COMPARISON OF DEEP FRICTION MASSAGE AND POST-ISOMETRIC RELAXATION TECHNIQUE IN COMBINATION WITH LONG WAVE DIATHERMY FOR THE MANAGEMENT OF ACHILLES TENDINOPATHY

Abstract

Background: Achilles tendinopathy is a load-related musculoskeletal condition associated with pain, restricted ankle movement and reduced physical function. Manual therapy techniques may be used as adjuncts to physiotherapy management. This study compared Deep Friction Massage (DFM) and Post-Isometric Relaxation (PIR), both combined with Long Wave Diathermy (LWD), in individuals with midportion Achilles tendinopathy.
Objective: To compare the effects of DFM combined with LWD and PIR combined with LWD on pain, ankle range of motion (ROM) and Achilles-specific functional status.
Methods: A quantitative randomized comparative controlled trial was conducted in 40 participants with clinically diagnosed midportion Achilles tendinopathy. Participants were randomly allocated in a 1:1 ratio to Group A (LWD + DFM; n=20) or Group B (LWD + PIR; n=20). Treatment was administered six sessions per week for four weeks (24 sessions). Outcomes were assessed at baseline, two weeks and four weeks using the Numeric Pain Rating Scale (NPRS), universal goniometry for ankle ROM, and the Victorian Institute of Sport Assessment–Achilles (VISA-A). Within-group changes were assessed using the Friedman test followed by Wilcoxon signed-rank pairwise testing with Bonferroni adjustment when appropriate. Between-group comparisons were performed using the Mann–Whitney U test.
Results: Both groups demonstrated improvement over four weeks. NPRS decreased from 5.70 ± 1.13 to 2.00 ± 0.86 in Group A and from 5.70 ± 0.98 to 1.35 ± 0.75 in Group B. VISA-A increased from 60.05 ± 8.17 to 80.65 ± 6.84 in Group A and from 62.35 ± 6.59 to 86.25 ± 4.38 in Group B. Ankle ROM increased in both groups. The study analysis reported statistically significant between-group differences at four weeks for NPRS, eversion ROM and VISA-A; the four-week change in dorsiflexion was also significantly greater in Group B, whereas plantarflexion and inversion did not show significant between-group differences.
Conclusion: Both treatment combinations were associated with improvement in pain, ankle ROM and Achilles-specific functional status over four weeks. The reported between-group differences occurred for selected outcomes. Larger controlled studies with longer follow-up and appropriate rehabilitation control conditions are needed to clarify the comparative effects of DFM and PIR when used with LWD