Transverse friction massage is a powerful yet underutilized treatment for injuries affecting the muscles, tendons and ligaments.
These tissues are generally referred to as the ‘soft tissues’, as opposed to bone. Transverse friction massage can be an effective treatment choice for tennis elbow, rotator cuff, ankle sprains and many other common soft tissue injuries.
Cross-friction massage, as it is commonly called, is a technique popularized by the late British orthopaedic physician, James Cyriax. He was one of the foremost specialists in the diagnosis and treatment of musculoskeletal injury and his findings are used by therapists of many different disciplines.
One of the great values of friction massage is the opportunity for the treating chiropractor to get immediate feedback on the potential effectiveness of the treatment. Further, depending on the site of injury, it can be easily taught to the patient.
When soft tissue structures are stressed beyond their physical capabilities, micro-tearing will occur. The normal physiological response to soft tissue micro-tearing is inflammation. The ideal end result of this inflammatory response is an area of fibrous repair (scar tissue) to the area of micro-tearing.
This scar tissue should also be along the lines of the physical stress to the injury – not against the ‘grain’ of the tissues.
Unfortunately, persistent and excessive overuse and/or immobilization of the healing soft-tissue will result in increased scar tissue. This increased scar tissue does not have the same characteristics as normal, healthy soft tissue. The scar tissue mass is not organized along the grain line of the tissue.
This area of increased fibrous tissue has decreased mobility and a loss of soft tissue elasticity. This loss of elasticity results in a soft tissue that is not as functional as before the injury. It creates scar tissue that is physically weaker and is prone to tearing. The stage is set for a vicious cycle of micro-tearing, inflammation, scarring and the re-aggravating of the soft tissue, leading to a return of pain.
The end result is an injury that never seems to get better, or at least never seems to stay healed.
How transverse friction helps
It has been hypothesized that friction has a local pain diminishing effect and results in better alignment of connective tissue fibres. Transverse massage is applied by the fingers directly to the injury site and transverse to the direction of the fibers. It can be used for injuries to muscular, tendinous and ligamentous structures.
The technique is often used in conjunction with chiropractic mobilization techniques. It is vital that transverse massage be performed only at the site of the injury. The effect is so local that unless the finger is applied to the exact site and friction given in the right direction relief cannot be expected.
Transverse friction massage produces stress perpendicular (not parallel) to the scar tissue collagen, and causes a remodelling of the scar tissue along the grain of the tissue.
Basically, friction massage prevents scar tissue adhesion formation and ruptures unwanted adhesions.
Friction massage, applied correctly, will also quickly result in an analgesic effect over the treated area, and ultimately result in improved soft tissue healing.
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