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Comic Book Catalog, Ver. 1.2,
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t-injury, once the inflammatory phase has ceased 
(6), the trainer can become more aggressive with the DTF alerting 
the patient that pain will be experienced. A good rule of thumb to 
follow is to back off if the numbing effects of the DTF are not realized 
within one to one and one half minutes (3). Duration of DTF should 
last approximately five minutes per contact point (2). Should the 
lesion require moving the finger three times in order to completely 
sweep the injury, then treatment time would last 15 minutes.
	It becomes obvious how useful DTF can be as a therapeutic tool in 
the training room. There is no equipment necessary which is beneficial 
in the typical training room with a limited budget as in the high 
school setting. All that is required of the trainer is the acquisition 
of the skill of administering DTF through experience and the patience 
of time required for administration when it is called for. The trainer's 
hand skilled in DTF could hasten the recovery of an injured athlete 
as well as insure that the likelihood of re-injury is cut down.   
<+B>ACKNOWLEDGEMENTS
	I would like to thank Ron DeAngelo for exposing me to this effective 
form of treatment of soft tissue injuries sustained by athletes. My 
thanks goes out to the rest of the "universally knowledgeable" staff 
at the Palm Beach Institute of Sports Medicine for a most educational 
internship. I would also like to thank Tracy Greene for her input 
on the finer points of deep transverse friction and to Dane Basch 
for the constant use of his computer. Final thanks go to Dr. Christine 
Boyd Stopka for pushing me toward excellence in athletic training 
and effective paper writing. 
<+B>Deep Transverse Friction: An Effective Therapeutic Tool
	In many athletic training settings, the trainer is limited to the 
tools he/she can use for rehabilitation because of budget or lack 
of technical ability. Deep transverse friction massage is a no-cost 
technique that can be used in concurrence with traditional therapies 
of ice, heat pacystem. Merely pressing 
over a sore spot is likely to do nothing more than make the patient 
uncomfortable (1). By following the pattern as outlined by Cyriax, 
the therapist/trainer can bring about the physiological effects previously 
discussed. Cyriax's method of DTF is as follows: (1)
	1) The right spot must be found. According to Cyriax, all pain arises 
from a lesion. It would stand to reason that unless this lesion is 
located (through palpation and functional tests), DTF over healthy 
tissue will afford no effect. The therapist must also be observant 
of referred pain as well. DTF over a sore spot away from the lesion 
will prove as fruitless.
	2) The physiotherapist's fingers and the patient's skin must move 
as one. Ointments and liniments would therefore be excluded when applying 
deep transverse friction. DTF works because the overlying tissue is 
that which moves over the lesion, not the therapist's fingers. If 
the therapist's fingers are allowed to slide, friction is limited 
to the surface between the moving parts (finger and skin).
	3) The friction must be given across the fibers composing the affected 
structure, hence the name deep <+">transverse <-">friction. Friction 
applied across the fibers is called for because longitudinal friction 
merely move blood and lymph along, whereas transverse frictions move 
the tissue itself (1) affording the mechanical effects described earlier. 
Longitudinal friction, applied distal to proximal, might be used following 
transverse friction to afford the return flow of blood and edema toward 
the heart (8).
	4) The friction must be given with sufficient sweep. The entire lesion 
must be manipulated for an adhesion reduced by half is still enough 
to cause abnormal function.
	5) The friction must reach deeply enough. All of the layers of overlying 
tissue must be manipulated so that the friction reaches the affected 
structure.
	6) The patient must adopt a suitable position. The patient must be 
made aware that some discomfort will be experienced during DTF.
	7) Muscles must be kept relaxed while being given DTF. issue that 
is contracted is difficult to mobilize. When the treatment is over, 
however, the muscle should undergo a series of contractions so mobility 
of the tissues can be maintained. 
	8) Tendons with a sheath must be kept taut. The sheath must be allowed 
to move over the tendon lest the two move as one affording no effect.
	Accompanying this pattern, Cyriax has also standardized hand positions 
according to the tissue to be treated. These hand positions are as 
follows: (1)
	1) Index finger crossed over middle finger. This position is used 
when applying DTF over a stabilized part. The thumb may be substituted 
when using this hand position.
