Deep Frictions

Question 1

what are the two goals of frictions?

Answer 1

• increase mobility of tissue

- prevent or treat scar

Question 2

when might frictions increase pain?

Answer 2

if done too vigorously over acute injury

Question 3

when would frictioning be indicated?

Answer 3

• chronic lesions of MSK tissue

- adhesions

Question 4

How should tendons and muscles be positioned when performing DTF?

Answer 4

• tendon with sheath - stretched
• muscle belly - relaxed
• ligament or tendon w/o sheath - depends

Question 5

should you be sliding over skin or moving it?

Answer 5

move it!

Question 6

DTF is usually painful at first. What should you do if

a) patient still isn’t desensitized after 5 minutes
b) you are trying to break down an adhered scar

Answer 6

a) stop

b) go another 5 min after desensitization

Question 7

what should one do after DTF? How long should you wait between sessions?

Answer 7

stretch and/or pain-free exercise after treatment, ice at home and also at clinic if acute

Question 8

your patient has come in every 3 days for DTF. Problems usually resolve after about 6 sessions, but you are still not seeing any improvements after 3. What do you do?

Answer 8

stop DTF

Question 9

This same patient also noticed some increase in pain and symptoms after those three sessions. Did you go too far?

Answer 9

Not necessarily - patients may feel exacerbation of symptoms the first few times, have to judge if the results are worth it and educate about ice etc

Question 10

how fast should you do frictions?

Answer 10

2-3 cycles a second

Question 11

how is the evidence level at this time?

Answer 11

not good