How to Rehab Tendon-Overuse Injuries with Cross-Fiber Friction Massage

How to Rehab Tendon-Overuse Injuries with Cross-Fiber Friction Massage

There are a lot of great things that come out of regular exercise, but an overuse injury involving a tendon isn’t one of them. Almost by definition, it seems to happen at the worst time — when you’re using a certain joint or muscle a lot, which tends to be in preparation for a big race or game.

Think: Achilles tendonitis or jumper’s knee (patellar tendonitis) when you’ve been pumping up your run intensity or duration. Or golfer’s elbow, thanks to overloading the forearm tendons with all the grabbing, pulling, climbing, and carrying that goes on in obstacle course training.

Related: The 4 Most Common Training Injuries — And How to Prevent Them

And no surprise, it hurts. Acute tendonitis comes with sharp pain and inflammation at the place where the tendon attaches to the bone that gets worse when you move it; chronic tendonitis is more dull but constant pain.

The standard treatment for a tendon injury is a good-old fashioned dose of RICE: rest, ice, compression, and elevation. But if that’s not doing the trick, and especially if you’ve had persistent pain that’s continued beyond three months, it might be time to add some cross-fiber friction massage to the mix, suggests Joe Tatta, PT, DPT, CNS, creator of the Integrative Pain Science Institute and author of Heal Your Pain Now. Here’s what you need to know.

How to Do Cross-Fiber Friction Massage

The good news is, you can do it yourself. The not so good news: It’s gonna hurt a little. (But actually, that’s a good thing, too – more on that in a second).

“Cross-fiber friction is typically very short, just 3 to 5 minutes, one or two times a day, preferably after exercise,” says Tatta. To do it, use the pads of your fingers to apply solid pressure and rub the affected tendon perpendicular to the length of its fibers. 

“Think of it like strumming strings of a guitar,” says Tatta, only harder. How hard depends on your own perception of the pain. “It should be hard enough that it’s unpleasant, but not extremely painful or unbearable.” If it is, stop, or you’ll risk making the injury worse.

Afterward, you should feel either no change or a little better — if it feels worse, don’t do it again, and see a physical therapist, suggests Tatta. And don’t try this technique if you suspect you have a ruptured or infected tendon or a fractured bone.

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Why Cross-Fiber Friction Massage Works

cross-fiber friction massage

Experts aren’t entirely sure, and there’s not a whole lot of scientific evidence as to how it works yet. Bart Wolbers, researcher and chief science writer at — which investigates the scientific validity of different health inventions — points to a few promising studies on the benefits of cross-fiber friction.

One, published in the American Association for Hand Surgery’s journal, Hand, found that the technique helped reduce pain and increase grip strength in people with tennis elbow. And a research review in the Journal of Sport Rehabilitation found it worked for both shoulder and elbow tendon problems, though again, the available research was limited.

“We’re still learning how manual therapy techniques help to lessen or mediate pain, but there are two predominant theories,” says Tatta. The first is that cross-fiber friction is stimulating healing to happen on a cellular level.

“When you injure a tendon, your body won’t replace it with new tendon — it lays down scar tissue in place of that,” explains Tatta. “Cross-fiber friction massage is essentially re-stimulating the inflammation response.” As a result, your immune system kicks back into gear and goes to work creating new or additional scar tissue to strengthen the tendon.

The second theory is that the pain you’re creating through the friction massage is itself a solution. “Pain is often used as a tool for stopping pain,” says Tatta. “This technique is applying pain on top of the tendonitis pain. As a result, the brain pays more attention to the new pain, and puts less emphasis on the old pain.”

In other words, cross-fiber friction may simply be a distraction method — albeit a very sophisticated one that works on the brain’s prefrontal cortex, amygdala (the emotional center of the brain), and the brain stem and spinal cord.

Related: Nerve Flossing: The New Treatment for Throbbing Nerve Pain

How to Know If Cross-Fiber Friction Massage is Working for You 

Some people will feel better right away, after a single session, says Tatta. For others, it might take a bit longer. But if it’s not working within two weeks, you’re probably not going to benefit from it. At this point, he recommends seeing a physical therapist.

“You might want to see one anyway, for at least one session, for more education on your injury and to get an exercise program for recovery,” says Tatta. A physical therapist can also help you determine what training errors might have caused the injury in the first place so you can avoid a reinjury in the future. 

“Ultimately, to heal the tendon, you really need to use a progressive exercise schedule that increases the weight load on your tendon every 10 to 14 days as you get stronger,” says Tatta. “Loading of the tendon can help you get it healthy again and pain-free, and a PT can help you determine your best schedule for recovery.” 

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