	2) Middle finger crossed over index finger as when grasping a limb 
with the thumb on the other side
	3) Two finger tips as used for larger lesions.
	4) Opposed finger and thumb as used for pinching.
	As with any therapeutic modality, DTF has indications that call for 
its use. The effectiveness of DTF is usually reserved for muscular, 
ligamentous, and tendinous lesions.
	DTF to muscular lesions is used to mobilize muscle tissue which breaks 
adhesions that form between muscle fibers (1). This mobility achieved 
through the breaking of adhesions must be maintained through full 
contraction of the muscle affected. Cyriax states that these contractions 
should come in the form of isometric contractions with the muscle 
in its broadest state, or fully flexed. (1) I believe that exercise 
in the form of low resistance and high repetitions will afford greater 
vascularizing of the area and afford proprioceptive effects. Whatever 
method is used, the muscle should not be taxed as to cause re-injury. 
For muscular lesions, the action of DTF may be summed up as affording 
a mobilization that passive stretching and active exercise (alone) 
cannot achieve. (1)
	DTF to ligamentous lesions serves to disperse blood clots and/or 
effusives. Mobility of the ligament is maintained by breaking up adhesions. 
Caution must be used when applying DTF to ligaments so as not to exacerbate 
the injury by aggravating torn tissue (3). DTF will afford benefits 
in first degree sprains, but proper healing time and/or surgical repair 
should be allowed before administering DTF in cases of second and 
third degree sprains.
	DTF to tendinous lesions is used for tendons both with and without 
sheaths. DTF for those tendons with a sheath is used to remedy cases 
of teno-synovitis. In teno-synovitis, the tendon does not move freely 
within the sheath causing pain and dysfunction. DTF serves to loosen 
the sheath from the tendon. Transverse friction is utilized to reduce 
the longitudinal friction occurring between the sheath and tendon 
(1). DTF to those tendons without sheaths is used remedy cases of 
tendonitis. In cases of tendonitis, the DTF is used to break up scar 
that continually forms as a result of overuse (1). 
	As with any therapeutic modality that has indications for its use, 
DTF also has its contraindications which include soft tissue infection, 
hemorrhage or clotting disorders, inflammatory disease, malignant 
tumors, any lesion located under a major nerve, and bursitis (1). 
In the case of bursitis, the cause of the inflammation must be found 
for bursae do not become inflamed by themselves.
	By following this technique as outlined by Cyriax, the trainer can 
expect the best results from DTF. Protocols for use of DTF vary according 
to indication and severity of the injury. The trainer must literally 
get the "feel" of DTF, but the technique is best administered progressively 
according to the patient's tolerance. In the sub-acute stages, I have 
found that DTF administered with the goal of fluid movement in mind 
works best in that the athlete will more than likely be in a hypersensitive 
state. At 48 hours post-injury, once the inflammatory phase has ceased 
(6), the trainer can become more aggressive with the DTF alerting 
the patient that pain will be experienced. A good rule of thumb to 
follow is to back off if the numbing effects of the DTF are not realized 
within one to one and one half minutes (3). Duration of DTF should 
last approximately five minutes per contact point (2). Should the 
lesion require moving the finger three times in order to completely 
sweep the injury, then treatment time would last 15 minutes.
	It becomes obvious how useful DTF can be as a therapeutic tool in 
the training room. There is no equipment necessary which is beneficial 
in the typical training room with a limited budget as in the high 
school setting. All that is required of the trainer is the acquisition 
of the skill of administering DTF through experience and the patience 
of time required for administration when it is called for. The trainer's 
hand skilled in DTF could hasten the recovery of an injured athlete 
as well as insure that the likelihood of re-injury is cut down.   
<+B>ACKNOWLEDGEMENTS
	I would like to thank Ron DeAngelo for exposing me to this effective 
form of treatment of soft tissue injuries sustained by athletes. My 
thanks goes out to the rest of the "universally knowledgeable" staff 
at the Palm Beach Institute of Sports Medicine for a most educational 
internship. I would also like to thank Tracy Greene for her input 
on the finer points of deep transverse friction and to Dane Basch 
for the constant use of his computer. Final thanks go to Dr. Christine 
Boyd Stopka for pushing me toward excellence in athletic training 
and effective paper writing. 
