The comparison of effectiveness of Cyriax deep transverse friction massage with ultrasound therapy in lateral epicondylitis of humerus: a randomized clinical trial

Lateral epicondylalgia of Humerus is the most common type of overuse injuries with different methods of treatment controversial. This randomized clinical trial aims to evaluate the effectiveness of Cyriax deep friction massage versus Ultrasound (US) plus passive stretching on lateral epicondylalgia.

In this study، patient with more than 6 weeks pain in lateral epicondyl were included. Evaluation of Pain via visual analog scale (VAS) in daily activities، resisted wrist extension، resisted middle finger extension، resisted fingers 2 to 5 extension، local tenderness and finally pain-free grip strength were assessed in all eligible patients. Patients randomized in two therapeutic groups. Pulsed ultrasound for 8 minutes plus passive stretching after that for 10 sessions in every other day was the selected intervention in the control group. Experimental group received 7 minutes of deep transverse friction massage plus mill’s manipulation in the end of each intervention for 5 sessions in every other day. All variables were assessed in follow up sessions including last therapeutic session then 1، 2 and 4 weeks followed the last therapeutic session. Inter and intra groups analysis were performed by Independent samples T Test، Repeated measure analysis and paired-sample T Test respectively.

Fifty patients (Deep friction massage=28 and Ultrasound=22) completed their therapeutic and 4 weeks follow up. In Deep friction massage group 75% were woman and 25% were man، while in Ultrasound group 86. 4% were woman and 13. 6% were man. The mean age of patients in Ultrasound group and Deep friction massage group is 48. 8 and 46. 1 respectively. Affected extremity in 62% patients is their dominant arm. In Ultrasound group، difference in pain score (VAS) in daily life and local tenderness variables before and after the therapy is significant (P<0. 05). In the rest of the variables، no difference is observed (P>0. 05). In Deep friction massage group، significant improvement is observed in all variables (P<0. 05). In inter group comparison، right after the therapy، considerable improvement is not observed in pain score (VAS) in daily life and local tenderness (P>0. 05)، However in other time intervals، it is reported (P<0. 05). Furthermore، in the rest of variables، we observe a significant improvement in all the groups and time intervals (P<0. 05).

It is concluded that in short term، Cyriax physiotherapy is statistically more effective than pulsed ultrasound plus passive stretching in improvement of lateral epicondylalgia.