Effect of Deep Friction Massage on Pain, Function, Kinesiophobia, and Quality of Life in Bicipital Tendinitis

Firat University

Status: Invitation-only

Conditions: Bicipital Tendonitis

Treatments: Other: Exercise; Other: Deep friction massage

Study type: Interventional

Funder types: Other

Identifiers

NCT07030972

FU_MGBeydagi_Omuz_B_2025/06-39

Details and patient eligibility

About

Bicipital tendinitis is a condition caused by inflammation of the biceps tendon, resulting in pain and limited movement in the front of the shoulder. This condition usually develops due to repetitive shoulder movements or overuse and can negatively affect daily life.

Treatment usually involves medications, cold applications, rest, and exercises. However, in some cases, these methods may not be sufficient. This study aims to investigate the effects of deep friction massage (DFM) when applied in addition to a standard exercise program. DFM is a massage technique that supports tissue healing, reduces pain, and improves mobility.

Within the scope of the study, the effects of DFM combined with exercise on pain, functional capacity, fear of movement (kinesiophobia), and quality of life will be evaluated. The findings obtained aim to contribute to the development of more effective approaches in the treatment of biceps tendinitis.

Full description

Bicipital tendinitis is a condition characterized by inflammation of the long head of the biceps tendon, causing pain and tenderness in the front of the shoulder. It typically develops due to repetitive shoulder movements or overuse and, if left untreated, can negatively impact quality of life. Treatment for biceps tendinitis focuses on reducing inflammation and swelling, strengthening the tendon, and preventing tendon rupture. Early/initial treatments for biceps tendinitis include nonsteroidal anti-inflammatory drugs, activity modification, nonsteroidal anti-inflammatory gels or patches for pain, and cold applications for pain and swelling. If symptoms do not improve, physical therapy may be recommended. These treatments typically include stretching and strengthening exercises, massage, or ultrasound therapy. Exercises aim to help keep muscles, joints, and tendons mobile and flexible. If symptoms are severe or persistent despite initial/early treatment, the doctor may recommend a steroid injection into the affected area to reduce inflammation and pain. After the injection, patients are typically prescribed rest, ice, acetaminophen (Tylenol) for pain, and a regimen of stretching/strengthening exercises.

Another important treatment method in the conservative management of tendinopathies is Deep Friction Massage (DFM). DFM is an approach that mechanically supports the remodeling of tissue and the healing process. This technique helps meet the tendon's oxygen and nutrient requirements by increasing blood flow in the treated area, while supporting the alignment of collagen fibers and facilitating the reorganization of scar tissue. The effects of deep friction massage on pain reduction and functional capacity improvement have been extensively documented in the literature. Additionally, the positive effects of this method on flexibility and range of motion from a biomechanical perspective are one of the reasons it is preferred in the management of musculoskeletal disorders.

The investigators believe that the application of deep friction massage in addition to a standard exercise program in patients with bicipital tendinitis could be a useful combination therapy to support tendon healing. This approach may create a synergistic effect in tendon healing by combining the positive effects of exercise with the long-term tissue benefits of deep friction massage. There are a limited number of studies in the literature suggesting that this combination is effective; therefore, more comprehensive and controlled research is needed to guide clinical practice.

Pain, functional capacity, kinesiophobia (fear of movement), and quality of life are critical in assessing the effects of biceps tendinitis on patients. Improving these parameters can accelerate patients' return to daily activities and improve their overall health. In light of this information, it is thought that the combined application of an exercise program and deep friction massage could be considered a potential treatment strategy for pain management and functional improvement in the treatment of biceps tendinitis. This study aims to evaluate the effects of deep friction massage, applied in addition to an exercise program, on pain, functional capacity, kinesiophobia, and quality of life in patients with biceps tendinitis. This will provide further insight into the efficacy of combined treatment methods and guide clinical practice.

Enrollment: 42 estimated patients

Sex: All

Ages: 20 to 55 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Diagnosis of bicipital tendinitis (tendinosis)
• Be between 20 and 55 years of age
• Have shoulder pain lasting longer than 3 months

Exclusion criteria

• Shoulder impingement or frozen shoulder
• Another shoulder problem such as a full-thickness rotator cuff tear or instability
• Having received physical therapy or manual therapy for the same shoulder within the past year
• History of upper extremity fracture
• History of shoulder surgery
• Presence of entrapment neuropathy
• Having radicular pain originating from the cervical vertebrae
• Having a systemic musculoskeletal disease
• Having mental and cognitive problems

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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42 participants in 2 patient groups

Control

Active Comparator group

Description:

Individuals in the control groups will be included in a routine exercise program. This exercise program will include shoulder joint range of motion exercises, finger ladder, Codman, and stick exercises, which will be applied to maintain functional range of motion in the early stages and increase it in the later stages. Isometric exercises will be applied to the scapular muscles to maintain muscle strength in the early stages. In the later stages, rotator cuff, scapular stabilizer, and deltoid strengthening exercises will be demonstrated and applied. Low-resistance therabands will be used for strengthening at the beginning. Additionally, neuromuscular control exercises and proprioceptive exercises will be included in the treatment to enhance joint stabilization and coordination. The exercises will be performed over a 6-week period, 3 days per week, with 10-30 repetitions.

Treatment:

Other: Exercise

Intervention group

Experimental group

Description:

Individuals in the intervention group will receive deep friction massage on the biceps tendon in addition to the routine exercise program and following the exercise program. The individual will be placed in a long sitting position with their back supported. While the patient's shoulder is next to the body and the elbow is flexed at 90 degrees, the therapist's thumb will be placed on the painful area on the extension of the biceps tendon fibers and a deep friction massage will be applied to the point where the tendonitis occurs in a transverse direction for 3-10 minutes.

Treatment:

Other: Deep friction massage

Other: Exercise