What Is Friction Massage?

If you are having difficulty moving or functioning normally due to injury, illness, or surgery, you may benefit from the skilled services of a physical therapist (PT) to help you recover. Your PT may use various treatments and modalities during your rehab. One treatment is called friction massage.

Friction massage, often referred to as transverse friction or cross friction massage, is a technique used to decrease the negative effects of scar tissue in the body. It is a specialized massage technique that may break up tissue adhesions that are limiting normal movement in the skin and the underlying tissues.

Understanding Scar Tissue and Adhesions

If you require surgery due to an injury or an orthopedic condition, your doctor will cut into your skin, tendons, and muscle tissue during the operation. Once things are sutured and healing has occurred, scar tissue may form.

Normal healthy tissue is made up of a substance called collagen. This collagen is comprised of cells that are arranged in a regular pattern. Healthy collagen is strong and can resist tensile forces that often occur when tissues are pulled and stretched.

During the body's normal healing process after a cut or injury, the collagen cells that make up the tissue are laid down in a haphazard pattern by your body. Thus, scar tissue is formed. This random accumulation of collagen cells is tight and does not react well to tensile and stretch forces.

You don't need to have had surgery to have scar tissue. Sometimes your body lays down scar tissue after a soft tissue injury, such as a muscle or tendon strain.

If you strain a muscle or tendon (made up of collagen), your body needs to lay down new collagen during the healing process. This new collagen is laid down in a random fashion, and scar tissue or tissue adhesions may form.

When scar tissue is present, it may limit normal motion. Healthy tissue is stretchy, and it moves as you move and stretch. Scar tissue is more rigid. Some motion may occur at scar tissue, but it is tighter and less pliable than healthy tissue.

If your physical therapist feels that scar tissue or adhesions are limiting your motion, they may use cross friction massage to get it gliding and sliding better. This process is called remodeling.

What Does Friction Massage Do?

Several goals may be achieved when your PT applies friction massage to adhesions or scar tissue. These may include:

• Movement of the affected tissue to break up scarring
• Realignment of collagen fibers of the tissue
• Increase blood flow to the tissue
• Relieving pain
• Stimulation of nerve fibers to decrease pain and improve mechanoreceptor activity

The main goal of any treatment in physical therapy is to help you move better and feel better. Applying friction massage to affected tissue may be one component to achieving this goal.

Friction Massage Technique

If your PT chooses to use friction massage during your treatment, a specific technique should be followed:

1. The patient should be comfortable, and the area to be massaged should be exposed.
2. If the scar tissue is in a muscle, that muscle should be relaxed. If the scar tissue is in a tendon sheath, that tendon should be slightly stretched during the procedure.
3. The PT places two or three fingers over the scar or adhesion.
4. The therapist moves their fingers perpendicular (at right angles) to the scar to smooth the collagen fibers down. The fingers and the underlying tissue move together. The massage should feel deep and uncomfortable but not painful.
5. The entire area of scar tissue or adhesion should be treated. This may take several minutes.

Friction massage may cause some pain, but the pain should remain within your tolerance. If the friction massage is too painful, you must inform your PT as the procedure is happening; less pressure may be used so you can tolerate the procedure.

After several minutes of cross friction massage, your therapist may assess the tissue mobility. Then, specific stretches may be done to elongate the scar tissue or adhesions. A home exercise program of stretches may be prescribed.

Contraindications

There are some instances where friction massage should not be used. These may include:

• In an active open wound
• In areas where bacterial infection is present
• In areas with decreased sensation
• If calcification is present in the muscle or tendon tissue
• In patients with decreased mental capacity who are unable to report their sensations or pain complaints to the PT.

Your PT should explain the friction massage procedure to you and inform you of the goals and any risks associated with it. That way you can make an informed decision about whether you'd like to have it done to you.

Diagnoses Treated With Friction Massage

Several different diagnoses may be treated with friction massage by your PT. These may include:

• Adhesive capsulitis in the shoulder (frozen shoulder)
• Joint contracture
• Scar tissue build up after surgery or trauma
• Muscle tears or strains
• After tendon tear
• Ligament tears
• For tendonitis or tendinopathy

If you have any condition that causes limited motion by scar tissue or adhesions, your PT may use friction massage to help manage it.

While friction massage is a popular technique used in physical therapy, some research suggests it is not more effective than other rehab techniques. One study found that static stretches and exercise were more effective than friction massage in improving tissue length and strength in uninjured soccer players.

Other studies have supported this finding. Still, you may find that your PT uses friction massage to help improve the way your injured tissues move as part of your rehab program.

Summary

After an injury or surgery, you may develop scar tissue or tissue adhesions that limit your normal motion. A physical therapist may use friction massage as part of your rehab program.

The therapist uses their fingers to massage your scar in a direction that is at right angles to the line of the scar. This technique may help improve scar tissue and adhesion mobility so you can move better.

A Word From Verywell

Working with a physical therapist can help improve the way you move after an injury or surgery. Friction massage, combined with appropriate stretches and exercises, can help you quickly get back to normal motion and mobility.