Deep Friction Massage in the Management of Patellar Tendinopathy in Athletes: Short-Term Clinical Outcomes

in Journal of Sport Rehabilitation

Click name to view affiliation

Paula Chaves
Search for other papers by Paula Chaves in
Current site
Google Scholar
PubMed Close
,
Daniela Simões
Search for other papers by Daniela Simões in
Current site
Google Scholar
PubMed Close
,
Maria Paço
Search for other papers by Maria Paço in
Current site
Google Scholar
PubMed Close
,
Sandra Silva
Search for other papers by Sandra Silva in
Current site
Google Scholar
PubMed Close
,
Francisco Pinho
Search for other papers by Francisco Pinho in
Current site
Google Scholar
PubMed Close
,
José Alberto Duarte
Search for other papers by José Alberto Duarte in
Current site
Google Scholar
PubMed Close
, and
Fernando Ribeiro
Search for other papers by Fernando Ribeiro in
Current site
Google Scholar
PubMed Close
DOI:
https://doi.org/10.1123/jsr.2019-0046
Keywords:
Cyriax; manual therapy; muscle strength; pain
First Published Online:
30 Sep 2019
In Print:
Volume 29: Issue 7
Page Range:
860–865
Restricted access

Context: Deep friction massage (DFM) is often used in the treatment of tendinopathies; however, the pressure applied may vary and interfere with the obtained results. Objective: To assess whether the immediate effects of DFM on pain (pain intensity and time to onset of analgesia) and muscle strength are dependent on the pressure applied during the DFM application in athletes with patellar tendinopathy. Design: Randomized, controlled, cross-over trial. Setting: University research laboratory (institutional). Participants: Ten athletes with diagnosis of unilateral patellar tendinopathy (age 27.90 [5.24] y). Interventions: All participants attended 4 sessions, 3 treatment sessions with DFM applied with different pressures (the mean pressure—previously determined for each participant—and the mean pressure ± 25%) and a control session, each of which was separated by 48 hours. Main Outcome Measures: Pain (intensity upon palpation and time to onset of analgesia), and muscle strength of knee extensors were assessed before and immediately after each session. Results: Pain intensity changed significantly over time (F1,9 = 52.364; P < .001; ηp2=.853) and among sessions (F3,27 = 82.588; P < .001; ηp2=.902), with a significant interaction for group × time (F3,27 = 19.841; P < .001; ηp2=.688). The knee extensors strength did not change significantly over time (F1,9 = 2.240; P = .17; ηp2=.199), nor a significant interaction for session × time was observed (F3,27 = 3.276; P = .07; ηp2=.267). Regardless of the pressure applied, the time to onset of analgesia was not significantly different (F2,18 = 1.026; P > .05; ηp2=.102). Conclusion: It was shown that DFM induces an immediate reduction in pain intensity upon palpation, regardless of the pressure performed. Notwithstanding, the reader should take into account the small sample size and the caution needed in the results’ interpretation.

Chaves, Paço, Silva, and Pinho are with the Institute of Research and Advanced Training in Health Sciences and Technologies, CESPU, Gandra, Portugal. Simões is with Santa Maria Health School, Porto, Portugal. Pinho is also with the School of Health Sciences, University of Aveiro, Aveiro, Portugal. Duarte is with the Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal. Ribeiro is with the School of Health Sciences and Institute of Biomedicine—iBiMED, University of Aveiro, Aveiro, Portugal.

Chaves (paulamchaves@gmail.com) is corresponding author.
  • Collapse
  • Expand

Journal of Sport Rehabilitation

Cover Journal of Sport Rehabilitation
  • 1.

    Abate M, Gravare-Silbernagel K, Siljeholm C, et al. Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Ther. 2009;11(3):235. PubMed ID: 19591655 doi:10.1186/ar2723

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409–416. PubMed ID: 18812414 doi:10.1136/bjsm.2008.051193

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Malliaras P, Cook J, Purdam C, Rio E. Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. J Orthop Sports Phys Ther. 2015;45(11):887–898. PubMed ID: 26390269 doi:10.2519/jospt.2015.5987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Cook JL, Khan KM, Purdam CR. Conservative treatment of patellar tendinopathy. Phys Ther Sport. 2001;2(2):54–65. doi:10.1054/ptsp.2001.0069

  • 5.

    D’Addona A, Maffulli N, Formisano S, Rosa D. Inflammation in tendinopathy. Surgeon. 2017;15(5):297–302. doi:10.1016/j.surge.2017.04.004

  • 6.

    Maffulli N, Longo UG, Denaro V. Novel approaches for the management of tendinopathy. J Bone Joint Surg Am. 2010;92(15):2604–2613. PubMed ID: 21048180

  • 7.

