondylitis is a common overuse tendinopathy in swimmers, caused by repetitive upper‑limb loading and stroke‑related asymmetries. Evidence suggests that eccentric strengthening promotes tendon remodeling and improves neuromuscular function, yet its effects in swimming populations remain under-investigated. Summary of the study: This randomized controlled trial compared eccentric isokinetic training (Controlled Active Motion) with passive isokinetic motion (Continuous Passive Motion) over a 6‑week supervised intervention in female Masters swimmers with chronic lateral epicondylitis. Twenty‑five participants completed the intervention. Neuromuscular outcomes, bilateral strength profiles, functional performance (push‑ups and medicine‑ball tests), and elbow range of motion were evaluated pre‑ and post‑intervention.
Type of trial RCT
Acronym (If the trial has an acronym then please provide)
Disease(s) or condition(s) being studied Musculoskeletal Diseases,Orthopaedics
Sub-Disease(s) or condition(s) being studied
Purpose of the trial Rehabilitation
Anticipated trial start date 07/04/2025
Actual trial start date 12/04/2025
Anticipated date of last follow up 10/06/2025
Actual Last follow-up date 18/06/2025
Anticipated target sample size (number of participants) 30
Actual target sample size (number of participants) 25
Recruitment status Completed
Publication URL
Secondary Ids Issuing authority/Trial register
STUDY DESIGN
Intervention assignment Allocation to intervention If randomised, describe how the allocation sequence was generated Describe how the allocation sequence/code was concealed from the person allocating the participants to the intervention arms Masking If masking / blinding was used
Parallel: different groups receive different interventions at same time during study Randomised Simple randomization using a randomization table created by a computer software program Sealed opaque envelopes Masking/blinding used Outcome Assessors
INTERVENTIONS
Intervention type Intervention name Dose Duration Intervention description Group size Nature of control
Experimental Group Eccentric Isokinetic Strengthening Three sessions per week, 1–12 sets × 5 repetitions per session, and progressive loading at 60°/s angular speed. 6 weeks (18 supervised sessions). Participants performed maximal voluntary eccentric contractions of elbow flexors and extensors using an isokinetic dynamometer in Controlled Active Active Motion mode. Training progressed from 1 set of 5 reps to 12 sets of 5 reps per session by week 4, maintained through week 6. Each session included a standardized warm-up and cool-down. 13
Control Group Passive Motion Protocol Three sessions per week, matching the experimental group volume (1–12 sets × 5 repetitions per session) at 60°/s angular velocity. 6 weeks (18 supervised sessions) Participants performed assisted elbow flexion and extension using an isokinetic dynamometer in Continuous Passive Motion mode, with submaximal effort. Volume progression mirrored the experimental group. Warm-up and cool-down were identical to the experimental protocol. 12 Active-Treatment of Control Group
ELIGIBILITY CRITERIA
List inclusion criteria List exclusion criteria Age Category Minimum age Maximum age Gender
Female Masters swimmers, aged 40–50 years Chronic lateral epicondylitis > 3 months Active competitive training Elbow pain during swimming ≥ 30 days Minimum 3 years of competitive experience Recent musculoskeletal injury (<3 months) Neurological disorders (supinator syndrome, cervical radiculopathy, etc.) Inflammatory diseases Fibromyalgia Ongoing physiotherapy for upper limb conditions Withdrawal if >2 consecutive absences or clinically significant pain exacerbation Adult: 19 Year-44 Year,Middle Aged: 45 Year(s)-64 Year(s) 40 Year(s) 50 Year(s) Female
ETHICS APPROVAL
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
Yes 11/12/2024 Institutional Review Board HighInstitute of Sport and Physical Education of Kef University of Jendouba
Ethics Committee Address
Street address City Postal code Country
University Campus of Boulifa Le Kef 7100 Tunisia
OUTCOMES
Type of outcome Outcome Timepoint(s) at which outcome measured
Primary Outcome Bilateral concentric peak torque of elbow extensors and flexors (Nm) was measured at 60°/s using an isokinetic dynamometer. Baseline - pre-intervention, and after 6 weeks of training -post-intervention.
