Scolaris Content Display Scolaris Content Display

Masaje de fricción transversal profundo para el tratamiento de la tendinitis lateral del codo o de la rodilla

Collapse all Expand all

References

References to studies included in this review

Schwellnus 1992 {published data only}

Schwellnus MP, Mackintosh L, Mee J. Deep transverse frictions in the treatment of iliotibial band friction syndrome in athletes: a clinical trial. Physiotherapy 1992;78(8):564‐8.

Stratford 1989 {published data only}

Stratford PW, Levy DR, Gauldie S, Miseferi D, Levy K. The evaluation of phonophoresis and friction massage as treatments for extensor carpi radialis tendinitis: a randomized controlled trial. Physiotherapy Canada 1989;41(2):93‐9.

References to studies excluded from this review

Balke 1989 {published data only}

Balke B, Anthony J, Wyatt F. The effects of massage treatment on exercise fatigue. Clinical Sports Medicine 1989;1:189‐96.

Baltaci 2001 {published data only}

Baltaci G, Ergun N, Tunay VB. Effectiveness of Cyriax manipulative therapy and elbow band in the treatment of lateral epicondylitis. European Journal of Sports Traumatology and Related Research 2001;23(3):113‐8.

Bisset 2007 {published data only}

Bisset L, Smidt N, Van der Windt DA, Bouter LM,  Jull G,  Brooks P, et al. Conservative treatments for tennis elbow—do subgroups of patients respond differently?. Rheumatology 2007;1:1601‐5.

Chiarello 1997 {published data only}

Chiarello CM, Gundersen L, O'Halloran T. The effect of continuous passive motion duration and increment on range of motion in total knee arthroplasty patients. Journal of Orthopaedic & Sports Physical Therapy 1997;25(2):119‐27.

Crosman 1984 {published data only}

Crosman LJ, Chateauvert SR, Weisberg J. The effects of massage to the hamstring muscle group on range of motion. Journal of Orthopaedic and Sports Physical Therapy 1984;6:168‐72.

Feehan 1989 {published data only}

Feehan RC. The efficacy of using transverse friction massage on improving active and passive range of motion in the client with chronic knee dysfunction. The Union Institute 1989;51(3):64.

Fernandez 2006 {published data only}

Fernández‐de‐las‐Penas C, Alonso‐Blanco C, Fernandez‐Carnero J, Miangolarr‐Page J. The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: a pilot study. Journal of Bodywork and Movement Therapies 2006;10:807‐11.

Fernandez 2008 {published data only}

Fernández‐Pérez AM, Peralta‐Ramírez MI, Pilat A, Villaverde C. Effects of myofascial induction techniques on physiologic and psychologic parameters: a randomized controlled trial. The Journal of Alternative and Complementary Medicine 2008;14(7):807‐11.

Iwatsuki 2001 {published data only}

Iwatsuki H, Ikuta Y, Shinoda K. Deep friction massage on the masticatory muscles in stroke patients increases biting force. Journal of Physical Therapy Science 2001;13(1):17‐20.

Joseph 2012 {published data only}

Joseph MF, Taft K, Moskwa M. Deep friction massage to treat tendinopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding. Journal of Sports Rehabilitation 2012;21(4):343‐53.

Kohia 2008 {published data only}

Kohia M, Brackle J, Byrd K, Jennings A,  Murray W,  Wilfong E. Effectiveness of physical therapy treatment on lateral epicondylitis. Journal of Sport Rehabilitation 2008;17(2):119‐36.

Malier 1986 {published data only}

Malier M, Troisier O. Deep transverse massage for the treatment of tennis elbow [La place du massage transversal profond dans le traitement des tendinites épicondyliennes: à propos de 131 cas]. Annales de Réadaptation et de Médecine Physique 1986;29:75‐83.

Mayer 2007 {published data only}

Mayer F, Hirschmuller A, Muller S, et al. Effect of short‐term treatment strategies over 4 weeks in Achilles tendinopathy. British Journal of Sport Medecine 2007;41(7):e6.

Nagrale 2009 {published data only}

Nagrale AV, Herd CR, Ganvir S, Ramteke G. Cyriax physical therapy versus phonophoresis with supervised exercise in subjects with lateral epicondylalgia: a randomized clinical trial. Journal of Manual and Manipulative Therapy 2009;17(3):171‐8.

Pellecchia 1994 {published data only}

Pellecchia GL, Hamel H, Behnke P. Treatment of infrapatellar tendinitis: a combination of modalities and transverse friction massage versus iontophoresis. Journal of Sport Rehabilitation 1994;3(2):135‐45.

Smidt 2002 {published data only}

Smidt N, Van der Windt DA, Assendelft WJJ, Devillé WL,  Korthals‐de Bos IB,  Bouter LM. Corticosteroid injections, physical therapy, or a wait‐and‐see policy for lateral epicondylitis: a randomised controlled trial. The Lancet 2002;359:657‐62.

