GENERAL CHARACTERISTICS
Hippocrates was the first author to describe the friction technique and the basic rules of its clinical application. However, it was the Roman physician Galen (131-201 A.D.) who developed a detailed system of treatment using friction. Working as a doctor in the gladiator school of Pergamum, Galen developed the practical concept of preparatory friction, or frictio praeparatoria, which was used to prepare gladiators before a fight, and therapeutic friction, or frictio apoterapia, which was used as a treatment procedure for the rehabilitation of injured gladiators.
In the 1920’s, The Finnish School of Massage, where the initial concept of sports massage was developed, greatly contributed to the technical arsenal of friction, especially the correct use of the thumb for the execution of this technique.
THE ROLE OF FRICTION AS A STRUCTURAL COMPONENT OF THE MASSAGE SESSION
Friction is stimulating massage technique. During massage of a segment or part of the body as a part of a stress-reduction or therapeutic massage session, friction is employed after effleurage and before the application of kneading.
Friction has a different technical approach to that of effleurage. The main difference between the two is in regards to the tissue level at which they are each aimed and applied. In the case of effleurage, the superficial layers of the soft tissue are targeted. When the practitioner applies friction, however, he or she works also with the connective tissue structures (i.e., fascia, aponeurosis, periosteum), skeletal muscles and periosteum. Thus, the practitioner has to use sufficient pressure so as to “pass” the skin level in order to achieve the correct application of friction.
Another difference is the increased speed of the strokes, with a view to producing local hyperemia. If friction is combined with even moderate pressure, a very powerful stimulation of the tissue results.
Friction is a local technique and does not affect large areas at once. For this reason, friction techniques can be applied either in the direction of venous and lymphatic drainage, or against it.
Friction has the greatest healing potential compared to any other massage techniques. The various applications of friction are an important part of every MEDICAL MASSAGE PROTOCOL. The repetitive application of friction in the inquired area activates fibroblasts and these cells are the body’s major repair tool. These fibroblasts produce collagen, which is the main protein that supports the inner structure of the body’s tissue and organs.
PHYSIOLOGICAL ROLE OF FRICTION
Friction results in many local and general effects. First of all, during friction local hyperemia of the skin and other soft tissues is produced. During intense friction, the temperature between the contact area of the hand and the soft tissue may rise an additional 36 C (96.8 F) degrees (Sarkisov-Sirasini, 1963). This increased local temperature, in combination with the application of pressure, triggers local controlled inflammation. The body’s response to this controlled inflammation is an increase in the blood supply to (and thereby oxygenation of) the soft tissue in the massaged area, with consequent stimulation of the local metabolism.
According to Jacob (1960), friction releases the largest amount of histamine from the tissue than any other massage technique. The release of histamine causes local capillary dilation in the massaged area. The increased histamine concentration in the blood produces general vasodilation of arterioles. Thus, blood circulation increases throughout the whole body, including the internal organs.
Another advantage of the increase of local histamine is that it becomes one of the major triggers for the activation of fibroblasts which then deposit collagen into the soft tissue of the injured area. Also, friction is a very important method in the elimination of reflex zones in the skin during a medical massage treatment. Thus, friction is a massage technique with the greatest healing potential and its application is a priceless clinical tool.
Friction with moderate pressure significantly increases the contractile response of the massaged muscles. This effect is widely used in sports as pre-event massage treatment.
Friction has a very unusual effect on the nervous system. On the hand, friction has a significant stimulating impact on the central nervous system; on the other, it has the strongest analgesic effect of any type of massage stroke (except vibration). The activation of touch, pressure, vibration and temperature receptors helps to inhibit the transmission of pain stimuli to the central nervous system. Friction also increases the adaptation of the peripheral receptors and helps to eliminate their hyperirritability. All these simultaneous occurrences are responsible for the great analgesic effect of friction.
Another important benefit of friction is the stretching of, and restoration of elasticity in, the fibrotic bridges that form connections between the skin, superficial fascia, aponeurosis, and periosteum (see below). Friction is the best way to deal with this problem because of its detailed approach to the tissue. This is why use of friction is successful in cellulite treatment. Friction with moderate pressure is also the best way to prepare muscles for the subsequent application of the kneading.