Secondary Outcome Push-up performance—number of repetitions, Seated Medicine Ball Chest Push Test—distance in meters, Elbow joint range of motion—flexion and extension in degrees Baseline and post-intervention - 6 weeks
RECRUITMENT CENTRES
Name of recruitment centre Street address City Postal code Country
High Institute of Sport and Physical Education of Kef University Campus of Boulifa Le Kef 7100 Tunisia
FUNDING SOURCES
Name of source Street address City Postal code Country
Dr. Wissem Dhahbi University Campus of Boulifa Le Kef 7100 Tunisia
SPONSORS
Sponsor level Name Street address City Postal code Country Nature of sponsor
Primary Sponsor Research Unit Sport Sciences Health and Movement High Institute of Sport and Physical Education of Kef University of Jendouba University campus of Boulifa Le Kef Le Kef 7100 Tunisia University
COLLABORATORS
Name Street address City Postal code Country
CONTACT PEOPLE
Role Name Email Phone Street address
Principal Investigator Wissem Dhahbi wissem.dhahbi@gmail.com +97450447321 University Campus of Boulifa
City Postal code Country Position/Affiliation
Le Kef 7100 Tunisia Assistant Professor. High Institute of Sport and Physical Education of Kef. University of Jendouba
Role Name Email Phone Street address
Scientific Enquiries Nadhir Hammami nadhir.hammami@issepkef.u-jendouba.tn +21625221263 University Campus of Boulifa
City Postal code Country Position/Affiliation
Le Kef 7100 Tunisia Head of Department. Associate Professor. High Institute of Sport and Physical Education of Kef. University of Jendouba
Role Name Email Phone Street address
Public Enquiries Nejmeddine Ouerghi najm_ouerghi@hotmail.com +21625300232 University Campus of Boulifa
City Postal code Country Position/Affiliation
Le Kef 7100 Tunisia Assistant Professor. Section Head in Department. High Institute of Sport and Physical Education of Kef. University of Jendouba
REPORTING
Share IPD Description Additional Document Types Sharing Time Frame Key Access Criteria
Yes Anonymized individual participant data (IPD), including baseline characteristics, adherence to the intervention, and outcome measures (elbow strength, functional performance, and range of motion), will be available upon reasonable request for research purposes. Informed Consent Form,Statistical Analysis Plan,Study Protocol IPD will be available starting 6 months after publication of primary results and for a period of 24 months following study completion. Researchers must submit a formal request specifying the intended use of the data. Access will be granted to proposals that are scientifically rigorous and comply with ethical standards. Applicants must sign a data use agreement guaranteeing confidentiality and non-commercial use of the data. Approval will be subject to review by the principal investigator and the institutional ethics committee.
URL Results Available Results Summary Result Posting Date First Journal Publication Date
No
Result Upload 1: Result Upload 2: Result Upload 3: Result Upload 4: Result Upload 5:
Result URL Hyperlinks Link To Protocol
Result URL Hyperlinks
Changes to trial information
Section Name Field Name Date Reason Old Value Updated Value
Trial Information Trial description 12/02/2026 Add a brief background as requested by the reviewer This study evaluated whether an isokinetic eccentric strengthening program (Controlled Active Motion mode—CAM) produces greater improvements in neuromuscular function, limb symmetry, and upper‑limb performance compared with a passive motion protocol (Continuous Passive Motion—CPM) in female Masters swimmers suffering from chronic lateral epicondylitis. The main objective was to determine which modality provides superior outcomes in concentric bilateral peak torque, muscular endurance, explosive power, and joint mobility This study evaluated whether an isokinetic eccentric strengthening program (Controlled Active Motion mode—CAM) produces greater improvements in neuromuscular function, limb symmetry, and upper‑limb performance compared with a passive motion protocol (Continuous Passive Motion—CPM) in female Masters swimmers suffering from chronic lateral epicondylitis. The main objective was to determine which modality provides superior outcomes in concentric bilateral peak torque, muscular endurance, explosive power, and joint mobility. Background and Objectives: This study investigated the efficacy of eccentric isokinetic muscle strengthening versus passive motion protocols on neuromuscular function and perfor-mance capacity in female swimmers with chronic lateral epicondylitis. Materials and Methods: Twenty-five swimmers (age 46.1±3.1 yrs) with lateral epicondylitis exceeding three months’ duration completed a randomized controlled trial comparing eccentric training in Controlled Active Motion mode (experimental group (EG), n=13) against pas-sive motion in Continuous Passive Motion mode (control group (CG), n=12). Both groups performed 18 supervised sessions over six weeks (60°/s angular velocity, progressive loading 1-12 sets × 5 repetitions). Bilateral concentric peak torque of elbow extensors and flexors constituted the primary outcomes. Secondary measures included push-up perfor-mance, explosive power assessed by the Seated Medicine Ball Chest Push Test, and goni-ometric range of motion. Linear mixed-effects models and analysis of covariance with baseline adjustment were employed.