<+B>Deep Transverse Friction: An Effective Therapeutic Tool
	In many athletic training settings, the trainer is limited to the 
tools he/she can use for rehabilitation because of budget or lack 
of technical ability. Deep transverse friction massage is a no-cost 
technique that can be used in concurrence with traditional therapies 
of ice, heat packs, and exercise to speed the recovery and re-admittance 
of the athlete to competition. By following the methods as outlined 
by Cyriax, the British physician that standardized the technique, 
deep transverse friction can be effective in treating the soft tissue 
injuries sustained by athletes. Through practice, the trainer skilled 
in deep transverse friction gains a hands-on therapeutic tool which 
costs nothing but could save time in the rehabilitation of athletes.
KEY WORDS;
deep transverse friction
friction
manual therapy
massage
transverse friction
<+B>REFERENCES
1. Cyriax, J., M.D. Textbook of Orthopaedic Medicine Vol.II 10th ed. 
Balliere Tindall. London 1980. pp.11-14
2. DeAngelo, R.A. Personal communication, Boca Raton, Fl. 8-90
3. Greene, T.A., M.A., P.T. Personal communication, Gainesville, Fl. 
4. Krusen, F.H., M.D., et al. Handbook of Physical Medicine and Rehabilitation 
2nd ed. W.B. Saunders Co. Philadelphia 1971. p.381
5. Lamar, C.P., M.D., et al. Handbook of Physical Medicine. American 
Medical Association. Chicago 1945. pp.70-72, 92
6. Prentice, W.E., Ph.D., P.T., A.T.,C. Rehabilitation Techniques 
in Sports Medicine. Times Mirror/ Mosby College Publications. St. 
Louis 1990. p.15
7. Prentice, W.E., Ph.D., P.T., A.T.,C. Therapeutic Modalities in 
Sports Medicine. Times Mirror/ Mosby College Publications. St. Louis 
1990. pp. 8-10
8. Smith, B., M.S., P.T. Personal communication, Boca Raton, Fl. 11-90 
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[edoc]
	The field of athletic training utilizes many therapeutic modalities 
which assist the speedy recovery and return of an athlete to competition. 
Examples of therapeutic modalities used in athletic training include 
cold, heat, ultrasound, electrical stimulation, therapeutic exercises, 
and the use of anti-inflammatories and analgesics. Many training rooms, 
particularly those in the high school setting, do not have the budget 
nor the personnel with the technical qualifications to make use of 
some of the more expensive, electrically driven modalities. One answer 
to the lack of therapeutic tools some trainers experience literally 
rests at the finger tips. Deep transverse friction massage, if administered 
properly, can afford positive effects on many of the soft tissue injuries 
sustained by athletes. Deep transverse friction (DTF) requires nothing 
outside of the therapist's hands making it particularly valuable to 
the athletic trainer in the typical training room.
	Massage in all of its forms is said to bring about two general physiological 
effects; reflexive effects and mechanical effects (5). The reflexive 
effects of massage serve to stimulate peripheral receptors which causes 
relaxation (5). The mechanical effects of massage bring about measures 
that assist return flow of blood and lymph to normal circulation and 
measures that produce intramuscular motion. In addition to direct 
mechanical displacement of fluids in vascular and lymphatic channels, 
massage acts to expedite removal of toxic or foreign materials from 
focal lesions (5). These focal lesions are the points that are specifically 
aimed at when using DTF.