TECHNICAL DISTINCTIONS OF FRICTION AS COMPARED WITH OTHER MASSAGE TECHNIQUES
Friction is a deeper stroke than effleurage. Thus, the practitioner has to first of all apply moderate vertical pressure so as to pass the skin level, and only after this start the actual friction strokes, without releasing the vertical pressure. The amount of vertical pressure used during friction allows the practitioner to address different layers of the soft tissue. All friction strokes, once the desired level of depth is attained, are directed horizontally.
Let’s take as an example the application of friction in the gluteal area on the gluteus maximus and piriformis muscles. In the clinical setting, the practitioner does not use friction on all layers of the soft tissue during any single application of friction. Friction on the various layers of the soft tissue is always alternated with other techniques. The purpose the following six videos is not to represent individual friction techniques, but rather to illustrate the concept of the application of friction layer by layer.
Anatomically, the soft tissue in the gluteal area is comprised of six levels (see Diagram): the skin and subcutaneous tissue; the superficial fascia which covers the gluteus maximus muscle; the gluteus maximus itself; the deep fascia which separates the gluteus maximus and piriformis muscles; the piriformis muscle; and the periosteum which covers the sacrum and femur as the deepest layer of the soft tissue in the gluteal area.
FRICTION ON THE SKIN
To address the skin in the gluteal area, the practitioner must employ superficial friction. Superficial friction can be applied along or across the lines of cleavage in the skin. The lines of cleavage reflect the predominant orientation of collagen fibers in the skin.
The video shows the detection of the lines of cleavage in the gluteal area. To find the direction of these lines grasp a fold of skin. You will find that the fold of only skin is created more easily (first part of the video) in one direction than in any other (second part of the video). The lines of cleavage reflect the predominant orientation of the collagen fibers in the skin.
The video shows the application of the superficial friction across the lines of the cleavage. Notice that during the application of the superficial friction passive hand (left hand in the video) tighten the skin first and the active (right) hand slides along the skin. Notice that during the application of superficial friction, the hand slides along the skin with very light vertical pressure. To review the detailed application of the superficial friction click here.
FRICTION ON THE SUPERFICIAL FASCIA
To apply friction along and, after this, across the fibers in the superficial fascia the practitioner should apply mild to moderate vertical pressure that allows him or her to compress the skin and subcutaneous tissue against the fascia, and then use friction.
Collagen fibers in the fascia are predominantly arranged in the direction of the underlying muscle fibers which the fascia covers. Notice in the video that the fingertips of the 2nd-to-4th fingers slide together with the skin across the superficial fascia. Also notice that the range of the friction strokes is restricted by the elasticity of the skin and fibrotic bridges which connects the skin to the superficial fascia.
The difference this friction with superficial friction is obvious: when friction is applied to the fascia the fingers move together with the skin, while during the application of superficial friction simply to the skin the fingers slide along the skin surface.
When the skin is pushed back and forth along the (underlying) superficial fascia, the friction stretches the fibrotic bridges which connect the subcutaneous tissue and the skin to the underlying superficial fascia. As a result, tension in the superficial fascia decreases owing to the fibrotic bridges regaining their original elasticity.
FRICTION ON THE GLUTEUS MAXIMUS MUSCLE
To address the gluteus maximus muscle using friction, the practitioner needs to compress the muscle to 50%. To get this degree of compression the practitioner needs first to determine the pressure required for 100% compression of the gluteus maximus muscle.
The beginning of the video shows the practitioner slowly compressing the gluteus maximus muscle using the thumb to detect the amount of pressure needed to reach 100% compression.
How to detect the 100% compression? When pressure is applied gradually, the practitioner will feel the slow descent of the thumb into the superficially located muscle (the gluteus maximus in the video). At some point, the thumb will feel that that tissue starts to resist further descent. This first sensation of resistance is a sign of the gluteus maximus muscle compression having reached 100%. To get the 50% compression desired, the practitioner reduces the pressure by half, and proceeds to apply the friction while maintaining the same degree of compression.
FRICTION ON THE DEEP FASCIA AND PIRIFORMIS MUSCLE
If the practitioner starts to use 100% compression of the gluteus maximus when applying the friction, he or she targets the deep fascia and piriformis muscle. When friction is applied with 100% compression of the gluteus maximus muscle, the practitioner uses the muscle’s compressed fibers as a transmitter of the friction to the deeper layers of the soft tissue in the gluteal area (i.e., fascia and piriformis muscle).
Friction on the deep fascia and the piriformis muscle can be applied in the directions both along and, after this, across the fibers of the piriformis.
