Midterm Review Flashcards
Modality
Application of some form of stress to the body for the purpose of eliciting an adaptive response
Phases of Healing: 1. Inflammatory Response Phase
- Chemical messengers elicit local and systemic effects, cells remove debris, and cells create groundwork for repair/regeneration
- Lasts 3-4 days
- Purpose: protect, localize and prepare for healing
Vasoconstriction
-Immediate response to injury: Norepinephrine limits blood loss
Vasodilation
- Occurs after Vasoconstriction due to the release of chemical mediators; Histamine and Leukotaxin
Cardinal Signs of Inflammation
- Heat
- Redness
- Swelling
- Pain
- Loss of function
WBCs and Inflammatory Response
Leukocytes:
- Margination = move to endothelial lining
- Pavementing= Line the endothelium in a tightly packed formation
- Chemotaxis = Drawn to injures site
- Phagocytosis begins
Clotting cascade
Permanent stop of blood loss from injure area
Fibrin patch
Fibrin forms the blood clot or scab over injured site
Phases of Healing: 2. Fibroblastic Repair
- Starts around 48-72 hrs after injury and may go on for 6 weeks
- 2 parts:
a. Granulation phase
b. Fibroblastic or proliferative phase
Fibroblastic Phase: a. Granulation
- Growth of new tissue(re-epithelialization)
- development of new blood vessels (angiogensis)
- development of fibrous tissue (Fibroplasia)
- Granulation tissue forms= connective tissue matrix
Fibroblastic Phase: b. Proliferation of fibroblasts
- accelerated laying down of collagen
- collagen matrix forms
Phases of Healing: 3.Maturation (remodeling phase)
- 3 weeks after injury
- Can last up to 2 years (majority 2 months)
- Granulation tissue replaced with Collagen fibers
- TYPE 3 collagen replaced with TYPE 1 collagen
Repair vs. Regeneration
Repair= tissues heal with a scar Regeneration = Actual tissue is replace (i.e. bone)
Fracture Healing: Phase I
Acute Phase: up to 1 week
- Hematoma forms= platelets (angiogensis)
- begins to develop fibrocartilage callus
Fracture Healing: Phase II
Repair/Regeration: up to 8-12 weeks
-Soft callus to hard callus: cartilage to bone occurs after week 3
Fracture Healing:
Phase III
Remodeling Phase: Resorption of callus
- as callus is removed trabecular bone lays down(may take years)
- Osteoblasts and Osteoclasts remodel the bone based on mechanical loading (Wolff’s Law)
Norepinephrine
causes Vasoconstriction; underlies “fight or flight” response
Enkephalins
Reduce pain perception by bonding to pain receptor sites
Endorphins
Morphine-like neurohormone; thought to increase pain threshold by bonding to pain receptor sites (generated by noxious stimuli)
Serotonin
Substance that causes local vasodilation and increase permeability of capillaries (generated by noxious stimuli)
Dorsal Nerve roots
Transmit:
- Sensory
- Afferent information
Ventral Nerve roots
Transmit:
- Motor
- Efferent information
Afferent Pathways: First order neuron
-connects to peripheral sensory receptor and projects info to DRG in SC. Synapses with cell body of second order neuron in DRG
Afferent Pathways: Second order neuron
cell body located in DRG
-crosses the midline and ascends to the thalamus
Afferent Pathways: Third order neuron
cell body in the thalamus and projects to cortex
Afferent Nerves (1st order)
- Aalpha(Ia and Ib): Large, thick myelin, fastest:Ia=muscle spindle; Ib=GTO
- Abeta: Large, thick myelin, fast = light touch, vibration, hair deflection
- Adelta: Small, Myelin, slow(fast pain) = Sharp pain, temp
- C: Smallest, unmyelin, slow pain = dull diffuse pain, intense pressure, extreme temp
Superficial Sensory Receptors
- Mechanoreceptors (pressure, skin stretch)
- Thermoreceptors
- Nociceptors: free nerve endings(pain)
Deep Sensory Receptors
- Proprioceptors: GTO, m. Spindle
- Nociceptors: Pain
- Mechanoreceptors: change in m length, tension
Paleospinothalamic Tract
“slow pain”
- Nociceptor
- 1st order neuron(C fiber) to laminae II and III of DRG horns: Substantia gelatinosa
