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ok Book System QuarryString SearchTarget Hogwood Enterprise Courier Pbywy series Courier `D|D| Courier kGOuuyf SizeToPage urier `D|D| Comic Book Catalog "Please $10 donation you like program"&\ Dane Basch"&\ " 2811 SW Archer Rd, Apt K-99"&\ " Gainesville, FL 32608"&\ " Ask I will wthe Author f"Thanks" SizeToPage syslockScreen c"Help" c"Text" "Select All" "Undo" "Clear" "Open" "Import" "Export" "Print Report" "Save As" "About Toolbook..." Comic Book Catalog..." c"File" AboutComicBookCatalog F, Ver. 1.1,"&\ " From HeadFirst Software. For those who keep track their many varied comic "&\ " books, here your answer organization." f"Enjoy!" enterBook AboutComicBookCatalog enterBook Please send $10 donation if you like this program to: Dane Basch 2811 SW Archer Rd, Apt K-99 Gainesville, FL 32608 Ask with donation, and I will send you the Author password. Thanks SizeToPage Select All Clear Import Export Print Report Save As About Toolbook... &About Comic Book Catalog... AboutComicBookCatalog Comic Book Catalog, Ver. 1.1, From HeadFirst Software. For those who like to keep track of their many and varied comic books, here is your answer to organization. Enjoy! books, here is your answer to organization. Enjoy! NewButtonGroup buttonUp buttonUp y5newPage DeleteButton "Do you really want delete f"Yes" buttonUp buttonUp Do you really want to delete this page? clear Delete SortButton ButtonUp "Sort on which f"Genre" "Title" "Publisher" "TitleField" "ThemeField" "PublisherField" ButtonUp ButtonUp Sort on which field? Genre Title Publisher Title TitleField Genre ThemeField Publisher PublisherField LeftArrowButton buttonUp buttonUp RightArrowButton buttonUp buttonUp SearchButton ButtonUp SysError ("Enter SearchTarget xfound" f"OK" ButtonUp ButtonUp Enter text to search for... cancel SearchTarget not found Search text not found! Search RepeatButton ButtonUp SysError SearchTarget xfound" f"OK" ButtonUp ButtonUp SearchTarget not found Search text not found! Repeat ExitButton buttonUp buttonUp Theme/Genre of Comic: ThemeField Name of Publisher: Title of Comic:::: TitleField PublisherField Grade/Condition::: GradeField Issue #: IssueField Purchase Price: PriceField Current Value:: ValueField "l ,b^aR ___.pfb c:\psfonts\pfm\nci_____.pfm c:\psfonts\por_____.pfb c:\psfonts\pfm\por_____.pfm c:\psfonts\pob_____.pfb c:\psfonts\pfm\pob_____.pfm c:\psfonts\pobi____.pfb c:\psfonts\pfm\pobi____.pfm c:\psfonts\poi_____.pfb c:\psfonts\pfm\poi_____.pfm c:\psfonts\zcmi____.pfb c:\psfonts\pfm\zcmi____.pfm c:\psfonts\zd______.pfb c:\psfonts\pfm\zd______.pfm c:\psfonts\pfm\pobi____.pfm 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 [tag] Body Single [fnt] Tms Rmn 240 49152 [algn] 225 [spc] 273 100 [brk] [line] [spec] [nfmt] 272 [tag] Bullet 1 [fnt] Modern 240 49152 [algn] 720 360 360 [spc] 273 144 100 [brk] [line] [spec] <*1> 360 [nfmt] 272 [tag] Bullet 2 [fnt] Courier 200 32768 [algn] 1080 360 360 [spc] 273 144 100 [brk] [line] [spec] <*0> 360 [nfmt] 272 [tag] Indent 1 [fnt] Bookman 240 49152 [algn] 209 1296 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Indent 2 [fnt] Helv 240 16384 [algn] 209 1800 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Number List [fnt] Palatino 200 49152 [algn] 720 360 360 [spc] 273 144 100 [brk] [line] [spec] <*:>. 360 [nfmt] 272 [tag] Bold & Center [fnt] NewCenturySchlbk 280 49152 [algn] 228 [spc] 230 100 [brk] [line] [spec] [nfmt] 272 [tag] First Indent [fnt] Tms Rmn 240 49152 [algn] 161 720 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Line Above [fnt] Palatino 240 49152 [algn] 225 [spc] 273 288 100 [brk] [line] [spec] [nfmt] 272 [lay] Standard [rght] 15840 12240 2160 1440 1440 1440 2160 10800 720 1440 2175 2880 3615 4320 5055 5760 6495 7200 7905 [hrght] [lyfrm] 11200 12240 1440 [frmlay] 1440 12240 1440 360 1440 1440 10800 [txt] [frght] [lyfrm] 13248 14400 12240 15840 167 96 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 41 0 0 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 56 0 0 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 70 0 0 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 80 0 73 1025 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 [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 s "l 0bbaR ue 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 ed 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 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 Lamar,okman 240 49152 [algn] 209 1296 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Indent 2 [fnt] Helv 240 16384 [algn] 209 1800 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Number List [fnt] Palatino 200 49152 [algn] 720 360 360 [spc] 273 144 100 [brk] [line] [spec] <*:>. 