Lec 6

Question 1

Definition of Deep transverse friction

Answer 1

Transverse massage is applied by the finger(s) directly to the lesion and transverse to the direction of the fibers.

Question 2

Deep transverse friction can be used:

Answer 2

after an injury and for mechanical overuse

Question 3

Deep transverse friction used on?

Answer 3

On muscles, tendons and ligaments.

Question 4

True or false

Pressure is applied with the ball of the practitioner’s thumb or fingers to the patient’s skin and muscle.

Answer 4

True

Question 5

True or false

Friction is usually slower in effect than injections but leads to a physically more fundamental resolution, resulting in more permanent cure and less recurrence?

Answer 5

True

Question 6

Effect of injection and deep friction

Answer 6

steroid injection is usually
successful in 1- 2 weeks,

deep friction may require up to 6 weeks to have its full effect

Question 7

The main effect of deep friction massage is to

Answer 7

apply shear forces to underlying tissues, particularly at the interface between 2 tissue types
(eg, dermis-fascia, fascia-muscle,
muscle-bone interfaces).

Question 8

True or false

Deep pressure keeps superficial tissues from shearing so that shear and force are directed at the deeper tissue surface interface.

Answer 8

True

Question 9

The main point of deep friction massage

Answer 9

to preventor slow adhesions of scar tissue.

Question 10

True or false

The technique is often used prior to and in conjunction with mobilization techniques.

Answer 10

True

Question 11

Important

Answer 11

In minor muscular tears,
friction is usually followed by active
movement,

in ligamentous tears by passive movement

in tendinous lesions by active unloaded movements

until full resolution has been achieved.

Question 12

True or false

It is vital that transverse massage be performed only at the site of the lesion. The effect is so local that, unless the finger is applied to the exact site and friction given in the right direction, relief cannot be expected.

Answer 12

True

Question 13

pain during friction massage is usually the result of

Answer 13

a wrong indication,
a wrong technique or
an unaccustomed amount of pressure.

Question 14

The results of deep friction

Answer 14

1- Relief of pain

the patient experiences a numbing effect during the friction and reassessment immediately after the session shows reduction in pain and increase in strength and mobility.

Question 15

True or false

The time to produce analgesia during the application of transverse friction is a few minutes and the post-massage analgesic effect may last more than 24 hours.

Answer 15

True

Question 16

Relief of pain

Answer 16

A- Pain relief during and after friction massage may be due to modulation of the nociceptive impulses at spinal cord level: the “gate control theory”.

Selective stimulation of the mechanoreceptors closes the gate for pain afferent’.

B- Friction also leads to increased destruction of pain provoking metabolites, such as Lewis’s substances. This metabolite, if present in too high a concentration, provokes ischaemia and pain.

C- deep friction of a localised area may give rise to a lasting peripheral disturbance of nerve tissue, with local
anaesthetic effect

Question 17

2- Effect on connective tissue repair

Answer 17

A- Friction stimulates phagocytosis

That gentle transverse friction, applied in the early inflammatory phase enhances the mobilization of tissue
fluid and therefore increases the rate of phagocytosis.

B- Friction stimulates fibre orientation in regenerating connective tissue:

mechanical stress applied to the repair tissue is the main stimulus for remodeling immature and weak scar tissue with fibers oriented in all directions and through several planes into linearly rearranged bundles of connective tissue.

Question 18

True or false

Friction prevents adhesion formation and ruptures unwanted adhesions

Answer 18

True

At a later stage when strong cross-links or adhesions have formed. The technique is then used to soften the scar tissue and to mobilize the cross links between the mutual collagen fibers and the adhesions between repairing connective tissue and surrounding tissues

Question 19

Friction induces a traumatic hyperemia.

Answer 19

Forceful deep friction produces
vasodilatation and increased blood flow to the area.

• It may be hypothesized that this facilitates the removal of chemical irritants and increases the transportation of endogenous
opiates resulting in a decrease in pain.

Question 20

Deep Transverse Friction Massage

Answer 20

• Goal is mobilization of soft tissue
  – Generally precedes activity
  – Movement is across the grain of the affected tissue
  – Avoid treatment with acute injuries

Question 21

Acupressure massage

Answer 21

– Based on Chinese art of acupuncture

– Physiological explanation and effectiveness may be based on pain modulation mechanisms

– Acupressure Massage can utilize acupuncture points in treatment

– Locate through measurement of electrical impedance or palpation

Question 22

How to do Acupressure Massage

Answer 22

Small circular motions are used to treat points (pressure to tolerance of athlete = generally more pressure = more effective treatment)

– Treatment time ranges from 1-5 minutes

– Can treat one or more points, working distal to proximal

– Will produce dulling or numbing sensation / results lasting from minutes to hours