FRICTION ON THE PERIOSTEUM
The periosteum is the last layer of the soft tissue before the bone. Actually, the periosteum, as its name suggests, is a thin connective tissue membrane which covers the bones. While applying friction to the periosteum in the gluteal area, the practitioner may work along the following bone structures: edge of the sacrum, the posterior edge of the greater trochanter, and the lateral edge of the sacroiliac joint. The last area is shown in the video.
Notice that the practitioner applies friction across the insertion of the gluteus maximus muscle on the bone itself. This is where the periosteum is addressed.
Friction can be applied with or without stabilizing (via tightening) the skin. In the first variant, the operator tightens the skin in the massaged area with the other hand (e.g., superficial friction). If the operator uses the second variant of friction, the skin moves together with the contact areas (e.g., Cyriax’s friction).
Friction can be directed either longitudinally to, or across: the lines of cleavage in the skin; the direction of the muscle fibers; the fibers of the fascia, tendon or ligament. Friction can also be conducted in a spiral or in a circular mode, as well as in opposite directions when two hands are used.
More than any other massage technique, friction demands from the practitioner knowledge of the body’s anatomy. He or she needs to have at least a basic idea about the orientation and structure of the soft tissue in the different parts of the body.
Always start with the application of friction along the fibers in the longitudinal or the spiral mode, and later switch to friction in the cross-fiber or the circular mode. Friction across the lines of cleavage is helpful in cases of fibrotic adhesions between the skin and the superficial fascia. Friction strokes along the muscle fibers are valuable for warming up an entire muscle exhibiting hypertonic pathology (i.e., hypertonus, trigger point, or myogelosis). In any case, cross-fiber friction has to alternate with longitudinal friction.
The speed of friction has to be significant if it is to have beneficial therapeutic effects. When less lubricant is applied to the massaged area, less energy is consumed by the practitioner to produce the same therapeutic effect, and thus the friction strokes are conducted more efficiently and are more effective.
Many friction techniques involve approaches similar to those for effleurage techniques. For example, ridging, pinching effleurage, or effleurage with interlocked hands have positioning of the hands and body similar to those for the friction techniques of similar names, respectively. However, in the case of friction strokes, the practitioner should increase the speed and pressure of the strokes. There are 14 types of friction.
TYPES OF FRICTION
SAWING FRICTION (SF)
This type of friction can be used on any flat part of the body and is especially effective on the soft tissue in the narrow spaces between two bone structures (e.g., between two ribs).
SF should be conducted using the ulnar edge of one or both hands. In the latter case, the hands have to be placed about 1 inch apart with the palms facing each other. The operator then moves his or her hands in the same or in opposite directions.
Friction with both hands can also be done with or without a fold of skin formed between them. This is an important detail because the forming of a fold of skin increases the impact of the SF. This is especially significant in cases of fibrotic connections between the skin and superficial fascia. If the operator does not have a fold of skin between the hands, sawing friction affects mostly the skin. This can be helpful during a medical massage treatment of the cutaneous reflex zones. Thus, both techniques are applicable.
In the first part of the video the bi-manual application of SF without a fold of skin is shown. Both hands are placed on their ulnar edges and gently pressed into two neighboring intercostal spaces. Move hands back and fourth in a sawing motion. This is more superficial application of SF.
In the second part of the video, the same SF is shown but with a fold of skin between the hands. Notice that the practitioner creates a fold of skin between both hands before the application of SF. Also, the practitioner needs to regain the fold of skin between the hands every time he or she feels the skin slipping away. Notice that the speed of the stokes is lower when SF with the fold of the skin is applied.
ALIGNED FRICTION (AF)
AF is performed using the fingertips of 2nd-and-3rd, 3rd-and-4th or 2nd-to-5th fingers. The choice of which contact surfaces to employ will depend upon the size of are to be massaged. The practitioner has to bring the fingers together and arrange the fingertips in one line, at an angle of about 40-50 degrees relative to the surface of the body. To apply additional pressure, increase the angle between the fingers and the body surface. The fingertips are the main contact areas. The impact of AF can be increased by adding pressure with the other hand.
AF is most effective on areas of tension developed between the skin and connective tissue structures (e.g., fascia, ligaments, etc.). This technique is especially effective when applied to surgical scars, in that helps loosen and stretch the soft tissues in these restricted areas.
