Cross-Friction Massage

If you have ever been treated by an athletic trainer, physical therapist, or other manual therapy practitioner for a subacute musculotendinous injury (like chronic tendinitis…which is technically tendinosis…), you may have had cross-friction massage performed on your injury. But you may not know exactly what it is or why your therapy provider chose that particular treatment for you.

Effects

Cross-friction massage facilitates muscle mobilization, tissue separation, and the break-up of scar tissue. All of these effects are due to a mechanical change in the area’s tissues caused by the clinician’s hands, fingers, or tools. Inflamed or painful tissue often can be associated with mechanical restrictions caused by adhesions between tissue layers. Essentially, friction massage is designed to rub on some of these tissues to break apart the places where the tissues are stuck to each other (causing pain and limiting motion). Most commonly, the tissues being worked on are fascia (connective tissue that covers practically everything else that makes up the body’s musculoskeletal system) and muscle or tendon (or both).

As you may recall from your science classes in school, friction creates heat. Locally-applied heat causes an increase in blood flow to the area, which facilitates the healing process (as long as the body part is in the appropriate stage of healing).

Technique

Cross-friction massage is actually quite simple to perform. In fact, performers can even apply cross-friction massage to their own injuries. To properly perform cross-friction massage, the thumb or fingers rub directly over the injured area (see below for the types of injuries that respond well to cross-friction massage) perpendicular to the alignment of the tissue fibers (which is where the “cross” comes from). A tool with a hard, defined edge can also be used but should only be used in self-treatment by those experienced with cross-friction massage and comfortable with instrument-assisted soft tissue mobilization.

Although this is a friction massage, you should use a small amount of cocoa butter, body butter or cream, or lotion during the massage to keep from rubbing your skin raw.

A note: Generally speaking, cross-friction massage is not very pleasant for the person receiving the treatment. Some people think it’s a “good hurt” while others just think it hurts. However, the injury typically feels much better after the treatment is over. It especially feels better the next day when you’re back to your activities that increase your pain.
It is still important to know the difference between intense discomfort and actual pain. While the treatment will most likely not be pleasant, it should not be exceedingly painful. If it is, stop the treatment and do not attempt to use cross-friction massage for that injury again until after your pain has decreased.

Uses

Cross-friction massage is helpful in the treatment of all sorts of musculotendinous injuries and conditions, including:

• Tendinitis (specifically: Achilles, patellar, biceps, FHL)
• Plantar fasciitis
• Post-surgical rehabilitation (for the breakdown of unwanted scar tissue) – do not do this on your own; leave the decision to use cross-friction massage up to your rehabilitation clinician (athletic trainer, physical therapist, etc.)
• Fascial restrictions and adhesions causing pain and limitation of movement
• Trigger points (but this is very painful and difficult to do on yourself – there are other treatment techniques that may be more effective and beneficial in this case)
• Muscles that feel tight or stiff

Whatever the condition being treated, it is important to remember that cross-friction massage, like all other injury treatment techniques, is not designed to be used in isolation. It should be used as a segment of the injury treatment plan, not as the only treatment.

Integration into a treatment plan

Cross-friction massage is more aggressive than some other soft tissue therapies (like the types of massage that most people think of when they talk about getting a relaxing massage). As a result, it is a good idea to start your self-treatment with a few minutes of light massage over the injured area before proceeding to the more aggressive cross-friction massage. You can also finish your treatment with a minute of light massage, as well.

Using ice massage as a continuation of the cross-friction massage can also be beneficial. However, you need to be sure that you do not spend too much time intentionally irritating the tissue fibers, as this can actually worsen your pain and inflammation.

Frequency of treatment

On a physiological level, cross-friction massage facilitates healing by actually causing inflammation, the first stage in the healing process. Treatments like cross-friction massage cannot be performed every day since this would be constantly subjecting the body to inflammatory treatments without ever allowing time for the body to recover (which is very similar to how overuse injuries develop in the first place). This would result in the already injured area getting “stuck” in the inflammatory process, unable to move on to the next stages of healing at a cellular level. If the injury being treated was not already a chronic injury, treating it with cross-friction massage and similar treatments on a daily basis would certainly make it one.

Since the purpose of injury treatments is to help recover from an injury instead of causing one, cross-friction massage should only be performed every other day or every third day.