Deep Transverse fractures*

Question 1

how do we stress test ligaments (see that they are in tact)?

Answer 1

stretch the ligament and see that they are pain

Question 2

how do we stress test tendon (see that they are in tact)?

Answer 2

resisted test - where the pain is helps differentiate between muscle and tendon.

Question 3

how do we stress test muscle (see that they are in tact)?

Answer 3

resisted test - isometric contraction

Question 4

deep transverse friction is a subclassification of

Answer 4

swedish remedial massage

Question 5

definition of deep transverse friction

Answer 5

A repetitive, specific, non-gliding technique that produces movement between the fibres of dense connective tissue*; increasing tissue extensibility & promoting ordered alignment of collagen within the tissues

Question 6

passive restraint

Answer 6

non contractile tissue 
stopping point at end of range
guide joint motion 
connect bone to bone
prevent excessive motion

Question 7

dynamic restraint

Answer 7

connect muscle to bone

transmit tensile load to produce joint motion or maintain posture

Question 8

upper limb synovial sheaths

Answer 8

between greater and lesser tubercle of humerus in intertubercular groove

Question 9

major structural component of connective tissue

Answer 9

collagen

Question 10

how is collagen aligned

Answer 10

oriented along axis of principal tensile physiological loading of CT
Roughly aligned in parallel bundles with scattered fibroblasts

Question 11

elongation

Answer 11

straightening out of crimping

Question 12

micro-failure

Answer 12

e.g. in cumulative overload

Question 13

failure

Answer 13

(tearing): e.g. macrofailure or clinical strain / fracture

Question 14

effects of injury and immobilisation on tendon

Answer 14

Irregular collagen arrangement
Different collagen types
Higher H2O content
More random crosslinks between fibres, bundles & adjacent tissues
Lower tensile stiffness
Lower ultimate strength of CT

Question 15

deep transverse friction analgesic effects

Answer 15

Counterirritant effect – stimulating (low-level) pain will activate body’s analgesic methods
Pressure / touch stimulus  Pain gate effect via stimulating large diameter mechanoreceptors which inhibit transmission of pain impulses
Resorption of local irritating metabolites (by-products of healing process)

Question 16

deep tissue friction effects - mobilisation

Answer 16

Mobilisation & remodelling of healing tissue  reduced ‘stiffness’
Increase extensibility between tissue layers by producing a widthways stretching across fibres separating them and lengthening cross bridges between collagen fibres, thus restoring interfibre mobility
Increase extensibility between tissue and neighbouring surfaces e.g. Bone
Reduction in muscle tone

Question 17

deep tissue friction effects - circulation

Answer 17

Local hyperaemia aiding the resolution of inflammation

Local ‘damage’  H substance released causing vasodilatation

Question 18

stages of inflammation

Answer 18

acute inflammatory phase
proliferative phase
remodelling phase

Question 19

acute inflammatory phase

Answer 19

vasodilation/constriction
phagocytosis - neutrophil + monocytes
72 hrs - heat, swelling, redness pain
tissue sensitivity 
altered chemical state

Question 20

proliferative phase

Answer 20

fibroelastic infiltration

collagen formation producing granulation and scar tissue damage

Question 21

remodelling phase

Answer 21

-contraction of scar
-vascularity reduces
-tensile strength of
collagen 
-starts end of second
week – up to 1 year

Question 22

deep tissue friction effects neurlogically

Answer 22

Neuromotor Excitability

Decrease in H-reflex (muscle tone) illustrating a reduction in neuromotor excitability when DTF applied to

Question 23

mechanistic effects of deep transverse friction

Answer 23

reduced excitability
increased range of motion
increased supinator strength

Question 24

contraindications of deep transverse friction

Answer 24

rheumatoid arthritis
calcification of soft tissue
over peripheral nerves- neuropraxia

Question 25

why is rheumatoid arthritis a contraindication for deep transverse friction

Answer 25

Potential for collagenous weakening due to RA  CI relevant to CT of affected joint(s) only e.g. ligt

Question 26

why is calcification a contraindication for deep transverse friction

Answer 26

muscle or tendon e.g.
Myositis Ossificans (Quads)
Calcified SST
Pellegrini-Steida Lesion (MCL)

Question 27

deep transverse friction technqiue

Answer 27

use area of hands to match target tissue size
apply accurately to site of tissue damage
apply at 90 degrees to tissue fibres
take tissues thu their full transverse sweep/ end feel
patients skin moves w/ finger over target tissue
warn patient it may be painful
pain must be within. patients pain tolerance
target tissue on stretch or shortened position

Question 28

muscle tissue is in stretch or shortened position

Answer 28

shortened

Question 29

tendon tissue is in stretch or shortened position

Answer 29

stretch

Question 30

tendon-synovial sheath complex is in stretch or shortened position

Answer 30

stretch

Question 31

deep transverse friction treatment parameters

Answer 31

depth of lesion
intensity - depends on stage of healing and pts pain tolerance
duration - 5-20 minutes
patient position - stretch or shortened position

Question 32

when should deep transverse friction is used in a clinical setting

Answer 32

Ideal for small isolated musculo-tendinous or ligamentous lesion
Effects are both MECHANICAL & NEUROPHYSIOLOGICAL, but never used as sole treatment technique