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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