Deep transverse frictions

Question 1

what kind of tests stress a ligament?

Answer 1

• applying tensile load - or stretching the ligament applies stress
• eg anterior drawer test of ACL or ATFL of ankle

Question 1

what is a deep transverse friction massage?

Answer 1

• a form of **deep tissue massage **
  *** repetitve, specific **non gliding technique that **produces movement between the fibres ** of dense connective tissue, increasing tissue extensibility and promoting ordered alignment of collagen within the tissues

Question 2

what kind of tests that a physio does stresses a tendon?

Answer 2

• resisted isometric contraction
• if it causes pain - may indicate tendon problem

Question 3

what might be 2 problems if the active ROM is equal to the passive ROM?

Answer 3

• joint dysfunction - capsular vs non capsular pattern of restriction
• muscle shortening - restriction to joint mvt is due to muscle crossing the joint

Question 4

is the passive ROM is more than the active ROM and if there is potential pain and weakness or no pain on isometric tests - what might the problem be?

Answer 4

• contractile unit lesion (tear)
• rupture - muscle, tendon, musculoteninous junction

Question 5

what is the function of the ligament in the joint capsule?

Answer 5

• connects bone to bone
• mechanical stability
• guides joint motion
• prevents excessive motion

Question 6

what is the function of tendons around a joint?

Answer 6

• connects muscle to bone
• transmits tensile load from muscle to bone to produce joint motion

Question 7

what are **synovial sheaths **and what is their function?

Answer 7

• synovial sheaths are found where the tendon passes under the ligaments
• function - to reduce friction between the tendons and the surrounding structures

Question 8

what is the major structural component of connective tissue?

Answer 8

collagen

Question 9

what is the stress / straim curve for a tendon?

Answer 9

• tendons dont contain much elastic material
• there isnt much lengthening
• rupture of tendon can occur @ 8% or greater

Question 10

what is the effect of injury and immobilisation on collagen?

Answer 10

• irregular collagen arrangement
• different collagen types
• higher water contact
• lower tensile strength and stiffness

Question 11

what is the function / purpose of deep friction massages?

Answer 11

• maintain the mobility within the soft tissue structures of muscles, ligaments and tendons and prevent adherent scar tissue from forming

Question 12

what are the effects of deep transverse friction massage?

Answer 12

• analgesia - this massage may cause low amounts of pain - but aims to relieve pain briefly
• mobilisation and remodelling of healing tissue - leading to reduced ‘stiffness’
• local hyperaema or redness around the area that was massaged - resolution of inflammation

Question 13

how can DTF cause analgesia?

Answer 13

• by the pressure/touch stimulus, activates the pain gate theory by stimulating large diameter mechanireceoptirs which inhibit transmission of pain impulses

Question 14

how can DTF increase mobilisation and remodelling of healing tissue?

3 ways

Answer 14

• increases extensibility between the tissue layers by producing a widthways stretching across fibres seperating them and lengthening cross bridges between collagen fibres, thus restoring mobility
  *** increasing extensibility between tissue and neighbouring surfaces **
• **reduction in muscle tone **

Question 15

how does DTF cause local hyperaemia and potentially aid the resolution of inflammation?

Answer 15

• DTF causes local damage - H substance is released causing vasodilatation

Question 16

how can DTF prevent adhesion formation or if scar tissue has already formed, how can it help to break it up?

Answer 16

• friction massage causes a transverse movement of the collagen fibers, it helps in preventing adhesion formation.
• In situations where adhesions are already formed a 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.

Question 17

what are the indications for deep transverse friction massage?

Answer 17

• this treatment is ideal for small isolated musculo-tendinous or ligamentous lesions/tears
• never used as a sole treatment technique

Question 18

what are the 3 contraindications for DTF?

Answer 18

• rhuematoid arthritis - as the arthritic joint will be suffering from collagenous weakening
• calcidication of soft tissue - eg myositis ossificans
• over peripheral nerves - could cause mild form of traumatic nerve injury (neuropraxia)

Question 19

what does the DTF technique involve?

Answer 19

• use area of your body that matches target tissue size eg one thumb for ATFL ligament, elbow for quads, hams etc
• apply accurately to site of tissue damage
• apply at 90 degrees to tissue
• take tissues through their full end of range - end feel
• apply technique within patients pain tolerance

Question 20

what is important to warn the patient regarding DTF technique?

Answer 20

• that the technique may be painful but local numbing response will be achieved within 2-5 mins
• NB - patients consent

Question 21

what are the parameters for DTF treatment?

Answer 21

• depth - depends on depth of lesion and stage of healing
• intensity - depends on stage of healing , eg 48 hours post vs 2 weeks or 3 months
• duration
• patient position