Monday, October 9, 2017

PT Techniques: Transverse Friction Massage

Friction massage is indicated for chronic conditions of soft tissues - usually tendons, ligaments, or muscles - arising from abnormal modeling of fibrous elements in response to fatigue stresses or accompanying resolution of an acute inflammatory disorder.  The intent is to restore or maintain the mobility of the structure with respect to adjacent tissues and to increase the extensibility of the structure under normal loading conditions.  The goal is to allow for increased energy-attenuating capacity of the part with reduced strain to individual structural elements.  Typical conditions in which friction massage is often indicated include:

TENDINITIS:
  • Suprasinatus or infraspinatus at the shoulder
  • Tennis elbow
  • deQuervain tendinitis at the wrist
  • Peroneal tendinitis at the ankle or foot

SUBACUTE OR CHRONIC LIGAMENTOUS SPRAINS:
  • Intercarpal ligament sprains at the wrist
  • Coronary ligament sprain at the knee
  • Minor medial collateral ligament sprains
  • Minor anterior talofibular sprains

Acute signs and symptoms should be resolved at the time at which friction massage is used.

Technique of Application:
The part should be well exposed and supported so as to reduce postural muscle tone.  The structure to be treated is usually put in a position of neutral tension.  It should be positioned so that the site of the lesion is easily accessible to the fingertips.  If adherence between a tendon and its sheath is suspected, then the tendon should be kept taut to stabilize it while the sheath is mobilized during the massage.          The therapist should be seated if possible.  His elbow should be supported to reduce muscle tension of more proximal parts.  The pad of the index finger, middle finger, or thumb is placed directly over the site of the pathology.  Fingers that are not being used at the time should be used to provide further stabilization of the therapist's hand and arm.  No lubricant is used; the patient's skin must move along with the therapist's fingers.
     Beginning with light pressure, the therapist moves the skin over the site of the lesion back and forth, in a direction perpendicular to the normal orientation of the fibers.  The amplitude of the movement is such that tension against the skin at the extremes of each stroke is minimal.  This is necessary in order to avoid friction between the massaging fingers and the skin, which might well produce a blister.
     At the beginning of the massage, the patient may feel mild to moderate tenderness.  This should not be a deterrent.  However, after 1 or 2 minutes of treatment with light pressure, the tenderness should have subsided considerably.  During the first treatment, the massage should be stopped after 5 or 6 minutes and the key signs reassessed.  If it is a muscular or tendinous lesion, the painful resisted movement is checked; if it is a ligamentous lesion, the painful joint play movement is retested.  The patient should feel some immediate improvement.  If they have not, the therapist should consider whether the technique of treatment was appropriate, assuming that the disorder is one for which friction massage is indicated.
     With successive treatments, the dept massage is always gradually increased, as described above and the length of treatment is gradually increased working up to 12 minutes each session  However, treatment should not be continued if, at anytime, symptoms increase.  It is not unusual for a patient to feel some increased soreness following the first or second session, but it must be distinguished from exacerbation of symptoms.
    A common mistake during treatment is the development of skin blisters or abrasions.  These result either from fingernails that are too long, or from poor technique that causes friction between the finger and skin.  Another common mistake is for the therapist to apply the massage to the area of pain rather that to the site of the lesion, they may not be the same location.  Friction massage should be avoided when the nutritional status of the skin is compromised and in cases with impaired vascular response.

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