Posted at 12.10.2018
The reason for this essay is to consider the merits of deep transverse frictions in the treating acute and serious soft tissue accidental injuries. To accomplish this I have considered an array of research that is conducted into the use of frictions. I've also considered the use of alternative solutions in the treating similar conditions in order to evaluate the potency of deep transverse frictions compared to each one of the other treatment options.
What is profound transverse friction?
Deep transverse friction was developed for the treating soft muscle lesions by the United kingdom osteopath Dr. James Cyriax who postulates that deep transverse friction works well in the reduction of fibrosis and facilitates the formation of strong, pliable scar tissue at the site of healing incidents. Deep transverse friction, which is also called cross-fibre frictioning (CFF), can help alleviate build-up of the crystalline debris that can form between tendons and their sheaths and lead to painful tendonitis. It can also help to offset the introduction of myofascial adhesions and soften those that are already present.
Deep transverse frictions should be administered with a braced finger or thumb moving across the grain of the muscle, tendon or ligament with a profound, non-gliding, friction heart stroke. It is not necessary to use a lubricant as this reduces friction. The therapist's thumb and the client's skin area should move as you over the exact site of the lesion to create a mechanical influence on the cells being cured. The massage must be applied directly over the website of the lesion and at right sides to the fibres, the stroke must also be wide enough to split the fibres without 'missing' over them. The procedure can hurt, but should be conducted within the pain tolerance threshold of the receiver, and really should be started out only with the knowledgeable consent of your client. It is contraindicated during the initial inflammatory level of an severe injury.
Deep transverse friction may be utilised in the treatment of both severe and persistent conditions. Its uses include;
mobilisation of interstial fluid
reduction or adjustment of oedema
increase of local blood vessels flow
decrease of muscle pain and stiffness
moderation of pain
facilitation of relaxation
avoidance or removal of adhesions (Wieting 2004).
There are a variety of massage therapy techniques that can have physiological, neurological and psychological effects. These may be used to decrease pain and the forming of adhesion, mobilise liquids, increase muscular rest, and increase vasodilatation (Wieting 2004).
Mechanical pressure on very soft tissues displaces smooth which then moves in the direction
of least level of resistance. Activity of the experts palm creates a pressure gradient
resulting in small amounts of fluid giving the soft cells and stepping into the venous or
lymphatic systems, enhancing lymphatic flow (Wieting 2004).
In addition to its mechanised effects, deep transverse friction (and other massage therapy techniques) causes the release of histamine which has a superficial vasodilatory result that helps in the washing out of metabolic waste products. A noticeable decrease in lactate occurs in massaged muscles which is often associated with reduced muscle spasm, increased endurance and drive of contraction. (Cox, 2007)
Other beneficial ramifications of massage include lowered blood viscosity and increased hematocrit levels. Addititionally there is a rise in circulating fibrinolytic compounds
along with chemicals such as myoglobin, creatine kinase, dehydrogenase, and
glutamic oxaloacetic transaminase which probably signify local muscle cell leakage
from the applied pressure. There is also release of endorphins and enkaphalin
production (Wieting 2004).
Impulses from the arousal of superficial skeletal muscle fibres, cutaneous and spindle receptors reach the spinal cord and could produce segmental moderation and even somatovisceral reflex changes (Wieting 2004).
The normal healing process can also be better by the breaking of mix bridges, which will help to prevent unnatural scarring. The mechanical action of the approach triggers hyperaemia and increased blood circulation to the area (Brosseau et al 2002). Furthermore shearing stresses are manufactured at cells interfaces below your skin. e. g. dermis-fascia, fascia-muscle, muscle-bone interfaces, the deep pressure inhibits shearing of superficial tissue and the shear push is directed at the deeper tissue surface program (Wieting 2004). This helps release underlying adhesions and promotes upgraded circulation to the region (Lorenzo 2004).
Sevier and Wilson (1999) express vigorous combination friction massage for 5-10 minutes
over the common extensor tendon perpendicular to root soft tissue constructions in
the treatment of lateral epicondylitis. Point friction may also be performed directly within the lateral eipcondyle and over the radial tunnel where it can be used in an effort to lessen venous congestion at the extensor carpi radialis origin. This is a strictly descriptive article of popular treatments for tennis elbow. No examination of any information regarding the efficacy of any of these treatments is given.
Disabella (2004) explains the utilization of friction therapeutic massage in conjunction with ultrasound
and/or electrical activation in the treating elbow and forearm overuse injuries.
In a organized review of the use of profound transverse friction massage in the treatment
of tendonitis Brosseau et al (2002) found only 2 randomised handled trials of
sufficient quality. Among which viewed patients acquiring treatment for iliotibial
band friction syndrome and the other at lateral epicondylitis.
The final results of both studies claim that transverse friction rub combined with other physiotherapy modalities does not significantly reduce tendonitis symptoms when compared to a control. However these studies were of small sample size making it difficult to attract conclusions regarding the benefits or not of treatment of iliotibial music group friction symptoms or tennis elbow with transverse friction massage therapy.
