In the early stages of proliferation when crosslinks are absent or still weak, friction must be very light so as to cause only minimal discomfort. Therefore, in the first day or two following an injury, friction is given with slight pressure only and over a short duration, say one minute. At a later stage when strong crosslinks or adhesions have formed, more intense friction is needed to break these down. The technique is then used to soften the scar tissue and to mobilize the cross links between the mutual collagen fibres and the adhesions between repairing connective tissue and surrounding tissues . This, together with the produced local anaesthesia, prepares the structures for the mobilizations that apply longitudinal stress to the structures and rupture the larger adhesions.
Friction induces a traumatic hyperemia.
Forceful deep friction produces vasodilatation and increased bloodflow to the area. It may be hypothesised that this facilitates the removal of chemical irritants and increases the transportation of endogenous opiates resulting in a decrease in pain. Such a forceful friction, resulting in traumatic hyperemia is only desirable in chronic, self perpetuating lesions. The reduction in pain achieved after a few minutes localised transverse friction may be very helpful to define the exact location of the lesion. In muscular, tendinous or ligamentous lesions, a few minutes of massage on the suspected spot results in diminished pain on testing immediately thereafter, so confirming the diagnosis as accurately as an infiltration with local anaesthesia.