- Synapses in dorsal horn and activates nociception-specific neurons in lamina I and II and becomes 2nd order neuron
Neospinothalamic Tract
“fast pain”: lasts as long as noxious stimuli
- Nociceptor
- 1st order neuron(Adelta) to DRG
- 2nd order neuron crosses and sends info to thalamus
- 3rd order neuron from thalamus to sensory cortex
Gate control Theory
- Located in Substantia gelatinosa (DRG II and III)
- Goal is to activate more Abeta fibers than C fibers to close gate
Descending Pain Modulation: Central Biasing theory and Endogenous Opiates Theory
-Stimulation of the PAG(midbrain) and NRM(pons/medulla) causes enkephalins and serotonin to inhib ascending neurons
Subjective Pain Assessment
- duration
- Freq
- Intensity
- Description
- Worse/Better
- Patterns
- Previous S&S
- Night Pain
Objective Pain Assessment
- Visual Analogue Scale: “1-10” with just a line instead
- Mcgill Pain Questionnaire: description of pain
- Pain Disability Index: 1-10 scale of disability on activities
Nagi’s Disablement Model
- Pathology: injury
- Impairment: Abnormality at site of injury
- Functional Limitations: limits in actions
- Disability: Limits in activities/roles
- Quality of Life: Health Related quality of life
Voltage
Amount of electrical pressure
Amplitude
The max distance that a pulse rises above or below the isoelectric baseline (flow)
Direct Current
- Uninterrupted, unidirectional flow of electrons
- Always cathode(neg) to anode(pos)
- Used for Iontophoresis: repels neg electrons to site of injury
Pulse duration
Horizontal distance of the shape of the pulse (pulse width)
Pulse Charge
the area within the waveform
Alternating Current
-Direction of current flow(amps) changes from positive to negative in a cyclical manner(no true pos or neg pole)
AC Freq vs. Cycle Duration
Frequency: cycles per second(Hz) or pulses/sec
Cycle duration: Inversely related to freq
Monophasic Current
- Unidirectional flow of electrons
- One phase per pulse
- depolarize nerves
- Create muscle contractions
Biphasic Currents
- Flow of electrons marked by periods of non-current flow
- each pulse has 2 phases (neg&pos)
Biphasic Symmetrical Current
- Comfortable for pt.
- Net charge of zero
- Neg to pos
- Use: NMES
Biphasic Asymmetrical: Unbalanced vs Balanced phases
Net Pos or Neg effect
- Unbalanced: 2 phases do not carry equal charges
- Use:NMES
- Balanced: 2 phases carry equal but not mirrored charges
- Use: TENS
Pulse Charge
- Measure of the number of electrons within a pulse(area in a waveform)
- Measured in MicroCoulombs
Pulse Frequency
- Number of events(pulses or cycles) per second
- Cycles/second (Hz)
Current Density
- Volts per square inch
- Inversely proportional to the size of electrode pad
Duty Cycle
Amount of time the current is flowing on as opposed to flowing off
-i.e. 10sec on/50 sec off
Proximity of Electrodes
Determine:
- Which tissue stimulated
- Depth of Stim
- Number of Parallel circuits
Selective Stim of Nerves
3 Factors to depolarize nerves:
- Diameter of nerve
- Sensory Abeta fibers
- Motor nerves
- Adelta and C: noxious - Depth of the nerve fiber in relation to the electrode
- Duration of the pulse or phase: Shorter pulse, more intensity that can be delivered
The Law of Dubois Reymond
- Sufficient Intensity: to cause depolarization of the cell membrane
- Steep enough ramp: rise must be rapid enough to prevent accommodation
- Duration Length: Duration length must be long enough in one direction that the nerve has time to depolarize
- Sufficient time for repolarization
Prevention of Accommodation
- Amp/Intensity
- Phase duration/Phase pulse
- Frequency
- Ramp
- Burst
E-Stim Uses
Muscle contraction: -Prevent atrophy(post surgery) -Neuromuscular re-education -Edema reductioin Pain control: Gate and descending pathway mod
Contraindications of E-Stim
- Cardiac dysfunction
- Pacemakers
- Pregnant
- Cancerous lesions
- Infected tissue
- Exposed implants
- Unstable fx
Iontophoresis
- Direct Current to drive neg or pos drug to patients skin/tissue
- Useful for acute epicondylitis
- Monopolar(dispersive pad)
