Windows Shareware Gold/Windows Shareware Gold Volume 3 Number 1 (Sherburne Knowledge Systems) (1991).iso/apps/f1445/comic.tbk

Asymetrix ToolBook File | 1991-05-09 | 92KB | 1,734 lines

ok Book
System
QuarryString
SearchTarget
Hogwood
Enterprise
Courier
Pbywy
series
Courier
`D|D|
Courier
kGOuuyf
SizeToPage
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`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
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Clear
Import
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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
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Title
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Title of Comic::::
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Grade/Condition:::
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"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
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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
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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 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
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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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