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Soft Tissue > Modulated Soft Tissue Techniques > Flashcards

Modulated Soft Tissue Techniques Flashcards

1
Q

Influencing Soft Tissue

A

Reduce tension/tightness

  • Improve ROM
  • Reduce pain

Stimulate low tone muscle

  • Facilitate motor firing
  • Improve motor control

Assist in healing

  • Move O2 and nutrients to the area of inflammation
  • Move cellular debris out of the area of inflammation
  • Edema reduction
  • “laying down new collagen fibers”
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2
Q

Effects of Soft Tissue Manipulation

A

Primary Effects:

  • Mechanical
  • Physiological
  • Psychological
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3
Q

Mechanical Effects

A

Movement of:

  • Blood
  • Lymph
  • Lung Secretions
  • Chronic Edema
  • Intestinal Contents

Mobilization of:

  • Muscle Fibers
  • Tendons
  • Tendon Sheaths
  • Ligaments
  • Joint Capsule
  • Skin and subcutaneous -tissue
  • Fascia
  • Scar tissue/Adhesions
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4
Q

Physiological Effects

A

Increased blood and lymph flow
Increased flow of nutrients
Removal of waste products and metabolites
Stimulation of the healing process
Resolution of chronic edema and hematomas
Pain relief
Increased extensibility of connective tissue
Increased joint movement
Facilitation of muscle activity
Stimulation of autonomic functions
Stimulation of visceral functions
Promotion of local and general relaxation

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5
Q

Psychological Effects

A 
Physical relaxation
Relief of anxiety and tension (stress)
Reduce fear
Stimulation of physical activity
Pain relief
General feeling of well-being (wellness)
Sexual arousal
General faith in the laying on of hands
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6
Q

Therapeutic Massage

A

the use of a variety of manual techniques designed to promote stress relief and relaxation, mobilize various structures, relieve pain and swelling, prevent deformity and promote functional independence in a person who has a specific health problem

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7
Q

Recreational Massage

A

use of a variety of manual techniques designed to relieve stress, promote relaxation and general wellness in a person who has no definable health problem

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8
Q

Hand Preparation

A

Nails: reasonable short, well rounded

Washed

Warm

Express gentleness, firmness, strength

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9
Q

Mediums

A
  • Always best to start with less

- Be careful of cross-contamination

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10
Q

Medium: Powder

A

allows deep work without any slipping on the skin

Ex) Chalk, Starch, boracic,
Baby powder

-Avoid heavily scented powders

Caution: powder gets on everything, may cause a fall, inhaling

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11
Q

Medium: Cream

A

tend to be absorbed by the skin

Ex) Lanolin, Nivea, Cocoa butter, Bee’s wax

-Caution: allergies and too much cream prevents firm grasp

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12
Q

Medium: Oil

A

skin and subcutaneous tissues

Ex) Baby oil, mineral oil, Vitamin E, Olive oil

-Caution: deep strokes are harder and can run into clothing

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13
Q

Medium: Soap and Water

A
  • Effective if the skin is scaly, dry or dirty
  • Use enough soap to create some soapsuds
  • Medicated or antibacterial soap is best
  • Stroking most useful technique
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14
Q

Positioning and Draping

A

Position

  • Comfortable for the patient as well as ease of access for the therapist
  • Remember your own body mechanics

Support
-Pillows, bolsters, towel rolls

Warmth

  • any part not being massaged should be covered when possible
  • Preserve modesty but at same time, body parts being massaged should be accessible and exposed
  • Most versatile material is a clean, folded sheet NOT the patient’s own clothing
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15
Q

Draping Position

A
  • Back open drape
  • Front open drape
  • Side open drape
  • LE drape
  • UE and neck drape
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16
Q

Essential Components of Good Technique

A

Comfortable support and positioning of patients

PT keeps hands flexible, relaxed and fit contour of body being massage

Correct rate of movement

Maintain an even rhythm

Regulate pressure according to type of stroke, type of tissue and purpose of treatment

Keep good body mechanics

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17
Q

Components of Bad Technique

A

Patient sore for multiple days post massage

Bruising

Patient not able to relax

Bony landmark massages

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18
Q

General Relaxation

A

state of the entire person

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19
Q

Local relaxation

A

state of the body part being treated

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20
Q

Factors that inhibit relaxation

A

Psychological factors

Strange or untidy surroundings

Odors, noise, cold

Inadequate support, draping, or positioning

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21
Q

Directions of the Stroke

A

Centripetal: toward the heart
-In the direction of venous and lymphatic flow

Centrifugal: away from the heart
-In the direction of arterial flow

Related to anatomical structure

Right angles to the tissue = cross friction

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22
Q

Pressure of the Stroke

A

Depends upon the purpose of the stroke and patient’s physical problems

Difficulty to evaluate accurately, but effect depends on the regulation of the pressure and the stimulation it produces

Varies based on patient

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23
Q

Superficial Pressure

A
  • produces mild stimulation, induces relaxation and diminishes pain
  • Best to use at beginning and end of a massage or as a transition between some strokes
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24
Q

Deep Pressure

A

-strong stimulation, increases tension and pain.

