Lecture 6: STM Flashcards
MT and massage billing code for STM
MT: 97140
massage: 97124
purposes of STM
local muscle relaxation
increase mobility of different tissues
specific massage techniques we will utilize
Hoffa technique
STM
functional massage
pathologies that can restrict motion
contracture
edema
adhesion
mechanical block
tone
spinal disc herniation
weakness
adverse neural tension
pain
psychosomatic or psychological factors
explain a contracture and how it restricts motion
soft tissue shortening due to immobilization/disuse
pathological cross links occur that cause shortening/adhesions that prevent normal alignment of collagen
difference between scar tissue and muscle contractures
ST = over proliferation during this phase of healing causing too many cross links
MC = permanent shortening of muscles that produce deformity; caused by prolonged spasm, guarding, imbalance, or immobilization
compare/contrast intraarticular edema and extraarticular edema
intra = excess fluid forming inside joint capsule; restrict motion in a capsular pattern
extra = outside joint capsule; restricts motion in noncapsular pattern
both restrict AROM and PROM
what are adhesions
abnormal joining of different types of tissue
fibrofatty tissue may proliferate inside joints and it may adhere between structures as it turns into scar tissue
types of treatment approaches for movement restriction
stretch
motion
surgery
physical agents
what is plastic deformation
elomgation that produced under loading that remains after load is removed
low load prolonged stretch for 30-60s
how can A/PROM address motion restrictions
inhibits contracture formation by physically disrupting the adhesions between gross structures and/or by limiting intermolecular cross linking
how does massage treat motion restriction
can increase tissue extensibility, control inflammation, control pain, and facilitate motion
thermotherapy can address motion restriction by
increasing soft tissue extensibility
how might sx be used to improve motion restriction
surgical release of adhesions, contractures, or tissue limited by spasticity limits
if motion is restricted by bony block
in cases stretching can’t lengthen a contracture
hypertonicity due to spasticity
physical agents help reduce motion restrictions by…
increasing soft tissue extensibility (thermo and cryo)
control pain/inflammation (cryo, thermo, US, light)
facilitate motion (tx, massage)
why is touch important
sensory receptors in skin
accustomed to relief with touch from utero
swedish massage originally developed where
stockholm, Sweden in 1847
1900 = Albert Hoffa published book “technik de massage” in Germany and is credited by many
underlies all modern techniques
modern massage techniques
Effleurage (stroking)
Petrissage (Kneading)
Tapotement (percussion)
Vibration
physiological effects of massage
stretch/loosened adhesions
increased venous/lymphatic flow/stimulated circulation that reduces edema and lactic acid
decreased neuromuscular excitability
sedation (muscle relaxation)
modulate pain
restore joint mobility
2 categories of physiologic effects are
mechanical and reflexive
psychological effects of massage
sedative
lowers tension and anxiety
feeling of being helped
what are mechanical effects
effects exerted through mechanical technique
stretching of muscle
elongating fascia
mobilizing adhesions
effects on muscle/skin
what are reflexive effects
exerts effects through skin an superficial connective tissue
believed to be an autonomic nervous system effect
effects of pain/circulation
indications for massage
swelling
decreased ROM
muscle spasm
pain
tightness in tissue
HA
trigger point
massage intervention allows the PT to treat what 2 things simultaneously
fascia and muscle
allows for deep tissue treatment
what is effleurage
“to skim over”
gliding stroke; doesnt move deep tissue
starts light and becomes heavier
deep effleurage stimulates capillary circulation
begins at peripheral areas and moves to heart
effleurage helps what
pinpoint tightness, trigger points, and muscle spasms
purpose of effleurage
accustom pt to touch
warm tissues
flush out tissue at end
create length in muscle
beginning and end of every massage
what is petrissage
“to knead”
kneading/press/toll muscles
break up areas of muscle tension
metabolic waste “wringed out” of muscles and pit back into circulation to be filtered
milking effect to increase venous return
purpose of petrissage
increase venous/lymphatic return
reduce muscle tension
remove metabolic waste
break adhesions
loosen adherent fibrous tissue
increase skin elasticity
how is single hand kneading performed
push in and away down medial line and work outward to lateral line
how is double hand kneading performed
hand over hand
press deep and pull in toward midline with pressure and depth
how is deep stripping performed
milking skin
apply uniform pressure in single line
how is C kneading performed
pinch and release
create lift to deeper tissues pull on fascia
