Don’t do cross friction massage on your Achilles tendon!

Oh for goodness sake, how is it possible that so many people believe that transverse friction or cross friction massage can heal an injured Achilles tendon? It cannot, and if a therapist tells you that it can, they don’t understand the science behind tendons and how they heal.

I’ve just come off a call with a patient who flared his Achilles tendon up after he followed the advice of two well-known therapists on YouTube who advocate it as “the best possible treatment” for Achilles pain. So I’ve decided to write this article to debunk two of the most common myths about cross friction massage and Achilles tendonitis. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

1. Myth 1: Cross friction massage stimulates the healing process by stirring up inflammation

2. Myth 2: You break down the scar tissue in the Achilles tendon when you do cross friction massage

3. "Cross frictions helped my Achilles pain – How do you explain that?"

4. Why I am so dead set against cross frictions

5. How we can help

I've also discussed it in this video:

Myth 1: Cross friction massage stimulates the healing process by stirring up inflammation

I was also taught this nonsense when I was a student back in 2002. There wasn’t any research to back it up – it was just what was hypothesised to happen. Since then, truckloads of research has been done on Achilles tendinopathy and how tendons heal and we now know that it doesn’t need an inflammatory response to heal.

What the tendon needs is a carefully graded strength training programme – it’s the load that you place on the tendon that stimulates it to produce new healthy collagen fibres to replace the old, damaged ones. Any therapist who tells you that cross frictions can heal your Achilles tendon through stimulating an inflammatory response has not kept up to date with the current research.

Myth 2: You break down the scar tissue in the Achilles tendon when you do cross friction massage

There's no scar tissue when you have Achilles tendinopathy or tendonitis. Yes, you can have a lump in your tendon, but that’s not scar tissue. That lump is caused by the cells in the tendon that change shape and become disorganised. I explain it in more detail in the video, but I’ve also written an article about what exactly causes that lump to form. Once again, it is strength training that is needed to stimulate the tendon to produce new cells and organise them in the correct way.

"Cross frictions helped my Achilles pain – How do you explain that?"

I’m not disputing that massage can decrease pain, and for some people cross frictions can have a pain dulling effect in the short term ... only for the pain to return when they start doing their sport again. A decrease in pain does not equal healing, and massage does not evoke a healing response in tendons – it’s just not how the pathology works.

Also consider the fact that most people will be doing cross frictions together with other treatments, e.g. resting from sport. We know that rest also works really well to calm Achilles pain down, so it may be that you’re wrongly attributing the decrease in pain to cross frictions.

Rest, by the way, also doesn’t heal tendons – it just calms the acute pain down. If you want your Achilles to heal, you have to do a graded strength training programme, otherwise you may get stuck in a boom-and-bust cycle of pain.

Why I am so dead set against cross frictions

At best, cross friction massage is causing patients to waste time on useless treatments when they could rather be following a treatment plan that is supported by the most up to date research. At worst, it can make a patient’s pain much worse and actually delay their recovery, as they have to wait for their tendons to calm down again before they can start rehab.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter, and Instagram.

References

1. Cook, J. L. (2018). "Ten treatments to avoid in patients with lower limb tendon pain." British Journal of Sports Medicine 52(14): 882-882.

2. Cook JL, Rio E, Purdam CR, et al. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? British Journal of Sports Medicine 2016;50:1187-1191.

3. Silbernagel, K. G., Brorsson, A., & Lundberg, M. (2011). The Majority of Patients With Achilles Tendinopathy Recover Fully When Treated With Exercise Alone: A 5-Year Follow-Up. The American Journal of Sports Medicine, 39(3), 607–613.