Stasinopoulos 2004a {published data only}

Stasinopoulos D, Johnson MI. Curiax physical therapy for tennis elbow/lateral epicondylitis. British Journal of Sport Medecine 2004;38(6):675‐7.

Stasinopoulos 2004b {published data only}

Stasinopoulos D, Stasinopoulos I. Comparison of effective exercise programme, pulsed ultrasound and transverse friction in the treatment of chronic patellar tendinopathy. Clinical Rehabilitation 2004;18(4):347‐52.

Stasinopoulos 2006 {published data only}

Stasinopoulos D, Stasinopoulos I. Comparison of effects of Cyriax physical therapy, a supervised exercise program and polarized polychromatic non‐coherent light (Bioptron light) for the treatment of lateral epicondylitis. Clinical Rehabilitation 2006;20(1):12‐23.

Struijs 2003 {published data only}

Struijs P, Damen PJ, Bakker E, Blankevoort L,  Assendelft WJ,  van Dijk CN. Manipulation of the wrist for management of lateral epicondylitis: a randomized pilot study. Physical Therapy 2003;83(7):608‐16.

Struijs 2006 {published data only}

Struijs P, Korthals‐de Bos I, van Tudler M, van Dijk CN,  Bouter LM,  Assendelft WJ. Cost effectiveness of brace, physical therapy, or both for treatment of tennis elbow. British Journal of Sports Medecine 2006;40:637‐43.

Thomee 1997 {published data only}

Thomee RA. A comprehensive treatment approach for patellofemoral pain syndrome in young women. Physical Therapy 1997;77(12):1690‐703.

Verhaar 1995 {published data only}

Verhaar JAN, Walenkamp GH, van Mameren H, Kester AD,  van der Linden AJ. Local corticosteroid injection versus Cyriax‐type physical therapy for tennis elbow. Journal of Bone and Joint Surgery [British Volume] 1995;77:128‐3.

Viswas 2012 {published data only}

Viswas R, Ramachandran R, Anantkumar P. Comparison of effectiveness of supervised exercise program and Cyriax physiotherapy in patients with tennis elbow (lateral epicondylitis): a randomized clinical trial. Scientific World Journal 2012;doi:10.1100/2012/939645.

Zhang 1987 {published data only}

Zhang ZB, Carter RM, Minikin BR, Telford RD. The influence of repeated massage on leg strength. Australian Institute of Sport Canberra 1987;5.

Zheng 2012 {published data only}

Zheng Z, Wang J, Gao Q, Hou J, Ma L, Jiang C, Chen G. Therapeutic evaluation of lumbar tender point deep massage for chronic non‐specific low back pain. Journal of Traditional Chinese Medicine 2014;32(4):534‐7.

Additional references

ACR 1996

American College of Rheumatology Ad Hoc Committee on Clinical Guidelines. Guidelines for the management of rheumatoid arthritis. Arthritis and Rheumatism 1996;39:713‐22.

ACR 2000

ACR: American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis and Rheumatism 2000;43:1905‐15.

Allander 1974

Allander E. Prevalence, incidence and remission rates of some common rheumatic diseases or syndromes. Scandinavian Journal of Rheumatology 1974;3:145‐53.

Antich 1986

Antich TJ, Randall CC, Westbrook RA, et al. Physical therapy treatment of knee mechanism disorders: comparison of four treatment modalities. Journal of Orthopaedic and Sports Physical Therapy 1986;8:255‐9.

APTA 2001

American Physical Therapy Association. Guide to Physical Therapist Practice: Part One: A Description of Patient/Client Management. Alexandria, Va: American Physical Therapy Association, 2001.

Chapman 1991

Chapman CE. Can the use of physical modalities for pain control be rationalized by the research evidence?. Canadian Journal of Physiology and Pharmacology 1991;69:704‐12.

Cyriax 1975a

Cyriax J. Diagnosis of soft tissue lesions. In: Cyriax J editor(s). Textbook of Orthopaedic Medicine. 9th Edition. Vol. 1, Baltimore: Williams and Wilkins, 1975.

Cyriax 1975b

Cyriax J. Treatment by manipulation, massage and injection. In: Cyriax J editor(s). Textbook of Orthopaedic Medicine. 9th Edition. Vol. 2, Baltimore: Williams and Wilkins, 1975.

Furlan 2008

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low back pain. Cochrane Database of Systematic Reviews 2001, Issue 4. [DOI: 10.1002/14651858.CD001929.pub2]

Godlee 2000

Godlee Fiona (editor). Clinical Evidence: A Compendium of the Best Available Evidence for Effective Health Care. First Edition. Vol. 4, London, England: BMJ Publishing Group, 2000.

Green 1998

Green S, Buchbinder R, Glazier R, Forbes A. Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcomes assessment, and efficacy. BMJ 1998;316:354‐60.

Grewal 2009

Grewal R, MacDermid JC, Shah P, King GJ. Functional outcome of arthroscopic extensor carpi radialis brevis tendon release in chronic lateral epicondylitis. Journal of Hand Surgery [American Volume] 2009;34(5):849‐57.

