Deep Friction Massage (DFM)
Evidence reviewed as of before 01-01-2021
Author(s): Ogourtsova, T. (PhD OT); Steven, E. (MSc App OT); Iliopoulos, G. (MSc App OT); & Majnemer, A. (PhD, OT, FCAHS)
Introduction
Deep friction massage (DFM), also known as cross friction massage, is a specific connective tissue massage. The purpose of DFM is to maintain the mobility within the soft tissue structures of ligaments, tendons, and muscles; to increase circulation; and to decrease the formation of scar tissue. The massage is deep, as the name implies, and must be applied transversely (perpendicular) to the specific tissue involved unlike the superficial type massage which is given in the longitudinal direction (parallel to tissues). The force in DFM is given perpendicular to the fibers to separate each fiber and align newly formed collagen.
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Parent & Family Information
Deep cross friction massage involves applying force perpendicular to the fibres (of muscles/tendons/ligaments). The objective is to separate each fibre and align newly formed collagen.
Deep cross friction massage targets muscles, tendons, and ligaments. It is used to treat tendopathies, chronic low back pain, and spasticity in patients who have had strokes and, recently, spasticity in children with cerebral palsy (CP). In one particular study, it was used specifically on the soleus and gastrocnemius along the Achilles tendon of children with CP.
There are many different forms of massage, but only one type of cross friction massage. However, the muscles/tendons/ligaments targeted by the deep cross friction massage can vary.
Deep cross friction massage was examined using one high-quality research study. The study did not show significant improvement in spasticity or motor function, in children with diplegic CP, when receiving deep cross friction massage compared to typical physiotherapy interventions.
It is important to note that results can vary from person to person.
In this study, the physiotherapist started with routine physiotherapy interventions (hot pack, reflex inhibitory postures and stretching the Achilles tendon) and then provided deep cross friction massage on both legs at soleus and gastrocnemius along the Achilles tendon. Therapist always started with right leg first.
The friction during a deep cross friction massage must be deep, therefore it can cause some discomfort/pain.
In this study, the deep cross friction massage was provided by a physiotherapist.
In this study the treatment was 30 minutes, 5x/week, for 6 weeks.
There is no specific treatment period for this type of intervention.
It has been reported that deep cross friction massage can be painful depending on the force used.
No specific side effects or risks were reported in the study. However, if you have concerns, we suggest that you discuss these with the treating therapist.
One high quality study examined the impact of deep cross friction massage on spasticity and motor function for a population of children with diplegic CP. There is currently no strong scientific evidence that deep cross friction massage works for this population more than other interventions to improve spasticity or motor function.
Information on this website is provided for informational purposes only and is not a substitute for professional medical advice.
One high quality RCT (Rasool et al., 2017) investigated the effects of cross friction massage on motor functional level among children with spastic diplegic CP. In this high quality RCT, children were randomized to receive cross-friction massage or no treatment; both groups received routine physiotherapy. Motor functional level was assessed by the Functional Level Scale at post-treatment (6 weeks). No significant between-group difference was found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that cross friction massage is as effective as no treatment in improving motor functional level in children with spastic diplegic CP.
One high quality RCT (Rasool et al., 2017) investigated the effects of cross friction massage on spasticity among children with spastic diplegic CP. In this high quality RCT, children were randomized to receive cross-friction massage or no treatment; both groups received routine physiotherapy. Spasticity was assessed using the Modified Ashworth Scale at post-treatment (6 weeks). No significant between-group difference was found.
Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that cross friction massage is as effective as no treatment in improving spasticity in children with spastic diplegic CP.
References
Rasool, F., Memon, A. R., Kiyani, M. M., & Sajjad, A. G. (2017). The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomised controlled trial. JPMA. The Journal of the Pakistan Medical Association, 67(1), 87–91. https://pubmed.ncbi.nlm.nih.gov/28065961/
Definitions
A group of lifelong disorders affecting a person’s movement, coordination, and muscle tone and which are the result of damage to the brain before, during, or shortly after birth.
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