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Year : 2019  |  Volume : 12  |  Issue : 4  |  Page : 331-334  

Effects of deep friction massage and static stretching in non-specific neck pain

1 Department of Physiotherapy, Mayo Hospital, KEMU, Lahore, Pakistan
2 Department of Physiotherapy, Sargodha Medical College, University of Sargodha (UOS), Sargodha, Pakistan

Date of Submission08-Oct-2018
Date of Acceptance27-Feb-2019
Date of Web Publication8-Jul-2019

Correspondence Address:
Muhammad Mustafa Qamar
Department of Physiotherapy, Sargodha Medical College, UOS, Sargodha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_196_18

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Introduction: Neck pain is a frequent complaint of the era. The muscles around the neck tend to get shorter, leading to restricted neck mobility. There are not much data about the effectiveness of deep friction massage in comparison with static stretching for reducing nonspecific neck pain. Purpose: The purpose was to find out whether these two interventions gave similar results and if one method is better to the other which could be the substitute of remedy. Study Design: This study was based a randomized control trial. Place of Study: This study was conducted at the Department of Physical Therapy, Mayo Hospital Lahore. Materials and Methods: Fifty-six patients with nonspecific neck pain were randomly located to have static stretching (Group A, n = 28) and deep friction massage (Group B, n = 28). Group A received six sessions of static stretching during 3 weeks (two sessions per week), whereas Group B received six sessions of deep friction massage during 3 weeks (two sessions per week). Results: Paired sample t-test was used. Statistically significant improvement was observed in both the groups in improving pain, Neck Disability Index (NDI), and range of motion (P > 0.05). No difference was found between the deep friction massage and static stretching in improving pain and range of motion. However, deep friction massage shows superior effects in NDI (P > 0.05). Conclusion: Deep friction massage and static stretching are equally effective in reducing the nonspecific neck pain in terms of alleviating pain and improving ranges of neck movement. However, deep friction massage shows superior effects in NDI.

Keywords: Deep friction massage, neck pain, static stretching

How to cite this article:
Yasin M, Ijaz Gondal MJ, Qamar MM, Basharat A, Rasul A, Ahmed W. Effects of deep friction massage and static stretching in non-specific neck pain. Med J DY Patil Vidyapeeth 2019;12:331-4

How to cite this URL:
Yasin M, Ijaz Gondal MJ, Qamar MM, Basharat A, Rasul A, Ahmed W. Effects of deep friction massage and static stretching in non-specific neck pain. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2020 Dec 2];12:331-4. Available from: https://www.mjdrdypv.org/text.asp?2019/12/4/331/262232

  Introduction Top

Neck pain is a frequent impairment linked to disability and massive health-care cost. Chronic neck pain causes large economic loss not only in terms of diagnosis but also for sick leave and premature retirement pension.[1] Over the past 20 years, the incidence of neck pain has risen at an even rate.[2],[3] In a study, the per year incidence ranged from 10% to 21% with women reporting more incidence than men.[4]

Nonspecific neck pain is simple neck pain, not having any obvious hidden disease causing pain.[5] It is characterized by an all-around sensation of increasing pain in the skin, ligaments, and muscles. The pathophysiologic mechanism of neck pain often remains unknown, for the reason accident and severe old age-related changes are expected in few cases. The cause of neck pain has many factors.[6] It is often inflammatory, degenerative changes or postural or mechanical causes. Etiological factors are bad alignment, low mood, neck strain, and sporting injuries.[7] Neck pain with decreased mobility is a common complaint. There were mechanical restriction and limited mobility between vertebrae.[8] Decrease range of motion and stiffness may accompany neck pain that may be worse by neck movements or steady neck postures.[9]

There are different strategies to treat neck pain, nonsteroidal anti-inflammatory drugs, painkillers, isometrics, mobilization, strengthening exercises, massage techniques, and stretching exercises. These are widely approved, determined, and conducted around the world.[10] Although many interventions are assumed as the quality of care for mechanical neck pain, marked proof in the aspect of the effectiveness of the nonoperative intervention is not available.[11]

Massage therapy, which is compatible and alternative treatments, which encompasses many special techniques that are sometimes used in regular order, likely as stroking, kneading, and percussion.[12] Stretching is assumed to give a lot of physical comforts that involve promoting flexibility, injury anticipation, promoting muscle and athletic performance, improving healing, and decreasing the onset of muscle soreness. Evidence showed that the tension generated in static stretching is half than that is produced in ballistic stretching.[13]

Clinical decision-making in case of treatment of patients having neck pain often depends on the observations of the clinical examination. The classification of the patient is the most benefit to the physical therapist when it depends upon signs and symptoms observed during clinical examination and when it is used to divide subgroups of patients that are homogeneous with respect to the outcomes of the certain intervention.[14] There is no conclusion available in the literature about the efficacy of deep friction massage in comparison with stretching exercises to mitigate nonspecific neck pain. Hence, a study was conducted to find out if these two techniques give similar results and if one method is better than other which could be the alternate way of treatment.