The tennis elbow study viewed 9 sessions of transverse friction rub given over
5 weeks in blend with other physiotherapy modalities and in isolation. The
comparison teams were the following;
deep transverse friction massage therapy with healing ultrasound and placebo ointment weighed against restorative ultrasound and placebo ointment
deep transverse friction massage weighed against phonophoresis alone
No difference was within pain relief, hold strength and useful status between the
groups. This review used dual blinding and a sound randomisation treatment but did
not statement withdrawals and dropouts (Brosseau et al 2002).
Another study of lateral epicondylitis was carried out by Smidt et al (2002). 185
patients with lateral epicondylitis of at least 6 weeks were randomised using computer
generated stop randomisation to 6 weeks of treatment with steroid injections,
physiotherapy or wait around and see coverage. The physiotherapy arm of the study consisted of
9 sessions of pulsed ultrasound, profound friction massage and an exercise program over 6
Outcome procedures were general improvement, severity of main issue, elbow
disability, grip strength and pressure pain threshold. Ahead of the main analysis a
reproducibility research on 50 patients was completed that exhibited good intertester
reliability for the study physiotherapists carrying out the outcome steps.
Intention to treat research was used with 6 weeks injections was significantly better
than all the options on all end result measures. There was a high recurrence rate in
the treatment group. The physiotherapy bundle (including frictions) gave better
long term effects than injection but was no better than wait to see policy.
Interestingly the wait and see plan had better long-term outcomes than injection and
physiotherapy that included transverse friction.
In an assessment article containing a listing of the evidence for the effectiveness of interventions for the management of lateral epicondylitis Nimgade et. al (2005) used the Cochrane Collaboration guidelines to examine the quality of the evidence reviewed. The Cochrane guidelines have 11 report items for inner validity, 6 for external validity and 2 for statistical requirements. Thirty studies were analyzed and the quality scores honored to each review varied between 2 and 9 (out of an possible 11). Eighteen of the studies obtained between 6 and 11 things giving a sign of good quality.
It appears that relative leftovers will eventually improve function however the use of early
active interventions including steroid treatment and physiotherapy modalities may
speed up recovery. The physiotherapy interventions evaluated included exercise and
ultrasound alone and in combination with friction therapeutic massage.
These authors concluded that, patients who need a rapid go back to work or usual
activities, may reap the benefits of one or two steroid shots for pain relief in the first few
weeks or calendar months and physiotherapy (which may include friction therapeutic massage) at any
Smidt et al (2003) completed a review to evaluate physiotherapy interventions for
lateral epicondylitis. This was a well conducted review that found only 1 RCT with
acceptable validity displaying exercises were significantly better than ultrasound plus
friction rub. The authors therefore concluded there was insufficient data for
the effectiveness for some interventions and there is weak proof that ultrasound
may have an advantageous effect.
For the treating sub serious bicipital tendonitis Gonzalez (2004) recommended
physical therapy involving soft tissue remedy with transverse gliding of the tendon
and cross-friction massage.
In the trial assessed by Brosseeau et al (2002) affecting patients with iliotibial band
friction syndrome profound transverse friction therapeutic massage was found in combination with break,
ice, stretches and ultrasound which was in comparison to a control group
receiving rest, ice, stretching exercises and ultrasound only. No statistically
significant difference was proven in pain relief after 4 consultations of friction
massage combined with the other modalities. There is however a clinically
important difference in pain when running.
This study had not been two times blinded but this is difficult to do where rehabilitation
interventions are concerned and can lead to tests of such modalities having
consistently low methodological ratings. However withdrawals and dropouts were
reported which is good practice but there have been issues with the randomisation
procedure (Brosseau et al 2002).
In a summary of aetiology, pathology and treatment of temporomandibular joint
syndrome Berman (2004) suggest friction rub may help inactivate result in points
due to non permanent ischemia and resultant hyperaemia produced by a firm cutaneous
pressure. Furthermore small fibrous adhesions in the muscle developed because of this of
surgery, personal injury, or prolonged limited action may be disrupted.
Many studies have used subjective and non validated scales for pain measurement and
the use of merged treatments causes issues when trying to evaluate treatment
efficacy (Brosseau et al 2002). This may make comparison of benefits between
different trials specifically difficult.
In studies where a lack of effect is demonstrated there are a variety of parameters that can donate to this. These include characteristics of restorative application (experience of therapist, rate, rhythm and depth of technique program), populace (age, sex, profession, athletics), disease (severe/chronic) and methodology
(blinding, randomisation, validated result measures, test sizes, comparison teams, 'rub only' group to assess specific effects) (Brosseau et al 2002).
Despite a lack of good quality research to recommend either its inclusion or
exclusion transverse friction therapeutic massage is a greatly trained, and used, physiotherapy
treatment in the management of muscle, ligament, tendon damage and pain.
The most the literature found appears to review the consumption of transverse friction massage therapy in the treating tennis elbow. There's a lack of good quality,
randomised, controlled studies testing the efficiency of transverse friction massage therapy either
in isolation or within management package deal. Many documents are descriptive in nature
of transverse friction massage being found in conjunction with other modalities. The
literature regarding mechanical, physiological, neurological results and possible
mechanisms of action is speculative that could be credited to such tests being difficult
to carry out.