Deep Friction Massage for the Treatment of Tendinopathy: A systematic review of a classic treatment in the face of a new paradigm of understanding

Authors: Michael Joseph, Kathryn Taft, Maria Moscwa, and Craig Denegar

Affiliations: The authors are with the Physical Therapy Department, University of Connecticut, Storrs, CT.

Acceptance Date: November 20, 2011

Abstract:
Study Design: Systematic literature review
Objective: To assess the efficacy of deep friction massage (DFM) in the treatment of tendinopathy through systematic review of the research literature.
Context: Anecdotal evidence supports the efficacy of DFM for the treatment of tendinopathy.  An advanced understanding of the etiopathogenesis of tendinopathy and the resultant paradigm shift away from an active inflammatory model has taken place since the popularization of the DFM technique by Cyriax for the treatment of “tendinitis.”  However, increasing mechanical load to the tendinopathic tissue as well as reducing pathologic fibrinogenesis and crosslinking during the healing process via transverse massage offers a plausible explanation for observed responses in light of the contemporary understanding of tendinopathy.
Evidence Acqusition: We surveyed research papers in all languages by searching Pubmed, Scopus, Pedro, CINAHL, PsycInfo, and Cochrane Library using the terms deep friction massage, deep tissue massage, deep transverse massage,  Cyriax, soft tissue mobilization, soft tissue mobilisation, cross friction massage, transverse friction massage.  We included four randomized comparison trials (RCT); three at the extensor carpi radialis brevis (ECRB) and one supraspinatous outlet tendinopathy, two non-randomized comparison trials; both receiving DFM at the ECRB, and three prospective non-comparison trials; supraspinatus, ECRB and achilles tendons.  Articles meeting inclusion criteria were assessed based upon PEDro and CEBM rating scales (Table 1).
Results: Nine studies met the inclusion criteria.
Evidence Synthesis: The heterogeneity of dependent measures did not allow for Meta-analysis.
Conclusion: The varied location, study design, etiopathogenesis and outcome tools used to examine the efficacy of DFM make a unified conclusion tenuous.  There is some evidence of benefit at the elbow in combination with a Mills manipulation, as well as for supraspinatous tendinopathy in the presence of outlet impingement and along with joint mobilization.  The examination of DFM as a single modality of treatment in comparison to other methods and control has not been undertaken and therefore its isolated efficacy has not been established.