Myofascial Release and Ultrasound, versus Deep Friction Treatment:

Which Is the Best for Patients with Tennis Elbow Injuries?

Safrin Arifin

and Karin Amalia Safitri

Physiotherapy Laboratory, Vocational Education Program, Universitas Indonesia, Depok, Indonesia

Insurance Administration and Actuary, Vocational Education Program, Universitas Indonesia, Depok, Indonesia

Keywords: Myofascial Release, Ultrasound, deep friction, tennis elbow.

Abstract: Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the

elbow. The forearm muscles and tendons become damaged from overuse repeating the same motions

again and again. This leads to pain and tenderness on the outside of the elbow. Rehabilitation programs

do help reduce the pain. Research aims: This research aims to compare between myofascial Release and

Ultrasound versus deep friction treatment and determine the best treatment for reducing pain for Tennis elbow

patients. Methodology: This study used a double-blind experimental design with an alpha value of 5%. The

study was conducted at the Clinic "Rumah Fisio." Based on the randomization technique, the sample was

drawn from the list of patients who are diagnosed with Tennis elbow and undergoing physiotherapy from

December 2018 to February 2019. The pain was measured using the Visual Analogue Scale (VAS). Research

findings: The results of the t-test analysis showed that Deep Friction (DF) [mean = 6,6 ; SD = 0.41, p = 0.000]

is more effective than Myofascial Release techniques and Ultrasound (MrU) (mean = 4.8 ; SD = 0,82) in

reducing pain for Tennis Elbow patients. Practical implications: This study offers an understanding of the best

treatment that would help in reducing the tennis elbow pain.

1 INTRODUCTION

Tennis elbow is a local inﬂammation near the

proximal (upper) attachments of wrist extensor

muscles, characterized by pain on palpation of the

lateral epicondyle of the humerus and in resisted

movements against wrist extension. It is a syndrome

of overuse (e.g., use of computer mouse, racquet

sports) that can result in considerable socioeconomic

costs resulting from a prolonged leave of absence

from work

11'

Myofascial release technique is the

facilitation of mechanical, neural and psycho-

physiological adaptive potential as interfaced via the

myofascial system.

Ultrasound therapy used in

physical medicine to relieve pain and increase joint

mobility

. Ultrasound increases blood flow and

oxygen to the affected area by increasing muscle

temperature. Clinical studies show that it has limited

effectiveness in reducing disability caused by tennis

elbow. However, when ultrasound is combined with

physical therapy such as massage and strengthening

and stretching exercises, its effectiveness increases.

In the research conducted by Haris Begovic and

Guan-Quan Zhou, showed, Ultrasound and Strain

gauge trigger changes in contractile properties and

transmission of style after the friction massage

Transfer is applied to the quadriceps tendon. This

change is displayed by the signal onset, which

provides information about the transmission of force

and stiffness in the elastic component. There is

evidence to justify the widespread use of ultrasound,

and one of them is related to its potential analgesics.

Our findings indicate that therapists pay attention to

increased pain after the use of ultrasound. These

results were also found by other studies that showed

ultrasound as an analgesic promoter that has the

potential to produce satisfactory results for pain

associated with the trigger point and decrease in

reported low back pain. Deep transverse friction is

applied perpendicular to the fibre in pushing each

strand in the trigger area which gives a mechanical

effect, local hyperemia, analgesia, and the

relationship of scar tissue to the structure of the

ligaments, tendons and muscles. Deep, transverse

friction can cause stimulation of nociceptive ends

connected to Aδ fibres and mechanoreceptors found

in soft tissue attached to large diameters of Aβ fibres.

This large diameter fibre affects cells in the posterior

Ariﬁn, S. and Amalia Saﬁtri, K.

Myofascial Release and Ultrasound, versus Deep Friction Treatment: Which is the Best for Patients with Tennis Elbow Injuries?.

DOI: 10.5220/0010684100002967

In Proceedings of the 4th International Conference of Vocational Higher Education (ICVHE 2019) - Empowering Human Capital Towards Sustainable 4.0 Industry, pages 345-348

ISBN: 978-989-758-530-2; ISSN: 2184-9870

345

horn cell and also facilitates the transmission of

small-diameter nociceptive information until the

safety gate is closed

From some of the studies above, no one has done

research directly between myofascial Release and

ultrasound versus deep transfer friction, because from

my practice experience at Rumah Fisio clinic, two

streams are used for patient therapy with each

claiming is that my flow is the best result because the

latest scientific journal supports it. Therefore I am

very interested in conducting a study based on

experimental studies.

2 METHODOLOGY

This study used a double-blind experimental design

with a pre-post-test design of two groups. The study

was divided into two groups, consisting of group 1

with Myofascial Release techniques and ultrasound

and group 2 with deep, transverse friction . with an

alpha value of 5%. The study was conducted at the

Clinic "Rumah Fisio." Based on randomization

technique, The number of study respondents was ten

people, treatment group 5 people and control group 5

people the sample was drawn from the list of patients

who are diagnosed with Tennis elbow and

undergoing physiotherapy from December 2018 to

February 2019. The pain was measured using the

Visual Analogue Scale (VAS).