Griffin 1963

Griffin JE, Touchstone JC. Ultrasonic movement of cortisol into pig's tissue. I.Movement into skeletal muscle. American Journal of Physical Medicine 1963;42:77‐85.

Guyatt 2008

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924‐6.

Halle 1986

Halle JS, Franklin RJ, Karalfa L. Comparison of four treatment approaches for lateral epicondylitis of the elbow. Journal of Orthopedic Sports Physical Therapy 1986;8:62‐9.

Hart 1994

Hart LE. Exercises and soft tissue injury. Ballieres Clinical Rheumatology 1994;8(1):137‐48.

Higgins 2011

Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions [Version 5.1.0] [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane‐handbook.org.

Johnson 2007

Johnson GW, Cadwallader K, Scheffel SB, Epperly TD. Treatment of lateral epicondylitis. American Family Physician 2007;76(6):843‐8.

Jordaan 1994

Jordaan G, Schwellnus MP. The incidence of overuse injuries in military recruits during basic military training. Military Medicine 1994;159(6):1994.

Kirk 2000

Kirk KL, Kuklo T, Klemme W. Iliotibial band friction syndrome: a review. Orthopedics 2000;23(11):1209‐17.

Lavine 2010

Lavine R. Iliotibial band friction syndrome. Current Reviews in Musculoskeletal Medicine 2010;3:18‐22.

Manal 1996

Manal RJ, Snyder‐Mackler L, Manal RJ, Snyder‐Mackler L. Practice guidelines for anterior cruciate ligament rehabilitation: criterion‐based rehabilitation progression. Operative Techniques in Orthopaedics 1996;6:190‐6.

Martens 1989

Martens M, Libbrecht P, Burssens A. Surgical treatment of the iliotibial band friction syndrome. American Journal of Sports Medicine 1989;17(5):651‐4.

Messier 1988

Messier SP, Pittala KA. Etiologic factors associated with selected running injuries. Medicine & Science in Sports and Exercise 1988;20(5):501‐5.

Messier 1995

Messier SP, Edwards DG, Martin DF, Lowery RB, Cannon DW, James MK, et al. Etiology of iliotibial friction syndrome in distance runners. Medicine and Sciences in Sports and Exercises 1995;27(7):951‐60.

Morin 1996

Morin M, Brosseau L, Quirion‐DeGrardi C. A theoretical framework on low level laser therapy (classes I, II and III) application for the treatment of OA and RA. Proceedings of the Canadian Physiotherapy Association. 1996:1.

Philadelphia 2001

The Philadelphia Panel. The Philadelphia Panel Evidence‐Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Knee Pain. Physical Therapy 2001;81(10):1‐300.

Pinshaw 1984

Pinshaw R, Atlas V, Noakes TD. The nature and response to therapy of 196 consecutive injuries seen at a runners clinic. South African Medical Journal 1984;65(8):291‐8.

Reinold 2002

Reinold MM, Wilk KE, Reed J, Crenshaw K, Andrews JR. Interval sport programs: guidelines for baseball, tennis, and golf. Journal of Orthopaedic and Sports Physical Therapy 2002;32(6):293‐8.

Roquelaure 2006

Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, et al. Epidemiologic surveillance of upper‐extremity musculoskeletal disorders in the working population. Arthritis and Rheumatism 2006;55(5):765‐78.

Schwellnus 1991

Schwellnus MP, Theunissen L, Noakes TD, Reinach SG. Anti‐inflammatory and combined anti‐inflammatory/analgesic medication in the early management of iliotibial band friction syndrome: a clinical trial. South Africa Medical Journal 1991;79(10):602‐6.

Schünemann 2011a

Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, Guyatt GH. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions [Version 5.1.0] [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane‐handbook.org.

Schünemann 2011b

Schünemann HJ, Oxman AD, Higgins JPT, Vist GE, Glasziou P, Guyatt GH. Chapter 11: Presenting results and ‘Summary of findings' tables. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions [Version 5.1.0] [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane‐handbook.org.

Shiri 2006

Shiri R, Viikari‐Juntura E, Varonen H, Helio M. Prevalence and determinants of lateral and medial epicondylitis: a population study. American Journal of Epidemiology 2006;164(11):1065–74.

Strauss 2011

Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons 2011;19(12):728‐36.

Struijs 2002

Struijs PAA, Smidt N, Arola H, van Dijk CN, Buchbinder R, Assendelt WJJ. Orthotics devices for the treatment of tennis elbow. Cochrane Database of Systematic Reviews 2002, Issue 1. [DOI: 10.1002/14651858.CD001821]

Thaunton 1987

Thaunton JE, Clement DB, Smart GW, McNicol KL. Non‐surgical management of overuse knee injuries in runners. Canadian Journal of Sport Sciences 1987;12(1):1987.

van der Heijden 1997

van der Heijden GJ, van der Windt DA, de Winter AF, van der Heijden GJ, van der Windt DA, de Winter AF. Physiotherapy for patients with soft tissue shoulder disorders: a systematic review of randomised clinical trials. BMJ 1997;315(7099):25‐30.

