Transverse friction massage :anaesthetic effect
Is it possible to use friction massage as a differential diagnostic medium : a test-retest experimental study
Steven De Coninck, Kurt Meeus 2005 ; presented on the Physiokongress in Aachen (Germany), 2006
• Purpose :
We would like to confirm the hypothetical diagnosis of a tenoperiostal tendinous lesion of the supraspinatus (tendinitis or tendinosis) by using a diagnostic or "test" friction massage (DFM).
• Method :
Inclusion criteria of the patients : the patient describes pain in the C5-dermatome. Specifically elevation movements during activities of daily life are painful and/or limited. There is no pain at rest. The pain started spontaneously, since max. 1 month (overuse lesion) or after trauma.
In the clinical examination following tests are positive : isometric abduction against resistance (R abd) ; a painful arc (PA) and/or end range pain on passive elevation (P elev).
Those data were collected by using a Cyriax Assessment Form.
On every positive test, the patient is asked to give a score to his painlevel by using a VAS.
Afterwards a diagnostic test friction massage is given on the tenoperiostal aspect of the supraspinatus tendon, for 5 minutes. (In literature, an anaesthetic effect of the friction massage is illustrated after a mean time of 2-3 minutes).
Immediately afterwards, the tests found positive in the clinical examination are repeated and the patient is asked again to give a pain score by using the VAS.
• Hypotheses :
If the patient really has a tenoperiostal supraspinatus problem, then, we expect that the positive tests from the examination became significantly better after applying the test friction massage for 5 minutes.
If not, then probably another pathology is present.
• Data / Results :
Clinical examination :
N = 20
9 male, 11 female (age between 25 and 63 y.)
On 11 occasions, all three variables (positive tests from the examination, described in the inclusion criteria) are positive.
In 9 patients there are two positive tests (in 6 cases R abd and PA ; in 3 other cases we found a R abd and P elev positive).
Post diagnostic friction massage :
17 patients described a clear pain reduction after applying the diagnostic friction massage.
1 patient didn't feel any difference at all with the R abd.
2 patients described for one or more tests a worsening of the pain.
Before the diagnostic friction massage (DFM), P elev was the most painful test : a mean score of 60,5 on the VAS.
After the DFM this was reduced toa score of 49,5.
On PA there was a pre-score of 58,4 and a post-score of 41,3.
On P elev there was a pre-score of 54,8 and a post-score of 41,1.
The mean pain reduction score after the DFM was 13,75 for the R abd, 17,1 for the PA and 11,2 for the P elev.
• Conclusion :
In 85% of the cases we found a clear link between the presumeable diagnosis of a tenoperiostal supraspinatus tendinopathy and the DFM.
By using a Paired Samples Test and Wilcoxon Test we found a significant pain reduction after the DFM on the R abd test and the P elev (p<0.001) and also on the PA (p<0.01).
• Discussion :
This test-retest project was a first small step towards a bigger intiative including a higher number of patients. It certainly gives inspiring data for further studies.
A consideration that can be incorporated too in future studies is the differential diagnosis with a chronic subdeltoid bursitis and a calcification of the subdeltoid bursa and/or supraspinatus tendon.
Incorporating the use of diagnostic infiltrations with a 0,5% procaine solution could be very usefull too from the differential diagnostic point of view.
This project illustrates the way in which a presumeable diagnosis of a contractile lesion could be confirmed in a cost-efficient and fast way.
Involving ligamentous lesions in future projects is adviseable too.
Steven De Coninck.