The Most Effective Non-Surgical Treatment for Sports-Related Injuries

Transverse friction massage is a powerful, yet underutilized, treatment for tennis elbow, rotator cuff, ankle sprains and many common injuries to the muscles, tendons and ligaments. Cross-friction massage, as it is commonly called, is a technique popularized by the late British orthopedic physician, James Cyriax, one of the foremost specialists in the diagnosis and treatment of musculoskeletal injury and pain syndromes. The real value of friction massage is the opportunity for the treating chiropractic physician or therapist to get “immediate” feedback on the potential effectiveness of the treatment.

Real Case Review

Joe consulted with me for pain localized in his right shoulder. The problem resulted from performing overhead military press movements. Joe was unable to “abduct” his arm without significant pain. In addition to the traditional orthopedic shoulder tests, I also performed a functional shoulder examination. One test, in particular, was a simple “resisted” abduction shoulder test. Joe was unable to perform the test without experiencing pain. As part of my evaluation (and treatment), I performed transverse friction massage at the tendon of the supraspinatus muscle. This time, Joe was able to abduct his arm with minimal pain. Over the course of two weeks, Joe was treated every other day, using transverse friction massage, and achieved a 90 percent resolution of his shoulder pain.

How and Why It Works

When soft tissue structures (muscle, tendon and ligaments) are stressed beyond their biomechanical load, micro-tearing will occur. The normal physiological response to soft tissue micro-tearing is inflammation. Although, at first, a good thing, the end result of inflammation without intervention is a normal scar along the lines of stress.

Unfortunately, persistent and excessive overuse and/or immobilization of the healing soft-tissue will result in increased scar tissue. This increased scar tissue does not have the same characteristics as normal, healthy soft tissue.

This increased fibrous tissue has decreased mobility and a loss of soft tissue extensibility. This loss of elasticity results in a loss of optimal function. In turn, this loss of function results in a vicious cycle of micro-tearing, inflammation, scarring and the re-aggravating of the soft tissue, leading to a return of pain.

How Transverse Friction Helps

It has been hypothesized that friction has a local pain diminishing effect and results in better alignment of connective tissue fibers. Transverse massage is applied by the finger(s) directly to the lesion and transverse to the direction of the fibers. It can be used after an injury and for mechanical overuse in muscular, tendinous and ligamentous structures.

The technique is often used prior to and in conjunction with mobilization techniques. 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. Transverse friction massage imposes rhythmical stress transversely to the remodeling collagenous structures of the connective tissue and, thus, re-orients the collagen in a longitudinal fashion.

Basically, friction prevents adhesion formation and ruptures unwanted adhesions. Friction massage, applied correctly, will quickly result in an analgesic effect over the treated area, providing a noticeable improvement in common soft tissue injuries.

For a detailed review of the science and application of transverse friction massage, I highly recommend the book Functional Soft Tissue Examination and Treatment by Manual Methods, by Warren Hammer, D.C.

Ronald Grisanti DC, DABCO, MS, is a board certified chiropractic orthopedist with a master’s degree in nutritional science. He has created an innovative Web-based program in helping chiropractors develop a nutritional, functional medicine-based practice called Chiropractic Mentors. He can be reached by e-mail at [email protected] or through his website,

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