	The most potent form of massage is deep transverse friction. By this 
means and by this means alone, massage can reach structures far below 
the surface of the skin (1). DTF serves to induce 1) traumatic hyperemia, 
2) movement, 3) increased tissue perfusion, and 4) mechano-receptor 
stimulation (1). Traumatic hyperemia may be followed by the release 
of histamines and/or acetyl choline from the tissues or followed by 
the brief and temporary anoxemia from the lack of blood in the compressed 
area (5). The response in any event is a dilation of the cutaneous 
vessels with an increased volume of cutaneous blood flow following 
DTF assisting in the absorption of edema and local effusives. Movement 
of the area under DTF serves to loosen adhesions both actually present 
and in the process of formation (1). Adhesions, or the abnormal unions 
of bodily tissue, decrease the mobility that is normally present between 
those tissues (1). Because adhesion and other scar tissue presence 
can be attributed to causing re-injury, their displacement is required 
to insure proper healing. Increased tissue perfusion and mechano-receptor 
stimulation serve to decrease pain in the same vein that pain is decreased 
via the Gate Control Theory of pain reduction (7). Impulses from the 
moving parts take precedence over afferent sensory stimuli, therefore 
the latter do not get through and pain is relieved (1). 
	DTF is best administered according to a specific system. Merely pressing 
over a sore spot is likely to do nothing more than make the patient 
uncomfortable (1). By following the pattern as outlined by Cyriax, 
the therapist/trainer can bring about the physiological effects previously 
discussed. Cyriax's method of DTF is as follows: (1)
	1) The right spot must be found. According to Cyriax, all pain arises 
from a lesion. It would stand to reason that unless this lesion is 
located (through palpation and functional tests), DTF over healthy 
tissue will afford no effect. The therapist must also be observant 
of referred pain as well. DTF over a sore spot away from the lesion 
will prove as fruitless.
	2) The physiotherapist's fingers and the patient's skin must move 
as one. Ointments and liniments would therefore be excluded when applying 
deep transverse friction. DTF works because the overlying tissue is 
that which moves over the lesion, not the therapist's fingers. If 
the therapist's fingers are allowed to slide, friction is limited 
to the surface between the moving parts (finger and skin).
	3) The friction must be given across the fibers composing the affected 
structure, hence the name deep <+">transverse <-">friction. Friction 
applied across the fibers is called for because longitudinal friction 
merely move blood and lymph along, whereas transverse frictions move 
the tissue itself (1) affording the mechanical effects described earlier. 
Longitudinal friction, applied distal to proximal, might be used following 
transverse friction to afford the return flow of blood and edema toward 
the heart (8).
	4) The friction must be given with sufficient sweep. The entire lesion 
must be manipulated for an adhesion reduced by half is still enough 
to cause abnormal function.
	5) The friction must reach deeply enough. All of the layers of overlying 
tissue must be manipulated so that the friction reaches the affected 
structure.
	6) The patient must adopt a suitable position. The patient must be 
made aware that some discomfort will be experienced during DTF.
	7) Muscles must be kept relaxed while being given DTF. issue that 
is contracted is difficult to mobilize. When the treatment is over, 
however, the muscle should undergo a series of contractions so mobility 
of the tissues can be maintained. 
	8) Tendons with a sheath must be kept taut. The sheath must be allowed 
to move over the tendon lest the two move as one affording no effect.
	Accompanying this pattern, Cyriax has also standardized hand positions 
according to the tissue to be treated. These hand positions are as 
follows: (1)
	1) Index finger crossed over middle finger. This position is used 
when applying DTF over a stabilized part. The thumb may be substituted 
when using this hand position.
	2) Middle finger crossed over index finger as when grasping a limb 
with the thumb on the other side
	3) Two finger tips as used for larger lesions.
	4) Opposed finger and thumb as used for pinching.
	As with any therapeutic modality, DTF has indications that call for 
its use. The effectiveness of DTF is usually reserved for muscular, 
ligamentous, and tendinous lesions.
	DTF to muscular lesions is used to mobilize muscle tissue which breaks 
adhesions that form between muscle fibers (1). This mobility achieved 
through the breaking of adhesions must be maintained through full 
contraction of the muscle affected. Cyriax states that these contractions 
should come in the form of isometric contractions with the muscle 
in its broadest state, or fully flexed. (1) I believe that exercise 
in the form of low resistance and high repetitions will afford greater 
vascularizing of the area and afford proprioceptive effects. Whatever 
method is used, the muscle should not be taxed as to cause re-injury. 
For muscular lesions, the action of DTF may be summed up as affording 
a mobilization that passive stretching and active exercise (alone) 
cannot achieve. (1)
	DTF to ligamentous lesions serves to disperse blood clots and/or 
effusives. Mobility of the ligament is maintained by breaking up adhesions. 
