23/ DTF

Question 1

What’s the 2 goal of DF?

Answer 1

↑ the mobility & extensibility of MSK tissues

Help prevent & treat scar tissue

Question 2

What are the 3 types of DF?

Answer 2

Transverse (deep transverse frictions = DTF)
Perpendicular to the orientation of the tissue fibres

Longitudinal
Parallel to the orientation of the tissue fibres

Circular
Small circles obliquely into the tissue

Question 3

What are the 3 therapeutics effects of DF?

Answer 3

Traumatic hyperemia = hausse anormale de l’afflux de sang dans un organe

Pain relief
Decreasing scar tissue & adhesions

Question 4

Explain the traumatic hyperemia effect of DF

Answer 4

↑ blood circulation & lymph flow

• Help with removal of chemical irritant by-products of inflammation
• ↓ venous congestion → ↓ edema & hydrostatic pressure on pain-sensitive structure

Question 5

Explain the pain relief effect of DF

Answer 5

Stimulates type I & II mechanoreceptors producing presynaptic anesthesia

Based on the Gate control theory of pain

Acute phase: if done too vigorously would cancel this effect & ↑ pain by too much stimulation of nociceptors

Question 6

Explain the Decreasing scar tissue & adhesions effect of DTF in the inflammatory and early proliferative phase

Answer 6

Inflammatory and early proliferative phases
- Light DTF only
Rationale:
- To minimize the cross-linking & enhance the extensibility of the new tissue
- To prevent adhesion formation
- To maintain mobility between tissues

Question 7

Explain the Decreasing scar tissue & adhesions effect of DTF in Late proliferative & remodeling phases

Answer 7

Late proliferative & remodeling phases
- Assists with the orientation of the collagen in the appropriate lines of stress
- Breakdown of adhesions
(due to transverse nature of the frictions)

Question 8

T/F
DF is indicated for:
1- Chronic lesions in the joints 
2- Acute injuries to ligament
3- Bursitis 
4- Acute inflammation (with acute swelling) 
5- subacute injuries to tendon 
6- before a strong stretch 
7- Adhesions between tissues
8- Hematomas or bruising
9- ↓ sensation or hypersensitivity (Light DF only)
10- Signs of infection
11 - Debilitated or open skin
12. ectopic ossification
13. cancer
14 - Pt have DVT but in an other area then the one treated

Answer 8

1- Chronic lesions in the joints - T
2- Acute injuries to ligament - T
3- Bursitis - F
4- Acute inflammation (with acute swelling) - F
5- subacute injuries to tendon - T
6- before a strong stretch - T
7- Adhesions between tissues - T
8- Hematomas or bruising - F
9- ↓ sensation or hypersensitivity (Light DF only) - F
10- Signs of infection - F
11 - Debilitated or open skin - F
12. ectopic ossification- F
13. cancer - F
14 - Pt have DVT but in an other area then the one treated - T

Question 9

How do you position for DTF the tissue if it’s

1. Td with no sheath and lig.
2. Td with sheath
3. Ms belly

Answer 9

1. Td with no sheath and lig.: Moderate pain free stretch vs relaxed vs optimal tissue exposure position
2. Td with sheath: Stretched
3. Ms belly: Relaxed

Question 10

There is mistakes in the first steps of the application of this DTF technique, find them!

• Use of lubricant or a hypoallergenic cream
• Done perpendicular, parallel or circular to the orientation of the tissue fibres
• Moves over the pt skin with the clinician’s finger over the site of the identified lesion with a circular motion

Answer 10

• No use of lubricant
• Done perpendicular to the orientation of the tissue fibres
• Moves the pt skin with the clinician’s finger over the site of the identified lesion back & forth
  Blisters prevention: important to moves skin with fingers

Question 11

In the DTF application technique, what amount of pressure is ideal?

Answer 11

Amount of tension/pressure

• Depend on the stage of healing
• Begin with light pressure and build up to the target pressure
• Need to reach the target tissue

Question 12

In the DTF application technique, what amplitude is ideal?

Answer 12

Sufficient to cover all of the affected tissue

Question 13

In the DTF application technique, what rate of application is ideal?

Answer 13

2-3 cycles/sec applied in a rhythmical manner

Question 14

Decribe the treatement duration for DTF

• for general guidelines
• for chronic lesions
• for remodelling phase

Answer 14

Generally stop when desensitization occurs*

• Usually takes 3-5 min
• If doesn’t occur within that time frame stop DTF

For Chronic lesions / Remodeling phase

• Continue for another 5 min after the desensitization period
• To enhance the mechanical effect on adhesions & scar tissue

Question 15

T/F
After application of DTF
1. Involved tissue is passively stretched
2. Involved tissue is actively exercised
3. Be careful not to cause pain with ex’s
4. Apply ice in acute conditions in the clinic and at home

Answer 15

All true

Question 16

What should be the DTF frequency?

Answer 16

When the excess tenderness has worn off

Takes generally 2-7 days

Question 17

T/F about the total number of treatment with DTF

1. The guidelines suggests 12 sessions for chronic patients
2. Most conditions should resolve within 10-15 sessions over 8-12 wks
3. If no tissue improvement after 5 sessions, Discontinue DTF

Answer 17

1. F -> Pt specific → until no further improvements
2. F -> Most conditions should resolve within 6-10 sessions over 2-8 wks
3. If no tissue improvement after 3 session, Discontinue DTF

Question 18

A patient is complaining of exacerbation of symptoms after the 3rd session of DTF

What do you tell him/her?
A. It's normal
B. It's abnormal, we need to stop DTF
C. No pain no gain
D. May the force be with you

Explain your choice

Answer 18

DTF May exacerbate Sx following the 1st 2-3 sessions

Need to determine if the ↑ in pain is acceptable considering pt’s condition and phase of healing

If no improvement after 3 sessions, discontinue DTF

Educate pt about it & ice application