5 ST & MFR Lecture Flashcards
Soft Tissue Techniques directly applied where?
Soft tissue preparation facilitates what?
Applied to muscular and fascial structures of body
Facilitates improvement of articular motion
What is soft tissue?
What is included?
Living tissues of the body other than bone
Fascia, Muscles, Organs, Nerves, Vasculature, Lymphatic
Fascia
What is it?
Composed of?
Function?
What is it not?
Complete system with blood supply, fluid drainage, & innervations (largest organ system in body)
Composed of irregularly arranged fibrous elements of varying density
Involved in tissue protection and healing of surrounding systems
It is not Tendons, Ligaments, Aponeuroses
Fascia is Omnipresent
There is a myofascialarthroidal continuity throughout the body
Describe continuity of Fascia
Perimysium (Fascia) –> Peritendium –> Periosteum
Pannicular Fascia
Outermost layer derived from Somatic mesenchyme and surrounds entire body with exception of orifices
Outer layer is adipose & Inner layer is membranous and adherent to outer portion
Axial & Appendicular Fascia
Internal to Pannicular layer; fused to Panniculus and surrounds all muscles, periosteum of bone, and peritendon of tendons
Meningeal Fascia
Surrounds nervous system including the Dura
Visceral Fascia
Surrounds body cavities (pleural, pericardial, & peritoneum)
Fascia is Omnipotent
Contractile components
Healing components
Provides for mobility and stability of MSK system
Myofibroblasts
Macrophages, Mast Cells
Fascia is Omniscient
20% of cutaneous mechanoreceptors supplying skin have receptive fields in subcutaneous tissue (loose fascia)
75% of stretch receptor free endings for muscles and proprioception in fascia
Viscoelastic Material
Any material that deforms according to rate of loading and deformity
Stress-Strain Relationship
Stress is force that attempts to deform CT structure
Strain is percentage of deformation of CT
Hysteresis
Difference between loading and unloading characteristics represents energy that is lost in CT system; energy loss is Hysteresis
Creep
CT under sustained, constant load (below failure threshold), will elongate (deform) in response to load
Ease
Direction in which CT may be moved most easily during deformational stretching
Palpated as sense of tissue “looseness”, or laxity/greater degree of mobility
Bind
Palpable restriction of CT mobility
Hooke’s Law
Strain (deformation) placed on an elastic body is in proportion to the stress (force) placed upon it
Wolff’s Law
Bone will develop according to stresses placed upon it
Sherrington’s Law
When muscle receives nerve impulse to contract, its antagonists, receive, simultaneously, an impulse to relax
Common Compensatory Patterns
Uncommon Compensatory Patterns
Uncompensated Pattern
80% of Healthy People (L/R/L/R)
20% of Healthy People (R/L/R/R)
Usually symptomatic and a trauma usually involved
Transition Zones of Spine
OA, C1, C2
C7, T1
T12, L1
L5, Sacrum
Transverse Restrictors
Tentorium Cerebelli
Thoracic Inlet
Thoracolumbar Diaphragm
Pelvic Diaphragm
Soft Tissue (ST) Technique
System of Dx and Tx directed toward tissues other than skeletal or arthrodial elements
Tx Goals for TTA
Stretch and increase elasticity of myofascial structures to return symmetry
Improve local tissue nutrition, oxygenation, and removal of metabolic wastes to normalize tissue texture
Tx Goals of Asymmetry of Myofascia
Restore symmetry
Normalize tone
Tx Goal for Restriction of Motion
Set fascia free to normalize ROM
Tx Goal for Tenderness
Normalize neurologic activity
Improve abnormal somato-somatic & somato-visceral reflexes
ST Indications
Diagnostically: identify restricted motion, sensitivity, TTA
Feedback about tissue response to OMT
Improve local & systemic immune response
Provide general state of relaxation
Enhance circulation to local myofascial structures
Provide general state of tonic stimulation
ST Relative Contraindications
Severe Osteoporosis
Acute injuries
ST Absolute Contraindications
Fracture/Dislocation
Neurologic entrapment syndromes
Serious vascular compromise
Local malignancy
Local infection
Bleeding disorders
Stretch (Parallel Traction)
Knead (Perpendicular Traction)
Inhibition
Increase distance between origin and insertion (parallel with muscle fibers)
Repetitive pushing of tissue perpendicular to muscle fibers
Push and hold perpendicular to fibers at musculotendinous part of hypertonic muscle
MFR
INR
System of diagnosis and Tx which engages continual palpatory feedback to achieve release of myofascial tissues
Tx system in which combined procedures are designed to stretch and reflexively release patterned ST and joint related restrictions
What are REMs (Release Enhancing Maneuvers)
Breath holding
Prone/Supine simulated swimming & pendulul arm swing
R/L cervical traction
Isometric limb and neck movements against table
Patient evoked movement from cranial nerves
Indications for MFR
SD
When HVLA or MET contraindicated
When counterstrain may be difficult secondary to patient’s inability to relax
Contraindications of MFR
Absolute
Relative
- Lack of consent or Absence of SD
- Infection of ST or Bone
- Fx, Avulsion, or Dislocation
- Metastatic disease
- ST injuries: Thermal, Hematoma, Open wounds
- Post Op Patients with wound dehiscience
- Rheumatologic condition involving instability of CS
- DVT or Anticoagulation therapy
Activating Forces
Inherent Forces
Respiratory Cooperation
Patient Cooperation
Using body’s PRM (primary respiratory mechanism)
Refers to physician directed, patient performed, inhalation/exhalation/holding breath to assist with manipulative intervention
Patient asked to move in specific directions to aid in mobilizing specific areas of restriction
MFR Treatment Endpoint
3-D release often palpated as:
Warmth, Softening, Increased ROM