Caution must be used when applying DTF to ligaments so as not to exacerbate 
the injury by aggravating torn tissue (3). DTF will afford benefits 
in first degree sprains, but proper healing time and/or surgical repair 
should be allowed before administering DTF in cases of second and 
third degree sprains.
	DTF to tendinous lesions is used for tendons both with and without 
sheaths. DTF for those tendons with a sheath is used to remedy cases 
of teno-synovitis. In teno-synovitis, the tendon does not move freely 
within the sheath causing pain and dysfunction. DTF serves to loosen 
the sheath from the tendon. Transverse friction is utilized to reduce 
the longitudinal friction occurring between the sheath and tendon 
(1). DTF to those tendons without sheaths is used remedy cases of 
tendonitis. In cases of tendonitis, the DTF is used to break up scar 
that continually forms as a result of overuse (1). 
	As with any therapeutic modality that has indications for its use, 
DTF also has its contraindications which include soft tissue infection, 
hemorrhage or clotting disorders, inflammatory disease, malignant 
tumors, any lesion located under a major nerve, and bursitis (1). 
In the case of bursitis, the cause of the inflammation must be found 
for bursae do not become inflamed by themselves.
	By following this technique as outlined by Cyriax, the trainer can 
expect the best results from DTF. Protocols for use of DTF vary according 
to indication and severity of the injury. The trainer must literally 
get the "feel" of DTF, but the technique is best administered progressively 
according to the patient's tolerance. In the sub-acute stages, I have 
found that DTF administered with the goal of fluid movement in mind 
works best in that the athlete will more than likely be in a hypersensitive 
state. At 48 hours post-injury, once the inflammatory phase has ceased 
(6), the trainer can become more aggressive with the DTF alerting 
the patient that pain will be experienced. A good rule of thumb to 
follow is to back off if the numbing effects of the DTF are not realized 
within one to one and one half minutes (3). Duration of DTF should 
last approximately five minutes per contact point (2). Should the 
lesion require moving the finger three times in order to completely 
sweep the injury, then treatment time would last 15 minutes.
	It becomes obvious how useful DTF can be as a therapeutic tool in 
the training room. There is no equipment necessary which is beneficial 
in the typical training room with a limited budget as in the high 
school setting. All that is required of the trainer is the acquisition 
of the skill of administering DTF through experience and the patience 
of time required for administration when it is called for. The trainer's 
hand skilled in DTF could hasten the recovery of an injured athlete 
as well as insure that the likelihood of re-injury is cut down.   
<+B>ACKNOWLEDGEMENTS
	I would like to thank Ron DeAngelo for exposing me to this effective 
form of treatment of soft tissue injuries sustained by athletes. My 
thanks goes out to the rest of the "universally knowledgeable" staff 
at the Palm Beach Institute of Sports Medicine for a most educational 
internship. I would also like to thank Tracy Greene for her input 
on the finer points of deep transverse friction and to Dane Basch 
for the constant use of his computer. Final thanks go to Dr. Christine 
Boyd Stopka for pushing me toward excellence in athletic training 
and effective paper writing. 
<+B>Deep Transverse Friction: An Effective Therapeutic Tool
	In many athletic training settings, the trainer is limited to the 
tools he/she can use for rehabilitation because of budget or lack 
of technical ability. Deep transverse friction massage is a no-cost 
technique that can be used in concurrence with traditional therapies 
of ice, heat packs, and exercise to speed the recovery and re-admittance 
of the athlete to competition. By following the methods as outlined 
by Cyriax, the British physician that standardized the technique, 
deep transverse friction can be effective in treating the soft tissue 
injuries sustained by athletes. Through practice, the trainer skilled 
in deep transverse friction gains a hands-on therapeutic tool which 
costs nothing but could save time in the rehabilitation of athletes.
