Friction Massage
One of the most valuable modalities for the treatment of pathology caused by chronic overuse soft tx syndromes
requires functional examination to find the location of the source of the pain, tender area is not necessarily the source.
1)MICRO-TEARING
occurs when soft tx is stressed beyond its biomechanical yield strength (tendon beyond 4% resting length)
response to micro-tearing = inflamation
inflammation allowed to rest and heal a normal scar will form along normal stress lines.
excessive overuse or immobilisation occurs increased fibrous tx will result which may spread and become tethered to surounding normal tx.
increase fibrous tx results in loss of mobility/extensibility
loss of extensibility means loss of function
loss of function results in re-aggravation of scat tx
thus vicious cycle of micro-tearing/inflammation/scarring
Scar may become the source of nociceptive stimuus
in early stages of healing scar tx is not as strong as later stages, thus it is thought the re-modelling phase of the inflammatory response depends on mechanical stimuli
2)Transverse Friction
resultant traumatic hyperaemia is the chief healing factor of friction
moving at right angles across tx will not damage normal healing tx but will prevent the formation of/or breakdown abnormal scar tx
moves the tx (longitudinal friction affects transportation of blood and lymph)
3)General friction "rules"
Chronic Phase
Acute Phase
Light friction massage can be used as collagen is immature, 4 days fibroblasts lay down gell like substance; 2 weeks before mature crosslinks form.
Deep stronger friction is necessary
Friction muscles in relaxed position to create same muscle broadening that occurs when muscle contracts
Friction tendons with minimal tensile tension ( on stretch)
4)FRICTION ANAETHESIA
most interesting effect of friction is the creation of anaesthesia
Pain gate theory; stimulation of large fibre mechanoreceptors will cause presynaptic inhibition at the SC thus preventing small diameter fibres from reaching consciousness
usually within 3 minutes of friction
5)TREATMENT TIME
minimum 10 minutes
Max 20 min (dependant on thickness of scar and length of time problem existed)
helps to precede with 5 min ultrasound
6) NUMBER OF TREATMENTS
if friction aggravates condition or pt doesn't numb within 3-5 min it is possible tx won't respont to treatment type
3 unsuccessful treatments sufficiently contraindicates further friction use
pt. schedules 3 times a week with 1 day in between
most overuse conditions respond within 2 weeks to 2 months
7) CONTRA-INDICATIONS
Hematomas
Calcifications
Acutely inflamed tx
Peripheral nerves should not be directly frictioned