Walker 1984

Walker JM. Deep transverse frictions in ligament healing. Journal of Orthopaedic and Sports Physical Therapy 1984;6(2):89‐94.

Walker‐Bone 2004

Walker‐Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis and Rheumatism 2004;51(4):642‐51.

Wilk 2004

Wilk KE, Reinold MM, Andrews JR. Rehabilitation of the thrower's elbow. Clinics in Sports Medicine 2004;23(4):765‐801, xii.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Jump to:

Schwellnus 1992

Methods

Study design: randomized, assessor‐blinded trial

Sample size at entry: 20
G1: deep transverse friction massage (DTFM) group 10
G2: control group 10
Treatment duration: 10 days
Follow‐up: 14 days

Participants

Setting: visitors to a sports injury clinic with unilateral chronic (> 4 weeks) iliotibial band syndrome causing pain severe enough to restrict running distance or speed (grade 3), or to prevent it altogether (grade 4)

Inclusion criteria:

  • Age in years (mean (± SE)): DTFM group 25 (± 6), control group 29 (± 5), P value 0.20 student t‐test

  • Weeks injured (mean (± SE)): DTFM group 23 (± 17), control group 74 (± 95)

  • Years of running (mean (± SE)): DTFM group 7.7 (± 5.5), control group 5.4 (± 6.2)

  • Kilometers run per week (mean (± SE)): DTFM group 45 (± 15), control group 64 (± 30)

  • Grade of injury (mean (± SE)): DTFM group 3.4 (± 0.5), control group 3.4 (± 0.5)

Exclusion criteria: < 18 years old, history of previous knee surgery, concomitant medical therapy

Interventions

Deep transverse friction massage: applied on days 3, 5, 7 and 10

Treated anatomical area (most tender area) with constant pressure, such that discomfort was experienced, but not severe pain; 2 minutes of light friction, then 8 minutes of harder friction

Technique: Pressure was applied with the index finger and reinforced with the ring finger, with the thumb acting as a pivot; brisk motion was initiated from the therapist's shoulder, with the wrist flexible and the hand stiff

Concurrent treatment:

  • Rest (apart from 3 * 30 min treadmill exercise tests on days 3, 7 and 14)

  • Ice 20 minutes twice daily

  • Stretch of iliotibial band, daily

  • Ultrasound: 1 MHz, 0.5 W/cm/cm (continuous), 5 minutes on days 3, 4, 5 and 6, then 7 minutes on days 7 and 10

  • G1 received deep transverse friction massage and concurrent treatment while control group received concurrent treatment only

Outcomes

Mean pain daily recall, total pain while running, % max pain experienced while running (VAS 0 to 10; 0 = no pain) for 3 treatment periods (days 0 to 2, 3 to 6, 7 to 14)

Notes

One participant was excluded for refusal to comply with the treatment group. Two participants were not accounted for in the control group (reasons not provided)

Per‐protocol analysis

Source of funding: "This research project was generously supported financially by Johnson and Johnson Pty Ltd"

Declarations of interest of primary researchers not provided

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Quote: ''patients were divided into two treatment groups on a random basis''

Comments: method not described

Allocation concealment (selection bias)

Unclear risk

Comments: Investigators state that they divided the 17 athletes into 2 groups without explaining the method of allocation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Comment: Participants and personnel were not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote: ''the efficacy of the treatment was assessed by a different therapist who was blind to the treatment group of the patient''

Comments: Insufficient information available to judge whether not blinding the participants had an impact on patient‐reported outcomes. More likely at 'high risk' for self‐reported subjective outcomes (eg, pain)

Incomplete outcome data (attrition bias)
All outcomes

High risk

Comments: This study had a 15% dropout rate (even across treatment groups). Duration of follow‐up was mentioned, but investigators did not perform an intention‐to‐treat analysis

Selective reporting (reporting bias)

Low risk

 Comments: The trial presented planned outcomes whether or not the result was significant. No selective reporting was found to be present

Other bias

High risk

Comment: Baseline imbalance was reported; mean age and duration of symptoms were different across groups

Stratford 1989

Methods

Study design: randomized controlled trial, parallel group, combination of interventions

Sample size at entry: 40
Group 1: ultrasound and placebo ointment without frictions—9
Group 2: ultrasound and placebo ointment with frictions—11
Group 3: phonophoresis without frictions—10
Group 4: phonophoresis with frictions—10
# male/# female: 20/20
Group 1: 2/7
Group 2: 5/6
Group 3: 5/5
Group 4: 8/2

Treatment duration: 9 sessions within 5 weeks

Follow‐up: 5 weeks

Participants

Setting: patients attending a community sports injuries clinic

Inclusion criteria: those who complained of discomfort at or about the lateral epicondyle; pain at the lateral aspect of the elbow during resisted wrist extension; radial deviation during complete elbow extension; tenderness in palpation over, or at, one of the following areas: (1) origin of extensor carpi radialis longus tendon, (2) origin of extensor carpi radialis brevis tendon, (3) extensor carpi radialis brevis at tendon body, and (4) extensor carpi radialis brevis tendon with tenderness extending from origin to the tendon body

