In using friction the object in view is to press deeply on the part under treatment and then to move the hand in a more or less circular direction. Any part of the hand may be used, but that generally employed is the tips of the fingers, or tip or ball of the thumb.
It is usual to recommend that the movement should be performed with the elbows straight so that the whole weight of the body may be thrown into the movement.
This instruction is open to great misconception. It would seem that it is often interpreted as implying that the masseur is to throw all the force that is possible into the movement. He therefore holds his breath and stiffens every muscle in the body in his attempt to secure the utmost limit of pressure. All that is needed to correct the misconception is to add to the instruction that the hand must be maintained supple with its muscles relaxed, that no muscle should be kept in a state of fixed contraction, and that the masseur should breathe freely and easily throughout the movement. Again, the muscles throughout the part to be treated must be in a state of complete relaxation. By rhythmical swaying of the trunk through a small amplitude an alternating compression and relaxation can be produced. The amount of pressure exerted can be regulated to a nicety, and by slowly progressive increase in pressure (provided the rhythm is slow and unbroken) no protective reflex will be excited, and far greater depth can be attained than by the exercise of any amount of force. Should any error of technique, such as injudicious haste, give rise to protective or other reflex, the movement should be discontinued until relaxation has again been secured - probably by the means of stroking. So widely does the misconception of the use of bodyweight in massage seem to exist, that it is necessary to emphasize the fact that force should very rarely have any place in treatment. Pressure, when exerted, should invariably be light at first and steadily progressive, the increase depending solely on the conditions present. When commencing treatment it is always a wise precaution to treat the patient as if he were suffering from a far more serious ailment than is actually present.
When we are faced with pathological deposits, chiefly in "gouty" or "rheumatic" subjects, firm, deep, vigorous friction will alone suffice for their removal. Particularly is this so when the deposits in question are found in the neighbourhood of joints. So, too, considerable vehemence is called for when dealing with old-standing oedema. The raison d'etre has already been indicated (see p. 19).
If we are able to attend to a patient, who has suffered a recent injury, so quickly that subcutaneous haemorrhage may still be in progress, it is most desirable that sufficient pressure be exerted forthwith to prevent any further effusion of blood; and, before it has had time to begin to organize, to disperse such blood as may have already escaped from the torn vessels. The area must be small, or the injury will be too severe to treat immediately in this manner with any hope of success. If, however, opportunity is afforded, friction with the ball of the thumb forms an ideal method of treatment. The distinction between "friction" of this type and some movements already described as "kneading" is negligible.
In sum, then, all that has been said in dealing with the forms of massage already considered holds good for friction. There is no call for the exercise of great strength or excessive pressure, and either of these may secure one or more of the detrimental results suggested elsewhere as being possible.
Friction is usually advocated to aid the absorption of local effusion and to break up the results of inflammatory processes. The latter term is in massage parlance frequently used in a somewhat loose sense, owing, it can only be supposed, to a lack of efficient training. Every masseur should be made to understand - mere verbal instruction is inadequate - how to distinguish between the "inflammation" of the ordinary physiological processes of repair after injury, the true inflammation due to sepsis, and that of sub-acute or chronic conditions which lead to the formation of pathological deposits. It is well to emphasize this distinction, as it is quite common to find that it is not clear in the minds of some masseurs. The result is that many a quiescent septic focus has been recalled into full activity through over-zealous endeavour by deep friction "to break up the inflammatory products" following a compound injury. In all places where massage work is being done for the wounded this danger cannot be over-emphasized. If friction is applied to a limb in which the muscles are relaxed there can be no necessity for the use of heavy pressure, and frictions that are administered without undue pressure will rarely set up a recrudescence of sepsis.
Fig. 11. - Friction of the iliac colon. Note that every care is taken to ensure that the abdominal muscles are relaxed; and, a point of distinction between this and other movements, that the inter-phalangeal joints are kept fully extended. It is preferable that the masseur should stand on the left side of his patient. He is shown here on the right side owing to the difficulty of reproduction.
Friction is also advocated for treatment of the colon: let us beware of the possible danger of paralysing the unstriped muscle which we wish only to stimulate (see Fig. 11).
Much has been written about nerve frictions, in which the pads of the fingers or thumb are placed on either side of the nerve and the circular movement imparted as the hand slowly ascends along the course of the nerve. Static nerve frictions are given by applying the movement to one or more specially selected points on the course of the nerve. One cannot suppose that any benefit can be derived by the axon, which is dependent for its vitality on the integrity of the nerve-cell from which it arises. This is so far removed from the site of our massage operations that the hope of securing any effect upon it is problematical in the extreme. That sufficient pressure can cause a solution in continuity we know: a lighter pressure will only have the effect of irritating, and less pressure still will probably have no effect at all. The result of friction on the neurilemma is a matter for speculation; it is difficult to explain any beneficial action, but easy to imagine the possibility of injury from excess. There remains the sheath. It has its own blood supply - the comes nervi communicans - and this is doubtless open to the influence of massage no less than other small blood-vessels. The lymph spaces in and around the sheath can be influenced in similar manner, and we know that in certain ailments pathological products are to be found in the sheaths of nerves. Under these conditions nerve frictions find their metier; and, should the deposits have been a cause of irritation, it is easy to understand that, by their removal, the neurilemma and axon are deprived of a definite source of danger and irritation. We know also that one cause of persistent and chronic neuralgia is the presence of minute adhesions which pull or press upon the nerve. It is possible to secure relief in specially selected cases by frictions. Nerve frictions, skilfully administered, have a delightfully invigorating effect. Excess and fatigue go hand in hand.
Nerve frictions should have a strictly limited use, and in all cases should be commenced tentatively. They should never be given in any acute condition, but only where the latter has subsided and active inflammation has ceased. The products of inflammation left deposited in the sheath may then be dealt with by frictions. Nerve frictions should never be administered unless specially prescribed or permitted by the medical man in charge of the case. Their promiscuous use may prove to be a fertile source of injury. It would be hard to produce physiological reasons in justification of nerve frictions in any case where the trouble is due to failure of the nerve-cell or its axon. A general working law may be formulated thus: - Nerve frictions are safe if pain is not increased. Little good can be expected from them if the nerve-cell or its axon is diseased or injured. Absorption of pathological products may be hastened, and adhesions stretched, provided a careful watch is kept, and treatment ceases the moment danger signals arise - the chief being the onset or increase of pain.
Friction also plays an invaluable part in the treatment of ulcers and wounds that do not heal rapidly.