Lecture 9 and 17 - Selective tissue testing (STT) and deep transverse friction (DTF) Flashcards
Which characteristic suggest a inert vs contractile tissue affection when there is pain:
1. in AROM and PROM, same direction
2. in AROM and PROM in opposite direction
3. RISOM painful
4. Pain at EOR
5. Resisted mvt not
painful
- in AROM and PROM, same direction - inert
- in AROM and PROM in opposite direction - contractile
- RISOM painful - contractile
- Pain at EOR - inert
- Resisted mvt not
painful - inert
Situation STT:
Which pattern?
What does it mean?
Limited or excessive ROM and pain in some directions
Limited or excessive ROM and pain in some directions
Inert tissue pattern
Non-capsular pattern
Mvt that stretch, pinch or move the affected structure causes pain
Situation STT:
Which pattern?
What does it mean?
Limited ROM, no pain
Limited ROM, no pain
Inert tissue pattern
Usually bone-to-bone E/F due to osteophytes
Situation STT:
Which pattern?
What does it mean?
Limited ROM and pain in every direction
Limited ROM and pain in every direction
Inert tissue pattern
Acute inflammatory condition vs. entire jt affected (capsular pattern) vs. psychosocial considerations
Situation STT:
Which pattern?
What does it mean?
Strong (relatively strong) and painful
Strong (relatively strong) and painful
Contractile tissue pattern
1st (or 2nd) degree strain
Other contractile structure lesion
contusion, tendinopathy, etc.
Inert structure lesion (bursitis, articular structure, etc)
Situation STT:
Which pattern?
What does it mean?
Weak and painful
Weak and painful
Contractile tissue pattern
2nd degree strain (may be 1st – 3rd)
Other contractile structure lesion
contusion, tendinopathy, etc.
Situation STT:
Which pattern?
What does it mean?
Weak and pain free
Weak and pain free
Contractile tissue pattern
Isolated 3rd degree strain
Chronic contractile structure lesion
Neurological cause
Situation STT:
Which pattern?
What does it mean?
All resisted mvts are painful
All resisted mvts are painful
Contractile tissue pattern
Severe inert structure lesion
bursitis, sprain, fracture, etc.
Psychogenic: exaggerated response by pt
T/F
STT is commonly used in clinical settings because of its selectivity when placing tissues under tension
It is very difficult to be “selective” when placing tissues under tension
Joint positioning affects multiple structures
Muscle contractions CANNOT occur in isolation
What’s the 2 goal of DF?
↑ the mobility & extensibility of MSK tissues
Help prevent & treat scar tissue
What are the 3 types of DF?
Transverse (deep transverse frictions = DTF)
Perpendicular to the orientation of the tissue fibres
Longitudinal
Parallel to the orientation of the tissue fibres
Circular
Small circles obliquely into the tissue
What are the 3 therapeutics effects of DF?
Traumatic hyperemia
Pain relief
Decreasing scar tissue & adhesions
Explain the traumatic hyperemia effect of DF
↑ blood circulation & lymph flow
- Help with removal of chemical irritant by-products of inflammation
- ↓ venous congestion → ↓ edema & hydrostatic pressure on pain-sensitive structure
Explain the pain relief effect of DF
Stimulates type I & II mechanoreceptors producing presynaptic anesthesia
Based on the Gate control theory of pain
Acute phase: if done too vigorously would cancel this effect & ↑ pain by too much stimulation of nociceptors
T/F
Decreasing scar tissue & adhesions is an effect obtained with light DTF in all phases of the healing process.
