Deep Transverse Frictions Tissue Injuries Health And Social Care Essay

Deep Transverse Frictions Tissue Injuries Health And Social Care EssayThe purpose of this essay is to consider the merits of rich transverse attritions in the give-and-take of acute and chronic soft tissue injuries. To facilitate this I have considered a wide range of research that has been conducted into the use of brushs. I have in addition considered the use of alternative therapies in the treatment of similar conditions in order to evaluate the strong point of deep transverse frictions in comparison to each of the different treatment methods.What is deep transverse friction?Deep transverse friction was developed for the treatment of soft tissue lesions by the British osteopath Dr. pack Cyriax who postulates that deep transverse friction is effective in the reduction of fibrosis and facilitates the formation of strong, pliable scar tissue at the site of healing injuries. Deep transverse friction, which is also known as cross-fibre frictioning (CFF), piece of ass help t o alleviate build up of the crystalline deposits that can form between tendons and their sheaths and result in indescribable tendonitis. It can also help to offset the development of myofascial adhesions and soften those that are already present.Deep transverse frictions should be administered with a braced finger or flicker moving across the grain of the musculus, tendon or ligament with a deep, non-gliding, friction stroke. It is non necessary to use a lubricant as this reduces friction. The therapists thumb and the clients skin should move as one over the exact site of the lesion to create a mechanical effect on the tissue being treated. The rub down must be applied straightway over the site of the lesion and at right angles to the fibres, the stroke must also be wide enough to sort out the fibres without skipping over them. The treatment can be paroxysmful, precisely should always be conducted within the pain tolerance threshold of the recipient, and should be started exclusively with the informed accept of the client. It is contraindicated during the initial inflammatory stage of an acute injury.Deep transverse friction may be utilised in the treatment of both acute and chronic conditions. Its uses allow mobilisation of interstial smooth reduction or modification of oedema increase of local blood flow decrease of muscle soreness and unwieldiness moderation of pain facilitation of relaxation prevention or elimination of adhesions (Wieting 2004). in that location are a variety of corrade techniques that can have physiological, neurologic and mental effects. These can be used to reduce pain and the formation of adhesion, mobilise fluids, increase muscular relaxation, and increase vasodilatation (Wieting 2004).Mechanical pressure on soft tissues displaces fluid which then moves in the directionof least resistance. Movement of the practitioners hand creates a pressure gradientresulting in small amounts of fluid leaving the soft tissues and g et in the venous orlymphatic systems, improving lymphatic flow (Wieting 2004).In addition to its mechanical effects, deep transverse friction (and other massage techniques) causes the leaving of histamine which has a superficial vasodilatory effect that assists in the washing out of metabolic waste products. A noticeable decrease in lactate occurs in massaged muscles which can be associated with reduced muscle spasm, change magnitude endurance and force of contraction. (Cox, 2007)Other beneficial effects of massage include decreased blood viscosity and increased hematocrit levels. There is also an increase in circulating fibrinolytic compoundsalong with substances such as myoglobin, creatine kinase, dehydrogenase, andglutamic oxaloacetic transaminase which probably represent local muscle cell leakagefrom the applied pressure. There is also release of endorphins and enkaphalinproduction (Wieting 2004).Impulses from the stimulation of superficial skeletal muscle fibres, cutaneous an d spindle receptors reach the spinal anesthesia cord and may produce segmental moderation and even somatovisceral reflex changes (Wieting 2004).The normal healing process may also be improved by the breaking of cross bridges, which will help to prevent abnormal scarring. The mechanical action of the technique causes hyperemia and increased blood flow to the area (Brosseau et al 2002). In addition shearing stresses are created at tissue interfaces below the skin. e.g.dermis-fascia, fascia-muscle, muscle-bone interfaces, the deep pressure prevents shearing of superficial tissues and the shear force is directed at the deeper tissue surface interface (Wieting 2004). This helps release underlying adhesions and promotes improved circulation to the area (Lorenzo 2004).Sevier and Wilson (1999) describe vigorous cross friction massage for 5-10 minutesover the earthy extensor tendon perpendicular to underlying soft tissue structures inthe treatment of lateral epicondylitis. Point friction may also be performed directly over the lateral eipcondyle and over the radial tunnel where it can be used in an attempt to reduce venous congestion at the extensor carpi radialis origin. This is a purely descriptive article of commonly used treatments for tennis elbow. No analysis of any evidence regarding the efficacy of any of these treatments is given.Disabella (2004) describes the use of friction massage in conjunction with ultrasoundand/or electrical stimulation in the treatment of elbow and forearm overuse injuries.In a dictatorial review of the use of deep transverse friction massage in the treatmentof tendonitis Brosseau et al (2002) found only 2 randomised controlled trials of sufficient look. One of which looked at patients receiving treatment for iliotibialband friction syndrome and the other at tennis elbow.The issuances of both studies suggest that transverse friction massage combined with other physiotherapy modalities does not significantly reduce tendonitis sym ptoms when compared to a control. However these studies were of small sample size making it difficult to draw conclusions regarding the benefits or not of treatment of iliotibial band friction syndrome or tennis elbow with transverse friction massage.The tennis elbow reflect looked at 9 sessions of transverse friction massage given over5 weeks in combination with other physiotherapy modalities and in isolation. Thecomparison groups were as follows deep transverse friction massage with therapeutic ultrasound and placebo ointment compared with therapeutic ultrasound and placebo ointment deep transverse friction massage compared with phonophoresis aloneNo rest was found in pain relief, grip strength and functional status between thegroups. This study used double blinding and a sound randomisation procedure but didnot report withdrawals and dropouts (Brosseau et al 2002).Another study of lateral epicondylitis was carried out by Smidt et al (2002). 