When last we left off, I was mentioning some of the typical courses of treatment for plantar fasciitis: ice, anti-inflammation medications, orthotics and calf muscle stretching. Most of the time these methods, either together or separately, will do the trick, but other times they won’t and the problem becomes chronic. In these cases, it may be worthwhile to try a therapy known as cross-friction massage (CFM).
Cross-friction massage is a technique popularized by the late British orthopedic physician, James Cyriax. Dr. Cyriax was one of the foremost specialists in the diagnosis and treatment of musculoskeletal injury and pain syndromes. Probably his most valuable contribution was a method of evaluation to identify the specific tissue (muscle, tendon, ligament, etc.) causing an individual pain or dysfunctional movement. Beyond that, he developed a variety of treatments for these problems that include manual manipulation of joints and soft-tissue. CFM falls within the latter category.
To understand the theory behind CFM, we first have to know a little bit of what goes on when muscles, tendons or ligaments are injured. Essentially, a strain or sprain means that the tissue is torn to some degree. Most often, and especially when we’re dealing with overuse injuries such as plantar fasciitis, the damage is classified as micro-tears. But although these tears may be small, the body’s reaction is still the same and can be summarized as follows: inflammation followed by repair followed by remodeling. During the repair phase, connective tissue cells are laid down in a random pattern so as to provide tensile strength to the area. Under a microscope, this scar-tissue looks something like cooked spaghetti, whereas normal, uninjured tissue looks more like a woven fabric. The weave provides strength, but it also allows for flexibility, as opposed to scar-tissue which does not. The remodeling phase is just what it sounds like – a rearrangement of the connective tissue fibers to a more normal “weave” pattern.
Cyriax believed that when this remodeling fails to occur properly, either from repeated trauma, immobilization or poor circulation to the injured tissue, pain and lack of mobility results. It was his theory that proper remodeling could be stimulated by manually manipulating the tissues to both break down the scar-tissue and promote circulation. In conjunction with stretching exercise, this would allow the body another chance to remodel the injured tissue along its proper lines, thereby increasing flexibility and reducing pain.
If you are able to visualize what I’ve described so far, you shouldn’t have any trouble understanding that the technique of CFM is much different from traditional massage, as we need to get down much deeper and more specific to a particular structure. Where most massage methods use some form of skin lubrication, CFM uses none so that the finger (usually one, but sometimes two) doing the massage is not sliding across the skin, but rather is taking the skin with it, allowing for the force to be transmitted directly to the deep tissue being treated. The motion is small, maybe an inch or so, back and forth “across the grain” of the tissue, so you have to have some idea which direction the structure normally runs. The amount of pressure should be moderate, which will often cause some amount of discomfort, but this should never be too painful. The massage should be done for 5-10 minutes (if your finger can take it – try it and you’ll see how hard this really is to do) and should be followed by some gentle stretching of the tissue and then 10 minutes of icing. Once (or twice if tolerable) per day should suffice.
Cross-friction massage is an effective tool for many areas commonly injured by running, particularly muscles and tendons. Plantar fasciitis is a good one to try it with, if only because it’s an area you can do yourself without having to be a contortionist.