The Most Effective Non-Surgical Treatment for Sports-Related Injuries?
Ronald J. Grisanti D.C., D.A.B.C.O., M.S.
Transverse friction massage is a powerful treatment for tennis elbow, rotator cuff, ankle sprains and many common injuries to the muscles, tendons and ligaments. Cross-friction massage is a technique popularized by the late British orthopedic physician, James Cyriax. Dr. Cyriax was one of the foremost specialists in the diagnosis and treatment of musculoskeletal injury and pain syndromes. Probably his most valuable contribution was a method of evaluation to identify the specific tissue (muscle, tendon, ligament, etc.) causing an individual pain or dysfunctional movement. 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. In many instances the friction massage is an alternative to steroid injections. Friction is usually slower in effect than injections but leads to a physically more fundamental resolution, resulting in more permanent cure and less recurrence. Whereas steroid injection is usually successful in 1- 2 weeks, deep friction may require up to 6 weeks to have its full effect. 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. Friction massage applied correctly will quickly result in an analgesic effect over the treated area providing a noticeable improvement. Mode of action Transverse massage either works quickly (after 6 to 10 session) or not at all. Relief of Pain It is a common clinical observation that application of local transverse friction leads to immediate pain relief - the patient experiences a numbing effect during the friction and reassessment immediately after the session shows reduction in pain and increase in strength and mobility. The time to produce analgesia during the application of transverse friction is a few minutes and the post-massage analgesic effect may last more than 24 hours.
Friction massage in action
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Effect on connective tissue repair Connective tissue regenerates largely as a consequence of the action of inflammatory cells, vascular and lymphatic endothelial cells, and fibroblasts. Regeneration comprises three main phases : Inflammation; proliferation (granulation) and remodeling. These events do not occur separately but form a continuous sequence of changes (cell, matrix and vascular changes) that begins with the release of inflammatory mediators and end with the remodeling of the repaired tissue. Friction massage may have a beneficial effect on all three phases of repair. Friction prevents adhesion formation and ruptures unwanted adhesions
Note adhesions & muscular scarring
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Indications in Shoulder and Elbow LesionsThe reduction in pain achieved after a few minutes localized transverse friction may be very helpful to define the exact location of the lesion. In muscular, tendinous or ligamentous lesions, a few minutes of massage on the suspected spot results in diminished pain on testing immediately thereafter, so confirming the diagnosis as accurately as an infiltration with local anesthesia. As a rule however, the friction is always chosen as the treatment of choice in athletes or in case the tendon is weakened (partial rupture). It can not be denied that repeated use of steroids, even in small doses and correctly applied, will temporarily weaken the tendinous structure. Steroids also take away inflammation and pain, so giving the patient the false feeling of being cured. The combination of a weakened tendon and abolition of pain can be disastrous for the tendon. Ligaments Transverse massage is an excellent treatment modality in acutely sprained ligaments. Dr. Grisanti's Comments I have been using this powerful technique for over 10 years. I have seen remarkable improvements in the following conditions: Rotator Cuff, tennis elbow, ankle sprains, knee pain, wrist injuries etc.. References
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