Noria Mitchell

@DptShewantsthe Awesome, thanks Abbie! What treatments would you consider pairing it with and what patients would you see it being most useful for?

@megansteele_SPT Thanks Megan, I completely agree! Would you use this for all patients with tendon injuries or is there certain things you would see in a patient that would prompt you to use it?

I'd use CFM for my pt's with tendinopathies. There's reasonable evidence supporting it's effectiveness for maintaining mobility and preventing scarring in CT. If my pt's like it and report improved function and pain, I don't see why not! bit.ly/2NtpnHy #PT582 #NM

@Christo54275309 Thank you Chris, I completely agree with your answer. If this intervention works well for the patient then it may be worth using, especially if there is not a risk causing harm.

...my patient responds well to the treatment. I think it will be trial and error on a case-by-case basis. #PT582 #NM journals.humankinetics.com/doi/abs/10.112…

This systematic review looks at the efficacy of cross friction massage in treating tendinopathy and found mixed results at best. A lot of the evidence seems to be anecdotal, but I would still attempt to treat a patient with cross-friction massage to see if... #PT582 #NM

@GauchoSilver @NAUPT582 Thank you Eva, I didn't even consider the toll that this intervention could take on our own hands. Do you think that this treatment would require a substantial amount of force in order to be affective? Could a lighter application potentially be beneficial in improving pain?

@NAUPT582 #PT582 #NM I would not use cross-friction massage on pts with tendinopathies. Evidence suggests that eccentric exercises are much more effective in treating tendinopathies and for this reason I would not put my hands thru the stress. journals.sagepub.com.libproxy.nau.edu/doi/pdf/10.119…

@yazzyfreshh @NAUPT582 Thanks Yasmin! Would there be any specific situation in which you would consider using cross friction? Maybe as a way to address pain?

@NAUPT582 #PT582 #NM This Cochrane review evaluating deep friction massage found no benefit with deep friction massage over other treatments. I personally would avoid it and focus treatment on eccentric exercises. ncbi.nlm.nih.gov/pubmed/12519601

@emilysomer93 Thanks Emily! Since this evidence may not be the strongest, have you personally seen cross friction used successfully? Would you consider using it and for what type of patient?

#pt582 #NM This cochrane review concluded there was no difference in deep transverse friction outcomes for IT band tenditinis/elbow tendinitis, however the evidence was low quality. I would think it loosens the fibrotic tissue in areas of chronic pain. …anelibrary-wiley.com.libproxy.nau.edu/doi/10.1002/14…

@llg336 Thanks Laura! I agree with your thought process, especially if there are indeed other interventions that are strongly supported by evidence. Even though the evidence is mixed, is there a specific scenario or purpose in which you would use the cross friction?

#NM #PT582 Good question! Since the evidence is indeed mixed, I would probably use other treatment techniques for now unless it was specifically requested by a patient and effective for them, or supported by strong evidence in the future. ncbi.nlm.nih.gov/pmc/articles/P…

@katburdettSPT Thank you Kat, I completely agree with your reasoning! In a chronic patient, when during treatment would you try to incorporate cross friction massage?

#NM #pt582 hey Noria, I think there’s a time that cross friction massage can be helpful and a time that it can’t. When it comes to chronic inflammation, doing a cross friction massage can restart the acute inflammatory process. At other times, If a tendonopatby is in an acute

@houseofstark22 @NAUPT582 Thanks Ben for your input! I have seen it a lot too and unfortunately sometimes as the primary treatment. What other treatments would you pair cross friction massage with and when exactly during treatment would you try to utilize it?

Noria, I think this a great question because it is used so much by PT's. I think that according to this article it can be a beneficial in treating at tendinopathy , but not the only part of the treatment. ncbi.nlm.nih.gov/pubmed/22234925 #PT582 @NAUPT582 #NM

@PJThompson93 Patrick, you have a really great argument. What if your patient is experiencing a lot of pain during your treatment, would you consider using CFM as a way to address the pain and not necessarily to make tissue changes?

#PT582 #NM I believe an exercise designed to target the tendon is a better use of time than CFM b/c it utilizes therapeutic stresses, while also strengthening the muscle attached to the tendon. This is more functional because muscle strength will be required to return to activity

@TayKit_SPT Thanks Taylor for sharing this article! When during your treatment with a patient would you incorporate DFM and for what purpose?

#PT582 #NM Even though there isn't much research, according to this systematic review there is excellent anecdotal evidence that supports the efficacy of DFM for the treatment of tendinopathies, so based on this I would personally use DFM on my patients. bit.ly/2zPusrT

@KSandifer_SPT Kaitlyn, you make an excellent point about how we may not be able to manually promote tissue changes. What treatment would you use then on someone with elbow tendonitis that is more likely to cause tissue changes?

#PT582 #NM According to this Cochrane review there is not strong evidence to support the use of transverse friction massage for elbow/knee tendonitis. If we do not actually create any tissue changes I would want to consider a better treatment option first bit.ly/2zWKArC

@n_skotak @NAUPT582 This article did a great job at describing how cross friction massage actually works and how along with decreasing pain, it can help realign and strengthen fibers as well as promote the healing process by bringing blood flow to the area. Thanks Nate for sharing!

@MichelleRumpel Good find, Michelle! If you were to use cross friction massage on a patient with tendonosis what other manual techniques would you pair with it?

A systematic review in 2012 found that there is not clear evidence for the efficacy of DFM alone, however when combined with other manual techniques it seems to be superior to exercise alone in cases of tendinopathy. bit.ly/2zPusrT #PT582 #NM

@mpwheeler47 Thanks Marissa! Based off of those numbers it definitely appears that a majority of PTs have success using cross friction. Do you know how exactly it would encourage proper healing?

#PT582 #NM bit.ly/2zUiFsg 88% PTs in this study use friction technique(84% of the time for tendinopathy). Based on their clinical expertise I would use cross friction to treat this. It is unlikely to cause harm & can encourage proper tissue healing and pain modulation.

@swaddell_ @NAUPT582 Thanks Stephanie! I also have personal experience with cross fiction and like you I thought it really helped. Have you seen it be successful on other tendons besides the patellar?

@amkaiserSPT We used the mirror very similarly to how you would for phantom limb, placing the pts hand in a mirrored box in hopes of making his brain believe that his right hand was actually moving in order to increase that hand’s function

@noriamitchell Thanks for sharing your experience trying mirror therapy with a patient post-CVA. What did your team specifically do in mirror therapy?

In neuro clinic we used mirror therapy with a pt s/p CVA but it was not effective. Research suggests that there is moderate evidence that mirror therapy can help UE function in pts post CVA in the subacute phase, however more research is needed #PT582 #AK bit.ly/2uttoUK

If the pt doesn't have any of the contraindications then I think that plyometrics would be beneficial following a joint replacement. I would implement them near the end of treatment when the pt has gained adequate strength and coordination #PT582 #KB bit.ly/2KcjqNS

Nathan, according to a few studies I found, a lumbar fusion can increase the motion and stress placed on the SI joint, potentially leading to low back pain. And the effects may be greater the closer the fusion is to the sacrum. #PT582 #NM bit.ly/2KCu0S7