Light DTF is suggested in the the inflammatory phase and early prolif phase
In Late proliferative & remodeling phases: not precised
Explain the Decreasing scar tissue & adhesions effect of DTF in the inflammatory and early proliferative phase
Inflammatory and early proliferative phases
- Light DTF only
Rationale:
- To minimize the cross-linking & enhance the extensibility of the new tissue
- To prevent adhesion formation
- To maintain mobility between tissues
Explain the Decreasing scar tissue & adhesions effect of DTF in Late proliferative & remodeling phases
Late proliferative & remodeling phases
- Assists with the orientation of the collagen in the appropriate lines of stress
- Breakdown of adhesions
(due to transverse nature of the frictions)
T/F DF is indicated for: 1- Chronic lesions in the joints 2- Acute injuries to ligament 3- Bursitis 4- Acute inflammation (with acute swelling) 5- subacute injuries to tendon 6- before a strong stretch 7- Adhesions between tissues 8- Hematomas or bruising 9- ↓ sensation or hypersensitivity (Light DF only) 10- Signs of infection 11 - Debilitated or open skin 12. ectopic ossification 13. cancer 14 - Pt have DVT but in an other area then the one treated
1- Chronic lesions in the joints - T 2- Acute injuries to ligament - T 3- Bursitis - F 4- Acute inflammation (with acute swelling) - F 5- subacute injuries to tendon - T 6- before a strong stretch - T 7- Adhesions between tissues - T 8- Hematomas or bruising - F 9- ↓ sensation or hypersensitivity (Light DF only) - F 10- Signs of infection - F 11 - Debilitated or open skin - F 12. ectopic ossification- F 13. cancer - F 14 - Pt have DVT but in an other area then the one treated - T
How do you position for DTF the tissue if it’s
- Td with no sheath and lig.
- Td with sheath
- Ms belly
- Td with no sheath and lig.: Moderate pain free stretch vs relaxed vs optimal tissue exposure position
- Td with sheath: Stretched
- Ms belly: Relaxed
There is mistakes in the first steps of the application of this DTF technique, find them!
- Use of lubricant or a hypoallergenic cream
- Done perpendicular, parallel or circular to the orientation of the tissue fibres
- Moves over the pt skin with the clinician’s finger over the site of the identified lesion with a circular motion
- No use of lubricant
- Done perpendicular to the orientation of the tissue fibres
- Moves the pt skin with the clinician’s finger over the site of the identified lesion back & forth
Blisters prevention: important to moves skin with fingers
In the DTF application technique, what amount of pressure is ideal?
Amount of tension/pressure
- Depend on the stage of healing
- Begin with light pressure and build up to the target pressure
- Need to reach the target tissue
In the DTF application technique, what amplitude is ideal?
Sufficient to cover all of the affected tissue
In the DTF application technique, what rate of application is ideal?
2-3 cycles/sec applied in a rhythmical manner
Decribe the treatement duration for DTF
- for general guidelines
- for chronic lesions
- for remodelling phase
Generally stop when desensitization occurs*
- Usually takes 3-5 min
- If doesn’t occur within that time frame stop DTF
For Chronic lesions / Remodeling phase
- Continue for another 5 min after the desensitization period
- To enhance the mechanical effect on adhesions & scar tissue
T/F
After application of DTF
1. Involved tissue is passively stretched
2. Involved tissue is actively exercised
3. Be careful not to cause pain with ex’s
4. Apply ice in acute conditions in the clinic and at home
All true
What should be the DTF frequency?
When the excess tenderness has worn off
Takes generally 2-7 days
T/F about the total number of treatment with DTF
- The guidelines suggests 12 sessions for chronic patients
- Most conditions should resolve within 10-15 sessions over 8-12 wks
- If no tissue improvement after 5 sessions, Discontinue DTF
- F -> Pt specific → until no further improvements
- F -> Most conditions should resolve within 6-10 sessions over 2-8 wks
- If no tissue improvement after 3 session, Discontinue DTF
A patient is complaining of exacerbation of symptoms after the 3rd session of DTF
What do you tell him/her? A. It's normal B. It's abnormal, we need to stop DTF C. No pain no gain D. May the force be with you
Explain your choice
DTF May exacerbate Sx following the 1st 2-3 sessions
Need to determine if the ↑ in pain is acceptable considering pt’s condition and phase of healing
Educate pt about it & ice application
