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Deep Transverse Friction Massage, Techniques, Uses

Deep transverse friction massage (DTFM) is one of several physiotherapy interventions suggested for the management of tendinitis pain. To assess the efficacy of DTFM for treating tendinitis. Deep friction massage is a specific connective tissue massage that was developed by Cyriax. The purpose of deep friction massage is to maintain the mobility within the soft tissue structures of ligament, tendon, and muscle and prevent adherent scars from forming. The massage is deep and must be applied transversely to the specific tissue involved unlike the superficial massage given in the longitudinal direction parallel to the vessels which enhances circulation and return of fluids.

Transverse friction massage (TFM), as an often used technique by therapists, is known for its effect in reducing the pain and losing the scar tissues. Nevertheless, its effects on neuromotor driving mechanism including the electromechanical delay (EMD), force transmission and excitation-contraction (EC) coupling which could be used as markers of stiffness changes, has not been computed using ultrafast ultrasound (US) when combined with external sensors.

The Principle of Deep Transverse Friction Massage

In addition to finding the right spot, the message must also be given the most effective way by following these basic principles:

The proper location must be found through proper evaluation procedures and palpation of the specific tendon, ligament, or muscle.
Friction massage must be given across the affected fibers. The thicker and stronger a normal structure, the more important friction is given strictly across the grain.
The therapist’s fingers and patient’s skin must move as one, otherwise moving subcutaneous fascia against muscle or ligament could lead to blister formation or subcutaneous bruising.
The friction massage must have sufficient sweep and be deep enough.
The patient must be in a comfortable position.

Deep Transverse Friction Massage Practical Aspects

Exact localization – It is important that transverse friction massage is given at the precise site of the lesion since, after all, we need to be on the correct spot in order to influence the scar formation. To determine that localization, a reliable functional examination is imperative.
No movement between finger and skin – We need to friction the specific structure and not the overlying skin. Do not glide over the skin, otherwise, you might damage the skin, making transverse friction massage impossible for the next session(s). If the patient used a creamy body lotion then cleansing the skin with alcohol or using a thin layer of cotton-wool between the finger and skin is a useful solution.
Transverse – Deep friction massage is given transverse to the fiber orientation, in order to mobilize the fibers in a most optimal way.
Sufficient amplitude – Make sure we make a big movement and move over-up-and again over the structure in order to have the most optimal contact on the structure. Therefore, before starting to friction, it is necessary to take a reserve of skin first we move the skin superficially in the opposite direction and then we apply pressure and perform the active phase of the deep friction.
Sufficient depth – How deep must the transverse friction massage be? Sufficient to reach the structure; so, it depends on the localization of the specific structure.
Starting position – Make sure the transverse deep friction massage is comfortable for you as well as for the patient. Position the patient in a way where you can easily reach the structure you want to friction. Make sure your position is also comfortable. Tendons with a tendon sheath are generally friction in a stretched position, just like ligaments (it gives you better contact on the structure). Muscle bellies are always frictioned in a shortened position (easier to move the fibers in relation to each other).
Various grips – are used, according to the nature and the position of the lesion.
The economy of effort – Concentrate on performing an arm movement instead of a small finger movement since this bigger arm movement is much more comfortable for the patient and for the therapist. Make sure you make a two-phase movement: active phase with more pressure (movement of the structure) and relaxation phase, without pressure. If you would use two active phases, with constant pressure it is quite more painfull and tiring. For most of the techniques, try to keep your own finger joints slightly flexed during the transverse friction massage (if you friction too much with your interphalangeal joints in hyperextension, you might provoke traumatic arthritis in those joints).
Frequency – For most lesions, 3 times/week is a sufficient frequency: usually 15′ of transverse friction massage per session; we start the first session with 10′. In some chronic lesions, the duration of treatment will reach 20′, 1-2 times/week. If more than one spot has to be treated (e.g. achilles tendinosis), it will be 10′ per localization. There are two exceptions in which a different strategy is used: an acute lesion of the medial collateral ligament of the knee and the lateral ankle ligaments. In those cases, the deep transverse friction is given in a progressive way. The details are discussed in the appropriate course modules.

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Indications of Deep Transverse Friction Massage

Muscular lesions – (muscle belly or musculotendinous junction), tendinous (most tenoperiosteal) and ligamentous lesions.
Pain relief – The analgesic effect of the messages can last up to 24 hours.
Stimulation of fiber orientation in regenerating connective tissue – Transverse friction when applied in early repair cycle enhances remodeling and hence reorientation of the collagen fibers in a longitudinal manner.
Prevention of adhesion formation – As friction massage causes a transverse movement of the collagen fibers it helps in preventing adhesion formation. In situations where adhesion are already formed more intense friction can help to break them as well. In such cases friction is used to mobilize the scar tissue and break the cross-linkages between the connective tissues and the surrounding structures.
Traumatic hyperemia – As it is a forceful and deep movement it effectively causes increased blood flow to the local area of application through vasodilatation. This assists in the removal of chemical irritants and allow the transportation of endogenous opiates, thus causing pain relief.
Supraspinatus tendinitis – on the “tip” of the shoulder
Tennis elbow or tendinitis – of the common flexor or extensor tendons of the forearms, just below the elbow on the outside
Achilles tendinitis – on the back of the heel and in the Achilles tendon
DeQuervain’s tenovaginitis – along with the thumb-side of the wrist
It is obvious that during the whole period of treatment of tendinitis – tenosynovitis or tenovaginitis, the patient must avoid all activities that provoke the pain, especially loading the affected contractile tissue.
Transverse massage – is an excellent treatment modality in acutely sprained ligaments ( superior and inferior acromioclavicular ligaments).
Maximize Performance
Decreased tension
Increased flexibility
Maintain healthy Muscles
Increased healing
Improved recovery
Increased range of movement
Decreased pain
Relaxation
Reduced stress
Reduced Muscle Spasm
Relieve Tight Muscles
Prevent Delayed Muscle Soreness
Reduced delayed onset muscle soreness
Reduced swelling
Improved sensation
Improved circulation
Prevents Injury
Improved Posture