The Shoulder

Deep Transverse Frictions

Technique

Deep transverse massage is a very precise technique. It is only effective if it is applied

To the right spot
across the fibres composing the affected structure (transverse)
Deeply enough - the vigour of the friction is proportional to the toughness and distance from the surface of the tissue at fault.
With sufficient sweep: the to-and-fro movements of the fingers must be great enough to reach the total area at fault.

The following points are paramount:

Position of the patient:
- comfortable
- with a maximum of exposure of the affected structure
- the affected structure must be under a slight amount of tension.
position of the therapist
- the most comfortable
- that allows economy of effort
position of hands and fingers
- usually with one hand
- the position must be comfortable
- and must allow economy of effort
- one finger (index or middle finger ) or thumb on the lesion. The frictioning finger is kept slightly flexed to ensure pressure with the fingertip. If the friction is given with the index finger, the tip of the middle finger reinforces the index on the nail.
- counterpressure is provided with the thumb when the friction is performed with the index reinforced by the middle finger. When the thumb does the friction, counterpressure is from the fingers.
- The pressure on the lesion must be such that the underlying skin and the subcutaneous fascia move as a whole with the therapist's finger.
- the friction always contains two phases
  The active phase is provided bij the use of the flexor muscles; the movement is with the arm, the metacarpophalangeal joints and the wrist are kept in a neutral postion.
  During the passive phase the pressure is slightly released and the fingers are brought back to the starting position. Again fingers and skin move as a whole over the lesion.
amount of pressure
Over recent decades friction has been held in some disrepute in that it was perceived by some as synonymous with very painful treatment. Though it cannot be claimed as wholly pain-free, the pain should not be unbearable. When excessive pain is provoked, this is usually the result of a failure to understand the meaning of the term 'deep', which means 'as deep as needed to reach the lesion', Many therapists misinterpret this in such a way that they feel that they always have to work hard physically, which obviously leads to pain and may do more harm than good.
The amount of pressure applied depends on several elements:
- The depth of the lesion. Increased pressure must be applied to deeper structures. Friction must always reach sufficient depth to move the affected fibres in relation to their neighbours and sometimes the underlying bone or capsule.
- sensitivity of the patient
- sensitivity of the localisation( lesser tuberosity is more painful to the touch than the major tuberosity)
- The tenderness of the lesion: in severely inflamed lesions that are very tender to touch, friction with the usual amount of force may be very painful.
  Pain can be avoided by starting with a minimal amount of pressure just enough to reach the lesion-and progressively increasing the force as treatment proceeds.
Duration and frequency
Friction is given with a rhythm of 60-100 to-and-fro movements per minute during ten to 20 minutes. The interval between sessions is usually two to three days, depending of the persistance of the local tenderness.
There is usually improvement after four to six sessions. If not, the method is considered useless and abandoned.
If friction works, the patient should be treated until well or until no further improvement accrues.