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Faculty Advisor(s)

Harold Merriman, PT, PhD, Joseph Day, PT, PhD, OCS

Description

Purpose/Hypothesis: Increased muscle and tendon stiffness plays a role in the development of musculoskeletal pathologies. A number of interventions have been proposed to temporarily reduce muscle/tendon stiffness including soft tissue mobilization (STM) techniques and stretching. The purpose of this study was to investigate the immediate and short-term effects of STM versus self-stretching on common extensor tendon (CET) stiffness in a group of recreational tennis players.

Subjects: Healthy recreational tennis players

Materials/Methods: Stiffness, measured with the shear wave modulus in kilopascals (kPa), was obtained at rest on the dominant CET using 2D ultrasound imaging shear wave elastography (SWE) (GE Logiq S8, 9L, linear transducer). A second stiffness measure was taken 5 minutes after the first measure to determine intra-rater reliability. Participants were then randomly assigned to a treatment group (STM or self-stretching). Stiffness measures were taken immediately after treatment for both groups and following a 15-minute rest. For each data collection, 4 measures were taken and averaged for a single data point. Within examiner intraclass correlation coefficients (ICC (3, 1)) with 95% confidence intervals were calculated. A repeated measures ANOVA using one between variable group (STM or stretching) and one within variable group (initial, post-treatment, and 15 minutes post-treatment)) was used in the main analysis. Significance was set at p ≤ 0.05 with a Bonferroni correction.

Results: Thirty-two participants (12 male/20 female, mean age =54.4± 13.8yr) were randomized into the STM (n=16) or stretching group (n=16). There were no group differences in body mass index, age, frequency of play, or shoulder activity levels (p>.10). The within day intra-rater reliability was excellent (ICC = .98 (95%CI = .95-.99)), minimal detectable change 10.9 (95%CI 21.4) kPa. There was no main effect for group or time, but there was a significant interaction between time and group (p = .015). For the STM group, there were significant decreases in tendon stiffness between rest and post treatment and between rest and 15 minutes post treatment (p≤.007, mean change ≥ -47.59kPA). For the STM group, no significant differences in stiffness existed between the post treatment and 15 minutes post treatment. The change in CET stiffness between rest and post treatment as well as between rest and 15 minutes post-treatment was significantly greater for the STM group compared to the self-stretching group (p≤.013), mean change ≥ -39.64kPA.

Conclusion: STM of the CET significantly decreased the resting tendon stiffness immediately after treatment and these changes were significantly different from the group that received stretching. The resting tendon stiffness remained diminished 15 minutes after the soft tissue technique was applied.

Clinical Relevance: Clinicians may consider STM techniques over self-stretching for the purpose of maintaining soft tissue stiffness balance in healthy recreational tennis players.

Publication Date

5-8-2025

Keywords

shear wave elastography, soft tissue mobilization, self-stretching, elbow

Disciplines

Physical Therapy | Rehabilitation and Therapy

Comments

Presented on February 13, 2025 at APTA Combined Sections Meeting

Soft Tissue Mobilization Is More Effective Than Self-Stretching in Reducing Common Wrist Extensor Tendon Stiffness in Recreational Tennis Players

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