In the first part of the video, AF using the fingertips of the 2nd-to-5th fingers is shown. Notice that the fingertips are moving along the paravertebral muscles with the skin, and that the left hand is placed on top of the right hand to increase vertical pressure and, thereby, the therapeutic impact. The practitioner must re-locate the fingertips every time he or she applies AF to a new area.
In the second part of the video, AF using the fingertips of 3rd-and-4th fingers is shown. The rules of the application are the same.
STRETCHING FRICTION (STF)
STF is a technique which combines friction with local stretching of the skin, fascia or aponeurosis. It should be performed on the flat areas of the body: e.g., the back.
In the first part of the video, the position and movement of the active hand are shown alone. Stabilize the active hand by pressing the thenar and hypothenar eminences (the base of the hand) into the soft tissue. Next, press the fingertips of the flexed fingers into the tissue. Now, move the fingers forward until the hand becomes flat. Try to keep the fingers together. Bring the fingers to the starting position and repeat the strokes back and forth on the same area.
The second part of the video shows the clinical application of STF. It requires the participation of the passive hand, which is placed on top of the active hand, close to the fingertips. The white arrow in the video indicates the direction of the pressure. The passive hand provides the vertical pressure needed for the application of STF. To work in the adjacent area, the practitioner should relocate the base of the hand and repeat the entire application.
During this stroke, the operator performs the classical friction technique using the fingertips and, at the same time, locally stretches the skin and fascia between the fingertips and the base of the hand.
In the effleurage section, we presented a technique called raking effleurage, one variant of which included a skin-stretching component. The applications of this type of effleurage and STF are similar, but there are some important differences.
Compare this video with the effleurage video.
First of all, the practitioner stays in the same area in the case of STF, while in the case of raking effleurage with the stretching component, he or she moves forward along the massaged area. Another difference regards the placement of the passive hand. In the case of STF, the passive hand applies the vertical pressure onto the fingers, while in the case of raking effleurage with the stretching component the passive hand applies vertical pressure onto the base of the hand.
PLANING FRICTION (PF)
PF is a bi-manual technique. This technique is a combination of friction and percussion. In the beginning, the video demonstrates the application of PF in a slow manner, for demonstration purposes. The practitioner has to completely extend and tighten the hands and fingers. The contact areas are the fingertips of the 2nd-to-5th fingers. The hand have to be placed at an angle of 30-45 degrees to the massaged area.
Press the fingertips (the left hand in the video) into the soft tissue and push the hand and skin forward so as to form a fold of skin in front of the fingertips. As soon as the left hand pushed the skin forward to the maximum of its elasticity the practitioner should lift hand and the fingertips of the right hand immediately replace the left hand in the same area. The practitioner should in this way rapidly alternate the hands while conducting the strokes. Each time the fingertips of either hand stroke the body surface the pressure is directed forward.
The second part of the video shows the clinical application of PF with the correct speed and interaction of both hands. Because of the combination of friction and percussion, this technique is especially effective in areas of tension in the superficial fascia and scars. Also, PF increases the contractile response of the massaged muscles.
SARKISOV-SIRASINI’S FRICTION (SSF)
I. M. Sarkisov-Sirasini, MD was the principal scientist who developed the concept of Russian Sports Massage. In 1963, he proposed the use of friction which combined deep-pressure effleurage with friction in the circular mode. As a sign of respect, this technique has been named after the author. SSF is to be used on large, flat areas of the body: e.g., along the vertebral column or on the thigh.
SSF is a bi-manual technique. The contact areas on the active hand are the thenar eminence, the palmar surface of the thumb, and the fingertips of the 2nd-to-5th fingers.
The beginning of the video shows the position of the active hand. The thenar eminence and thumb of the active hand are pressed into the soft tissue and the fingertips of the 2nd-to-5th fingers start to perform circular friction.
As soon as circular friction is established, the supportive hand is placed on top of the thumb of the active hand to elicit additional pressure (the white arrow in the video). After pressure has been applied, the supportive hand pushes the active hand forward while the fingertips of the active hand continue to perform circular friction.
Be sure that active hand busies itself simply with the circular friction and that it is the supportive hand that assumes responsibility for the forward movement of the hands.
This video shows the clinical application of SSF on the posterior thigh, on the hamstring muscles.