- Quantity of ions delivered is the amount of charge delivered
- Dose = Current/Time
1. Dexamethasone(neg): inflammation
2. Lidocaine/dex or lido/epi (pos)= pain control
Sensory (High) Transcutaneous Electrical Nerve Stimulation(TENS):
Asymmetrical balanced biphasic current:
- Intensity= to contract then back off(sensory)
- Freq= 60-100 pps
- Pulse width=60-100pps
- Duration=as needed(all day)
- Onset Relief=less than 10 min
- Lasting relief=mins to hours
- Uses Gate Control
Motor(low) TENS
Asymmetrical balanced biphasic current:
- Amps=to muscle twitch
- Freq=2-4 pps
- Pulse width= 150-250 microseconds
- Duration=30 mins
- Onset=20-40 mins
- Lasting relief=hours
- Uses both Gate and Descending pathways
- Best for chronic pain
Brief-Intense(Noxious) TENS
Asymmetrical balanced biphasic current:
- Amps=painful muscle contractions
- Freq=Greater than 100pps
- Pulse width=300-1000 microseconds
- Duration=15-30 mins
- Onset= less than 15 mins
- Lasting=less than 30 mins
- Uses Endogenous Opiate mechanism
Interferential Current(IFC):
Two crossed channel high frequency currents to create a deep tissue stim:
- Freq=4000Hz(ch1) and 4080Hz(ch2)
- Beat frequency=80Hz
- Duration=15-30 mins
- Intensity=tolerable sensory or muscle twitch
Microcurrent Elecrtrical Stim(MENS)
Theory: works at cellular level to assist in healing and pain reduction
- flow=1-999 microamps
- Freq=0.1-1000Hz
- Duration=0.5-5000 microseconds
- Intensity=subsensory
- Duration=30mins to 2hrs
Muscle Re-Education
- Russian Carrier Frequency=2500-5000Hz
- Freq=30-60pps
- Intensity=Visible muscle contraction
- Ramp=1:5(20%) to 1:3(30%) to 1:2(50%
- Pt. contracts with machine
- Tx time=15-20 mins
- Russian tx Time= 10/50/10
E-Stim for M. Spasm parameters:
Electrode: bipolar, target motor or trigger points
- Pulse rate=50-60pps
- Intensity=visible contraction
- Duty cycle= 10sec on/10sec off
- Ramp= 1-2 sec on/ 1-2 off
- Duration= 10-20 mins
Motor-level Edema Parameters
- Gentle= 1-10pps
- No added pain= 30-50pps
- Intensity=visible contraction
- Agonsit 5-10 secs then antagonist 5-10 secs
HVPC(sensory) for Acute Edema
- Freq=120 pps
- Intensity= sensory, no contraction
- Polarity= cathode over injured tissue in bath
- Duration= 4x30mins with 60 mins rest intervals
Biphasic Parameters for Contraction
-Freq=1-200 pps
-Duration=20-300 microseconds
-Intrapulse=100 microseconds
-Intensity=Contraction
-Burst duty cycle=40-50%
-On/off duty cycle= 1:5, 1:3
Ramp=1-3 seconds
Ultrasound
- Converts electrical energy into acoustical energy
- Frequency: 1MHz-3MHz
Reverse piezoelectric effect
- As the AC reverses polarity, the Piezo crystal expands and contracts, producing US energy
- High frequency sounds waves that travels through tissues and is absorbed
Beam Profile
- Multiple waves emerge from the head
- Energy is uniform close to head the diverges as it moves away from the source
- Becomes less consistent; Spatial peak intensity = end of waveform
Beam Nonuniformity Ratio (BNR)
- The consistency of the US output
- Ratio between the highest intensity in an ultrasound beam and the output reported on the meter
- Lower ratio = more uniformity (1:1 = perfect; 8:1 = equals unsafe)
US FDA labeling requirements
- Output Frequency
- Effective Radiating Area (ERA: area of effective heat)
- BNR
- Beam profile
- Date of last service/calibration
US Absorption in tissues
- Tissues with higher protein density have a higher rate of absorption
- i.e. tendons, ligs, muscle and blood and fat absorb little US energy
- Cartilage and bone reflect
US Frequency
- Determines depth of treatment
- Depth inversely related to frequency
- 1MHz(4cm or more) deeper than 3MHz(2cm)
- 3MHz heats 3x faster but 1MHz heating effects last longer
US dosage(intensity)
- Watts/surface area (W/cm^2)
- Higher does means higher amount of sound energy delivered to tissues in less time
- common dosage = 1.5 w/^cm2 (>2.5-3 could cause tissue damage)
US Common Intensity settings
- 0.5-0.75 = knee, elbow, iliac crest, wrist, ac joint, ankle
