SOFT TISSUE DEEP TRANSVERSE FRICTIONS

THE USE OF DEEP TRANSVERSE FRICTIONS IN THE TREATMENT OF ACUTE AND CHRONIC SOFT- TISSUE INJURIES

Deep transverse friction is a soft-tissue technique popularised by Dr James Cyriax. Its use as a soft-tissue treatment is widespread, and yet the evidence base for its effectiveness is limited. The application of the treatment and its theorised effects on tissue are discussed in this article

BY PAULA CLAYTON, SPORTS MASSAGE PRACTITIONER

INTRODUCTION The effectiveness of deep transverse frictions (DTF) in the treatment of soft-tissue injuries has yet to be conclusively proven (1–5). Overall, most of the literature examining the use of DTF has been ambiguous. For treatment of soft-tissue injuries to be effective,

the therapist requires a fundamental understanding of the multiple components of soft-tissue healing and recognition of the current best available research evidence (6,7). Therefore, the choice of treatment and timing of intervention should influence the physiological and biomechanical properties of the injured tissue during the different stages of healing in order for management to be effective (6). This type of approach optimises conditions for tissue regeneration and repair and maximises functional outcome (7–11).

SCAR TISSUE FORMATION Following injury of sufficient magnitude to fibrous tissue or muscle, repair takes place by the establishing of a fibrin mesh, which becomes infiltrated with fibroblasts to form a scar (12). Unfortunately, the scar may also involve adjacent unaffected structures, severely affecting their mobility and function. Immediately after an injury to the skeletal muscle, a gap

formed between the damaged muscle fibres is filled with a haematoma. Within the first day, inflammatory cells including phagocytes invade the haematoma and begin to deliquesce

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the blood clot (13–15). Blood-derived fibrin and fibronectin cross-link to form early granulation tissue, an initial extracellular matrix (ECM) that acts as a scaffold and anchorage site for the invading fibroblasts (14). Some of the fibroblasts in granulation tissue may also be derived from the myogenic cells (16). More importantly, this newly formed tissue provides the wound tissue with the initial strength to withstand the contraction forces applied to it (17–20). Fibroblasts then start synthesising the proteins and proteoglycans of the ECM to restore the integrity of the connective tissue framework (17–21).

Although a great majority of the injuries to the skeletal muscle heal without formation of a fibrous scar that affects function, the proliferation of fibroblasts can sometimes be extreme and produce dense scar tissue within the injured muscle. In such cases, usually associated with muscle trauma, and particularly with re-ruptures, the scar can create a mechanical barrier that considerably delays or even completely restricts the regeneration of the myofibres across the injury gap (22,23). In skeletal muscle, disruption of the epimysium from

OF THE MULTIPLE COMPONENTS OF SOFT TISSUE HEALING

A THERAPIST REQUIRES A FUNDAMENTAL UNDERSTANDING

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