Massage Therapy: Treating Tendinosis (Tennis Elbow) with SCIENCE

Tags:achilles tendinosis cause individuals chronic condition chronic injury cross fiber friction massage deep transverse friction massage elbow pain functional status grip strength inflammatory drug lateral epicondylalgia lateral epicondylitis muscle contraction nsaid patellar tendinosis phonophoresis randomized clinical trial tendinosis tennis elbow transverse friction ultrasound application voltaren

Tendonosis is misnamed tendonitis (an inflammation of the tendon) when in reality the tendon has suffered chronic injury, often from when your body has tried to reverse a moving load. This time when injuries are most common is the “eccentric” phase of muscle contraction, as compared to the “concentric” phase of picking up a load.

Many tendinosis conditions cause individuals a great deal of pain, e.g.:

• achilles tendinosis
• patellar tendinosis, or “jumper’s knee”
• tendinosis on the medial or lateral epicondyl of the humerus (”golfer’s” or “tennis elbow” respectively)

See the latest treatments beyond the jump:

There are a number of effective treatments, both manual and prescription, to heal this chronic condition. I quickly want to review two research articles:

This first one, by Nagrale et al. (2009), is a randomized clinical trial of sixty patients age 30-60 with lateral epicondylalgia (outside elbow pain, or “tennis elbow”). Two groups received treatment 3 times per week for 4 weeks. The researchers compared 5 minutes of treatment with phonophoresis, or ultrasound application, of Voltaren (diclofenac), a non-steroidal anti-inflammatory drug (NSAID) to 10 minutes of deep transverse friction massage followed by a so-called “Mill’s manipulation.” Without getting into the measures of pain, grip strength, or functional status, both groups were statistically significant (P<0.05) in improving the patients across the board. More importantly, the “Cyriax technique” of cross-fiber friction massage was twice as effective as the phonophoresis group. If we remember the chronic nature of the injury — after most inflammation has disappeared — we can understand how causing controlled inflammation with massage is more beneficial than using a transdermal anti-inflammatory drug.

In the second one, a review of the animal, cellular, and clinical research by Murrell (2007), tendinosis is shown to be effectively treated by nitric oxide patches. In the body, the nitric oxide synthases synthesize a small soluble gas, Nitric oxide (NO), which acts as a messenger molecule. Delivering NO via a “glyceryl trinitrate” patch enhances the clinical outcome of treating tendinosis, in terms of reducing pain, increasing range of motion, and increasing strength. Interestingly, the most significant of the findings reviewed, a randomized controlled trial by Paoloni et al. (2005) uses neither NSAIDs nor deep transverse friction massage. In that study, 24 weeks of standard physical therapy treatment was perfomed on 53 patients with supraspinatus tendinopathy. The 26 patients receiving glyceryl trinitrate patches had significantly reduced (P<0.05) pain compared to the 27 patients using placebo patches.

Similarly, fibromyalgia might be linked to a nitric oxide deficiency; see further Life Extension Foundation’s article: http://www.lef.org/protocols/immune_connective_joint/fibromyalgia_01.htm… What role does nitric oxide really have in the development of tendinosis, fibromyalgia, “locked short” myofascia, and trigger points? I’ll be interested to find out!

So if you have tendinosis, try getting deep transverse friction massage from a qualified therapist, like me at the Art of Massage, 1831 Monument Ave, Richmond, VA.

Sources

Murrell GA. (2007). “Using nitric oxide to treat tendinopathy”. Br J Sports Med 41 (4): 227–31. doi:10.1136/bjsm.2006.034447. PMID 17289859. http://bjsm.bmj.com/content/41/4/227.full

Nagrale AV, Herd CR, Ganvir S, Ramteke G. (2009). “Cyriax physiotherapy versus phonophoresis with supervised exercise in subjects with lateral epicondylalgia: a randomized clinical trial.” J Man Manip Ther 17 (3): 171-8. PMID 20046624. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762836

Paoloni JA, Appleyard RC, Nelson J, Murrell GA. (2005). “Topical glyceryl trinitrate application in the treatment of chronic supraspinatus tendinopathy: a randomized, double-blinded, placebo-controlled clinical trial.” Am J Sports Med 33 (6): 806-13. doi: 10.1177. PMID 15827365. http://ajs.sagepub.com/content/33/6/806.full

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