Effect of Deep Transverse Friction Massage Versus Stretching Techniques on Performance Among Lebanese and Syrian Football Players
Phase: NA
Conditions: Deep Transverse Friction Massage
Sponsor: Mohammed Ali FAKHRO, DPT

 
NCT03540888 
16, May, 2017 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Effect of Deep Transverse Friction Massage Versus Stretching on Football Players’ 
Performance 

Effect of Deep Transverse Friction Massage Vs. Stretching Techniques 
2
 
 
Procedure 
 
 
In order to recruit the participants, gyms and football clubs across South-
Lebanon and Damascus-Syria were visited and information sheets were distributed. 
These sheets, (1) explained the study purpose, (2) stressed on the voluntary 
participation and the free will to withdraw from the study, (3) described the experiment 
process and its duration; (5) stated possible risks and benefits, (6) stressed over 
confidentiality and (7) provided investigators contact methods. 
 
To start with the experiment, each enrolled participant signed a consent form. 
Then, an independent examiner who was not involved in the enrollment process had 
systematically allocated participants into one of the three intervention groups, by 
withdrawing names randomly out of a bowl. The first draw was assigned to the static 
stretching group; the second draw assigned to the dynamic stretching group; the third 
draw assigned to the DTFM group, and so on. In addition, the investigator who entered 
eligible participants in the study was not aware of which group they were allocated. 
 
The experiment took place in July 2017, over a four weeks period, and 
participants in each group followed their intervention protocol three times a week, for 
a total of 12 sessions. 
 
Static stretching group. Static stretching was chosen for its effectiveness in 
increasing both acute and chronic extensibility.23All participants laid on the floor in a 
supine position with both feet pointing upwards. The tested limb was in full knee 
extension and the foot in a relaxed position and was moved up passively to a point of 
slight pain or discomfort at the posterior aspect of the thigh. This technique puts the 

Effect of Deep Transverse Friction Massage Vs. Stretching Techniques 
3
 
 
hamstrings muscle at its greatest possible length. According to the American College of 
Sports Medicine (ACSM), this position should be held for 30 seconds and was 
performed three times for a total of one minute and 30 seconds, 15 minutes after a 
match or training. The contralateral leg was stabilized by means of another collaborator 
in order to prevent compensation by rotation or elevation of the pelvis.15,21 
 
Dynamic stretching group. The dynamic stretching technique was included for 
its positive effects on agility and muscle strength.26 Participants in this group, swung 
their tested leg actively into hip flexion while keeping their knee fully extended and their 
ankle fully plantar flexed, until a stretch was felt in the posterior thigh. This was repeated 
over 30 seconds and included in the participant's warm-up phase.23 
 
Deep transverse friction massage group. Participants were taught by one of 
the examiners how to sit and perform pre-exercise self-massages on their tested leg 
MTJ. The procedure consisted of applying friction massage by fingertips transversely 
to the hamstrings tendon, in a sitting position. The tendon was located over four finger 
widths proximal to the medial and lateral epicondyles of the femur. One examiner 
carefully monitored how the technique was performed to assure the precision of the 
application. This massage technique was applied over a duration of 30 seconds.10 
 
Data Collection Methods 
 
 
Measurements took place on three occasions, (1) baseline, on the first session; 
 
(2) 15 minutes, after the first intervention (acute phase); and (3) after four weeks 
(chronic phase). In addition, (1) age, (2) height, (3) weight and (4) and injury occurrence 
rate was recorded for each footballer. On the other hand, flexibility, agility and maximal 

Effect of Deep Transverse Friction Massage Vs. Stretching Techniques 
4
 
 
voluntary muscle strength measures were taken in the same manner and time for 
all participants across groups. 
 
All measurements were taken by one assessor who didn’t know at the time of 
testing to what group the data belonged to. In addition, this assessor was not involved 
in the implementation of any of the techniques in this study. 
 
