Evaluating the Effectiveness of Deep Transverse Frictional Massage Combined with Conventional Physiotherapy for Tendinopathies: A Systematic Review and Meta-analysis.

BACKGROUND

Tendinopathies are common musculoskeletal disorders characterized by pain and functional impairment, often requiring therapeutic interventions for effective management. This systematic review and meta-analysis aimed to evaluate the effectiveness of deep transverse frictional massage (DTFM) combined with conventional therapy for the treatment of tendinopathies.

METHODS

A study search of electronic databases including MEDLINE, Google Scholar, and PubMed databases, was conducted for randomized controlled trials, pilot study, and comparative study design comparing the combined application of DTFM with conventional physiotherapy (e.g., exercise, stretching, or modalities) to conventional therapy alone for the treatment of tendinopathies. Inclusion criteria were studies that reported clinical outcomes such as pain reduction and disability. Data extraction was performed independently by reviewers. A meta-analysis was conducted using random-effects models to estimate the pooled effect size, and heterogeneity was assessed using the I statistic. The risk of bias was assessed using the Cochrane risk-of-bias approach.

RESULTS

A total of 13 studies met the inclusion criteria. The combined treatment group (DTFM + conventional therapy) showed significant improvements in pain reduction (standardized mean difference (SMD) = -0.92, 95% confidence interval (CI): -1.70 to -0.14, p < 0.05) and disability in the shoulder (SMD = -15.05, 95% CI: -15.60 to -14.50, p < 0.05) and elbow (SMD = -2.67, 95% CI: -3.38 to -1.96, p < 0.05) compared to conventional therapy alone. No significant adverse effects were reported.

CONCLUSION

The findings suggest that DTFM, when combined with conventional therapy, offers significant benefits over conventional therapy alone in the management of tendinopathies, particularly in reducing pain and improving function. The exact physiological mechanisms through which DTFM works in combination with conventional therapies remain unclear. Research into how DTFM influences tissue healing, collagen remodeling, or pain reduction pathways could provide more insights into its effectiveness and guide its integration into treatment protocols.