3 RESULTS

Table 1: Distribution of Respondents by Gender.

Gender Mr

Per cent

(

)

D.F.

Per cent

(

)

Male 5 100 5 100

Female 0 0 0 0

Total 5 100 5 100

Based on table 1. Appears in the group treatment

MrU (group 1) has a sample with gender five male

(100%). Whereas at group treatment D.F. (group 2)

has an example with gender five male (100%)

Table 2. Distribution of respondents by age.

rU D

characteristic mean S.D. mean SD

age 29.50 3.37 29.56 2.92

Table 2 shows, the sample MrU has a mean age

of 29.50 years old and in D.F. groups has an average

age of 29.56 years past.

Table 3.: Distribution of Respondents Based on Pain

Measurement with VAS (Visual Analogue Scale) units of

mm (millimeters) in groups MrU.

Respondents Pain scale

Before

intervention

Before

intervention

Differenc

es before

& after an

interventi

8,3

8,7

9,1

8,4

9,0

3,7

2,9

5,5

3,1

4,2

4,6

5,8

3,6

5,3

5,8

Total

Mean ±

8,7

±0,35

3,88

±1,04

4,82

± 0,82

Based on table 3, the average value of pain

measurement using VAS in MrU group before

treatment is 8,7 and after surgery is 3.8. the average

difference of pain measurement value by using VAS

before and after treatment is 4.82, and the amount of

the standard deviation is 0.82.

Table 4: Distribution of Respondents Based on Pain

Measurement with VAS (Visual Analogue Scale) units of

mm (millimetres) in groups D.F.

Respondents Pain

scale

Before

intervention

Before

interven

tion

Differenc

es before

& after

the

interventi

9,1

8,7

9,3

8,4

8,9

2,6

1,9

2,2

1,6

2,9

6,5

6,8

7,1

6,8

6,0

Total

Mean ±

8,8

±0,34

2,24

±0,5

6,6 ±

0,4

Table 5: The results of Normality Test data degree of tennis

elbow pain before and after treatment.

Pain scale P Value

(Saphiro

wilk test)

Tennis elbow MrU DF

Before 0,501 0,976

Afte

0,519 0,919

ICVHE 2019 - The International Conference of Vocational Higher Education (ICVHE) “Empowering Human Capital Towards Sustainable

4.0 Industry”

346

Based on table 5 it can be seen the results of

normality test data on the MrU group with the

probability value in the pre-test (p-value) is 0.501, so

it can be concluded that the data are normally

distributed (p> 0.05). The probability value in the

post-test (p-value) is 0.519, so it can be found that the

data has a normal distribution (p> 0.05). Data

normality test results in the D.F. group with the

probability value in the pre-test (p-value) is 0.976,

and it can be concluded that the data are typically

distributed (p> 0.05). The probability value in the

post-test (p-value) is 0.919, so it can be found that the

data is normally distributed (p> 0.05).

Tabel 6: Hasil T-test untuk Uji Hipotesis.

n Mean ± S.D. p

MrU 5 4,8 ± 0,82 0,000

DF 5 6,64 ± 0,41 0,000

Based on table 6. the value of pain measurement in

the treatment group I, namely the administration of

myofascial Release, which was analyzed using the

Paired Sample T-test obtained probability value (p-

value) of 0,000. The probability value is smaller than

0.05 (p <0.05), this means that Ha is accepted and Ho

is rejected. It can be concluded that in hypothesis I

there is an influence of myofascial Release and

Ultrasound on pain reduction in tennis elbow.

Hypothesis II test is to determine the effect of deep,

transverse friction on pain reduction in tennis elbow.

To test hypothesis II, the Paired Sample T-test was

used.

Based on table 6. the value of pain measurement

in treatment group II, namely the provision of deep,

transverse friction which was analyzed using the

Paired Sample T-test obtained probability value (p-

value) of 0,000. The probability value is smaller than

0.05 (p <0.05), this means that Ha is accepted and Ho

is rejected. It can be concluded that in hypothesis II

there is an effect of giving deep transversion friction

to decrease pain in tennis elbow

4 CONCLUSION

Based on the results of the research, it can be

concluded that DF [mean = 6,6, SD = 0.41, p = 0.000]

is more effective than MrU (mean = 4.8, SD = 0,82)

in reducing the pain of tennis elbow patients. The

results of One-Way ANOVA study also showed that

there was a significant difference in the decrease of

pain produced by frequency treatment of D.N. & E.S.

[F (1, 6) = 12,333, p = 0,007].

ACKNOWLEDGEMENTS

The author would like to thank Allah Azza Wa Jalla,

my dear Hannah, Vinka, Juno & Echa. Sincere

gratitude for Prof. Sigit and the doctor's team for the

valuable discussions and assistance during the

drafting process.