    Rudavsky A, Cook J. Physiotherapy management of patellar tendinopathy (jumper’s knee). J Physiother. 2014;60(3):122–129. PubMed ID: 25092419 doi:10.1016/j.jphys.2014.06.022

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Torres R, Ferreira J, Silva D, Rodrigues E, Bessa IM, Ribeiro F. Impact of patellar tendinopathy on knee proprioception: a cross-sectional study. Clin J Sport Med. 2017;27(1):31–36. PubMed ID: 26829609 doi:10.1097/JSM.0000000000000295

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Reinking M. Tendinopathy in athletes. Phys Ther Sport. 2012;13(1):3–10. PubMed ID: 22261424 doi:10.1016/j.ptsp.2011.06.004

  • 10.

    Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466(7):1539–1554. PubMed ID: 18446422 doi:10.1007/s11999-008-0260-1

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Blackwood J, Ghazi F. Can the addition of transverse friction massage to an exercise programme in treatment of infrapatellar tendinopathy reduce pain and improve function? A pilot study. Int Musculoskelet Med. 2012;34(3):108–114. doi:10.1179/1753615412Y.0000000005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev. 2002(4):CD003528.

    • Search Google Scholar
    • Export Citation
  • 13.

    Chaves P, Simões D, Paço M, Pinho F, Duarte JA, Ribeiro F. Cyriax’s deep friction massage application parameters: evidence from a cross-sectional study with physiotherapists. Musculoskelet Sci Pract. 2017;32(32):92–97. doi:10.1016/j.msksp.2017.09.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Joseph MF, Taft K, Moskwa M, Denegar CR. Deep friction massage to treat tendinopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding. J Sport Rehabil. 2012;21(4):343–353. PubMed ID: 22234925 doi:10.1123/jsr.21.4.343

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Loew LM, Brosseau L, Tugwell P, et al. Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis. Cochrane Database Syst Rev. 2014;11:CD003528.

    • Search Google Scholar
    • Export Citation
  • 16.

    Maffulli N, Sharma P, Luscombe KL. Achilles tendinopathy: aetiology and management. J R Soc Med. 2004;97(10):472–476. PubMed ID: 15459257 doi:10.1177/0141076809701004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Prabhakar AJ, Kage V, Anap D. Effectiveness of cyriax physiotherapy in subjects with tennis elbow. J Nov Physiother. 2013;3(3):156. doi:10.4172/2165-7025.1000156

    • Search Google Scholar
    • Export Citation
  • 18.

    Rees JD, Maffulli N, Cook J. Management of tendinopathy. Am J Sports Med. 2009;37(9):1855–1867. PubMed ID: 19188560 doi:10.1177/0363546508324283

  • 19.

    Rees JD, Wilson AM, Wolman RL. Current concepts in the management of tendon disorders. Rheumatology. 2006;45(5):508–521. PubMed ID: 16490749 doi:10.1093/rheumatology/kel046

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Reinking MF. Current concepts in the treatment of patellar tendinopathy. Int J Sports Phys Ther. 2016;11(6):854. PubMed ID: 27904789

  • 21.

    Stasinopoulos D, Johnson MI. Cyriax physiotherapy for tennis elbow/lateral epicondylitis. Br J Sports Med. 2004;38(6):675–677. PubMed ID: 15562158 doi:10.1136/bjsm.2004.013573

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Atkins E, Kerr J, Goodlad E. A Practical Approach to Orthopaedic Medicine: Assessment, Diagnosis, Treatment. 3rd ed. London, UK: Churchill Livingstone, Elsevier; 2010.

    • Search Google Scholar
    • Export Citation
  • 23.

    Begovic H, Zhou GQ, Schuster S, Zheng YP. The neuromotor effects of transverse friction massage. Man Ther. 2016;26(1532–2769 (Electronic)):70–76. doi:10.1016/j.math.2016.07.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Chamberlain GJ. Cyriax’s friction massage: a review. J Orthop Sports Phys Ther. 1982;4(1):16–22. PubMed ID: 18810110 doi:10.2519/jospt.1982.4.1.16

  • 25.

    Davidson CJ, Ganion LR, Gehlsen GM, Verhoestra B, Roepke JE, Sevier TL. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Med Sci Sports Exerc. 1997;29(3):313–319. PubMed ID: 9139169 doi:10.1097/00005768-199703000-00005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Gehlsen GM, Ganion LR, Helfst R. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999;31(4):531–535. PubMed ID: 10211847 doi:10.1097/00005768-199904000-00006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009;14(5):531–538. PubMed ID: 19027342 doi:10.1016/j.math.2008.09.001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Gregory MA, Deane MN, Mars M. Ultrastructural changes in untraumatised rabbit skeletal muscle treated with deep transverse friction. Physiotherapy. 2003;89(7):408–416. doi:10.1016/S0031-9406(05)60074-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Hassan S, Hafez A, Seif H, Kachanathu S. The effect of deep friction massage versus stretching of wrist extensor muscles in the treatment of patients with tennis elbow. Open J Ther Rehabil. 2016;4:48–54. doi:10.4236/ojtr.2016.41004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Llorca-Torralba M, Borges G, Neto F, Mico JA, Berrocoso E. Noradrenergic locus coeruleus pathways in pain modulation. Neuroscience. 2016;338:93–113. PubMed ID: 27267247 doi:10.1016/j.neuroscience.2016.05.057

