Deep Transverse Frictions Tissue Injuries Health And Social Care Essay

Deep Transverse Frictions Tissue Injuries Health And societal C ar EssayThe purpose of this essay is to consider the merits of deep crosswise corrasions in the discussion of great and chronic soft interweave injuries. To facilitate this I have considered a wide range of explore that has been conducted into the utilise of skirmishs. I have in any case considered the hoagyprogram of alternative therapies in the treatment of similar conditions in order to evaluate the effectiveness of deep transverse brushs in comparison to each of the former(a) treatment methods.What is deep transverse friction?Deep transverse friction was developed for the treatment of soft tissue lesions by the British osteopath Dr. James Cyriax who postulates that deep transverse friction is effective in the simplification of fibrosis and facilitates the seduceation of strong, pliable scar tissue at the site of healing injuries. Deep transverse friction, which is similarly known as cross-fibre fricti oning (CFF), basin help to alleviate build up of the crystalline deposits that can form between tendons and their sheaths and result in botherful tendonitis. It can also help to offset the development of myofascial adhesions and unwrap those that are already present.Deep transverse frictions should be administered with a braced finger or ripple moving across the grain of the muscle, tendon or ligament with a deep, non-gliding, friction stroke. It is not necessary to use a lubricant as this reduces friction. The therapists thumb and the clients skin should move as one over the take aim site of the lesion to create a mechanical effect on the tissue being treated. The rub down moldiness be applied directly over the site of the lesion and at right angles to the fibres, the stroke must also be wide enough to divide the fibres without skipping over them. The treatment can be perturbful, but should forever and a day be conducted within the pain tolerance threshold of the recipien t, and should be started unless with the informed consent of the client. It is contraindicated during the sign inflammatory stage of an acute injury.Deep transverse friction whitethorn be utilised in the treatment of both acute and chronic conditions. Its uses include mobilisation of interstial fluid reduction or variety of oedema increase of local blood point reducing of muscle soreness and stiffness rilievo of pain facilitation of relaxation prevention or elimination of adhesions (Wieting 2004).There are a variety of massage techniques that can have physiological, neurological and psychological personal effects. These can be employ to reduce pain and the physical composition of adhesion, mobilise fluids, increase muscular relaxation, and increase vasodilatation (Wieting 2004).Mechanical pressure on soft tissues displaces fluid which wherefore moves in the directionof least resistance. Movement of the practitioners hand creates a pressure gradientresulting in gnomish amou nts of fluid leaving the soft tissues and entering the venous orlymphatic systems, improving lymphatic flow (Wieting 2004).In admission to its mechanical effects, deep transverse friction (and other massage techniques) causes the exit of histamine which has a glib vasodilatory effect that assists in the washing out of metabolic waste products. A noticeable decrease in lactate occurs in massaged muscles which can be associated with reduced muscle spasm, increased endurance and bear on of contraction. (Cox, 2007)Other beneficial effects of massage include decreased blood viscosity and increased haematocrit levels. There is also an increase in circulating fibrinolytic compoundsa yearn with substances such as myoglobin, creatine kinase, dehydrogenase, andglutamic oxaloacetic transaminase which probably represent local muscle cell leakagefrom the applied pressure. There is also release of endorphins and enkaphalinproduction (Wieting 2004).Impulses from the stimulation of superficial skeletal muscle fibres, cutaneous and spindle receptors reach the spinal cord and may produce segmental moderation and even somatovisceral reflex changes (Wieting 2004).The normal healing process may also be ameliorate by the breaking of cross bridges, which will help to prevent aberrant scarring. The mechanical action of the technique causes hyperaemia and increased blood flow to the area (Brosseau et al 2002). In addition shearing stresses are created at tissue interfaces below the skin. e.g.dermis-fascia, fascia-muscle, muscle-bone interfaces, the deep pressure prevents shearing of superficial tissues and the shear force is directed at the deeper tissue surface interface (Wieting 2004). This helps release underlying adhesions and promotes improved circulation to the area (Lorenzo 2004).Sevier and Wilson (1999) describe vigorous cross friction massage for 5-10 minutesover the common extensor tendon perpendicular to underlying soft tissue structures inthe treatment of sidelon g epicondylitis. Point friction may also be performed directly over the lateral eipcondyle and over the radial tunnel where it can be used in an attempt to reduce venous congestion at the extensor carpi radialis origin. This is a purely descriptive article of commonly used treatments for tennis cubitus. No analysis of any test regarding the efficacy of any of these treatments is given.Disabella (2004) describes the use of friction massage in conjunction with ultrasoundand/or electrical stimulation in the treatment of elbow and forearm overuse injuries.In a systematic analyse of the use of deep transverse friction massage in the treatmentof tendonitis Brosseau et al (2002) put only 2 randomised controlled trials ofsufficient quality. One of which looked at patients receiving treatment for iliotibialband friction syndrome and the other at tennis elbow.The outcomes of both studies suggest that transverse friction massage combined with other physiatrics modalities does not significa ntly reduce tendonitis symptoms when compared to a control. However these studies were of small sample size qualification it difficult to draw conclusions regarding the benefits or not of treatment of iliotibial band friction syndrome or tennis elbow with transverse friction massage.The tennis elbow study looked at 9 sessions of transverse friction massage given over5 weeks in combination with other physiatrics modalities and in isolation. Thecomparison groups were as follows deep transverse friction massage with therapeutic ultrasound and placebo salve compared with therapeutic ultrasound and placebo ointment deep transverse friction massage compared with phonophoresis aloneNo difference was found in pain relief, grip strength and functional status between thegroups. This study used double blinding and a sound randomisation procedure but didnot report withdrawals and dropouts (Brosseau et al 2002).Another study of lateral epicondylitis was carried out by Smidt et al (2002). 