To effortlessly execute SSF the practitioners must use the correct body mechanics. The propulsion of the active and passive hands comes from the practitioners’ body leaning forward. Such approach unloads the hands and arms and makes the execution of SSF easier.
SSF targets the skeletal muscles as well as the fascia and aponeurosis. Because of the significant pressure applied, all muscle layers are affected. However, the technique does not induce pain, even in areas of hypertonus or trigger point, owing to the fact that the contact area employed is large (thumbs and thenar eminences) and that pressure is distributed equally.
SSF is very effective as a preparation of the muscle with hypertonic muscular pathology for the medical massage treatment, especially trigger point therapy. To apply this technique in cases of the trigger point, place the thenar eminence of the active hand on the area of the trigger point and compress the tissue. Do not move through the massaged area, but rather remain in the same spot. In this case, the moderate ischemic compression achieved, combined with friction of the surrounding tissue, has the advantage of diminishing the activity of the pain analyzing system in the area of the trigger point. This approach is especially helpful when the patient has a very painful trigger point or hypertonus.
CROSSING FRICTION (CRF)
CRF usually is used on the rounded parts of the body: i.e., shoulders, arms, thighs, etc. The practitioner uses the radial edge of the hand between the thumb and index finger: i.e., the 1st metacarpal space. Anatomically, this part of the hand perfectly matches the rounded edges of the arms or legs. CRF conducted with both hands can move in the same or in opposite directions. CRF is always applied perpendicularly to the axis of the extremity.
The video shows the application of CRF on the posterior thigh. The thumbs are pressed against the tendon of the biceps femoris muscle and the index fingers are pressed against the tendons of the semitendinosus and semimembranosus muscles. The entire first metacarpal space squeezes the soft tissue between the thumbs and index fingers. Lean forward to increase pressure on both hands, and apply CRF in the opposite or in the same direction.
CYRIAX’S FRICTION (CF)
This technique is one of the key elements of the so-called Cyriax’s treatment procedure. J. Cyriax, DO, of England developed this technique in the 1970s. CF is the application of friction strictly perpendicularly to the predominant orientation of collagen fibers in the tendon or of myofibrils in the skeletal muscles.
There are two main target of CF: flat connective tissue structures (fascia or aponeurosis) and tendons and ligaments. Abnormalities in the fascia and aponeurosis are formed as a result of chronic somatic or visceral disorders. We discussed this subject above, in the general characteristics section.
CF has a very powerful healing effect on inflamation in the tendons, ligaments and periosteum developed as a result of trauma or chronic overload. Read more about this in the chapter Periostal Massage, in the Medical Massage, Vol. I textbook.
It is best to use the tips of the thumb, index finger, or thumb plus index finger. CF has to be strong enough to press the thumb (and fingers) into the skin and move the skin across the fascia, aponeurosis, tendon, ligament or perisoteum. The practitioner may increase the speed of the strokes to intensify the clinical impact of CF.
Dr. Cyriax formulated five necessary conditions for the proper application of CF: accurate diagnosis; exact knowledge of the principal orientation of fibers in the massaged tissues; strictly perpendicular direction of strokes; movement of the finger together with the underlying skin; and significant sweep of the strokes (Cyriax, 1976).
Video shows the application of CF on the Achilles’ tendon WITH skin stabilization. The practitioner stretches and tighten the skin over the Achilles’ tendon by pulling the skin down using the thumb and index finger of the left hand. The right thumb applies intense friction across the fibers.
This video shows the application of CF across the iliotibial tract WITHOUT skin stabilization. Notice that CF without skin stabilization is more difficult to execute, especially when seeking to maintain a high speed of strokes. The dashed U-shaped line indicates the greater trochanter.
RIDGING FRICTION (RF)
There are two variants of RF: using the knuckles of the distal interphalangeal joints, and using the knuckles of the proximal interphalangeal joints.
1. RF USING THE KNUCKLES OF THE DISTAL INTERPHALANGEAL JOINTS
The beginning of the video shows the contact areas for the application of RF using the knuckles of the distal interphalangeal joints.
The next part of the video presents the application of one-handed RF in a slow manner, for demonstration purposes. Make a fist, place it on the massaged area, and press the knuckles of the distal interphalangeal joints of the 2nd through 5th fingers into the soft tissue. Also, press the thenar and hypothenar eminences (i.e., the base of the hand or hands) into the tissue so as to stabilize the hand and free the knuckles for the application of the friction. Notice that the thumb is slightly abducted to provide additional stability for the hand.