- 0.75-1.0 = forearm shoulder, ant lower leg
- 1.0-1.5 = calf, upper arm, lateral leg
- 1.5-2.0 = thigh, butt
- 2.0-2.5 = thigh, butt on larger bodies
US thermal effects and Tx time
- Tissue must be increased greater than or equal to 4 degrees C
- temp increase per minute x time = degrees reached (3-4)
US Tx Area
- No greater than 2-3x the ERA
- Move sound head in slow manner to prevent hot spots (4cm per sec)
US coupling methods
- Direct coupling = with a water based gel or biofreeze; non-reflective material to increase viscosity
- Pad (bladder)
- Water immersion method
US thermal Effects
- Mild heating = 1 degree C results in increased metabolic activity, initiation of the inflammatory process
- Moderate heating = 2-3 degree C results in increase blood flow, decreased pain, spasms, and chronic inflammation
- Vigorous heating = 4 degree C results in improved viscoelastic properties of collagen
Non-Thermal US effects
- Pulsed US
- Due to Cavitation and Acoustic Microstreaming
Cavitation (2 kinds)
=Formation of gas filled bubbles that expand and compress, causing pressure changes in tissue fluids
- Stable cavitation = rhythmic contraction and expansion of gas bubbles; facilitates fluid movement and membrane transport (GOOD)
- Unstable cavitation = formation of bubbles at the low pressure part of the US cycle; results in bubble collapse and tissue damage (BAD)
Acoustical Microstreaming
- Unidirectional movement of fluids along the boundaries of cell membranes
- US causes interstitial fluids to flow and strike cell membranes
- Increases cell permeability to Na and Ca and function
Indications for Pulsed US
- Prior to stretching and manual therapy when pt has low ROM
- Scar tissue and joint contracture
- Indentifying stress Fxs
US Contraindications
- Acute
- Ischemic
- Circulatory problems
- DVT
- Anesthetic areas
- Spinal cord, heart, eyes, skull, genitals
- Infections
- Pacemaker
- Over pregnancy
- During menstruation
- Cancer
Phonophoresis
-US is used to deliver a medication by opening pathways to drive molecules into the tissues
Short Wave Diathermy
- Therapeutic generation of local heating by high frequency electromagnetic waves (radio waves)
- Continuous or pulsed
Advantages of Diathermy
- Thermal effects to US but effect deeper
- Heats larger area
- Doesnt reflect from bone so less likely to create hot spots
- Pulsed can create thermal effects as well, heat retained 3 x longer
Disadvantages of Diathermy
- Expensive
- Treat on pt at a time
- potential for burns
Pulsed SWDiathermy
- Heats tissues at depths of 3-5 cm
- Max increases 4-6 degrees C
SWD: 1. Induction field generators
- Places pt in electromagnetic field
- Magnetic waves are generated as electrical current is conducted through coiled wire
- Produce greatest heat within the muscle directly beneath the coil
SWD: 2. Capacitive Field Generators
- Body is actually placed in the electric field and is a part of the circuit
- Electrical signals sent through body which acts as a resistor
Traction Indications
- HNP
- Facet Impingement
- Facet hypomobility
- Degenerative disc disease
- Stenosis: lateral/Central
- Muscle spasm
Traction Contraindications
- Acute, except HNP
- Unstable spine (spondy)
- Fxs or dislocations
- RA patients
- Vertebral artery problems or vertigo
- Fused segments
- Pregnancy for lumbar
- Recent ab/thoracic surgery
- osteoporosis
- cancer
- local infections
Types of Traction
- Manual= more specific to a segment
- Positional= ideal for localizing a segment on one side
- Mechanical= 80-200lbs(1/2) for separation of lumbar
- Bed= ropes and pulleys
- Cottrell 90/90= increases posterior tilt with ropes (good for stenosis, not HNP)
- Inversion boots= increases BP
- Home doorway
Tx Duration/Frequency: Lumbar
- 50% body weight
- Increase 5-15 lbs per session
- Initial = 5-10mins
- Typical = 20-30 mins
- QD to TIW = 6-12 txs
Cervical Traction: Position and Force
-Mid C2-5: 10-20 deg
-Lower C5-7: 25-30 deg
Neutral to slight Ext = 0-5 deg