KEY WORDS;
deep transverse friction
friction
manual therapy
massage
transverse friction
<+B>REFERENCES
1. Cyriax, J., M.D. Textbook of Orthopaedic Medicine Vol.II 10th ed. 
Balliere Tindall. London 1980. pp.11-14
2. DeAngelo, R.A. Personal communication, Boca Raton, Fl. 8-90
3. Greene, T.A., M.A., P.T. Personal communication, Gainesville, Fl. 
4. Krusen, F.H., M.D., et al. Handbook of Physical Medicine and Rehabilitation 
2nd ed. W.B. Saunders Co. Philadelphia 1971. p.381
5. Lamar, C.P., M.D., et al. Handbook of Physical Medicine. American 
Medical Association. Chicago 1945. pp.70-72, 92
6. Prentice, W.E., Ph.D., P.T., A.T.,C. Rehabilitation Techniques 
in Sports Medicine. Times Mirror/ Mosby College Publications. St. 
Louis 1990. p.15
7. Prentice, W.E., Ph.D., P.T., A.T.,C. Therapeutic Modalities in 
Sports Medicine. Times Mirror/ Mosby College Publications. St. Louis 
1990. pp. 8-10
8. Smith, B., M.S., P.T. Personal communication, Boca Raton, Fl. 11-90 
 Lamar, C.P., M.D., nothing 
outside of the therapist's hands making it particularly valuable to 
the athletic trainer in the typical training room.
	Massage in all of its forms is said to bring about two general physiological 
effects; reflexive effects and mechanical effects (5). The reflexive 
effects of massage serve to stimulate peripheral receptors which causes 
relaxation (5). The mechanical effects of massage bring about measures 
that assist return flow of blood and lymph to normal circulation and 
measures that produce intramuscular motion. In addition to direct 
mechanical displacement of fluids in vascular and lymphaic channels, 
massage acts to expedite removal of toxic or foreign materials from 
focal lesions (5). These focal lesions are the points that are specifically 
aimed at when using DTF.
	The most potent form of massage is deep transverse friction. By this 
means and by this means alone, massage can reach structures far below 
the surface of the skin (1). DTF serves to induce 1) traumatic hyperemia, 
2) movement, 3) increased tissue perfusion, and 4) mechanoreceptor 
stimulation (1). Traumatic hyperemia may be followed by the release 
of histamines and/or acetyl choline from the tissues or followed by 
the brief and temporary anoxemia from the lack of blood in the compressed 
area (5). The response in any event is a dilation of the cutaneous 
vessels with an increased volume of cutaneous blood flow following 
DTF assisting in the absorption of edema and local effusives. Movement 
of the area under DTF serves to loosen adhesions both actually present 
and in the process of formation (1). Adhesions, or the abnormal unions 
of bodily tissue, decrease the mobility that is normally present between 
those tissues (1). Because adhesion and other scar tissue presence 
can be attributed to causing re-injury, their displacement is required 
to insure proper healing. Increased tissue perfusion and mechanoreceptor 
stimulation serve to decrease pain in the same vein that pain is decreased 
via the Gate Control Theory of pain reduction(7). Impulses from the 
moving parts take precedence over afferent sensory stimuli, therefore 
the latter do not get through and pain is relieved (1). 
	DTF is best administered according to a specific system. Merely pressing 
over a sore spot is likely to do nothing more than make the patient 
uncomfortable (1). By following the pattern as outlined by Cyriax, 
the therapist/trainer can bring about the physiological effects previosly 
discussed. Cyriax[ver]
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[edoc]
	The field of athletic training utilizes many therapeutic modalities 
which assist the speedy recovery and return of an athlete to competition. 
Examples of therapeutic modalities used in athletic training include 
cold, heat, ultrasound, electrical stimulation, therapeutic exercises, 
and the use of anti-inflammatories and analgesics. Many training rooms, 
particularly those in the high school setting, do not have the budget 
nor the personnel with the technical qualifications to make use of 
some of the more expensive, electrically driven modalities. One answer 
to the lack of therapeutic tools some trainers experience literally 
rests at the finger tips. Deep transverse friction massage, if administered 
properly, can afford positive effects on many of the soft tissue injuries 
sustained by athletes. Deep transverse friction (DTF) requires nothing 
outside of the therapist's hands making it particularly valuable to 
the athletic trainer in the typical training room.
	Massage in all of its forms is said to bring about two general physiological 
effects; reflexive effects and mechanical effects ere is your answer to organization.
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