Age (mean in years (± SD))
Group 1: 43.8 (± 9.8)
Group 2: 44.6 (± 9.8)
Group 3: 40.1 (± 8.3)
Group 4: 44.7 (± 8.7)

Disease duration (months: mean (± SD))
Group 1: 4.3 (± 3.2)
Group 2: 2.1 (± 1.2)
Group 3: 5.2 (± 7.2)
Group 4: 5.4 (± 4.1)

Exclusion criteria: combined lesions; bilateral elbow problems at initial assessment; history of prior surgery; history of an injection to the elbow within the past 6 months

Interventions

Deep transverse friction massage
Treated anatomical area (elbow) with friction massage applied perpendicular to the structure of interest for 10 minutes, 3 times per week, 9 treatment sessions within 5 weeks
Frictions for groups 2 and 4: position of participant: for lesion at origin of the extensor carpi radialis longus or brevis tendon, elbow flexed at 90 degrees with forearm fully supinated; if lesion at or included tendon body or extensor carpi radialis brevis tendon, elbow flexed at 45 degrees with forearm pronated

Concurrent treatment for group 1 and group 2: ultrasound and placebo ointment
Ultrasound: Dosage varied from 1.3 w/cm2 continuous output to 0.5 w/cm2 pulsed (1:4). Application technique: sound head moved in slow concentric circles, while sound head contact with the participant was maintained at the same time. Duration: 6 minutes

Concurrent treatment for groups 3 and 4: phonophoresis
Phonophoresis: 10% hydrocortisone ointment used with ultrasound treatment

Outcomes

Pain

  • Pain‐free function (8 pain‐free item, 8 = better)

  • Pain VAS (0 to 100 mm; 0 = worst).

Grip strength

  • Ration index of pain‐free grip strength (grip strength: kilograms of force). Ratio is pain‐free grip divided by maximum grip of uninvolved limb

Function

  • Function VAS (0 to 100 mm; 0 = worst)

Functional status (success or failure to perform pain‐free strengthening program for the wrist extensor muscles, with the elbow extended, without subsequent regression within 2 weeks of follow‐up)

Notes

We extracted the outcome of pain on VAS (0 to 100), not pain‐free function, for the review

Source of funding: "This work was supported by the Physiotherapy Foundation of Canada"

Declarations of interest of primary researchers not provided

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: ''The study design was a two by two factorial design. The subjects were randomly assigned using a balanced blocked randomization table''

Allocation concealment (selection bias)

Unclear risk

Comments: Method of allocation concealment was not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Comment: Participants and personnel were not blinded to treatment

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Quote: ''Decision was made by the assessor who was blind to both interventions''

Comments: Insufficient information was available on which to base judgement if not blinding participants had an impact on patient‐reported outcomes

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comments: No description of withdrawals and dropouts was mentioned. However, all randomly assigned participants were accounted for in the results

Selective reporting (reporting bias)

Low risk

Comments: The trial presented all planned outcomes whether or not the result was significant. No selective reporting was found to be present

Other bias

High risk

Comments: Baseline imbalance was reported; the duration of symptoms was different across groups

DTFM: Deep transverse friction massage.

SD: Standard deviation.

SE: Standard error.

VAS: Visual analog scale.

Characteristics of excluded studies [ordered by study ID]

Jump to:

Study

Reason for exclusion

Balke 1989

Not tendinitis

Baltaci 2001

Combination of interventions; co‐interventions not applied to the control group

Bisset 2007

Combination of Interventions; co‐interventions not applied to the control group

Chiarello 1997

Healthy participants

Crosman 1984

Healthy participants

Feehan 1989

Not tendinitis

Fernandez 2006

Combination of Interventions; co‐interventions not applied to the control group

Fernandez 2008

Combination of Interventions; co‐interventions not applied to the control group

Iwatsuki 2001

Study was not a randomized controlled trial

Joseph 2012

Study was not a randomized controlled trial

Kohia 2008

No control group

Malier 1986

No control group

Mayer 2007

No control group

Nagrale 2009

Combination of Interventions; co‐interventions not applied to the control group

Pellecchia 1994

Combination of Interventions; co‐interventions not applied to the control group

Smidt 2002

Combination of Interventions; co‐interventions not applied to the control group

Stasinopoulos 2004a

Combination of Interventions; co‐interventions not applied to the control group

Stasinopoulos 2004b

No control group

Stasinopoulos 2006

Combination of interventions: Cyriax and Mill's manipulation; co‐intervention not applied to the control group

Struijs 2003

Pilot study

Struijs 2006

Combination of Interventions; co‐interventions not applied to the control group

Thomee 1997

Not tendinitis

Verhaar 1995

No control group

Viswas 2012

Combination of interventions: Cyriax and Mill's manipulation; co‐intervention not applied to the control group

Zhang 1987

Not tendinitis

Zheng 2012

Study was not a randomized controlled trial

Data and analyses

Open in table viewer
Comparison 1. Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain (VAS 0‐100, 0 = worst) (change from baseline) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 1.1

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 1 Pain (VAS 0‐100, 0 = worst) (change from baseline).