Start to make little oval strokes with each knuckle, alternating between them. Later in the video, RF at normal speed is shown. The application of RF demands some coordination of the fingers. In your spare time, practice it using piano-like movements of the fingers.
The next part of the video shows the application of RF using two hands in the mobile mode. It is easier if one hand (the left in the video) grasps the thumb of the other hand (the right hand in the video) and both hands work as one tool.
RF can be executed in the fixed or the mobile mode. In the case of fixed RF, the hand(s) stays in the massaged area. If mobile RF is applied, the hand(s) moves along the massaged segment combining the RF and effleurage. The video shows the application of mobile, bi-manual RF in the parallel and opposite directions. For best results, use a small amount of lubricant.
2. RF USING THE KNUCKLES OF THE PROXIMAL INTERPHALANGEAL JOINTS
This type of RF creates stronger pressure, therefore the practitioner has to be more careful. The beginning of the video shows the contact areas for the application of this friction: the knuckles of the proximal interphalangeal joints of the 2nd through 5th fingers.
The next parts of the video show the movement of the knuckles of the proximal interphalangeal joints in a slow manner (for demonstration purposes) and later at the normal speed of application.
Make a half-fist (i.e., don’t close your fist completely), press the knuckles of the proximal interphalangeal joints into the soft tissue, and apply RF in a way such that each knuckle alternates, creating small oval-shaped strokes. Notice that the thumb is in slight abduction so as to additionally stabilize the wrist joint during the application of the strokes.
The video first shows the hand staying in the same area, that is, RF applied in the fixed mode, then shows the application of RF in the mobile mode.
The final part of the video presents the bi-manual application of RF with both hands acting as one tool. However, the hands may also work as two tools in the parallel direction or in opposite directions.
RF can be conducted with both hands placed on opposite sides of an extremity (the thigh, in the video) compressing soft tissue against the bone, and applied in the direction of drainage (e.g., medial and lateral sides of the thigh).
FRICTION-KNEADING (FK)
We developed this technique for massage on large areas with significant muscular mass (e.g., paravertebral regions, thigh, etc.). This is a bi-manual technique, with one hand playing the leading role and the other hand having a supportive role.
The beginning of the video shows the movements of the leading hand from the frontal view. The leading hand makes a fist and is placed on the massaged area on the dorsal surface of the proximal phalanges of the 2nd-to-5th fingers.
If the fist is tight FK becomes a more aggressive technique, while a relaxed fist provides a softer application of FK. The decision as to how tight the fist is to be formed should be based on the degree of resistance of the large muscles in the massaged area — the greater the muscle’s resistance, the tighter the fist should be. The leading hand should execute circular movements as shown in the video. Also, the video shows the movements of the leading hand from the posterior view.
The leading hands needs additional stabilization during the strokes because it can slip to the side and the practitioner may strain the wrist joint. Necessary stabilization is provided by the supportive hand. The supportive hand is placed on its ulnar edge and embraces the fist and wrist joint of the leading hand. Don’t embrace the leading hand too tight, so as to allow it to conduct its circular strokes.
The supportive hand has another important function. It targets the skin and superficial fascia by stretching the fibrotic bridges between these anatomical structures during the mobile application of FK.
The most common mistake during the application of this technique is incorrect placement of the supportive hand. The ulnar edge of the supportive hand has to slide along the skin, but in many cases practitioners squeeze the wrist joint, thus keeping the supportive hand above the body surface; this error renders the supportive hand useless.
The last part of the video shows the clinical application of FK on the paravertebral muscles. Press the ulnar edge of the supportive hand into the tissue, hug the fist and wrist joint of the leading hand, which starts to apply circular strokes. The practitioner should combine circular strokes in the wrist joint with simultaneous application of vertical pressure on the fist.
Now the practitioner has two choices: to remain in the same place applying FK in the fixed mode, or to move both hands along the massage area applying FK in the mobile mode (shown in video). The advantage of the mobile mode is the impact of the supportive hand on the fibrotic bridges as discussed above.
During the application of FK in the mobile mode, the ulnar edge of the supportive hand pushes forward a fold of skin in front of both hands, thereby reducing tension in the skin and superficial fascia.
If the circular strokes have a small radius, the practitioner delivers the therapeutic impact of friction only. If the practitioner increases the radius of the circular strokes and applies vertical pressure simultaneously, he or she combines the therapeutic impacts of friction and kneading.