  Materials and Methods Top

Our work was conducted at the Department of Physiotherapy, Mayo Hospital, Lahore. Patients diagnosed with nonspecific neck pain were recruited. The consent form was used to obtain permission from each patient according to the Declaration of Helsinki. Fiftysix patients were recruited by nonprobability sampling and divided by lottery method into Group A and B. Group A participants received static stretching of the upper part of the trapezius, scalene, and sternocleidomastoid, whereas Group B received deep friction massage on the same muscles group. In addition to that, both groups received a hot pack for 10 min before the treatment. Both the groups received treatments for 3 weeks with a frequency of two sessions/week.

Spurling's test and upper-limb tension test used to assess the neck pain. Data were collected after a thorough physical examination by the therapist. It involved both subject and objective examination. The information involving demographic data and duration of onset nature and type of pain was noted. The patients were randomly entitled to receive either stretching of neck muscles or deep friction massage technique.

A visual analog scale (VAS) 0 taken as “no pain” and 10 taken as “severe imaginable pain” was used to measure the intensity of pain. The patients had also accomplished the Neck Disability Index (NDI) to assess the disability. The NDI was scored from 0 to 50. The more score corresponded to the more disability. The neck range of motion (ROM) was assessed by a universal goniometer.

Statistical analysis

Analysis of data had been observed by SPSS version 16.0 (SPSS for Windows, SPSS Inc., Chicago, IL, USA). Frequency tables and percentages were given for qualitative variables. Mean ± standard deviation also with its range represented the quantitative variables. To collate the mean differences of quantitative variables, independent t-test was used. P < 0.05 will be considered as significant.

  Results Top

The physical characteristic of the subjects

There were 53 participants who had finished the sessions and three were let out, as they were unable to complete the treatment sessions. The mean age of the patient was 40.96 ± 5.79 years. The maximum age in both the study groups was 50 years, whereas the minimum age was 35 years. There were 11 males and 17 females in Group A, whereas in Group B, there were 13 males and 15 females.

Effect on visual analog scale pain scale after the study period

Improvement in pain on a VAS was examined in both the groups. In a poststudy, 70% improvement in pain was estimated on VAS in deep friction massage group and approximately 77% in static stretching group (P < 0.005). However, no difference in response was observed in between the groups [Figure 1].
Figure 1: Pain intensity on visual analog scale

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Poststudy effect on Neck Disability Index

In static stretching, the mean score of NDI at baseline was 21.48 ± 8.43; it was improved by 44% after treatment. In group deep friction massage, the mean score was 22.00 + 7.52. After treatment, the mean score was improved to 64% [Figure 2]. Both showed a significant difference in improving NDI; however, deep friction massage showed superior effects (P = 0.03).
Figure 2: Neck Disability Index at baseline and poststudy

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Poststudy effect on cervical neck range of motion

We had found a significant improvement (P = 0.000) in active cervical ROM in both the study groups. The active neck flexion was improved by 36% in Group A (static stretching group) and 43% in Group B (deep friction massage group). The cervical extension was improved in Group A and Group B by 39% and 46%, respectively. Similarly, the right- and left-side bending and rotation were also improved as compared to baseline in both the groups.

  Discussion Top

The impetus of the present work was to estimate the effectiveness of deep friction massage and static stretching in nonspecific neck pain patients. This study suggested that both static stretching and deep friction massage can improve nonspecific neck pain. A 70% improvement in pain was found in Group B and approximately 77% in the Group A. Similarly, NDI score was improved by 44% in Group A, whereas 64% in Group B.

Our study suggested that stretching and deep friction massage can help in the restoration of the flexibility of the neck muscles. Massage also has an added effect on improving pain, which adjusts of the pain perception on the spinal cord that was in accordance with the pain gate theory. The effect of pain perception into the posterior horn of the spinal cord from the pain receptor system was rejected by the mechanoreceptors presented in the same tissues, leading to increasing destroying of pain-promoting metabolites. This metabolite, if remained present in very large quantity, would cause ischemia and pain.[15]

The cervical pain commonly associated with bad posture during different working conditions such as bankers, computer workers, and drivers and people who sit forward head position for prolonged time. Physiotherapy treatment can play a big role in the treatment of postural neck pain. We had applied deep friction massage and static stretching to treat neck pain. Passive manual stretching improves muscle elasticity and reduces joint stiffness. The result of static stretching significantly improved ROM, which was consistent with the study conducted in the other areas of the body. The marked gain in ROM of the shoulder, hip, and knee was found within the group when the heat was followed by stretching.[16] In a recent study, it was concluded that it was common clinical scrutiny that the use of deep friction massage led to quick pain ease. The patient experienced a numbing effect during the session and reported a reduction in pain and increase in strength and mobility.[17]

Research suggested that posture correction and improvement in flexibility by static stretching showed marked improvement in neck pain.[18] Stretching could markedly improve pain and ROM.[19] Stretching exercises alone or in combination with the strengthening exercises showed good results in relieving neck pain and disability and improving the ranges of the neck.[18],[20] Combination therapy of deep friction massage and static stretching can be beneficial in improving muscle flexibility, pain, and disability.

