KEY POINT
• Therapeutic friction offers many benefits, such as increasing local circulation, breaking up tissue, and stimulating nerve fibers.

Friction, in everyday language, commonly conjures a thought of disharmony. When two people have friction between them, they are (metaphorically speaking) rubbing each other the wrong way. Or, if a person creates friction, their behavior can result in irritation or inflame a situation. When a circumstance is described as frictional, its signature is composed of resistance as well as potentially fiery or hot energy.
When understanding friction as a hands-on technique, we can use this relational concept to inform the way we use it with our clients. Sometimes a little disharmony is necessary to move things that are stuck, misaligned, or too heavily intertwined away from each other. Quite literally, there are times when a “break up” is necessary for stagnation to return to flow.
As in all things, balance is necessary. Used in the right way, friction can be therapeutic. However, uninformed or negligent use can result in less-than-positive effects or even potential harm. Therefore, wise use is imperative.
To ensure we use friction wisely, let’s remind ourselves what it is, when it is used, what its variations are, and when to take caution or completely avoid use.

Friction—An Overview

The term friction comes from the Latin root frictio, which means “to rub.” As a therapeutic manual technique, friction is performed by rubbing one surface against another, also known as a shearing force. Heat is generated by the resistance between the two surfaces. For this reason, friction strokes are applied with little to no lubricant; that way, the tissue can be grabbed and manipulated with more precision. The stroke can be applied slowly or briskly depending on the depth and therapeutic intent.  

Superficial Friction

When superficial friction is applied, the therapist’s palms, ulnar sides of hands, or forearms are one surface and the client’s skin is the other surface. Heat is generated by gliding one’s hands swiftly back and forth in linear or circular fashion across the surface of the skin. A benefit of this technique for the therapist is they get a brief cardio workout! However, the therapist must take care to not sustain this variation of friction for an extended period because it can be exhausting. A little friction goes a long way.
Superficial friction strokes are used therapeutically to:
• Increase local circulation and lymph flow
• Increase connective tissue pliability by warming the ground substance
• Break up adhered tissue

Deep Friction

When deep friction is applied, the therapist’s thumb(s), fingertips, or knuckles are used to compress superficial tissue and manipulate it across underlying tissue. It can be used on any tissue where adhesions exist and is commonly used on tendons and ligaments. Strokes are shorter and more specific. Just as with superficial friction, a little goes a long way.
Applying deep friction to adhesions or scar tissue accomplishes several goals:
• Realigns linear connective tissue fibers that have become disorganized
• Stimulates nerve fibers, which has been shown to decrease pain and improve mechanoreceptor activity
• Breaks up excess scar tissue, which improves general tissue mobility and joint range of motion

When and How to Use It

Since friction is primarily designed to break up adhesions (areas that are unhealthfully intertwined or stuck together), its most common use is in areas of previous injury where scar tissue has built up.  
However, superficial friction is also very useful for clients who have that “brick wall” type of feeling when you broadly stroke the area. In other words, this technique is of great service when your palpation skills determine it is difficult to differentiate the edges of muscles and it would be beneficial to warm the area, separate skin and superficial fascia from underlying tissue layers, and begin to release target muscle tissue from surrounding tissues so they can slide across each other more freely.
Anytime there is limited range of motion, friction can be useful to free up the restriction. Of course, the practitioner must first assess where the restriction originates.  This is one reason why having a solid knowledge of anatomy and kinesiology is so important. Without adequate recognition of where muscles run and what they do, it is difficult (if not impossible) to adequately address restrictions and apply techniques that renew range of motion.
It is beneficial to apply range-of-motion techniques before and after applying friction, especially around joints. This informs the therapist of its effectiveness and whether more friction might be indicated. Be sure to always warm the tissue before applying deep friction techniques.

Variations in Therapeutic Application

As often happens with basic strokes learned in school, practitioners gravitate toward only one or two primary methods or approaches rather than the vast array of variations available. Friction is no exception. Its variations include:
Rolling friction (superficial). This variation is used on extremities only. Place the target tissue(s) firmly between your outstretched, parallel hands, palms facing each other. Then, move hands back and forth briskly in opposing directions.
Wringing friction (superficial). This variation is similar to rolling friction except the practitioner’s hands are wrapped around the extremity. Move your hands around the extremity briskly in opposing directions, like wringing water from a towel or sponge.  
Parallel friction (deep). Using thumbs, fingertips, knuckles, the heel of the hand, or the ulnar side of the hand, compress superficial tissue and move it back and forth along the fibers of the target tissue. Pace can be slow or brisk.
Cross-fiber friction (deep). Using thumbs, fingertips, knuckles, the heel of the hand, or the ulnar side of the hand, compress superficial tissue and move it back and forth across the fibers of the target tissue. Pace can be slow or brisk.
Circular friction (deep). Similar to parallel and cross-fiber friction, use thumbs, fingertips, knuckles, the heel of the hand, or the ulnar side of the hand to compress superficial tissue. However, instead of working parallel or back and forth across the fibers of the target tissue, use circular motions. Pace can be slow or brisk.

Cautions and Contraindications

The primary caution with friction is to not overdo it. Since it is a heat-producing, chafing type of stroke, one must be careful to use it mindfully. Friction strokes need only be performed for 10–15 seconds on any given target area.  
Another caution is to be mindful that scar tissue has a purpose in areas of injury. Its purpose is to protect tissue from further injury and fill in gaps where healthy tissue once existed. Our goal, then, is to reduce excess scar tissue that is limiting range of motion or causing pain. The best way to stay within a healthy range is to reassess the tissue after treatment. The client’s range of motion should improve, but without causing further pain or instability.
Complete contraindications include:
• Open skin lesions
• Contagious skin diseases
• Areas that are numb
• Varicose veins
• Bruises
• Inflamed areas (as a general rule, if it’s already hot, it doesn’t need more heat!)
It is worthwhile to note that creating inflammation in tissue that has been stagnant for too long can actually be therapeutic. The body’s inflammatory response helps tissues heal, as well as be saturated with nutrients. By stimulating this response, the practitioner sends a signal to the nervous system that an area needs attention. However, if it’s already hot, it is on the nervous system’s radar.

Sometimes Friction is Good

While we don’t want to go through life creating a bunch of friction, there are times when it is beneficial. When things (or even people) get stuck or immobilized by an injury or troubling experience, stirring things up can generate momentum toward change. Remaining within healthy boundaries is key. As with people, we must approach the body with respect, reverence, and a genuine desire to be of service. So, go ahead . . . get frictional!