Effects of Deep Friction Massage versus Stretching and Strengthening Exercise in the Management of Lateral Epicondylitis

Background: Lateral epicondylitis (LE) is a common cause of elbow pain, often leading to reduced wrist function and handgrip strength. Conservative interventions, including exercise and manual therapy, are widely used, but comparative effectiveness remains under investigation.

Objective: To find out the effects of deep friction massage, stretching and strengthening exercise in the management of LE of elbow.

Methods: A prospective intervention study was conducted from July 2018 to June 2019 at BSMMU, Dhaka. A total 60 patients aged 20–80 years with LE were randomly assigned to Group A (stretching and strengthening exercises, ultrasonic therapy, wrist splinting, activity modification) or Group B (deep friction massage, ultrasonic therapy, wrist splinting, activity modification). Both interventions were applied three times per week for six weeks, and all participants received Naproxen 250 mg twice daily with Omeprazole 20mg for two weeks. Outcomes included pain (VAS), wrist ROM (goniometer), and grip strength (sphygmomanometer), assessed at baseline, 2nd, 4th, and 6th weeks.

Results: Baseline characteristics were comparable between groups. Both interventions significantly reduced pain after six weeks (Group A: VAS 7.27±0.69 to 1.47±0.51; Group B: 7.30±0.65 to 2.27±0.58; p<0.001). Group A achieved faster and greater pain relief at 4 and 6 weeks compared to Group B (p=0.029 and p<0.001, respectively). Wrist flexion and extension improved significantly in both groups (p<0.001), with greater gains in Group A. Handgrip strength increased markedly in Group A (27.05±3.84 to 45.50±6.20 mmHg; p<0.001) but not in Group B (26.75±3.65 to 29.10±4.05 mmHg; p=0.082).

Conclusion: Stretching and strengthening exercises provided superior pain relief, improved wrist ROM, and enhanced handgrip strength compared to deep friction massage in patients with lateral epicondylitis.