Of the various massage manipulations, however, friction has the greatest power of causing the absorption of inflammatory products, especially of cellular inflammatory products (apart from pus).

This holds good along with another proposition - that all massage manipulations promote absorption.

Since there are many transition forms between purely serous inflammatory products and those mixed with cells and fibrin, and since, likewise, there are transition forms between stroking over large areas of skin and rubbing over small areas, i.e., between effleurage and friction, it is impossible to draw a sharp line between the many experiments which have been performed with these two manipulations. Mosengeil showed as early as 1876, and since then Sturm and Gallis have proved, the power of massage to promote absorption in connection with joints; Reibmeyer and Hoffinger in connection with the abdomen; Zawadski (effleurage) in connection with subcutaneous tissue; Kellgren and Colombo in connection with subcutaneous tissue, joints, abdomen, and muscles; Castex in the case of traumatic inflammatory products of many different kinds, etc.

The practitioner should clearly grasp that the more purely serous, the more recent the inflammatory products are, the more effective is effleurage; the more fibrinous and cellular elements they contain and the older they are, the more does deep kneading, i.e., friction, show its real value in producing retrogressive changes and forcing the final products into the lymph channels and thence into the blood stream.

Friction is of great therapeutic value in connection with haema-tomata, infiltrations in the skin and subcutaneous tissue (cellulitis), in the muscles, tendons, joint capsules, ligaments, and fascia, and in the nerve trunks in the case of interstitial neuritis. Also in exudations in the abdomen, as in appendicitis and perimetritis, in parametritic exudations in the pelvis, in corneal opacities, etc., friction, if necessary with very gentle pressure, is of great use.

I would mention here that all purulent processes, all pus, contra-indicate massage in their neighbourhood. (See Contra-indications to Massage.)

Friction can produce disintegration of the tissues and break them up into small particles. This is its most important effect in promoting reabsorption. It also spreads the inflammatory products over a larger area, so that they are more readily removed by the blood stream. Lastly, the crushing of the newly-formed capillaries by friction no doubt sometimes aids retrogressive changes, since they maintain a higher level of nutrition in the inflammatory connective tissue and help its organisation.

By its power of causing reabsorption of inflammatory products, massage, especially friction, helps to loosen or stretch parts which have become shortened by inflammation, or have become adherent to other parts (scar contractions, peritoneal adhesions between the bowels, fixation of the uterus by para- or perimetric exudations, etc.).