Comparison of The Effectiveness of Instrument-Assisted Soft Tissue Mobilization Technique, Ultrasound therapy, or Deep Friction Massage on Fast Recovery and Accelerating Tissue Healing in Groin Strain

Background: Instrument-assisted soft tissue mobilization technique (IASTM), Ultrasound therapy (US), and Deep Friction Massage (DFM) offered to manage adductor muscles for facilitating the fast recovery and promoting tissue healing. Few studies are available about the effects of IASTM, how far the effectiveness of ultrasound on the functional recovery is still under debate. Deep friction massage is known to be used to promote muscle fiber arrangement. Methods: 46participants divided randomly into four groups; (I) control group, no agent used (n=10), (II) instrument-assisted soft tissue mobilization technique (n=12). (III) Ultrasound therapy (n=12) (IV) Deep friction massage (n=12). 15 sessions delivered to all participants over five weeks, day after day. Analysis: Numerical Pain Scale, Inclinometer, dynamometer, and ultrasound imaging used to measure pain severity, pain-free abduction passive range of motion, maximum pain-free adductor contraction, and tissue healing respectively. Baseline measurements were done before any intervention, and measures after the 1st week, 3rd week, and at the end of the therapeutic intervention. Repeated measures MANOVA used to compare within and between groups. Result: IASTM and US show a significant effect on Pain, recovery (ROM {P<0.031, P <0.018} – Strength {P <0.026, P <0.041}), and proper healing (P <0.049, P <0.021). Initially, ultrasound was effective in reducing pain intensity and accelerating healing but, IASTM is more effective in gaining recovery. DFM only has a tissue healing effect (P <0.039). Conclusion: IASTM is the most effective method regarding fast recovery and proper tissue healing in groin strain unless the pain is not a big issue.

Tyler TF, Silvers HJ, Gerhardt MB, et al. Groin injuries in sports medicine. Sports health. 2010; 2:231-6.

Serner A, van Eijck CH, Beumer BR, et al. Study quality on groin injury management remains low: a systematic review on the treatment of groin pain in athletes. Br J Sports Med. 2015; 49(12):813.

Wong S, Ning A, Lee C, Feeley BT. Return to sport after muscle injury. Curr Rev Musculo-skeletal Med.2015; 8:168-75.

Almeida MO, Silva BN, Andriolo RB, et al. Conservative interventions for treating exer-cise-related musculotendinous, ligamentous and osseous groin pain. Cochrane Database Syst Rev. 2013; 6. DOI: 10.1002/14651858.CD009565.pub2.

Joseph MF, Taft K, Moskwa M, Dene-garCR.Deep friction massage to treat tendi-nopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding. J SportsRehabil. 2012; 21:343-53.

Morishita K, Karasuno H, Yokoi Y, et al. Ef-fects of therapeutic ultrasound on a range of motion and stretching pain. J Phys Ther Sci. 2014; 26: 711-15.

Moubarez DA, Mohamed KA, El Din SS, Basheer MA, El Baz AA. Muscle ultrasound in assessment of critical illness neuromyo-pathy in comparison with nerve conduction. J. Adv. Pharm. Educ. Res. 2019;9(1):11-6.

Dawood M.S., Al-Salihi A.R., Qasim A W. La-ser therapy of muscle injuries. Lasers Med Sci. 2013; 28(3):735-42.

Fekri L, Rezvani A, Karimi N, Ezzati K. The Effect of Low-Power and High-Power Laser Therapy on Pain, Tenderness and Grip Force of the Patients with Tennis Elbow. Pharma-cophores. 2019;10(3):89-95.

Hossaini SM, Bahador A. Application of the High-Intensity Laser Therapies on Ceramic Brackets Debonding: A Literature Review. Ann. Dent. Spec. 2018;6(1):363-6.

Kim J, Sung DJ, Lee J. Therapeutic effective-ness of instrument-assisted soft tissue mo-bilization for soft tissue injury: mechanisms and practical application. J ExercRehabil. 2017;13(1):12-22.

Schaefer JL, Sandrey MA. Effects of a 4-week dynamic-balance-training program supple-mented with Graston instrument-assisted soft-tissue mobilization for chronic ankle instability. JSportsRehabil. 2012; 21(4):313-26.

Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accel¬erates knee ligament healing. J Orthop Sports Phys Ther 2009; 39(7):506-14.

Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument-assisted soft tissue mobilization: a systematic review. J Can Chi-ropr Assoc. 2016;60(3):200-211.

Walker BJ., Berde CB., “Acute Pain” in A Prac-tice of Anesthesia for Infants and Children. (6th Edition), 2019 (Book in print)

EmrahAkgun E., Kozaci N., Avci M. Meas-urement of the pain levels of patients with extremity traumas and assessment of the at-titudes of emergency physicians to pain management. Annals of Medical Research. 2018;25(4)553-8.

Michener, Lori A., Alison R. Snyder, and Bri-an G. Leggin. "Responsiveness of the numer-ic pain rating scale in patients with shoulder pain and the effect of surgical status." Jour-nal of sport rehabilitation 20, no. 1 (2011): 115-128.

Pua YH, Wrigley TV, Cowan SM, Bennell KL. Intrarater test-retest reliability ofa hip range of motion and hip muscle strength meas-urements in persons with hip osteoarthritis. Arch Phys Med Rehabil. 2008; 89(6):1146-1154.

Roach S, San Juan JG, Suprak DN, Lyda M. Concurrent validity of digital inclinometer and universal goniometer in assessing pas-sive hip mobility in healthy subjects. Int J Sports Phys Ther. 2013;8(5):680-688.

Hayes K, Walton JR, Szomor ZL, Murrell GAC.Reliability of 3 methods for assessing shoulder strength. J Shoulder Elbow Surg. 2002: 11(1): 33-39.

Martins J, da Silva JR, Da Silva MRB, Bevilaqua-Grossi D. Reliability and Validity of the Belt-Stabilized Handheld Dynamome-ter in Hip- and knee strength Tests. J Athl Train. 2017;52(9):809-19

Draghi F, Zacchino M, Canepari M, Nucci P, Alessandrino F. Muscle injuries: ultrasound evaluation in the acute phase. J Ultrasound. 2013; 16(4):209–214.

Lee JC, Mitchell AW, Healy JC. Imaging of muscle injury in the elite athlete. Br J Radiol. 2012; 85(1016):1173–85.

Rantanen J, Thorsson O, Wollmer P, Hurme T, Kalimo H. Effects of therapeutic ultra-sound on the regeneration of skeletal myofi-bers after experimental muscle injury. Am J Sports Med 1999; 27(1):54-59.

Loew LM, Brosseau L, Tugwell P, et al.Deep transverse friction massage for treating lat-eral elbow or lateral knee tendinitis. Cochrane Database of Systematic Reviews. 2014; 8 (11).doi: 10.1002/14651858.CD003528.pub2.

Alves AN, Fernandes KPS, Deana AM, Bussa-dori SK, Mesquita-Ferrari RA. Effects of low-level laser therapy on skeletal muscle repair: a systematic review. Am J Phys Med Rehabil. 2014; 93(12): 1073– 1085.

Mesquita-Ferrari RA, Martins MD, Silva JA Jr, et al., Effects of low-level laser therapy on expression of TNF-α and TGF- β in skeletal muscle during the repair process. Lasers Med Sci 2011; 26(3):335-40

Loghmani MT, Warden SJ. Instrument- As-sisted Cross-Fiber Massage Accelerates Knee Ligament Healing. J Ortho Sports Phys Ther. 2009; 39(7): 506 – 14.

Gehlsen GM, Ganion LR, Helfst R. Fibroblast responses to variation in soft tissue mobili-zation pressure. Med Sci Sports Exerc. 1999; 31(4):531-535.

Jarvinen, T.A.; Jarvinen, M.; Kalimo, H. Re-generation of injured skeletal muscle after the injury. Muscles Ligaments Tend. J. 2013; 3(4): 337–345.

LaumonierT, and Menetrey J, Muscle injuries and strategies for improving their repair. Journal Experimental Orthopedics. 2016; 3(1): 15.

Stratford PW, Levy DR, Gauldie S, Miseferi D, Levy K. The evaluation of phonophoresis and friction massage as treatments for ex-tensor carpi radialis tendinitis: a random-ized controlled trial. Physiotherapy Canada 1989;41(2):93–9.