Max separation at approx 24 deg of flexion
-Begin at 8-10 lbs
-Do not exceed 30 lbs (2x weight of head)
-tx time: 5-15 minutes
Therapeutic Magnets
-Measured in Gauss(G) or telsa (T); 1T - 10,000G
-Pain relief around 300-5,000G
MRI= 15,000G
Intermittent Compression
-Mechanical pressure that encourages venous and lymphatic return from the extremities
- Circumferential: equal compression
- Sequential: increases distal to proximal
Intermittent Cold Compression
- Circumferential: most effective in acute phase to prevent inflammation
- Sequential: assists subacute/chronic by a pumping mechanism to get rid of wastes
Physiologic Effects of Compression
- Decreased capillary hydrostatic pressure
- Causes increased reabsorption of interstitial fluids by lymphatic system
Contraindications for Intermittent compression
- DVT
- Compartment syndromes
- Fx areas
- Heart failure
- Vascular diseases
- Pulmonary edema
- Dermatitis
Set up and Applications for Int compression
- Compression should be above DBP of athlete
- May increase compression up to 20mmHg below SBP
- Elevate extremity
- Duty cycle = 3:1
- Tx time = 20-30 mins
- temp= 50-60 degrees
Superficial Heat
-Heating of the skin and underlying tissues to depths less than 2cm
Local Effects of Superficial Heat
- Each 1.8 deg F rise in skin temp = Cellular metabolic rate increases 13%
- Using heat too soon after an injury causes cell damage via hypoxia
Vascular Effects of SH
Increases:
- Delivery of O2
- Delivery of WBC’s
- Delivery of chemical mediators
- Capillary permeability
- lymphatic/venous return
- removal of metabolic wastes
Mechanism of Heat Dissipation
- First 5 mins = Rapid increase of skin temp through conduction
- After 7-10 mins = temp gradient evens out, vasodilation there is enough cool blood sent to area to slow down temp
- After 20 mins= vessels which were max vasodilator begin to constrict: Rebound Vasoconstriction
Rebound Vasoconstriction
- Body’s response to save the underlying tissue by sacrificing the superficial layers
- Mottling = warning sign that skin temp are increasing too quickly
Indications of Superficial Heat
- Subacute/chronic inflammation, pain, and muscle spasms
- Decreased ROM
- Reduction of joint contractures
- Hematoma Resolution
Contraindications of Superficial Heat
- Acute injuries
- Impaired circulation
- Poor thermal regulation
- Anesthetic areas
- Tumors
- infections
- Elderly; children
Moist Heat Packs
- Rapid increase of skin surface temp
- Average temp rise will be 3.8 deg C at a depth of 1cm
- Use 5-6 layers
- Tx time = 20-30 mins
Warm Whirlpools
- The greater the body area the cooler the water (avoid hyperthermia)
- Assist in muscular relaxation
- NEVER exceed 115 deg F
- Tx Time = 20-30 mins
Contrast Baths
- Stimulates milking effect
- Subacute/chronic indications
- Hot to cold ratio = 3:1
- End on appropriate treatment
- Does not affect subcutaneous tissue greater than 1cm
- Warm: 105-110 F
- Cold: 50-60 F
- Tx time: 20 min (4-5 cycles)
Paraffin Bath
-7 parts wax, 1 part mineral oil
-Hand and wrist tx
-Temp btw 118-126 F(UE), 113-121 F(LE)
Increases articular temps up to 6.3 F
-Best for Chronic inflammatory
-Tx time: 15-20 min
Cryotherapy
- Application of cold modalities that have a temp range btw 32-65 deg F
- Heat is REMOVED from the body and absorbed by the cold
Primary Use of Cryotherapy
- To decrease Metabolic rate of tissue (reduces O2 and secondary hypoxia)
- Also control pain by stimulating Abeta fibers, reducing muscles spasms and control edema
Indications for Cryotherapy
- Acute injury
- Acute or chronic pain
- Post-surgical pain
- small burns
- Acute or chronic muscle spasms
- Neuralgia
- Spasticity 2nd to CNS disorders
Contraindications for Cryotherapy
- Cold allergy
- Cardiac and respiratory problems
- Circulatory problems
- Open wounds
- Anesthetic skin
- Raynaud’s phenomenon -blood vessel spasms
- Prolonged application over superficial nerves
HBOT
- Patient is placed in an environment that is 2-3 x atmospheric absolute (ATA)
- 1ATA = sea level