how is skin rolling performed
pinch and release superficially
how is finger tip kneading performed
pressure lifted through 4 fingers using gravity and weight of pt
used at occiput for nuchal line massage
what is tapotement or percussion
brisk bouncy firm contact used to tone the muscles, firm sagging skin, and increase circulation
brisk blows administered with relaxed hands
not good for kids or elderly
types of strokes for percussion
hacking = strike with hypothenar
clapping/cupping = hands create suction; used for postural drainage to mobilize bronchial secretions
beating = closed fist
purpose of tapotement
increase circulation
stimulate subcutaneous structures
tone/firm muscles
what is vibration
fine/tremulous movement to assist secretion removal from airways
applied during exhalation
hands remain in contact with pt
rhythmic trembling from whole forearm
used in conjunction with postural drainage and cupping to loosen secretion
what is a friction massage
james Cyriax and Gillean Russell
affects MSK structurs
heavy compression over sift tissues will stretch scars and loosen adhesions
technique of friction massage
tips of fingers or thumb or heel of hand should move in small circles across the muscle fiber rather than alonf the longitudinal axis of fibers
pressure gradually increases with pt tolerance
pressure never abruptly released
purpose of friction massage
trigger point release; deep pressure
loosen scar tissue
aid in absorption of local edema
what is cross friction massage
used for chronic tendon inflammation
used with chronic inflammation when process gets “stuck”
increases tendon stiffness
used most often with chronic overuse problems like epicondylitis, tendonitis, etc
technique for cross friction massage
tendon in slight stretch
deep circular or cross fiber massage to break up adhesions
perpendicular to fiber orientation
7-10 min every other day
very painful and noxious = warn pt
purpose of cross friction massage
increase inflamamtion to a point where inflammatory process is complete and injury can progress into the later stages of the healing process
assist to appropriate proliferation
break up adhesions or minimize rough surfaces between tendons and their synovial sheath
what is a myofascial trigger point
hyperirritable locus within a taut band of skeletal muscle, tendons, myofascial ligaments, and capsules surrounding joints, periosteum, or skin
what is a latent trigger point
doesnt cause spontaneous pain but may restrict movement or cause weakness
what is an active trigger point
causes pain at rest
tender to palpation
characterized by referred pain pattern similar to pts pain complaint
trigger points are found most commonly where? these are identified by what?
found commonly in postural muscles
identified by a jump sign (pt cries out, winces, etc)
what is a trigger point release massage
small friction like circular patterns are used on trigger point
like friction massage but pressure held longer
what is instrumented assisted soft tissue mobilization
friction massage that uses tools
like standard massage but specialized instruments used
allow more direct treatment of involved tissues
indications for PT to use IASTM
hands cant create needed force
excessive scar tissue
forms of tendonopathy
muscle/ligament strain
plantar fasciitis and ITB syndrome
types of IASTM
graston = metal stainless steel blades
ASTYM = plastic tools, designed to promote regeneration of tissue
SASTM = sound assisted soft tissue mobilization
what is functional massage
combines passive and active mobilization of joints and massage technique
similar to friction
good for stretch and collagen alignment
muscle compression and stretch assists in reducing motion restriction from soft tissue
what is strain counterstrain functional massage
preposition muscles in relaxed initial position by shortening them, shorten spindle to relax muscle, move origin closer
positional release therapy
what is active release technique functional massage
affected tissues cam be treated by using combo of specific muscle movements as well as applying specific and direct pressures
AROM or PROM assisted by PT
technique for functional massage
combine synchronized repeated joint movements in rhythmic manner
direction of force in line with muscle fibers
release force when resetting the position of jt
pressure dependent on pt reactivity
what is rolfing
holistic healing
tissue tension relationship with psychological well being
what is trager
rocking the body, shaking, or swinging body parts
release tightness to improve mobility
psychophysical integration
what is Bindegewebsmassage
connective tissue massage similar to reflexology
assists with circulation and blood flow
what is acupuncture/reflexology
chinese pressure massage to activate meridians
uses hands to reactivate referring parts on the body
corrects vegetative functions of body using ANS
what is shiatzu
similar to chinese acupressure
Japanese pressure massage
