Friction Massage

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Definition/Description

 Friction is defined as “an accurately delivered penetrating pressure applied through fingertips” . Cyriax, who is seen as the founder of the friction therapy, believed that deep frictions are appropriate for the treatment of tendinitis, tenosynovitis, muscle strains, ligament lesions and scar healing .

Clinically Relevant Anatomy

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Purpose

The role of the therapist is to minimize the scarring that develops perpendicular to the actin and myosin filaments, to facilitate the proliferation of the fibroblasts in the scar and to develop a strong, mobile scar that won’t be a source of recidivate pain when returning to normal activities.

The goal of friction massage is to influence cell behavior in all soft tissues. Friction massage is supposed to induce  :

• Traumatic hyperemia, which helps to evacuate pain triggering metabolites.

• Movement of the affected structure which prevents or destroys adhesions and helps optimize the quality of scar tissue and mechanoreceptor stimulation.

• Stimulation of mechanoreceptors, producing a quantity of afferent impulses that stimulate a temporary analgesia.

• Fibroblastic proliferation, responsible for the repair en regeneration of collagen.

• Realignment of collagen fibers, determined by the magnitude of applied pressure.

Technique

The 8 rules of deep friction massage are :

• Diagnostic movements and palpation must single out the tissue at fault and the exact location on that tissue.

• The physical therapist’s fingers and patient’s skin must move simultaneously to avoid injury to the skin.

• The massage must be given perpendicular to the tissue’s fiber to smooth the scar down.

• The massage must be given with sufficient sweep to assure that the whole scar is treated.

• The friction must be given deeply, administered within the patient’s pain tolerance. The pain will gradually diminish during the massage.

• The patient must adopt a posture that will adequately expose the tendon.

• If the lesion lies in the belly of the muscle, the muscle must be put on slack. This will aid in separation of the muscle fibers during the massage.

• Tendons with a sheath must be put on stretch to assure maximum success of the massage.

The contraindications include skin diseases, inflammation due to bacterial action, traumatic en rheumatoid arthritis, calcification in soft tissue, bursitis and tunnel syndromes.

Key Research

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Clinical Bottom Line

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