The correct application of FK depends upon the practitioner’s proper body mechanics. This video addresses this important point. Notice the position of the practitioner’s right shoulder, arm and forearm. Such a position is necessary for the application of the vertical pressure at the same time as the hand conducts its circular movements originating from the wrist joint. This is only way to perform FK easily without risking hand injury, and to maintain fluidity of the strokes.
SUPERFICIAL FRICTION (SRF)
SRF is not a classical friction technique. As we discussed above, during friction the practitioner has to press the contact area of the hand into the soft tissue, compress the skin against the underlying tissue or bone, and perform the friction with the skin moving together with the contact area. Thus, the main target of the friction techniques is the tissue underneath the skin. However, in the case of SRF, the main target is the skin itself. In this technique, the contact area of the hand slides along the skin surface without any accompanying application of vertical pressure.
In the video, the application of SRF on the lower back is shown. To perform SRF correctly, the skin has to be tightened first. Notice in the video that the left hand pulls the skin to the left to tighten it. As a result the fingertips of the right hand can slide back and forth along the skin surface with great speed.
The speed of the strokes is a critical factor because the practitioner should end the application of SRF in any particular area only after he or she feels heat having built up between the patient’s skin and and the contact area of the practitioner’s hand. Don’t use lubricant, and remove from the skin any that there may be before you apply SRF.
The practitioner may use other contacts areas as well: the whole palm, the thenar eminence, the hypothenar eminence, the thenar-plus-hypothenar eminences (the base of the hand), the dorsal surfaces of the proximal or middle phalanges, the ulnar side of the hand or fist, or the fingertip(s).
SRF is a very important technique of medical massage treatment in areas of cutaneous reflex zones and trigger points. It increases local temperature, triggers vasodilation, and stimulates circulation and metabolism in these areas. Another important benefit of SRF is its impact on hyperirritability of the peripheral sensory receptors; SRF helps to quickly restore the normal threshold of the activation of these receptors, thereby eliminating cutaneous reflex zones, sometimes even after only a single session.
ELBOW FRICTION (EF)
The practitioner may use the elbow for the application of the friction. The video shows the application of EF in the circular mode in the gluteal area.
EF is a very simple technique and is frequently used, especially on large muscle groups or if the client has well developed muscles. However, EF has many disadvantages for the client and ultimately for the practitioner’s practice. The elbow has very low sensitivity compared to the hand and fingers, and it is simply impossible to apply friction in the layer-by-layer mode, which is an important way to use friction on any part of the body. This fact alone greatly diminishes the healing impact of EF. The practitioner will have a much better response from the clients if he or she avoids excessive application of EF and uses other friction techniques.
EF is a great massage technique but it has a narrow window of its application. However, there are cases when the practitioner conducts entire massage session using the elbow for the effleurage, friction and compression. From a massage science point of view, this is unacceptable practice, because an approach such as this devalues massage therapy as a profession by diminishing its healing power. In a sense the massage therapy session is a symphony of the various techniques which should be individually adjusted to each client. When practitioner locks him or herself within one or two techniques he will have difficulties to build up massage practice.
One of the major reasons behind such excessive use of the elbow one encounters in the profession is the invoking, by its proponents, of the physical challenge to the practitioner when working on large muscles (which is true enough when incorrect body mechanics are deployed). Our response, founded on science as well as on personal experience and that of others, is that if the practitioner grasps and masters correct body mechanics, he or she will be able to easily work all day long on large muscle groups using even the most technically challenging massage techniques without great physical challenge. To read more about body mechanics, click here.
GRASPING PERMANENT FRICTION (GPF)
The application of GPF is similar to the effleurage technique with the same name (to review click here). The only difference is the fact that while applying GPF the practitioner uses more vertical pressure and applies friction with the skin along or across the underlying soft tissue.
FRICTION WITH INTERLOCKED HANDS (FIH)
The application of FIH is similar to the effleurage technique with the same name (to review click here). The only difference is the fact that while applying FIH the practitioner uses more vertical pressure and applies friction with the skin along or across the underlying soft tissue.
PINCHING FRICTION (PIF)
The application of PIF is similar to the effleurage technique with the same name (to review click here). The only difference is the fact that while applying PIF the practitioner uses more vertical pressure and applies friction with the skin along or across the underlying soft tissue.