185pa tients with lateral epicondylitis of at least 6 weeks were randomised using calculating machinegenerated block randomisation to 6 weeks of treatment with steroid hormone injection,physiotherapy or wait and read policy. The physiotherapy arm of the study consisted of9 sessions of pulsed ultrasound, deep friction massage and an exercise program over 6weeks.Outcome measures were general improvement, severity of main complaint, elbowdisability, grip strength and pressure pain threshold. anterior to the main study areproducibility study on 50 patients was carried out that demonstrated redeeming(prenominal) intertesterreliability for the research physiotherapists carrying out the outcome measures.Intention to treat analysis was used and at 6 weeks injection was significantly betterthan all other options on all outcome measures. There was a high recurrence rate inthe injection group. The physiotherapy package (which include frictions) gave betterlong term outcomes than injection but w as no better than wait and see policy.Interestingly the wait and see policy had better long term outcomes than injection andphysiotherapy that included transverse friction.In a inspection article containing a unofficial of the picture for the effectiveness of interventions for the management of tennis elbow Nimgade et. al (2005) used the Cochrane Collaboration guidelines to assess the quality of the evidence reviewed. The Cochrane guidelines have 11 score items for internal validity, 6 for external validity and 2 for statistical criteria. Thirty studies were reviewed and the quality scores awarded to each study varied between 2 and 9 (out of a possible 11). Eighteen of the studies scored between 6 and 11 points giving an indication of good quality.It appears that relative rest will eventually improve function but the use of earlyactive interventions including steroid injection and physiotherapy modalities mayspeed up recovery. The physiotherapy interventions reviewed included e xercise andultrasound alone and in combination with friction massage.These authors concluded that, patients who need a speedy return to work or usualactivities, may benefit from one or two steroid injections for pain relief in the first fewweeks or months and physiotherapy (which may include friction massage) at anystage.Smidt et al (2003) carried out a review to evaluate physiotherapy interventions forlateral epicondylitis. This was a well conducted review that found only one RCT withacceptable validity showing exercises were significantly better than ultrasound plusfriction massage. The authors in that locationfore concluded there was insufficient evidence forthe effectiveness for around interventions and there was weak evidence that ultrasoundmay have a beneficial effect.For the treatment of sub acute bicipital tendonitis Gonzalez (2004) recommendedphysical therapy involving soft tissue therapy with transverse gliding of the tendonand cross-friction massage.In the trial reviewe d by Brosseeau et al (2002) involving patients with iliotibial bandfriction syndrome deep transverse friction massage was used in combination with rest,ice, stretching exercises and ultrasound and this was compared to a control groupreceiving rest, ice, stretching exercises and ultrasound only. No statisticallysignificant difference was demonstrated in pain relief after 4 sessions of frictionmassage combined with the other modalities. There was however a clinicallyimportant difference in pain when running.This study was not double blinded but this is difficult to do where rehabilitationinterventions are concerned and can result in trials of such modalities havingconsistently low methodological scores. However withdrawals and dropouts were inform which is good practice but there were problems with the randomisationprocedure (Brosseau et al 2002).In a summary of aetiology, pathology and treatment of temporomandibular jointsyndrome Berman (2004) suggest friction massage may help inacti vate trigger points overdue to temporary ischemia and resultant hyperaemia produced by a firm cutaneouspressure. In addition small fibrous adhesions in the muscle formed as a result ofsurgery, injury, or lengthy restricted motion may be disrupted.Many studies have used subjective and non validated scales for pain measurement andthe use of combined treatments causes difficulties when trying to evaluate treatmentefficacy (Brosseau et al 2002). This can work comparison of outcomes betweendifferent trials particularly difficult.In studies where a neediness of effect is demonstrated there are a number of variables that can contribute to this. These include characteristics of therapeutic application (experience of therapist, rate, rhythm and judgment of technique application), population (age, sex, occupation, sports), disease (acute/chronic) and methodology(blinding, randomisation, validated outcome measures, sample sizes, comparison groups, massage only group to assess specific effec ts) (Brosseau et al 2002).Comments ConclusionsDespite a lack of good quality evidence to recommend either its inclusion orexclusion transverse friction massage is a wide taught, and used, physiotherapytreatment in the management of muscle, ligament, tendon injury and pain.The majority of the literature found seems to review the usage of transverse friction massage in the treatment of tennis elbow. There is a lack of good quality,randomised, controlled trials testing the efficacy of transverse friction massage eitherin isolation or as part of management package. Many papers are descriptive in natureof transverse friction massage being used in conjunction with other modalities. Theliterature regarding mechanical, physiological, neurological effects and possiblemechanisms of action is speculative which could be due to such trials being difficultto conduct.