360 [nfmt] 272 [tag] Bold & Center [fnt] NewCenturySchlbk 280 49152 [algn] 228 [spc] 230 100 [brk] [line] [spec] [nfmt] 272 [tag] First Indent [fnt] Tms Rmn 240 49152 [algn] 161 720 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Line Above [fnt] Palatino 240 49152 [algn] 225 [spc] 273 288 100 [brk] [line] [spec] [nfmt] 272 [lay] Standard [rght] 15840 12240 2160 1440 1440 1440 2160 10800 720 1440 2175 2880 3615 4320 5055 5760 6495 7200 7905 [hrght] [lyfrm] 11200 12240 1440 [frmlay] 1440 12240 1440 360 1440 1440 10800 [txt] [frght] [lyfrm] 13248 14400 12240 15840 [[ver] [sty] [files] [prn] PostScript Printer [lang] [desc] 672037765 672004068 [fopts] [lnopts] Body Text [docopts] [tag] Body Text [fnt] AvantGarde 200 16384 [algn] 225 [spc] 475 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Body Single [fnt] Tms Rmn 240 49152 [algn] 225 [spc] 273 100 [brk] [line] [spec] [nfmt] 272 [tag] Bullet 1 [fnt] Modern 240 49152 [algn] 720 360 360 [spc] 273 144 100 [brk] [line] [spec] <*1> 360 [nfmt] 272 [tag] Bullet 2 [fnt] Courier 200 32768 [algn] 1080 360 360 [spc] 273 144 100 [brk] [line] [spec] <*0> 360 [nfmt] 272 [tag] Indent 1 [fnt] Bookman 240 49152 [algn] 209 1296 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Indent 2 [fnt] Helv 240 16384 [algn] 209 1800 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Number List [fnt] Palatino 200 49152 [algn] 720 360 360 [spc] 273 144 100 [brk] [line] [spec] <*:>. 360 [nfmt] 272 [tag] Bold & Center [fnt] NewCenturySchlbk 280 49152 [algn] 228 [spc] 230 100 [brk] [line] [spec] [nfmt] 272 [tag] First Indent [fnt] Tms Rmn 240 49152 [algn] 161 720 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Line Above [fnt] Palatino 240 49152 [algn] 225 [spc] 273 288 100 [brk] [line] [spec] [nfmt] 272 [lay] Standard [rght] 15840 12240 2160 1440 1440 1440 2160 10800 720 1440 2175 2880 3615 4320 5055 5760 6495 7200 7905 [hrght] [lyfrm] 11200 12240 1440 [frmlay] 1440 12240 1440 360 1440 1440 10800 [txt] [frght] [lyfrm] 13248 14400 12240 15840 [frmlay] 15840 12240 1440 360 14472 1440 1440 10800 [txt] [elay] 3 326 89 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 6 157 90 32 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 14 85 83 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 21 159 83 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 24 167 96 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 41 0 0 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 56 0 0 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 70 0 0 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 80 0 73 1025 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 [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] [sty] [files] [prn] PostScript Printer [lang] [desc] 672038189 672004068 [fopts] [lnopts] Body Text [docopts] [tag] Body Text [fnt] AvantGarde 200 16384 [algn] 225 [spc] 475 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Body Single [fnt] Tms Rmn 240 49152 [algn] 225 [spc] 273 100 [brk] [line] [spec] [nfmt] 272 [tag] Bullet 1 [fnt] Modern 240 49152 [algn] 720 360 360 [spc] 273 144 100 [brk] [line] [spec] <*1> 360 [nfmt] 272 [tag] Bullet 2 [fnt] Courier 200 32768 [algn] 1080 360 360 [spc] 273 144 100 [brk] [line] [spec] <*0> 360 [nfmt] 272 [tag] Indent 1 [fnt] Bookman 240 49152 [algn] 209 1296 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Indent 2 [fnt] Helv 240 16384 [algn] 209 1800 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Number List [fnt] Palatino 200 49152 [algn] 720 360 360 [spc] 273 144 100 [brk] [line] [spec] <*:>. 360 [nfmt] 272 [tag] Bold & Center [fnt] NewCenturySchlbk 280 49152 [algn] 228 [spc] 230 100 [brk] [line] [spec] [nfmt] 272 [tag] First Indent [fnt] Tms Rmn 240 49152 [algn] 161 720 [spc] 273 144 100 [brk] [line] [spec] [nfmt] 272 [tag] Line Above [fnt] Palatino 240 49152 [algn] 225 [spc] 273 288 100 [brk] [line] [spec] [nfmt] 272 [lay] Standard [rght] 15840 12240 2160 1440 1440 1440 2160 10800 720 1440 2175 2880 3615 4320 5055 5760 6495 7200 7905 [hrght] [lyfrm] 11200 12240 1440 [frmlay] 1440 12240 1440 360 1440 1440 10800 [txt] [frght] [lyfrm] 13248 14400 12240 15840 [frmlay] 15840 12240 1440 360 14472 1440 1440 10800 [txt] [elay] 3 326 89 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 6 157 90 32 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 14 85 83 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 21 159 83 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 24 167 96 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 41 0 0 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 56 0 0 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 70 0 0 0 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 80 0 73 1025 16384 0 0 65533 65535 Standard 0 0 0 0 0 0 0 0 0 0 65535 0 0 0 0 0 0 [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. Enjoy! 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