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Cross Friction Massage (Transverse Friction Massage) Cross Friction Massage (XFM or CFM) Aka Transverse Friction Massage (TFM) Acute phase: Light friction used to promote proper collagen fiber alignment & preservation of normal mobility (decrease adhesions) Chronic phase: Requires deeper & stronger friction to break cross-linked fibers & to re-initiate the inflammatory process of healing CFM Technique Patient’s skin is dry; no lubricant Doctor uses reinforced finger (a “T” bar can be used) Muscle bellies are relaxed & shortened (there are exceptions) Doctor’s finger & patient’s skin move as ONE unit Friction is applied at right angle to affected fibers Use as much pressure as the patient can tolerate Start gently & when anesthetic effect occurs (3 to 5 minutes), friction deeper. If no anesthetic effect, stop at 5 minutes. Otherwise, continue treatment for 10+ minutes Follow with stretching and/or therapeutic exercise 3x/week for 2 to 8 weeks Supraspinatus 1. At distal attachment (insertion) – proximal to greater tuberosity of humerus a. Arm at side b. GH extended and adducted (arm behind back) 2. Musculotendinous junction – GH joint at 90 degrees abduction Infraspinatus 1. At distal attachment (insertion) – posterior to greater tuberosity of humerus with arm at side Subscapularis Distal attachment (insertion) – medial to lesser tuberosity of humerus Common forearm extensor tendon Extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris Just distal to lateral epicondyle with elbow at 90 degrees flexion, wrist extension Common forearm flexor tendon Pronator teres, flexor carpi radialis, Palmaris longus, flexor carpi ulnaris Just distal to medial epicondyle with elbow at 90 degrees flexion, forearm pronation, wrist flexion Ankle ligaments Anterior talofibular ligament (ATFL), calcaneofibular ligament, posterior talofibular ligament, deltoid ligament Quadriceps tendon / patellar tendon (ligament) / medial and lateral knee retinaculum Superior, inferior, medial, lateral to patella with knee in extension Gluteus medius 1. Distal attachment (insertion) – just proximal to greater trochanter with patient side-lying Hamstring 1. Proximal attachment (origin) – just distal to ischial tuberosity a. Patient supine with hip joint flexed b. Patient prone with hip joint neutral, knee flexed Rectus femoris Proximal attachment (origin) – just distal to AIIS with patient supine and hip joint flexed