Healthcare and Medicine Reference
In-Depth Information
Incorporating a variety of techniques along with
the friction treatment gives maximum opportunity
to mobilize the affected tissues and prevents the
client from having to withstand long durations of
DTF that can be uncomfortable. More specific
guidelines for how to incorporate DTF with other
treatments are given in the specific treatment
suggestions for each condition in Section 2.
Deep longitudinal stripping
Deep longitudinal stripping technique involves a
slow longitudinal gliding stroke applied to muscle
or other soft tissue with the intent of encouraging
tissue elongation and elasticity. Deep tissue massage
is another common name for this technique,
although this term can be misleading because
many different techniques access deep tissues of
the body. It is an excellent method for reducing
hypertonicity and increasing pliability in muscles
and connective tissues. When deep longitudinal
stripping technique is applied to muscle fibers, it
helps encourage lengthening and elasticity in those
fibers leading to a reduction in hypertonicity
(muscle tightness) and increased flexibility.
The deep, long gliding strokes create tangential
pulling forces on superficial and deep connective
tissues. These tangential forces stimulate Ruffini
endings (a specialized sensory receptor cell in the
skin) in the connective tissue creating a neurologi-
cal response that leads to increased tissue rela-
xation . 25 Deep longitudinal striping is also the most
effective way to inactivate myofascial trigger points
when using a direct manual approach. 26 Deep
longitudinal stripping techniques are parallel to the
direction of the muscle fibers being treated. The
stroke usually extends from one tendinous attach-
ment of the muscle to the other. In some cases
short segments of muscle or other soft tissue are
treated without covering the entire length of the
The technique can be applied with varying levels
of pressure, although it is most effective when the
pressure level is moderately deep. Adequate pres-
sure is usually when the client perceives it as right
on the pain/pleasure threshold. In addition to
the client's feedback, the practitioner must be
skilled in reading the client's tissue response to
gauge the appropriate pressure level. If the client
Figure 4.5 Deep transverse friction to the wrist
extensor tendons.
The practitioner performs DTF by placing the
fingers on the skin and then applying a back and
forth motion that is perpendicular to the fiber
direction ( Fig. 4.5 ). The friction technique is
applied directly to the site of the soft-tissue lesion.
DTF applications use a significant amount of pres-
sure. However, too much pressure can cause reac-
tive muscle splinting or further tissue injury. Deep
friction is most effective when the client reports
the sensation as uncomfortable, even mildly pain-
ful, but bearable. If the pressure is within tolerable
limits a sensation of analgesia can develop after a
few minutes of treatment, decreasing the discom-
fort and making the treatment more tolerable. 10
The analgesia effect is likely due to stimulation of
non-pain sensory receptors and nociceptor inhibi-
tion as described in the gate theory of pain . 21-23
There are different views on how long DTF
should be applied. Cyriax advocated treatments
of 20-minutes' duration given every other day in
an ideal treatment setting . 24 Some recommend
shorter treatments, such as 10 minutes . 10 The
author has found it effective to apply much shorter
durations of friction treatment and to intersperse
the friction with other techniques. For example,
apply deep friction for 20-30 seconds and then
follow with other techniques, such as compressive
effleurage, sweeping cross fiber, or compression
broadening. Active and passive range of motion
and stretching procedures can then be performed
to encourage proper tissue remodeling. This com-
bination of techniques is repeated several times
during the treatment session.
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