Quantitative application of transverse friction massage and its neurological effects on flexor carpi radialis

The Beliefs and Attitudes of Cypriot Physical Therapists Regarding the Use of Deep Friction Massage

Background: Deep friction massage (DFM) is a widely used technique by physical therapists worldwide for chronic pain management. According to Dr. James Cyriax, compliance with the proposed guidelines is vital to obtain the desired therapeutic results. Objectives: This study explored the beliefs and attitudes of Cypriot physical therapists to DFM and their compliance with the suggested guidelines to identify any empirical-based application patterns and compare them to the suggestions of Cyriax. In addition, the prevalence of DFM use in clinical practice in Cyprus was investigated. Methods: Questionnaires, consisting of 18 multiple choice questions and a table of six sub-questions, were distributed to 90 local physical therapists. Results: A total of 70% of respondents declared that they perform DFM in their daily practice. The respondents answered 11 out of the 19 technical questions in compliance with the guidelines. Conclusion: The study revealed the DFM application pattern of Cypriot physical therapists. The compliance percentage of this pattern to Cyriax guidelines was 58% in general and 62.5% for patients with chronic conditions.

A Hand-Held Device to Apply Instrument-Assisted Soft Tissue Mobilization at Targeted Compression Forces and Stroke Frequencies

Instrument-assisted soft tissue mobilization (IASTM) is a manual therapy technique that is commonly used to treat dysfunctions in ligaments and other musculoskeletal tissues. The objective of this study was to develop a simple hand-held device that helps users accurately apply targeted compressive forces and stroke frequencies during IASTM treatments. This portable device uses a force sensor, tablet computer, and custom software to guide the application of user-specified loading parameters. To measure performance, the device was used to apply a combination of targeted forces and stroke frequencies to foam blocks and silicone pads. Three operators using the device applied targeted forces between 0.3 and 125 N with less than 10% error and applied targeted stroke frequencies between 0.25 and 1.0 Hz with less than 3% error. The mean error in applying targeted forces increased significantly at compressive forces less than 0.2 N and greater than 125 N. For experimental validation, the device was used to apply a series of IASTM treatments over three-weeks to rodents with a ligament injury, and the targeted compressive force and stroke frequency were repeatedly applied with an average error less than 5%. This validated device can be used to investigate the effect of IASTM loading parameters on tissue healing in animal and human studies, and therefore can support the optimization and adoption of IASTM protocols that improve patient outcomes.

Acute effects of direct inhibitory pressure over the biceps brachii myotendinous junction on skeletal muscle activation and force output

Force (F) reduction is reported with myotendinous junction (MTJ) manipulation. Autogenic inhibition reflex (AIR) activation is supposed to be the main mechanism. Still, its role remains unclear. The study aimed at assessing the effects of MTJ direct inhibitory pressure (DIP) on neuromuscular activation and F in the elbow flexor (agonist) and extensor (antagonist) muscles. After maximum voluntary contraction (MVC) assessment, thirty-five participants randomly performed submaximal contractions at 20, 40, 60, and 80% MVC. Electromyographic (EMG), mechanomyographic (MMG), and F signals were recorded. Protocol was repeated under (i) DIP (10-s pressure on the biceps brachii MTJ) with the elbow at 120° (DIP₁₂₀), (ii) DIP with the elbow at 180° (DIP₁₈₀), and (iii) without DIP (Ctrl). Electromechanical delay (EMD) components, EMG and MMG root mean square (RMS), and rate of force development (RFD) were calculated. Independently from the angle, DIP induced decrements in MVC, RFD, and RMS of EMG and MMG signals and lengthened the EMD components in agonist muscles (P<0.05). The DIP-induced decrease in F output of the agonist muscles seems to be possibly due to a concomitant impairment of the neuromuscular activation and a transient decrease in stiffness. After DIP, the antagonist muscle displayed no changes; therefore, the intervention of AIR remains questionable.

Force Sensing for an Instrument-Assisted Soft Tissue Manipulation Device

Instrument-assisted soft tissue manipulation (IASTM) is a form of mechanotherapy, e.g., massage, that uses rigid devices which may be machined or cast. The delivered force, which is a critical parameter during IASTM, is not measured and not standardized in current clinical IASTM practice. In addition to the force, the angle of treatment and stroke frequency play an important role during IASTM. For accurate IASTM treatment, there is a strong need to scientifically characterize the IASTM delivered force, angle of treatment, and stroke frequency. This paper presents a novel, mechatronic design of an IASTM device that can measure the localized pressure on the soft tissue in a clinical treatment. The proposed design uses a three-dimensional (3D) load cell, which can measure all three-dimensional force components simultaneously. The device design was implemented using an IMUduino microcontroller board which provides tool orientation angles. These orientation angles were used for coordinate transformation of the measured forces to the tool–skin interface. Additionally, the measured force value was used to compute the stroke frequency. This mechatronic IASTM tool was validated for force measurements in the direction of tool longitudinal axis using an electronic plate scale that provided the baseline force values to compare with the applied force values measured by the tool. The load cell measurements and the scale readings were found to agree within the expected degree of accuracy.