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 1 Pain (VAS 0‐100, 0 = worst) (change from baseline).

2 Grip strength (ratio index, higher is better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 1.2

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 2 Grip strength (ratio index, higher is better).

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 2 Grip strength (ratio index, higher is better).

3 Function (VAS 0‐100, 0 = worst) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 1.3

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 3 Function (VAS 0‐100, 0 = worst).

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 3 Function (VAS 0‐100, 0 = worst).

4 Function (pain‐free function; average number of pain‐free items; higher is better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 1.4

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 4 Function (pain‐free function; average number of pain‐free items; higher is better).

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 4 Function (pain‐free function; average number of pain‐free items; higher is better).

5 Functional status (number of successes to perform strengthening program) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 1.5

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 5 Functional status (number of successes to perform strengthening program).

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 5 Functional status (number of successes to perform strengthening program).

Open in table viewer
Comparison 2. Massage + phonophoresis vs phonophoresis only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain (VAS 0‐100, 0 = worst) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.1

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 1 Pain (VAS 0‐100, 0 = worst).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 1 Pain (VAS 0‐100, 0 = worst).

2 Grip strength (ratio index, higher is better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.2

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 2 Grip strength (ratio index, higher is better).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 2 Grip strength (ratio index, higher is better).

3 Function (VAS 0‐100, 0 = worst) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.3

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 3 Function (VAS 0‐100, 0 = worst).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 3 Function (VAS 0‐100, 0 = worst).

4 Function (pain‐free function; average number of pain‐free items; higher is better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.4

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 4 Function (pain‐free function; average number of pain‐free items; higher is better).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 4 Function (pain‐free function; average number of pain‐free items; higher is better).

5 Functional status (number of successes to perform strengthening program) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 2.5

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 5 Functional status (number of successes to perform strengthening program).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 5 Functional status (number of successes to perform strengthening program).

Open in table viewer
Comparison 3. Massage + physical therapy vs physical therapy only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 3.1

Comparison 3 Massage + physical therapy vs physical therapy only, Outcome 1 Pain.

Comparison 3 Massage + physical therapy vs physical therapy only, Outcome 1 Pain.

1.1 Daily pain

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Pain while running

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 % of maximum pain while running

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 1 Pain (VAS 0‐100, 0 = worst) (change from baseline).
Figures and Tables -
Analysis 1.1

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 1 Pain (VAS 0‐100, 0 = worst) (change from baseline).

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 2 Grip strength (ratio index, higher is better).
Figures and Tables -
Analysis 1.2

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 2 Grip strength (ratio index, higher is better).

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 3 Function (VAS 0‐100, 0 = worst).
Figures and Tables -
Analysis 1.3

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 3 Function (VAS 0‐100, 0 = worst).

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 4 Function (pain‐free function; average number of pain‐free items; higher is better).
Figures and Tables -
Analysis 1.4

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 4 Function (pain‐free function; average number of pain‐free items; higher is better).

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 5 Functional status (number of successes to perform strengthening program).
Figures and Tables -
Analysis 1.5

Comparison 1 Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only, Outcome 5 Functional status (number of successes to perform strengthening program).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 1 Pain (VAS 0‐100, 0 = worst).
Figures and Tables -
Analysis 2.1

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 1 Pain (VAS 0‐100, 0 = worst).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 2 Grip strength (ratio index, higher is better).
Figures and Tables -
Analysis 2.2

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 2 Grip strength (ratio index, higher is better).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 3 Function (VAS 0‐100, 0 = worst).
Figures and Tables -
Analysis 2.3

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 3 Function (VAS 0‐100, 0 = worst).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 4 Function (pain‐free function; average number of pain‐free items; higher is better).
Figures and Tables -
Analysis 2.4

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 4 Function (pain‐free function; average number of pain‐free items; higher is better).

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 5 Functional status (number of successes to perform strengthening program).
Figures and Tables -
Analysis 2.5

Comparison 2 Massage + phonophoresis vs phonophoresis only, Outcome 5 Functional status (number of successes to perform strengthening program).

Comparison 3 Massage + physical therapy vs physical therapy only, Outcome 1 Pain.
Figures and Tables -
Analysis 3.1

Comparison 3 Massage + physical therapy vs physical therapy only, Outcome 1 Pain.