185patients with lateral epicondyliti s of at least 6 weeks were randomised apply computergenerated block randomisation to 6 weeks of treatment with steroid injection,physiotherapy or wait and see policy. The physiotherapy arm of the study consisted of9 sessions of pulsed ultrasound, deep friction massage and an exercise program over 6weeks.Outcome measures were general improvement, severity of main complaint, elbowdisability, grip strength and pressure pain threshold. Prior to the main study areproducibility study on 50 patients was carried out that demonstrate good intertesterreliability for the research physiotherapists carrying out the outcome measures.Intention to treat analysis was used and at 6 weeks injection was significantly betterthan all other options on all outcome measures. There was a high recurrence rate inthe injection group. The physiotherapy package (which included frictions) gave betterlong term outcomes than injection but was no better than wait and see policy.Inte domicileingly the wait and see p olicy had better long term outcomes than injection andphysiotherapy that included transverse friction.In a review article containing a summary of the evidence for the effectiveness of interventions for the oversight of tennis elbow Nimgade et. al (2005) used the Cochrane Collaboration guidelines to assess the case of the evidence reviewed. The Cochrane guidelines have 11 score items for internal validity, 6 for external validity and 2 for statistical criteria. Thirty studies were reviewed and the quality scores awarded to each study varied between 2 and 9 (out of a possible 11). Eighteen of the studies scored between 6 and 11 points giving an indication of good quality.It appears that relative rest will eventually improve function but the use of earlyactive interventions including steroid injection and physiotherapy modalities mayspeed up recovery. The physiotherapy interventions reviewed included exercise andultrasound alone and in combination with friction massage.These authors concluded that, patients who need a rapid return to work or publicactivities, may benefit from one or two steroid injections for pain relief in the first fewweeks or months and physiotherapy (which may include friction massage) at anystage.Smidt et al (2003) carried out a review to evaluate physiotherapy interventions forlateral epicondylitis. This was a well conducted review that found only one RCT withacceptable validity showing exercises were significantly better than ultrasound plusfriction massage. The authors therefore concluded there was insufficient evidence forthe effectiveness for most interventions and there was weak evidence that ultrasoundmay have a beneficial effect.For the treatment of sub acute bicipital tendonitis Gonzalez (2004) recommended physical therapy involving soft tissue therapy with transverse gliding of the tendonand cross-friction massage.In the trial reviewed by Brosseeau et al (2002) involving patients with iliotibial bandfriction syndrome deep transv erse friction massage was used in combination with rest,ice, stretching exercises and ultrasound and this was compared to a control groupreceiving rest, ice, stretching exercises and ultrasound only. No statisticallysignificant difference was demo in pain relief after 4 sessions of frictionmassage combined with the other modalities. There was however a clinicallyimportant difference in pain when running.This study was not double blinded but this is difficult to do where rehabilitationinterventions are concerned and can result in trials of such modalities havingconsistently low methodological scores. However withdrawals and dropouts werereported which is good practice but there were problems with the randomisationprocedure (Brosseau et al 2002).In a summary of aetiology, pathology and treatment of temporomandibular jointsyndrome Berman (2004) suggest friction massage may help inactivate trigger pointsdue to temporary ischemia and resultant hyperaemia produced by a firm cutaneouspres sure. In addition small fibrous adhesions in the muscle formed as a result ofsurgery, injury, or prolonged restricted motion may be disrupted. more studies have used subjective and non validated scales for pain measurement andthe use of combined treatments causes difficulties when assay to evaluate treatmentefficacy (Brosseau et al 2002). This can make comparison of outcomes betweendifferent trials particularly difficult.In studies where a lack of effect is demonstrated there are a number of variables that can contribute to this. These include characteristics of therapeutic application (experience of therapist, rate, rhythm and depth of technique application), population (age, sex, occupation, sports), disease (acute/chronic) and methodology(blinding, randomisation, validated outcome measures, sample sizes, comparison groups, massage only group to assess specific effects) (Brosseau et al 2002).Comments ConclusionsDespite a lack of good quality evidence to recommend either its inc lusion orexclusion transverse friction massage is a widely taught, and used, physiotherapytreatment in the management of muscle, ligament, tendon injury and pain.The majority of the literature found seems to review the usage of transverse friction massage in the treatment of tennis elbow. There is a lack of good quality,randomised, controlled trials testing the efficacy of transverse friction massage eitherin isolation or as part of management package. Many papers are descriptive in natureof transverse friction massage being used in conjunction with other modalities. Theliterature regarding mechanical, physiological, neurological effects and possiblemechanisms of action is speculative which could be due to such trials being difficultto conduct.