Flexibility. Extensibility of the hamstrings muscle represented knee flexibility.20 
Hamstrings muscle injury is common in sports requiring running. It is usually, the result 
of a muscle imbalance where the quadriceps muscle is strong and hamstrings are weak 
and inflexible, what puts a great deal of pressure on the hamstrings leading to injury and 
strain.31 Straight leg raise (SLR) is a widely used outcome measure used to assess the 
extensibility of the hamstrings muscle, where its high reliability makes it an easy and 
reliable method ICCs of 0.96, and high SEM values (2.2o) and MDD (6o).20 SLR was 
first applied to all participants across the groups. All football players laid supine and 
taught to relax during testing. The tested limb was raised by a volunteer therapist with 
the knee in full extension and the foot in a relaxed position. The other lower limb was 
stabilized in a neutral hip rotation and full knee extension by another volunteer. The test 
was stopped once the therapist felt a strong resistance, or when the pelvic rotation was 
noted. Then, the assessor placed the goniometer over the greater trochanter, with one 
arm aligning the lateral femoral condyle, and the other arm aligning parallel to the 
ground, in a direction to the mid-axillary line and recorded the hip angle. The scores 
were recorded as degrees of range of movement.20 

Effect of Deep Transverse Friction Massage Vs. Stretching Techniques 
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Agility. Agility was chosen to represent the footballer’s performance. This 
athletic event involves elements of speed, change of direction, and varying types of 
movement.28 After the measurement of the extensibility, agility was measured by the 
T-Drill test. The T-Drill has been proven to be a highly reliable testing measurement, 
ICC (0.95 with 95 % confidence interval).12,25 Footballers were instructed on how to 
perform the T-Drill and on the test procedures. Then, they were instructed to jog for 2 
min to warm-up. The participants performed the T-drill twice and the trial with the best 
time was taken for analysis by the mean of an alert assessor with a stopwatch. Results 
were measured in seconds and scores were interpreted as (1) excellent, < 9.5; (2) 
good, 9.5-10.5; (3) average, 10.5-11.5; and (4) poor, > 11.5.25,28 A diagram of the T-
Drill with its dimensions are shown in (Figure 2). 
 
FIGURE 2. Diagram of T-Drill procedure. 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Strength. Finally, maximal voluntary muscle strength was measured by one 
repetition maximum (1RM) tests. The ICC for 1-RM test-retest measures was (0.983, 
95% confidence interval= 0.964–0.997.4 After a rest time of 5 min, participants were 

Effect of Deep Transverse Friction Massage Vs. Stretching Techniques 
6
 
 
guided to the knee flexors strengthening machine (hamstrings curl machine). 
Resistance was placed just proximal to the posterior part of the calcaneus bone. 
Footballers performed first specific warm-up, consisting of a set of ten repetitions of 
knee flexion, with a light load. Afterwards, for safety reasons, an estimation of hamstring 
1RM was calculated using Brzycki formula [Weight lifted ÷ (1.0278 - (0.0278 × Number 
of repetitions)]. This formula exhibited a relatively low level of bias (1.6 to 0 kg) and had 
an ICC above 0.97 and the lower end of the 95% confidence interval was above 0.94.17 
Maximal voluntary strength was recorded in kilograms. 
 
Data Analysis 
 
 
Data were analyzed using the Statistical Package for the Social Sciences (SPSS) 
version 21.0 for Windows. Descriptive statistics (mean, standard deviation) were 
calculated to characterize participants’ age, weight, and height. Means of the main key 
variables of the study were also calculated. The Shapiro–Wilk test was used to check 
the normality of the data distribution. A probability (p) value of >0.05 means that there 
was no significant difference between groups. 
To check for any difference in the incidence of muscle injury between each of the 
intervention groups, Fisher exact test was used because expected cell count was less 
than 5. 
Dependent t-tests were used to determine any significant differences between 
the acute and chronic phases of extensibility, agility and muscle strength, and to check 
the difference between the baseline and chronic phases of these dependent variables. 
  

Analysis of variance (ANOVA) test was used to check for any significant 
difference between the interventions groups and each of the extensibility, agility, and 
strength.  This test was repeated for three different phases (baseline, acute and 
chronic). Moreover, after a statistically significant difference was shown between the 
variables, Tukey’s Post Hoc test was used to show where the differences occurred 
between intervention groups.