Summary of findings for the main comparison. Massage + ultrasound and placebo ointment compared with ultrasound + placebo ointment only for treating lateral elbow tendinitis (tennis elbow)

Massage + therapeutic ultrasound and placebo ointment compared with ultrasound + placebo ointment only (follow‐up 2 weeks) for treating tendinitis

Patient or population: patients with extensor carpi radialis tendinitis
Settings: community sports injuries clinic in Canada
Intervention: massage + therapeutic ultrasound and placebo ointment
Comparison: therapeutic ultrasound + placebo ointment only

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (US + placebo ointment only)

Massage + US and placebo ointment

Pain
Visual analog scale

Scale from 0 to 100 (lower is better)
Follow‐up: mean 2 weeks

Mean change in pain in the control groups was
4.6 mm

Mean change in pain in the intervention groups was
6.6 lower
(15.40 lower to 28.60 higher)

20
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

MD = ‐6.60 (‐28.60 to 15.40)

Absolute improvement = ‐7% (‐29% to ‐15%)

Relative percentage change = 8% (‐24% to 37%)

Not statistically significant

Proportion reporting pain relief of 30% or greater not measured

See comment

See comment

Not estimable

See comment

Not measured

Function
Visual analog function index

Scale from 0 to 100 (higher is better)
Follow‐up: mean 2 weeks

Mean function (vas 0 to 100, 0 = worst) in the control groups was
78.1 mm

Mean function (VAS 0‐100, 0 = worst) in the intervention groups was
1.8 lower
(18.64 lower to 15.04 higher)

20
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

MD = ‐1.80 (‐18.64 to 15.04)

Absolute improvement = 2% (‐19% to 15%)

Relative percentage change = ‐3% (‐28% to 23%)

Not statistically significant

Quality of life—not measured

See comment

See comment

Not estimable

See comment

Not measured

Patient global assessment of success not measured

See comment

See comment

Not estimable

See comment

Not measured

Adverse events not measured

See comment

See comment

Not estimable

See comment

Not measured

Withdrawals due to adverse events not measured

See comment

See comment

Not estimable

See comment

Not measured

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; ECRT: Extensor carpi radialis tendinitis; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aAllocation concealment was unclear. Only assessors were blinded. Baseline imbalance was reported.
bVery few participants.
cWide confidence intervals.

Figures and Tables -
Summary of findings for the main comparison. Massage + ultrasound and placebo ointment compared with ultrasound + placebo ointment only for treating lateral elbow tendinitis (tennis elbow)
Summary of findings 2. Massage + phonophoresis compared with phonophoresis alone for treating lateral elbow tendinitis (tennis elbow)

Massage + phonophoresis compared with control (phonophoresis only) (follow‐up 2 weeks) for treating tendinitis

Patient or population: patients with extensor carpi radialis tendinitis
Settings: community sports injuries clinic in Canada
Intervention: massage + phonophoresis
Comparison: phonophoresis only

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (phonophoresis only) (follow‐up 2 weeks)

Massage + phonophoresis

Pain
Visual analog scale

Scale from 0 to 100 (lower is better)
Follow‐up: mean 2 weeks

Mean change in pain in the control groups was
1 mm

Mean change in pain in the intervention groups was
1.2 lower
(17.84 lower to 20.24 higher)

20
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

MD = ‐1.2 (‐20.24 to 17.84)

Absolute improvement = ‐1%
(‐20% to 18%)

Relative percentage change = 6% (‐86% to 97%)

Not statistically significant

Proportion reporting pain relief of 30% or greater not measured

See comment

See comment

Not estimable

See comment

Not measured

Function
Visual analog scale

Scale from 0 to 100 (higher is better)
Follow‐up: mean 2 weeks

Mean function in the control groups was
78.8 mm

Mean function in the intervention groups was
3.7 higher
(14.13 lower to 21.53 higher)

20
(1 study)

⊕⊝⊝⊝
Very lowa,b,c

MD = 3.70 (‐14.13 to 21.53)

Absolute improvement = 4% (‐14% to 22%)

Relative percentage change = 5% (‐18% to 28%)

Not statistically significant

Quality of life not measured

See comment

See comment

Not estimable

See comment

Not measured

Patient global assessment of success not measured

See comment

See comment

Not estimable

See comment

Not measured

Adverse events not measured

See comment

See comment

Not estimable

See comment

Not measured

Withdrawals due to adverse events not measured

See comment

See comment

Not estimable

See comment

Not measured

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; ECRT: extensor carpi radialis tendinitis; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aAllocation concealment was unclear. Only assessors were blinded. Baseline imbalance was reported.
bVery few participants.
cWide confidence interval.

Figures and Tables -
Summary of findings 2. Massage + phonophoresis compared with phonophoresis alone for treating lateral elbow tendinitis (tennis elbow)
Summary of findings 3. Deep transverse massage + physical therapy compared with physical therapy alone for treating lateral knee tendinitis

Deep transverse friction massage + physical therapy compared with physical therapy alone

Patient or population: patients with iliotibial band friction syndrome (knee tendinitis)

Settings: community sports injury clinic in South Africa

Intervention: deep transverse massage and physical therapy

Comparison: physical therapy alone

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Deep transverse massage

Daily pain
Visual
analog scale (VAS)
Scale from 0 to
10 (lower is better)

Follow‐up mean 2
weeks

Mean daily pain
in the control groups was
1 point

Mean daily pain in

the intervention groups was
0.4 lower
(0.8 lower to 0.00 higher)

