Thursday Thoughts: Poll on Cross Friction Massage | Modern Manual Therapy Blog

Thursday Thoughts: Poll on Cross Friction Massage

Why Do You Use Cross Friction Massage?

I want to go back to this facebook page post in case you missed it, were in the camp that uses it, or missed the link in Monday's post.

While we're at it, if you have not already, please review some modern manual therapy articles here, here, and here. If you do not want to take the time to review, those articles sum up modern manual therapy. There are little to no mechanical effects. "Tissue work" is more like tissue stimulation. All of the rapid effects we get with manual therapy applications are neuro-physiologic. You would have to apply excessive force just to deform superficial fascia only 1%.

So it is established that CFM does not realign scar tissue, AND it's not ok to cause pain, especially when the patient is already in pain. What on earth would be the reason why you would use this technique when any number of non painful (IASTM, compression wrapped neurodynamics, repeated motions, PNF) techniques would get the same or better results?

I did not realize until that facebook post that my many of my facebook followers are probably not blog readers as I am probably preaching to the choir here.

Keeping it Eclectic...


  1. Curious to know the results of the poll...

  2. Also if you click "see previous responses" after you vote... it takes you to the page Dr. E posted.

  3. There aren't many times I've found CF massage more effective than other modalities, but it has actually been the single thing that made a difference for my left elbow/forearm this time around. I have used it a couple of times over the past 3 months at specific spots that felt like they were unusually stiff with bilateral comparison and also sites of pain with elbow flexion, nothing like the daily approach I used to hear recommended. It worked, that's all I can say.

    I also didn't make things painful, I just worked the spot at a 4-5/10, which didn't cause any guarding, and didn't change the pressure until it was a 0-1/10. It took a while, around 10-15 minutes and one cramped hand, to do this to the point where nothing hurt no matter what. I then gave the tissue about a week of rest and very very light work, and I felt sore in a way that reminds me of a tough workout, but nothing more. I was fine for 8 weeks after that, then accidentally grabbed an ez curl that was loaded with 35's instead of 25's and aggravated the tissue. So, I did one more session and I've been fine since. I progress my curls about a pound per week and have no issues, and have been able to get back to doing weighted pull ups.

    This was after several months of failed IASTM and compression band mobilizations, active release, and eccentric work. I just couldn't make any progress, which was new to me. In the past, this combination worked just fine.

    Important history of elbow injuries: First injury was from December 2002, when I spontaneously climbed ropes many times over the course of a week without any legs, because I could and it was faster to get through the SEAL obstacle course that way. I was scruffing while waiting to class up with BUDS class 245. It took 6 months to get back to normal. I was fine for several years, but I would always run into problems when I got really strong and was curling my bodyweight on a barbell. I couldn't get past that, every time the pain started creeping back so I just stopped trying to add past that. Started gymnastic strength training in 2008, prior strength training allowed me to achieve straddle planche quickly but I did not give my elbows anywhere near the time needed to safely adjust to the straight arm position. Obviously I got some pretty nasty tendinopathy that took about a year to get over, and it would come back several times between 2009 and 2013 because I did too much too fast with straight arm work. My recent injury came from riding a mechanical bull, which I obviously will not do again :) All the prior injuries made slow but steady progress, but this one just would not heal. The CF massage made all the difference, but again it was not old-school style, so maybe you wouldn't consider it CF at all.

    Figured I'd detail the sequence of events since you asked :) I wrote off cross-friction early on, but in this case it worked really nicely... but I didn't exactly follow the old-school guidelines either. I followed the advice of a girl who's starting her third year of her DPT program this fall, the girlfriend of a classmate of mine, after listening and having her demonstrate so I wouldn't overdo it.

    Question: Would you say that what we are doing with nearly all modalities is essentially a combination of 'reprogramming' spinal reflexes to alter muscle tension and altering top-down interpretation of an existing and ongoing pain signal?

    My understanding is that there is also a short term inflammatory response, mediated primarily by mast cell degranulation, that can aide whatever remodeling is going on, but I wouldn't expect that to be the major contributor.

    Very curious to hear your input, and what you would call what I did if it does not meet your criteria for cross-friction massage.

  4. Joshua, sorry to hear you went through all that for a long time! I am glad you have solved it. In terms of what you did, CFM, or TFM is just a term for a technique. What any technique really does is really up for debate but you pretty much nailed it. There are many explanations why this worked, and more global approaches like IASTM, neurodyanmics, eccentric loading, etc did not. It's entirely possible you had some sort of peripheral nervous system tethering in your radial nerve as described by Bove. Maybe your gentle CFM like technique freed this up, thus diminishing the effects of an active Abnormal Impulse Generating System. This is a peripheral explanation. A central explanation is that perhaps your virtual representation needed a bit more defining locally and shown that pressure and touch is non threatening. Either way, again, I am open to any technique that brings on results, I just want to enlighten those that think excessive force is necessary and that pain and/or discomfort is par for the course. Most of the time it is not.

  5. I'm in my first year in PT school and one of my professors was talking about deep cross friction tissue message and using it as a way to mobilize connective tissue adhesions (specifically talking about in the hamstrings). And to alleviate those adhesions to allow for the muscle fibers to realign.

    I get that fascia is too strong (or conversely we are too weak) to make any sort of measurable difference in the extensibility of those structures. Is it different in the case of muscle?

  6. No, it's not different. Almost no manual therapy has pure mechanical effects. The old school thought was that fascia was less organized and easier to deform and stretch. If we can't affect fascia, wet most certainly do not change muscle fiber.

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