  Conclusion Top

Deep friction massage and static stretching are equally effective in reducing the nonspecific neck pain in terms of alleviating pain and improving ranges of neck movement. However, deep friction massage shows superior effects in NDI.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: A systematic critical review of the literature. Eur Spine J 2006;15:834-48.  Back to cited text no. 1
Tsakitzidis G, Remmen R, Dankaerts W, Van Royen P. Non-specific neck pain and evidence-based practice. Eur Sci J 2013;9:18-20.  Back to cited text no. 2
Binder AI. Cervical spondylosis and neck pain. BMJ 2007;334:527-31.  Back to cited text no. 3
Kanchanomai S, Janwantanakul P, Jiamjarasrangsi W. One-year incidence and risk factors of thoracic spine pain in undergraduate students. J Phys Ther Sci 2013;25:15-20.  Back to cited text no. 4
Binder A. The diagnosis and treatment of nonspecific neck pain and whiplash. Eura Medicophys 2007;43:79-89.  Back to cited text no. 5
Ylinen J, Takala EP, Nykänen M, Häkkinen A, Mälkiä E, Pohjolainen T, et al. Active neck muscle training in the treatment of chronic neck pain in women: A randomized controlled trial. JAMA 2003;289:2509-16.  Back to cited text no. 6
Cheng CH, Cheng HY, Chen CP, Lin KH, Liu WY, Wang SF, et al. Altered co-contraction of cervical muscles in young adults with chronic neck pain during voluntary neck motions. J Phys Ther Sci 2014;26:587-90.  Back to cited text no. 7
Cassidy JD, Lopes AA, Yong-Hing K. The immediate effect of manipulation versus mobilization on pain and range of motion in the cervical spine: A randomized controlled trial. J Manipulative Physiol Ther 1992;15:570-5.  Back to cited text no. 8
Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol 2010;24:783-92.  Back to cited text no. 9
Sharma A, Angusamy R, Kalra S, Singh S. Efficacy of post-isometric relaxation versus integrated neuromuscular ischaemic technique in the treatment of upper trapezius trigger points. Indian J Physiother Occup Ther 2010;4:1-5.  Back to cited text no. 10
Sueki DG, Chaconas EJ. The effect of thoracic manipulation on shoulder pain: A regional interdependence model. Phys Ther Rev 2011;16:399-408.  Back to cited text no. 11
Vicenzino B, Paungmali A, Teys P. Mulligan's mobilization-with-movement, positional faults and pain relief: Current concepts from a critical review of literature. Man Ther 2007;12:98-108.  Back to cited text no. 12
Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. J Back Musculoskelet Rehabil 2017;30:1149-69.  Back to cited text no. 13
Cleland JA, Childs JD, Fritz JM, Whitman JM. Interrater reliability of the history and physical examination in patients with mechanical neck pain. Arch Phys Med Rehabil 2006;87:1388-95.  Back to cited text no. 14
Cobb TK, Dalley BK, Posteraro RH, Lewis RC. Anatomy of the flexor retinaculum. J Hand Surg Am 1993;18:91-9.  Back to cited text no. 15
Kostopoulos D, Nelson AJ Jr., Ingber RS, Larkin RW. Reduction of spontaneous electrical activity and pain perception of trigger points in the upper trapezius muscle through trigger point compression and passive stretching. J Musculoskelet Pain 2008;16:266-78.  Back to cited text no. 16
Hassan SM, Hafez AR, Seif HE, Kachanathu SJ. The effect of deep friction massage versus stretching of wrist extensor muscles in the treatment of patients with tennis elbow. Open J Ther Rehabil 2016;4:48.  Back to cited text no. 17
Cunha AC, Burke TN, França FJ, Marques AP. Effect of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: A randomized clinical trial. Clinics (Sao Paulo) 2008;63:763-70.  Back to cited text no. 18
Häkkinen A, Salo P, Tarvainen U, Wirén K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. J Rehabil Med 2007;39:575-9.  Back to cited text no. 19
Häkkinen A, Kautiainen H, Hannonen P, Ylinen J. Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: A randomized one-year follow-up study. Clin Rehabil 2008;22:592-600.  Back to cited text no. 20


  [Figure 1], [Figure 2]


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