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Pud D, Granovsky Y, Yarnitsky D. The methodology of experimentally induced diffuse noxious inhibitory control (DNIC)‐like effect in humans. Pain. 2009;144(1–2):16–19. PubMed ID: 19359095 doi:10.1016/j.pain.2009.02.015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Vigotsky AD, Bruhns RP. The role of descending modulation in manual therapy and its analgesic implications: a narrative review. Pain Res Treat. 2015;2015:1–11. doi:10.1155/2015/292805

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Viswas R, Ramachandran R, Korde Anantkumar P. Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial. ScientificWorldJournal. 2012;2012:1–8. PubMed ID: 22629225 doi:10.1100/2012/939645

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016;50(19):1187–1191. PubMed ID: 27127294 doi:10.1136/bjsports-2015-095422

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Graven-Nielsen T, Arendt-Nielsen L. Impact of clinical and experimental pain on muscle strength and activity. Curr Rheumatol Rep. 2008;10(6):475–481. PubMed ID: 19007539 doi:10.1007/s11926-008-0078-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Silbernagel KG, Gustavsson A, Thomee R, Karlsson J. Evaluation of lower leg function in patients with Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2006;14(11):1207–1217. PubMed ID: 16858560 doi:10.1007/s00167-006-0150-6

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Farina S, Valeriani M, Rosso T, et al. Transient inhibition of the human motor cortex by capsaicin-induced pain. A study with transcranial magnetic stimulation. Neurosci Lett. 2001;314(1–2):97–101. PubMed ID: 11698155 doi:10.1016/S0304-3940(01)02297-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Farina S, Tinazzi M, Le Pera D, Valeriani M. Pain-related modulation of the human motor cortex. Neurolog Res. 2003;25(2):130–142. doi:10.1179/016164103101201283

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39.

    Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model: a discussion of the between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991;69(5):683–694. PubMed ID: 1863921 doi:10.1139/y91-102

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Struyf F, Lluch E, Falla D, Meeus M, Noten S, Nijs J. Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders. Eur J Appl Physiol. 2014;115(2):225–234. PubMed ID: 25431129 doi:10.1007/s00421-014-3059-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Crossley KM, Thancanamootoo K, Metcalf BR, Cook JL, Purdam CR, Warden SJ. Clinical features of patellar tendinopathy and their implications for rehabilitation. J Orthop Res. 2007;25(9):1164–1175. PubMed ID: 17469196 doi:10.1002/jor.20415

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Cyriax JH, Cyriax PJ. Cyriax’s Illustrated Manual of Orthopaedic Medicine. 2nd ed. Oxford, UK: Butterworth-Heinemann; 1993.

  • 43.

    Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63(suppl 11):S240–S252. doi:10.1002/acr.20543

    • Search Google Scholar
    • Export Citation
  • 44.

    Shenoy S, Mishra P, Sandhu JS. Peak torque and IEMG activity of quadriceps femoris muscle at three different knee angles in a collegiate population. J Exerc Sci Fitness. 2011;9(1):40–45. doi:10.1016/S1728-869X(11)60005-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles Testing and Function With Posture and Pain. 5th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2005.

    • Search Google Scholar
    • Export Citation
  • 46.

    Hislop HJ, Montgomery J. Daniels & Worthingham’s Muscle Testing: Techniques of Manual Examination. 8th ed. St. Louis, MO: Saunders Elsevier; 2007.

    • Search Google Scholar
    • Export Citation
  • 47.

    Mentiplay BF, Perraton LG, Bower KJ, et al. Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study. PLoS ONE. 2015;10(10):e0140822. PubMed ID: 26509265 doi:10.1371/journal.pone.0140822

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Croisier JL, Foidart-Dessalle M, Tinant F, Crielaard JM, Forthomme B. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med. 2007;41(4):269–275. PubMed ID: 17224433 doi:10.1136/bjsm.2006.033324

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Goats GC. Massage--the scientific basis of an ancient art: part 2. Physiological and therapeutic effects. Br J Sports Med. 1994;28(3):153–156. PubMed ID: 8000810 doi:10.1136/bjsm.28.3.153

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50.

    De Bruijn R. Deep transverse friction: its analgesic effect. Int J Sports Med. 1984;5:S35–S36. doi:10.1055/s-2008-1025944

  • 51.

    Nijs J, Daenen L, Cras P, Struyf F, Roussel N, Oostendorp RA. Nociception affects motor output: a review on sensory-motor interaction with focus on clinical implications. Clin J Pain. 2012;28(2):175–181. PubMed ID: 21712714 doi:10.1097/AJP.0b013e318225daf3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 10950 2976 294
Full Text Views 294 100 26
PDF Downloads 265 87 8