Lecture 22: Deep Transverse Frictions Flashcards
What are deep frictions?
What are the goals of deep frictions?
- A repeated friction massage that is applied to the ms, tendon, tendon sheath and ligaments (developed by James Cyriax)
- To increase the mobility and extensibility of MSK tissue.
To help prevent (in the early phases of healing scar tissue adhesions) and treat scar tissues ( later phases of healing treat the scar tissue itself).
What are the types of DF?
- Transverse (DTF): perpendicular to the orientation of the tissue fibers
- Longitudinal: parallel to the orientation of the tissue fibers
- Circular: small circles oblique into the tissue.
Usually we friction w/ index finger reinforced w/ 3rd finger overtop.
What are the therapeutic effects of DF?
Traumatic hyperemia: increase circulation
Pain relief
Decrease scar tissue and adhesions
What is traumatic hyperemia?
DF increase blood circulation and lymph flow which:
- Helps w/ removal of chemical irritant by-products of inflammation
- Decreases venous congestion which decreases edema and hydrostatic pressure on pain-sensitive structures.
Longitudinal frictions are more likely to achieve this goal.
How does DF help w/ pain relief?
Gate Control Theory of Pain: If you stimulate mechanoreceptors in the same area as nociceptors, you close the nociceptors in that are to stimulation. You get pain relief as a result.
- Through DF type 1 and 2 mechanoreceptors are stimulated producing presynaptic anesthesia.
- If done in the acute phase too vigorously, this would cause too much stimulation of the nociceptors increasing, rather then relieving pain.
How does DF decrease scar tissue and adhesion?
Acute?
Long term?
It is the transverse frictions that have the greatest effect w/ respect to this goal.
Inflammatory and early proliferative phase:
- Light DTF, do not want to cause pain or break down granulation tissue.
- Just using as a preventative measure to prevent adhesion formation and minimize the cross linking of new tissue.
- Enhance extensibility of new tissue
- Maintain mobility btwn tissues.
Late Proliferative and Remodelling Phases:
- Assit w/ the orientation of collagen in the appropriate line of stress
- Breakdown of adhesion b/c of transverse nature of the frictions.
What are indications for using DF?
- Chronic lesions ms, tendon, sheath, ligament or joint.
- Adhesions in ligaments, ms or btwn tissues.
- Acute injuries to ligaments, tendon or ms. (light)
- Before a strong stretch to desensitize tissue
What are contraindications to DF?
- Acute inflammation (if swelling present or increase in pain- pain should decrease during the treatment )
- Burisitis (b/c fiction was the cause, so do not want more friction)
- Hematomas or bruising
- Open skin
- Tissue infections
- Decreased sensation or hypersensitivity
- Ectopic ossification
- Cancer
- Venous or arterial pathology (DVT)
What is important for DTF?
How are tissues positioned for DTF?
Location: need to know anatomy and palpation skills. B/c you need to be perpendicular to tissue. Use a test to confirm you palpated the correct ms or tendon.
Tendon w/ no sheath and ligaments: Varies depending on specific tissue (moderate pain free stretch vs relaxed vs optimal tissue exposure position)
Tendon w/ sheath: stretched (b/c need a stable base to friction)
Ms belly: relaxed
What position does the pt use to apply DTF?
- Good BM
- Finger position:
1. Middle finger over index finger (most common)
- Thumb on thumb: medium area
- 2-3 fingers, or 2-3 fingers reinforce (large size or deep area)
- Pinch grip btwn thumb and index finger.
What is the application technique for DTF?
- No lubricant used
- Perpendicular to orientation of the tissue
- Move pt skin w/ the clinicians fingers over the site of the identified lesion back and forth.
- it is important to move the skin to prevent blisters.
How much pressure should be applied during DTF?
Rate of application?
- depends on stage of healing
- Begin w/ a light pressure and build up to the target pressure
- need to reach target tissue.
- 2-3 cycles/sec applied in a rhythmical manner.
How long should DTF be applied for?
At first the pt experiences pain.
-Stop once desensitization has occurred, which usually takes 3-5 min. If it doesn’t happen in this time frame: STOP. Also stop if pain increase.
For chronic lesions in the remodelling phase, go for an addition 5 minutes after the desensitization has occurs to enhance the mechanical effects on adhesions and scar tissue.
Acute-desensitization
Chronic-desensitization+5 min
What should be done after DTF application?
Involved tissue is either passively stretched or actively exercise, AROM not resisted ex.
Be careful not to cause pain w/ exercise.
Apply ice in acute conditions.
How often should DTF be done? How many total treatments are needed?
- When the tenderness has worn off another treatment can be done (takes 2-7 days).
- Pt specific. Use until no further improvements are seen.
Most conditions should improve in 6-10 sessions over 2-8 weeks.
If no improvements are seen after 3 sessions, discontinue DTF.
- Note that it may exacerbate symptoms after 1st 2-3 session. So PT needs to determine if the increase in pain is acceptable given the pts condition and phase of healing. Apply ice.
