Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis

Laurianne M Loew; Lucie Brosseau; Peter Tugwell; George A Wells; Vivian Welch; Beverley Shea; Stephane Poitras; Gino De Angelis; Prinon Rahman

doi:10.1002/14651858.CD003528.pub2

Cochrane Database of Systematic Reviews

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

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DOI:

https://doi.org/10.1002/14651858.CD003528.pub2 Copiar DOI

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Cochrane Database of Systematic Reviews

Versión publicada:

08 noviembre 2014see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Salud musculoesquelética

Copyright:

Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Laurianne M Loew

School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
Lucie Brosseau

Correspondencia a: School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada

[email protected]
Peter Tugwell

Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
George A Wells

Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
Vivian Welch

Bruyère Research Institute, University of Ottawa, Ottawa, Canada
Beverley Shea

Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
Stephane Poitras

School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
Gino De Angelis

Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
Prinon Rahman

School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada

Contributions of authors

LB and LML were responsible for writing the manuscript, extracting and analyzing data, and selecting trials for the initial review.

LML, PR and GDA performed data extraction and updated selections from the reference list, the analyses, and the interpretation of results.

PR was responsible for the literature search update.

BS, PT, GW, VW and SP contributed methodological expertise and commented on early drafts.

Sources of support

Internal sources

Institute for Population Health, University of Ottawa, Canada.
Ottawa Health Research Institute, Canada.

External sources

Holistic Health Research Foundation of Canada, Canada.

Declarations of interest

All the authors have no conflict of interest to declare.

Acknowledgements

The review authors thank Lisa Levesque, Shaïman Gibeault, Judith Robitaille, Michel Boudreau, Michael Saginur, and Sarah Clément for help with data extraction and literature retrieval, as well as the editorial team of the Cochrane Musculoskeletal Review Group for valuable comments on early drafts.

Version history

Published

Title

Stage

Authors

Version

2014 Nov 08

Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis

Review

Laurianne M Loew, Lucie Brosseau, Peter Tugwell, George A Wells, Vivian Welch, Beverley Shea, Stephane Poitras, Gino De Angelis, Prinon Rahman

https://doi.org/10.1002/14651858.CD003528.pub2

2002 Oct 21

Deep transverse friction massage for treating tendinitis

Review

Lucie Brosseau, Lynn Casimiro, Sarah Milne, Vivian Welch, Beverley Shea, Peter Tugwell, George A Wells

https://doi.org/10.1002/14651858.CD003528

Differences between protocol and review

We used the "Risk of bias" tool to assess the risk of bias in included studies and presented the results in "Summary of findings" tables.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Study flow diagram.

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Figure 2

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

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Figure 3

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

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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).

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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).

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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).

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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).

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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).

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Analysis 2.1

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

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Analysis 2.2

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

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Analysis 2.3

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

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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).

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Analysis 2.5

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

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Analysis 3.1

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

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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 low^a,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 low^a,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.

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)

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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 low^a,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 low^a,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.

Summary of findings 2. Massage + phonophoresis compared with phonophoresis alone for treating lateral elbow tendinitis (tennis elbow)

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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 low^a,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.

Summary of findings 3. Deep transverse massage + physical therapy compared with physical therapy alone for treating lateral knee tendinitis

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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.

Table 1. Inclusion and exclusion critieria according to the PICOTS strategy

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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

Comparison 1. Massage + therapeutic ultrasound (US) and placebo ointment vs US + placebo ointment only

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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

Comparison 2. Massage + phonophoresis vs phonophoresis only

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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]

Comparison 3. Massage + physical therapy vs physical therapy only

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

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