REFERENCES

Begovic, H., Zhou, G., Schuster, S., & Zheng, Y. 2016. The

neuromotor effects of transverse friction massage.

Manual Therapy, 26, 70-76

DOI:10.1016/j.math.2016.07.007.

Chaves, P., Simões, D., Paço, M., Pinho, F., Duarte, J. A.,

& Ribeiro, F. 2017. Cyriax's deep friction massage

application parameters: Evidence from a cross-

sectional study with physiotherapists. Musculoskeletal

Science & Practice, 32, 92–97.

https://doi.org/10.1016/j.msksp.2017.09.005

De Groef, A., Van Kampen, M., Verlvoesem, N., Dieltjens,

E., Vos, L., De Vrieze, T., Christiaens, M. R., Neven,

P., Geraerts, I., & Devoogdt, N. 2017. Effect of

myofascial techniques for treatment of upper limb

dysfunctions in breast cancer survivors: a randomized

controlled trial. Supportive care in cancer: official

journal of the Multinational Association of Supportive

Care in Cancer, 25(7), 2119–2127.

https://doi.org/10.1007/s00520-017-3616-9

Doley M., Warikoo D., Arunmozhi R. 2013. Effect of

Positional Release Therapy and Depp Transverse

Friction Massage of Gluteus Medius Trigger Point-A

Comparative Study. Journal of Exercise Science and

Physiotherapy. Vol. 9, No. 1, 40-45.

Gutierrez, M. I., Lopez-Haro, S. A., Vera, A., & Leija, L.

2016. Experimental Verification of Modeled Thermal

Distribution Produced by a Piston Source in

Physiotherapy Ultrasound. BioMed research

international, 2016, 5484735.

https://doi.org/10.1155/2016/5484735

Hassan, S., Hafez, A., Seif, H. and Kachanathu, S. 2016.

The Effect of Deep Friction Massage versus Stretching

of Wrist Extensor Muscles in the Treatment of Patients

with Tennis Elbow. Open Journal of Therapy and

Rehabilitation, 4, 48-54.

DOI: 10.4236/ojtr.2016.41004.

Hari Haran, R., & Singh, A. 2013. Effect of High Power

Pain Threshold Static Ultrasound Combined with

Transverse Friction Massage and Stretching on Upper

Trapezius Myofascial Trigger Point. Indian Journal Of

Physiotherapy & Occupational Therapy-An

International Journal, 7(3), 113-117. Retrieved

from http://www.i-

scholar.in/index.php/ijpot/article/view/42652.

Joshi, S., Metgud, S., & Ebenezer, C., 2013. Comparing the

effects of Manipulation of Wrist and Ultrasound,

Friction Massage and Exercises on Lateral

Myofascial Release and Ultrasound, versus Deep Friction Treatment: Which is the Best for Patients with Tennis Elbow Injuries?

347

Epicondylitis: A Randomized Clinical Study. Indian

Journal of Physiotherapy and Occupational Therapy -

An International Journal. DOI Number:

10.5958/j.0973-5674.7.3.093

Kamali, F., Mohamadi, M., Fakheri, L., &

Mohammadnejad, F. 2019. Dry needling versus friction

massage to treat tension-type headache: A randomized

clinical trial. Journal of bodywork and movement

therapies, 23(1), 89–93.

https://doi.org/10.1016/j.jbmt.2018.01.009

Magri, L. V., Carvalho, V. A., Rodrigues, F. C., Bataglion,

C., & Leite-Panisse, C. R. 2017. Effectiveness of low-

level laser therapy on pain intensity, pressure pain

threshold, and SF-MPQ indexes of women with

myofascial pain. Lasers in medical science, 32(2), 419–

428. https://doi.org/10.1007/s10103-016-2138-x

Mohamadi, M., Piroozi, S., Rashidi, I., & Hosseinifard, S.

2017. Friction massage versus kinesiotaping for short-

term management of latent trigger points in the upper

trapezius: a randomized controlled trial. Chiropractic

& manual therapies, 25, 25.

https://doi.org/10.1186/s12998-017-0156-9

Patra, P., & Nayana, D.N. 2013. Effect of 3-d torque and

muscle splay Techniques on subjects with Posterior

tibial tendon dysfunction: A comparative study.

International Journal of Pharmaceutical and

Biological Research (IJPBR) 4(4).

Santiago, V., & Raphael, K.G., 2018. Perceived helpfulness

of treatments for myofascial TMD as a function of

widespread comorbid pain. Clinical Oral

Investigations, 23, 2929-2939.

https://doi.org/10.1007/s00784-018-02797-6

Vieira, W., Aguiar, K., Silva, K., Canela, P., Silva, F., &

Abreu, B. 2012. Overview of ultrasound usage trends in

orthopaedic and sports physiotherapy. Critical

ultrasound journal. 4. 11. 10.1186/2036-7902-4-11.

ICVHE 2019 - The International Conference of Vocational Higher Education (ICVHE) “Empowering Human Capital Towards Sustainable

4.0 Industry”

348