Classification
| Element |
Detail |
| Category |
Non-Swedish — Cross-Fiber Friction |
| Subcategory |
Circular (point) friction |
| FOMTRAC |
PC 3.2h |
| Fritz method |
Friction (circular, multidirectional at one point) |
Purpose
- Break adhesions at bony attachments and focal lesion sites where linear friction is impractical
- Address trigger points that are too small or deep to effectively treat with linear DTF
- Generate multidirectional shearing forces to disrupt adhesions oriented in multiple planes
Mechanism
The reinforced fingertip makes small circles on the skin, taking the skin and underlying tissue with it in a rotational shearing pattern. Because the circles generate force in every direction around the circumference, the technique addresses adhesions oriented in multiple planes simultaneously — unlike linear DTF, which targets adhesions in only one plane (perpendicular to fibers). This multidirectional shear is particularly effective at bony attachments where collagen fibers radiate in multiple directions from the periosteum. The sustained circular friction produces local hyperemia and stimulates fibroblast activity, promoting organized collagen remodeling at the attachment site.
Indications
- Bony attachment adhesions (epicondyles, greater trochanter, tibial tuberosity)
- Periosteal adhesions from chronic tendinopathy at the enthesis
- Trigger points (as a focused friction alternative to sustained compression)
- Small focal adhesions where Cyriax DTF amplitude (2-3 cm) exceeds the lesion size
- Lateral epicondylitis — at the periosteal attachment
- Patellar tendinopathy — at the inferior pole of the patella
- Plantar fasciitis — at the calcaneal attachment
Contraindications
- Acute inflammation (first 48-72 hours)
- Open wounds or infection at the treatment site
- Acute periostitis (inflammation of the periosteum)
- Anticoagulant therapy (modify pressure)
- Fracture at or near the treatment site
- Calcification within the target tissue
Effects
Immediate:
- Local hyperemia at the attachment site
- Mechanical disruption of adhesion cross-links in multiple planes
- Gate control analgesia (develops after 1-2 minutes, similar to DTF)
- Post-treatment soreness at the bony prominence (expected)
Cumulative (repeated sessions):
- Progressive reduction in adhesion density at the attachment
- Improved tendon-to-bone interface mobility
- Reduced pain on loading the affected structure
Risks and Side Effects
- Periosteal bruising — bony attachments are superficial; excessive pressure causes significant soreness
- Post-treatment soreness (24-48 hours) — expected; typically more pronounced than with DTF because of periosteal sensitivity
- Skin irritation if lubricant is present (must be removed)
- Aggravation if applied during acute phase
Expected Outcomes
Short-term (within session):
- Analgesic onset after 1-2 minutes
- Local warmth and hyperemia
- Decreased tenderness on re-palpation
Medium-term (over 6-12 sessions):
- Reduced adhesion density at the bony attachment
- Decreased pain with resisted and loaded activities
- Improved function at the affected joint
Execution
| Step |
Detail |
| Client position |
Position that exposes the target bony attachment; tissue may be shortened or neutral |
| Remove lubricant |
Clean the area; friction requires no lubricant |
| Hand placement |
Reinforced fingertip (index supported by middle finger) placed directly on the lesion at the bony attachment |
| Action |
Small circular movements; the skin moves with the finger (no slide); the circle covers the entire lesion area |
| Amplitude |
Small — 1-2 cm diameter circles (smaller than DTF amplitude) |
| Rate |
~2 circles per second |
| Duration |
1-3 minutes per site |
| Depth |
Moderate to deep — must reach the attachment; adjust for periosteal sensitivity |
| Lubricant |
None |
Parameters
| Parameter |
Range |
Clinical Reasoning |
| Circle diameter |
1-2 cm |
Must cover the lesion without extending beyond it; smaller than DTF sweep |
| Rate |
~2 circles/sec |
Consistent rhythm generates steady heat and hyperemia |
| Duration |
1-3 min per site |
Allows analgesic onset and therapeutic effect |
| Depth |
Moderate to deep |
Must reach the periosteum/enthesis; start lighter at bony prominences |
| Frequency |
2-3x/week |
Consistent with all friction technique protocols |
Clinical Notes
- Most common error: Making the circles too large, which distributes force over a wider area and reduces effectiveness at the focal lesion. Keep the circles small and centered precisely on the attachment point.
- How to know it is working: Analgesic onset after 1-2 minutes (same as DTF). The tissue at the attachment feels less "gritty" or "crunchy" on re-palpation after treatment.
- When to use this vs. Cyriax DTF: Use circular friction when the target is a small bony attachment or a point lesion. Use DTF when the target is a longer tendon or ligament where perpendicular fiber orientation provides a clear linear sweep direction.
- Clinical pearl: Circular friction is often the best approach for enthesopathies (conditions at the tendon-bone interface) because the collagen fibers at the enthesis fan out in multiple directions — linear friction in one direction misses fibers oriented in other planes, but circles address all orientations.
Verbal Script
> "I'm going to make small circles right at the point where the [tendon] attaches to the bone. This will feel quite specific and may be uncomfortable at first, but a numbing effect should develop after about a minute. Let me know if the pressure needs adjusting."
Distinguishing Features
| Feature |
Circular Friction |
Cyriax DTF |
| Motion pattern |
Small circles at one point |
Linear back-and-forth perpendicular to fibers |
| Amplitude |
1-2 cm diameter circles |
2-3 cm linear sweep |
| Best for |
Bony attachments, small focal lesions |
Longer tendons, ligaments, muscle adhesions |
| Fiber orientation needed? |
No — circles cover all orientations |
Yes — must identify fiber direction to work perpendicular to it |
| Tissue positioning rules |
Less strict (often at neutral) |
Cyriax positioning rules apply strictly |
Students confuse circular friction with Cyriax DTF because both are deep friction techniques with no lubricant and no skin slide. The motion pattern is the key distinction: circles vs. linear. Choose circular when the target is a point (attachment, nodule); choose DTF when the target is a line (tendon, ligament).
Key Takeaways
- Circular friction uses small (1-2 cm) circles at a single point to generate multidirectional shearing forces without sliding on the skin
- Best suited for bony attachments and small focal lesions where fiber direction is variable and linear DTF cannot be optimally oriented
- No lubricant, 1-3 minutes per site, expect analgesic onset after 1-2 minutes
- Distinguished from Cyriax DTF by motion pattern (circular vs. linear) and target type (point vs. line)
- Particularly effective for enthesopathies because the circular motion addresses collagen fibers oriented in all directions at the tendon-bone interface