17
(1 study)

⊕⊝⊝⊝
very lowa,b

MD = ‐0.4 (‐0.8 to 0)

Absolute improvement = ‐4% (‐8% to 0%)

Relative percentage change = ‐40% (‐80% to 0%)

Not statistically significant

Proportion reporting pain relief of 30% or greater not measured

See comment

See comment

Not estimable

See comment

Not measured

Function not measured

See comment

See comment

Not estimable

See comment

Not measured

Quality of life not measured

See comment

See comment

Not estimable

See comment

Not measured

Patient global assessment not measured

See comment

See comment

Not estimable

See comment

Not measured

Adverse events not measured

See comment

See comment

Not estimable

See comment

Not measured

Withdrawals due to adverse events

See comment

See comment

Not estimable

See comment

Not measured

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; ITBF: Iliotibial band friction syndrome (knee tendinitis); RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aRandomization and allocation concealment were unclear. Only assessors were blinded. No intention‐to‐treat analysis was done, and baseline imbalance was reported.
bVery few participants.

Figures and Tables -
Summary of findings 3. Deep transverse massage + physical therapy compared with physical therapy alone for treating lateral knee tendinitis
Table 1. Inclusion and exclusion critieria according to the PICOTS strategy

Inclusion

Exclusion

Participants/Population (P)

  • Outpatients or inpatients

  • Diagnosis: tendinitis pain

  • Chronic versus acute conditions

  • Normal weight (BMI < 25 kg/m2)

  • Age groups ≥ 18 years

  • Medically stable

  • Mentally competent

Participants/Population (P)

  • Cancer (and other oncologic conditions)

  • Dermatologic conditions

  • Healthy normal

  • Mixed population

  • Multiple conditions (presenting other chronic problems additional)

  • Neurologic conditions

  • Pediatric conditions

  • Psychiatric conditions

  • Pulmonary conditions

  • Scoliosis

  • Condition in which rapid weight loss or exercise is contraindicated (angina, frailty, advanced osteoporosis)

  • Obese or overweight patient (BMI ≥ 25 kg/m2)

Interventions (I)

  • Eligible interventions: deep transverse frictions  techniques only, in community or not, and with or without:

    • Concurrent programs (eg, stretching exercises, modalities (ultrasound), phonophoresis)

    • Supervision

  • Eligible control groups: conventional therapy, untreated, waiting list, active physical therapy treatments, educational pamphlets

Interventions (I)

  • Surgery (ie, not the effects of surgery)

  • Medication (eg, phonophoresis with medications)

  • Thermal biofeedback

Comparisons (C)

Studies were included if they compared an intervention group (eg, deep transverse frictions techniques combined with modalities, exercises) with a comparison group (eg, placebo, no treatment, active treatment such as modalities, exercises)

Comparisons (C)

Studies were excluded if they did not compare the intervention group with a comparison group (eg, placebo, no treatment, active treatment such as modalities, exercises)

Outcomes (O)

  • Functional status (self‐care activities)

  • Medication intake (if reported)

  • Muscle strength

  • Pain intensity

  • Participant satisfaction

  • Quality of life

  • Compliance

Outcomes (O)

  • Biochemical measures

  • Participant compliance with medication

  • Psychosocial measures (depression, home and community activities, leisure, social roles, sexual functions)

  • Serum markers (except ESR)

Period of time (P)

Studies were included if the intervention period lasted longer than 1 week or 1 treatment session, with or without a follow‐up period 

Period of time (P)

Studies were excluded if the intervention period lasted less than 1 week or 1 treatment session 

Study designs (S)

  • Randomized controlled trial

  • Controlled clinical trial

*English and French articles only.

Study designs (S)

  • Case series/case report

  • Case control studies

  • Cohort studies

  • Data (graphic) without a mean and SD

  • Sample size of fewer than 5 participants per experimental group

  • Studies with greater than 20% dropout rate

BMI: Body mass index.
ESR: Erythrocyte sedimentation rate.
PICOTS: Populations, interventions, comparators, outcomes, timing, and setting framework.
SD: Standard deviation.

Figures and Tables -
Table 1. Inclusion and exclusion critieria according to the PICOTS strategy
Comparison 1. Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain (VAS 0‐100, 0 = worst) (change from baseline) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Grip strength (ratio index, higher is better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Function (VAS 0‐100, 0 = worst) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Function (pain‐free function; average number of pain‐free items; higher is better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Functional status (number of successes to perform strengthening program) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 1. Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only
Comparison 2. Massage + phonophoresis vs phonophoresis only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain (VAS 0‐100, 0 = worst) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Grip strength (ratio index, higher is better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Function (VAS 0‐100, 0 = worst) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Function (pain‐free function; average number of pain‐free items; higher is better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Functional status (number of successes to perform strengthening program) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 2. Massage + phonophoresis vs phonophoresis only
Comparison 3. Massage + physical therapy vs physical therapy only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Daily pain

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Pain while running

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 % of maximum pain while running

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 3. Massage + physical therapy vs physical therapy only