The neuromotor effects of transverse friction massage

BACKGROUND

Transverse friction massage (TFM), as an often used technique by therapists, is known for its effect in reducing the pain and loosing the scar tissues. Nevertheless, its effects on neuromotor driving mechanism including the electromechanical delay (EMD), force transmission and excitation-contraction (EC) coupling which could be used as markers of stiffness changes, has not been computed using ultrafast ultrasound (US) when combined with external sensors.

AIM

Hence, the aim of this study was to find out produced neuromotor changes associated to stiffness when TFM was applied over Quadriceps femoris (QF) tendon in healthy subjcets.

METHODS

Fourteen healthy males and fifteen age-gender matched controls were recruited. Surface EMG (sEMG), ultrafast US and Force sensors were synchronized and signals were analyzed to depict the time delays corresponding to EC coupling, force transmission, EMD, torque and rate of force development (RFD).

RESULTS

TFM has been found to increase the time corresponding to EC coupling and EMD, whilst, reducing the time belonging to force transmission during the voluntary muscle contractions.

CONCLUSIONS

A detection of the increased time of EC coupling from muscle itself would suggest that TFM applied over the tendon shows an influence on changing the neuro-motor driving mechanism possibly via afferent pathways and therefore decreasing the active muscle stiffness. On the other hand, detection of decreased time belonging to force transmission during voluntary contraction would suggest that TFM increases the stiffness of tendon, caused by faster force transmission along non-contractile elements. Torque and RFD have not been influenced by TFM.

Effects of Massage on Muscular Strength and Proprioception After Exercise-Induced Muscle Damage

Exercise-induced muscle damage (EIMD), which is commonly associated with eccentric exercise, unaccustomed exercise, and resistance training, may lead to delayed onset muscle soreness, swelling, decreased muscle strength, and range of motion. Many researchers have evaluated various interventions to treat the signs and symptoms of EIMD. However, the effects of massage after EIMD are unclear. Here, we investigated the effect of massage on muscle strength and proprioception after EIMD. All subjects randomly were divided into an EIMD-treated control group (n = 10) and a massage-treated after EIMD experimental group (n = 11). Exercise-induced muscle damage was induced by repeated exercise. Massage treatment was provided by physiotherapist for 15 minutes. It consists of light stroking, milking, friction, and skin rolling. Lactate was evaluated by Lactate Pro analyzer in pre- and postexercise. Surface electromyography (muscle activity) and sonography (muscle thickness) were used to confirm the muscular characteristics. Proprioception was investigated by dual inclinometer. As a result, massage treatment on the gastrocnemius after EIMD increased activation of the medial gastrocnemius during contraction (p ≤ 0.05). In the lateral and medial gastrocnemius, the θs, which is the angle between muscle fibers and superficial aponeurosis, showed a significant change (p ≤ 0.05). However, there are no differences in the θd, which is the angle between muscle fibers and deep aponeurosis. We also found that proprioceptive acuity in the ankle joint was significantly greater in the massage-treated experimental group compared with that in the control group (p ≤ 0.05). These findings suggest that massage of the gastrocnemius after EIMD can improve muscle strength and proprioception by influencing the superficial layer of the gastrocnemius.

The Use of the MyoDK for Mechanical Pressure in the Treatment of Chronic Lateral Epicondylalgia: A Pilot Study

INTRODUCTION

Chronic Lateral Epicondylalgia (CLE) is potentially associated with a significant reduction of the patient's quality of life; its treatment by manual Deep Transverse Friction (DTF), although widely accepted, lacks standardization. The purpose of our study was to evaluate the efficacy of the MyoDK device, which allows deep transverse pressure (DTP) monitoring, for treatment of CLE.

MATERIALS AND METHODS

This is a single centre observational study for treatment of CLE by the MyoDK device. In a given year, all patients who appeared at our institution with a diagnostic of CLE were screened for possible inclusion. Exclusion criteria were: confounding factors on pain and function of the upper limb, cognitive impairment, inability or unwilling to give informed consent or to comply with treatment protocol. Our primary outcome measure was the pain reduction measured by the VAS pain scale (VAS) at 6 weeks. Our intervention consisted in applying a pressure from 0.5 to 10kg/100mm(2) for 20 minutes, once a week for 6 weeks, using the MyoDK device.

RESULTS

Thirty patients were screened. Two were excluded for incomplete protocol, remaining 28 for analysis. Mean age was 47.3, 23 were male (82.1%), 24 were affected on their dominant side (85.7%). We had a significant reduction in VAS pain score at 12 weeks (80.8 vs 13.0; p<0.01). There were no side effects reported.

CONCLUSION

Our study showed the safety of the use of a standard protocol using the MyoDK device for treatment of CLE. We believe that further controlled studies will establish the MyoDK as a reliable option for treatment of CLE.