- 1ATA increase = 33 ft
- High O2 cause vasoconstriction, decreasing blood flow at least 20%
- O2 content in HBOT is increased 6.6mL of O2 per 100mL of blood
- Best for ACUTE
HBOT Indications
- Inflammatory conditions
- Sprains/strains
- DOMS
- Muscle soreness
- wounds
- tendon lacerations
- Crush injuries
- compartment syndromes
HBOT Contraindications
- Ear infections
- Pregnancy
- Sinusitis
- Asthma
- Fever
- Seizure disorders
- Eye infections
- pneumothorax
Continuous Passive Motion (CPM)
- Goal is to prevent or decrease negative effects of immobilization
- Promotes more natural alignment of collagen fibers
- Gaines ROM
- Assists with apprehension to ROM
- Decreases need of manipulation following TKA
- Assists in joint nutrition
- Assits in venous/lymphatic return
CPM Indications
- TKA
- ACL reconstruction
- Osteochondral repair
- Chondromalacia surgery
- Tendon lacerations
CPM Contraindications
- Unstable fxs
- Uncontrolled infections
CPM Tx Time
1 hour 3x per day
-6-8 hours a day post surgery
Biofeedback
- The use of instrumentation to bring physiological events to conscious awareness
- Objectively measures the process
- Converts what is being measured into feedback that optimizes the desired effect
EMG Biofeedback
-Electrical activity of muscle recorded and transformed into visual and auditory signals
=3 electrodes positioned over muscle
-1 Point of reference
-2 active over muscle
Raw EMG process
- Filtered: removal of noise = anything above or below 80-250Hz(muscle activity)
- Amplification: Microvolt range to millivolt range
- Rectification: All deflections from isoelectric line are made + or -
- Integration: smoothes the signal, allowing area of curve to be quantified
- Transduced
Biofeedback Indications
-Muscle re-education
-Relaxation
-ROM = must be able to do activity w/out amplifying pain through ROM
=Goal: decrease pain/increase function
Biofeedback Contraindications
- Patient prohibited from moving joint
- Isometric contractions are contraindicated
Infrared Lamps
- Wavelength range: 780-12,500nm
- Used to dry open wounds and sedate superficial sensory nerves
- Radiant modality: an electrical current passes through a carbon or tungsten filament
Infrared: Luminous
- WL = 780-1,500 nm
- Thermal effects: 5 go 10 mm deep
Infrared: Nonluminous
- WL = 1,500 - 12,500 nm
- Thermal effects: <2mm
- More superficial
- Energy formed by metal coil
UV Light
- WL = 180 - 400 nm
- Heats body’s tissue for either tissue destruction or therapeutic effects
Types of UV
- UV-A: erthema w/o pigmentation
- UV-B: erythema w/o pigmentation
- UV-C: kills bacteria; rarely causes burns/blisters
UV Contraindications
- Sunlight Sensitivity
- Meds or foods that increase sunlight sensitivity
- Hyperthyroidism
LASER
Light Amplification by Stimulated Emission of Radiation
Laser Light Therapy
- Emits photons (light energy) in very specific regions of the electromagnetic spectrum
- Do not have a thermal effect on tissue
- 10 milliwatts
Low Level Laser Therapy
-Increases ATP production in the mitochondria of the cell
LLLT Indications
- Wounds
- Mild joint pain
- Epicondylitis
- CTS
- Plantar fasciitis
Soft Tissue Mobilization Indications
- Pain
- Edema
- Muscle Spasm
- Trigger points
- Adhesions/scar tissue
- Anxiety
- Decreased ROM
Soft Tissue Mobilization Contraindications
- Acute inflammation
- Infection
- Skin conditions
- DVT
- Tissue irritability
- Malignancies
Effleurage
- Most versatile and frequently used
- Stroking
- Enhances venous
Petrissage
- Lifting, kneading, wringing, and rolling tissues
- Targets Muscles
- Separates muscle fiber, fascia, and scar tissue
Tapotement
- Percussion; tapping or pounding
- Stimulates muscular and systemic relaxation
- Desensitization of irritated nerve endings
Deep Transverse Friction
- Friction, cross-friction, DTF, deep massage, deep transverse/friction massage
- Pain relief via gate control/endogenous opiate release
- collagen re-orientation
- Prevention of adhesions
- Increases local blood perfusion