Section Name Field Name Date Reason Old Value Updated Value
Trial Information Trial description 12/02/2026 As requested by the Trail reviewers : "Under the summary, please also provide a brief background about your study and not only how it is conducted" This study evaluated whether an isokinetic eccentric strengthening program (Controlled Active Motion mode—CAM) produces greater improvements in neuromuscular function, limb symmetry, and upper‑limb performance compared with a passive motion protocol (Continuous Passive Motion—CPM) in female Masters swimmers suffering from chronic lateral epicondylitis. The main objective was to determine which modality provides superior outcomes in concentric bilateral peak torque, muscular endurance, explosive power, and joint mobility. Background and Objectives: This study investigated the efficacy of eccentric isokinetic muscle strengthening versus passive motion protocols on neuromuscular function and perfor-mance capacity in female swimmers with chronic lateral epicondylitis. Materials and Methods: Twenty-five swimmers (age 46.1±3.1 yrs) with lateral epicondylitis exceeding three months’ duration completed a randomized controlled trial comparing eccentric training in Controlled Active Motion mode (experimental group (EG), n=13) against pas-sive motion in Continuous Passive Motion mode (control group (CG), n=12). Both groups performed 18 supervised sessions over six weeks (60°/s angular velocity, progressive loading 1-12 sets × 5 repetitions). Bilateral concentric peak torque of elbow extensors and flexors constituted the primary outcomes. Secondary measures included push-up perfor-mance, explosive power assessed by the Seated Medicine Ball Chest Push Test, and goni-ometric range of motion. Linear mixed-effects models and analysis of covariance with baseline adjustment were employed. Background: Chronic lateral epicondylitis is a common overuse tendinopathy in swimmers, caused by repetitive upper‑limb loading and stroke‑related asymmetries. Evidence suggests that eccentric strengthening promotes tendon remodeling and improves neuromuscular function, yet its effects in swimming populations remain under-investigated. Summary of the study: This randomized controlled trial compared eccentric isokinetic training (Controlled Active Motion) with passive isokinetic motion (Continuous Passive Motion) over a 6‑week supervised intervention in female Masters swimmers with chronic lateral epicondylitis. Twenty‑five participants completed the intervention. Neuromuscular outcomes, bilateral strength profiles, functional performance (push‑ups and medicine‑ball tests), and elbow range of motion were evaluated pre‑ and post‑intervention.
Section Name Field Name Date Reason Old Value Updated Value
Trial Information Trial description 12/02/2026 As requested by the trial reviewer. Answer to the comment : "Under the summary, please also provide a brief background about your study and not only how it is conducted" Background: Chronic lateral epicondylitis is a common overuse tendinopathy in swimmers, caused by repetitive upper‑limb loading and stroke‑related asymmetries. Evidence suggests that eccentric strengthening promotes tendon remodeling and improves neuromuscular function, yet its effects in swimming populations remain under-investigated. Summary of the study: This randomized controlled trial compared eccentric isokinetic training (Controlled Active Motion) with passive isokinetic motion (Continuous Passive Motion) over a 6‑week supervised intervention in female Masters swimmers with chronic lateral epicondylitis. Twenty‑five participants completed the intervention. Neuromuscular outcomes, bilateral strength profiles, functional performance (push‑ups and medicine‑ball tests), and elbow range of motion were evaluated pre‑ and post‑intervention. Background: Chronic lateral epicondylitis is a common overuse tendinopathy in swimmers, caused by repetitive upper‑limb loading and stroke‑related asymmetries. Evidence suggests that eccentric strengthening promotes tendon remodeling and improves neuromuscular function, yet its effects in swimming populations remain under-investigated. Summary of the study: This randomized controlled trial compared eccentric isokinetic training (Controlled Active Motion) with passive isokinetic motion (Continuous Passive Motion) over a 6‑week supervised intervention in female Masters swimmers with chronic lateral epicondylitis. Twenty‑five participants completed the intervention. Neuromuscular outcomes, bilateral strength profiles, functional performance (push‑ups and medicine‑ball tests), and elbow range of motion were evaluated pre‑ and post‑intervention.
Section Name Field Name Date Reason Old Value Updated Value
Eligibility Age group 12/02/2026 Answer to the reviewer comment. Middle Aged: 45 Year(s)-64 Year(s) Adult: 19 Year-44 Year, Middle Aged: 45 Year(s)-64 Year(s)
Section Name Field Name Date Reason Old Value Updated Value
Ethics Ethics List 12/02/2026 We correct the ethics committee's email address. It was simply an unintentional mistake when filling out the form. TRUE, Institutional Review Board HighInstitute of Sport and Physical Education of Kef University of Jendouba, University Campus of Boulifa, Le Kef, 7100, Tunisia, , 11 Dec 2024, 0021658156107, nadhir.hammami@issepkef.u-jendouba.tn, 39912_38099_4737.pdf TRUE, Institutional Review Board HighInstitute of Sport and Physical Education of Kef University of Jendouba, University Campus of Boulifa, Le Kef, 7100, Tunisia, , 11 Dec 2024, 0021658156107, bouassida_anissa@yahoo.fr, 39912_38099_4737.pdf
Section Name Field Name Date Reason Old Value Updated Value
Funding Source FundingSources List 12/02/2026 Aswer to the reviewer comment. No external funding institutional support only, Not applicable, Le Kef, 7100, Tunisia, Self Funded, None, Not applicable, Le Kef, 7100, Tunisia, Self Funded,
Section Name Field Name Date Reason Old Value Updated Value
Funding Source FundingSources List 19/02/2026 Aswer to the reviewer comment. None, Not applicable, Le Kef, 7100, Tunisia, Self Funded, Dr. Wissem Dhahbi, University Campus of Boulifa, Le Kef, 7100, Tunisia, Self Funded,