Lab #3 Flashcards
what is the mechanism of action for soft tissue techniques?
- relaxes hypertonic muscles and reduce spasms by decreasing alpha motor neuron and Hoffman reflexes, relaxes the patient
- stretches and increases elasticity of shortened fascial structures; stretching will provide general state of tonic stimulation
- improves circulation and nutrition delivery, waste removal
- identifies TART and somatic dysfunction
- improves immune response
what are the indications for soft tissue technique?
- somatic dysfunction shown by TART findings
- hypertonic muscles or tension in fascial structures, or to soften muscles enough to feel TART changes in structures underneath
- provide tonic stimulation to hypotonic muscles
- findings related to somato-somato or viscero-somatic reflexes, see how tissue responds to manipulation
- prepare the tissue for other types of manipulation
relative contraindications for the soft tissue technique
issues with skin, fascia, muscle, ligament, bone, joint, viscera, or vascular
how to do the cervical paravertebral muscle bilateral (B/L) linear traction (B/L longitudinal stretch)
- patient lies supine with the doctor at head of table. The patient cradles the patient’s head with the thumbs near the ears and fingers underneath the neck bilaterally
- physician keeps elbows tight against body, leans back, performs B/L parallel (linear) stretch and holds position for 3-5 seconds
- repeat until the tissues soften, or hold until you can feel the tissues relax
- reassess
how to do the cervical paravertebral muscle unilateral perpendicular stretch
- the patient lies supine and the doctor stands at table side opposite to which side is being treated
- physician reaches around the neck and grasps the medial aspect of the paraspinal muscles with finger pads, and other hand (cephalad) on patient’s forehead to stabilize head
- keeps caudad arm straight, draws paravertebral muscles ventrally (up toward ceiling)
- perform stretch in gentle, rhythmic, or kneading fashion until tissues soften and relax
- reassess
how do you do the prone perpendicular stretch?
- patient lies prone, and the physician stands on the table side opposite to the side of the hypertonic muscles
- place thumb and thenar eminence of hand closest to patient’s head on the medial aspect of the patient’s thoracic or lumbar paravertebral muscles on side being treated
- either place second hand directly next to first hand (least pressure), directly over the first hand (medium pressure), or crossed over the first one (most pressure)
- keep elbows straight, lean body weight ventrally then laterally, with respect to patient
- physician holds stretch for 3-5 seconds, repeats several times or sustains until the tissues soften
- reassess
bowstringing
perpendicular stretches are sometimes called this because you’re stretching the muscle fibers away from the spine, like stretching a bowstring away from its bow
how do you do the prone parallel stretch?
- patient lies prone and the physician stands on side of table opposite to the hypertonic muscles
- physician crosses forearms and places palms on patient with fingers pointing in opposite directions, parallel to paraspinal muscles
- approximate (bring together) your hands so that the skin is brought together
- use palm of hands to push the skin out and stretch the skin, while leaning forward, to stretch paraspinal muscles
- physician holds the stretch for 3-5 seconds and repeats several times or sustains the stretch until the tissues soften
- reassess
how do you do the perpendicular traction technique?
- patient lies in lateral recumbent (knees drawn up) position, with hypertonic muscles up; physician stands in front of patient’s chest
- physician places palms of hands side by side, fingerpads on the medial aspect of the paraspinal muscles
- pull hands out to the side while leaning back to induce a lateral force
- hold stretch for 3-5 seconds and repeat several times or sustain the stretch until tissues soften
- reassess
how do you do the lumbar passive prone perpendicular stretch with ASIS (prone pressure with counterleverage)?
- the patient lines prone, with head turned toward physician; physician stands at side of table, opposite to the one being treated
- physician’s caudad (toward the pt’s feet) hand contacts in the ASIS on the side being treated, lifts it dorsally (toward ceiling)
- cephalad (toward the head) hand contacts medial aspect of the hypertonic lumbar paraspinal muscles, press ventrally and laterally
- hold the stretch for 3-5 seconds and repeat several times or sustain the stretch until the tissues soften
- reassess
ASIS landmark
anterior superior iliac spine; projection of the pelvis on the ventral side of the person laterally
how do you do the lumbar passive lateral recumbent technique?
- patient lies in lateral recumbent position (on side knees drawn up), side with hypertonic muscles up
- physician stands in front of patient’s chest, places fingerpads of both hands on medial aspect of paraspinal muscles and places forearms on the patient’s lateral chest wall and innominate (hip bone)
- exert force ventrally (toward ceiling) and laterally (towards side)
- hold the stretch for 3-5 seconds and repeat several times or sustain the stretch until the tissues soften
- reassess
case presentation: 26yo female with achy upper back and neck. Physical exam finds that cervical range of motion is slightly decreased with extension, rotation in both directions, sidebending. Positive erythema test in upper right thoracic region and hypertonic paraspinal muscles bilaterally in cervical and upper thoracic region. What diagnosis would you make?
cervical and thoracic pain due to muscle spasm
what are the OMT options for cervical soft tissue treatment?
cervical paravertebral muscle bilateral linear traction (B/L longitudinal stretch)
cervical paravertebral muscle unilateral perpendicular stretch
what are the OMT options for thoracic soft tissue treatment?
perpendicular traction: lateral recumbent
passive perpendicular stretch (prone)
passive parallel stretch (prone)
