Background Deep transverse friction
massage, one of several
physical therapy interventions suggested for the management of
tendinitis pain, was first demonstrated in the 1930s by Dr James Cyriax, a renowned orthopedic surgeon in England. Its goal is to prevent abnormal fibrous adhesions and abnormal
scarring. This is an update of a Cochrane review first published in 2001.Objectives To assess the benefits and harms of deep transverse friction
massage for treating lateral elbow or lateral knee
tendinitis.Search methods We searched the following electronic databases: the specialized central registry of the Cochrane Field of Physical and Related
Therapies,the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, and the Physiotherapy Evidence Database (PEDro), up until July 2014. The reference lists of these trials were consulted for additional studies.Selection criteria All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing deep transverse friction
massage with control or other active interventions for study participants with two eligible types of
tendinitis (ie, extensor carpi radialis
tendinitis (lateral elbow
tendinitis,
tennis elbow or
lateral epicondylitis or lateralis epicondylitis humeri) and iliotibial band friction syndrome (lateral knee
tendinitis)) were selected. Only studies published in English and French languages were included.Data collection and analysis Two review authors independently assessed the studies on the basis of inclusion and exclusion criteria. Results of individual trials were extracted from the included study using extraction forms prepared by two independent review authors before the review was begun.Data were cross-checked by a third review author. Risk of bias of the included studies was assessed using the "Risk of bias"tool of The Cochrane Collaboration. A pooled analysis was performed using mean difference (MD) for continuous outcomes and risk ratio (RR)for dichotomous outcomes with 95% confidence intervals (CIs).Main results Two RCTs (no new additional studies in this update) with 57 participants met the inclusion criteria. These studies demonstrated high risk of performance and detection bias, and the risk of selection, attrition, and reporting bias was unclear.The first study included 40 participants with lateral elbow
tendinitis and compared (1) deep transverse friction
massage combined with
therapeutic ultrasound and placebo
ointment (n = 11) versus
therapeutic ultrasound and placebo
ointment only (n = 9) and (2)deep transverse friction
massage combined with
phonophoresis (n = 10) versus
phonophoresis only (n = 10). No statistically significant differences were reported within five weeks for mean change in
pain on a 0 to 100 visual analog scale (VAS) (MD -6.60, 95%CI -28.60 to 15.40; 7% absolute improvement), grip strength measured in kilograms of force (MD 0.10, 95% CI -0.16 to 0.36) and function ona 0 to 100 VAS (MD -1.80, 95% CI -0.18.64 to 15.04; 2% improvement),
pain-free function index measured as the number of painfree items (MD 1.10, 95% CI -1.00 to 3.20) and functional status (RR 3.3, 95% CI 0.4 to 24.3) for deep transverse friction
massage,and
therapeutic ultrasound and placebo
ointment compared with
therapeutic ultrasound and placebo
ointment only. Likewise for deep transverse friction
massage and
phonophoresis compared with
phonophoresis alone, no statistically significant differences were found for
pain (MD -1.2, 95% CI -20.24 to 17.84; 1% improvement), grip strength (MD -0.20, 95% CI -0.46 to 0.06) and function (MD3.70, 95% CI -14.13 to 21.53; 4% improvement). In addition, the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the quality of evidence for the
pain outcome, which received a score of "very low".
Pain relief of 30% or greater, quality of life, patient global assessment, adverse events, and withdrawals due to adverse events were not assessed or reported.The second study included 17 participants with iliotibial band friction syndrome (knee
tendinitis) and compared deep transverse friction
massage with
physical therapy intervention versus
physical therapy intervention alone, at two weeks. Deep transverse friction
massage with
physical therapy intervention showed no statistically significant differences in the three measures of
pain relief on a 0 to 10 VAS when compared with
physical therapy alone: daily
pain (MD -0.40, 95% CI -0.80 to -0.00; absolute improvement 4%),
pain while running (scale from 0 to 150) (MD -3.00, 95% CI -11.08 to 5.08), and percentage of maximum
pain while running (MD -0.10, 95% CI -3.97 to 3.77). For the
pain outcome, absolute improvement showed a 4% reduction in
pain. However, the quality of the body of evidence received a grade of "very low."
Pain relief of 30% or greater, function, quality of life, patient global assessment of success, adverse events, and withdrawals due to adverse events were not assessed or reported.Authors' conclusions We do not have sufficient evidence to determine the effects of deep transverse friction on
pain, improvement in grip strength, and functional status for patients with lateral elbow
tendinitis or knee
tendinitis, as no evidence of clinically important benefits was found.The confidence intervals of the estimate of effects overlapped the null value for deep transverse friction
massage in combination with
physical therapy compared with
physical therapy alone in the treatment of lateral elbow
tendinitis and knee
tendinitis. These conclusions are limited by the small sample size of the included randomized controlled trials. Future trials, utilizing specific methods and adequate sample sizes, are needed before conclusions can be drawn regarding the specific effects of deep transverse friction
massage on lateral elbow
tendinitis.