Is there a role for deep friction massage in the management of patellar tendinopathy? Technique characterization and short-term clinical outcomes

• Author(s): Paula Maria Dias Chaves
• Date: 2018
• Persistent ID: https://hdl.handle.net/10216/112863
• Origin: Repositório Aberto da Universidade do Porto
• Subject(s): Ciências da saúde; Health sciences
• Document Type: Doctoral thesis
• Language: Portuguese

Description

The aim of this work was to characterize and analyze the parameters of application of deep friction massage (DFM) in physiotherapy clinical practice, namely the pressure applied and its influence on the symptoms of patellar tendinopathy. First, it was analyzed the literature regarding DFM description and grounding. Next, an observational, cross-sectional and analytical study was conducted, with Portuguese physiotherapists selected through a snow-ball sampling method, that completed an online questionnaire. This allowed to determine the prevalence of DFM utilization in clinical practice and characterize the application parameters used. It was also performed an observational, crosssectional and analytical study with a convenience sample, aiming to determine the minimum skin pressure necessary to promote a macroscopic deformation of the patellar tendon. To determine if a dose-response relationship exists between the pressure applied during DFM and time to onset of analgesia, in the patellar tendon, a two-phase study was performed, where firstly, through an observational, cross-sectional and analytical study, it was characterized the mean pressure applied by physiotherapists during DFM; after this, the pressure observed in the previous study was used in a randomized, controlled, cross-over and cross-sectional trial evaluating the effect of different DFM pressures in the time to onset of analgesia. At last, a randomized, controlled and cross-over trial with athletes with patellar tendinopathy was performed, whose objective was to assess whether the pressure applied during DFM impacts on clinical outcomes, namely pain, muscle strength and range of motion. With the results of this work, it was concluded that DFM is highly used by Portuguese physiotherapists, which present a high heterogeneity and variability in the application parameters chosen. They applied a pressure 2.3 kg/cm2 (1.02; 4.16), which is above the average skin pressure needed to promote the macroscopic deformation of the patellar tendon (1.1 ± 0.37 kg/cm2), regardless of the characteristics of the individual. It was also concluded that DFM induces an immediate reduction of pain, irrespectively of the intensity of pressure applied.