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25
Q

Rate and Rhythm of the Stroke

A

General rule: strokes should be slow, gentle and rhythmic

Slow strokes are relaxing, 6-7 inches per second in the larger areas

Faster strokes increase tension

Percussion strokes are required to be rapid

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26
Q

Duration and Frequency of massage

A

Therapeutic massage: 15-20 min

Lymphatic massage: 15 min or longer

Full-body massage: 45 min or longer

Cross friction massage: 10 – 12 min or longer

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27
Q

Classifications of Massage Strokes

A

-Stroking

-Petrissage
(Kneading, Pick-up, Wringing, Skin Rolling)

-Tapotement
(Hacking, clapping, beating, pounding)

  • Vibration and Shaking
  • Deep Friction
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28
Q

Stroking

A

-movement performed with the entire palmar surface of one or both hands moving in any direction on the surface of the body

29
Q

Purpose of Stroking

A

Begin and/or finish a massage sequence

Applying medium

Helps patient relax and become accustomed to therapist’s hands

Slow = promotes relaxation
Fast = stimulating

Provides information to the therapist about the patient’s tissues

Help relieve muscle spasm and indirectly pain

Also used for joining sequences of other strokes

30
Q

Stroke Pattern

A

Movement can be in any direction

One direction at a time

Move along a line parallel to the long axis of the body or across the long axis

Can be diagonal

Continuous movement
Rhythmic movement

One or both hands

31
Q

Effects of Stroking

A

Produced through direct mechanical input

Significant relaxation when performed slowly
(Sedative effect)

Stimulating effect on sensory nerve endings when performed quickly
(Invigorating effect)

Dilation of arterioles in the deeper tissues when applies slow/deep

32
Q

Indications of Stroking

A

Help relieve or reduce the effects of:

Pain (acute or chronic)
Muscle Spasm (acute or chronic)
Superficial scar tissue (skin)
Flatulence, constipation or abdominal discomfort
Move with the direction of the bowel
Right, up, over, down on left
Insomnia
33
Q

Contraindications to Stroking

A

Large open areas (burns, wounds) - Always
Gross edema (danger of splitting the skin with the strokes) - Always
Cancer, infections, lacerations - Always
Marked varicosities if damage to vein wall might occur - Usually
Precautions - Rare
Extremely hairy regions of the body
Hyperesthisia (sensitive / ticklish)

34
Q

Effleurage

A

Slow, stroking movement performed with increasing pressure in the direction of flow in the veins and lymph vessels

Centripetal movements

Has a definite pause

35
Q

Purpose of Effleurage

A

Move contents of superficial veins and lymph vessels

Facilitating circulation

Used between manipulations to mobilize tissue fluids

Finish off a massage sequence

36
Q

Basic Technique and Direction of Effleurage

A

Direction of venous and lymphatic flow atarting with fingertip then palmar surface of hand

Stroke is directed toward the lymph glands

Distal to proximal

Hands return to starting position for next stroke

Ex) Arm and Back = go towards axilla
Knee = go towards posterior

37
Q

Rate and Depth of Effleurage

A

Rate:

  • Slow
  • 6-7 inches per second
  • Even rhythm

Depth

  • Pressure gradually increases
  • Blood and lymph pushed through veins and lymph channels
  • Pause at end of each stroke, allows valves in vessels to close
38
Q

Effects of Effleurage

A

Blood flow moved toward heart

Lymph flow moved toward glands to accelerate healing

Congestion in capillaries is relieved which stimulates circulation and facilitates healing

Increase mobility of skin and superficial tissues

Dilation of superficial arterioles – axon reflex

Relief of pain by stimulation of large-diameter mechanoreceptors

39
Q

Therapeutic Use of Effleurage

A

Accustom patient and therapist to the intervention

Follow up the deeper strokes (friction, kneading) and enhance absorption of waste products

Sub acute and chronic stages of inflammation to promote absorption of inflammation byproducts

Relieve pain and promote relaxation

40
Q

Indications of Effleurage

A 
Chronic edema
(Especially in extremities)
Chronic pain
Chronic muscle spasm
Superficial scar tissue
41
Q

Contraindications of Effleurage

A

Same for stroking

Add:
Chronic swelling in the lower limb associated with congestive heart failure – Usually
Other heart conditions in which lower limb edema occurs - Usually

42
Q

Petrissage

A

Pressure or kneading massage

Firm pressure applied to tissues

Mobilize deep muscle tissue or skin and subcutaneous tissues

Four types of strokes
Kneading
Picking up
Wringing 
Skin rolling
43
Q

Petrissage: Kneading

A

Alternately compress and release muscles and tissue

Circular motion

Purpose:

  • Mechanical action to affect deep tissue
  • Mobilize muscle fibers to lengthen and glide over other muscles
  • Promote normal function
44
Q

Kneading Basic Technique

A

Direction of movement is circular, constant pressure (light to heavy)

Movement of hands occurs during relaxation phase

Can use several parts of one or both hands, fingers, or thumb

2 phases:
-Pressure phase the hand and the skin move together on the deeper structures
-Release phase they glide smoothly to an adjacent area
Then repeat!

45
Q

Kneading Rate and Depth

A

Rate:

  • Slow
  • 3-4 seconds to complete a movement
  • Lower rate if finger/thumb pads
  • Duration: 20 – 60 seconds

Depth:

  • Significant pressure on tissues
  • Varies based on structures you are working on
  • Not harmful pressure
46
Q

Kneading Technique

A

Compression kneading: palmar kneading, classic stroke, entire palmar surface of the hand

A: pressure applied during ½ the circle and relaxation the other half
B: progression of hand movement along the trunk
C: progression of hand movement along the leg, either side of limb

47
Q

Other Types of Kneading

A 
Squeeze kneading
Finger pad kneading 
Thumb pad kneading
Reinforced kneading
Knuckle kneading

Pressure: light to moderate
Direction: circular or elliptical
Rate: 0.5 – 2 seconds per cycle
Duration: 0 – 20 seconds duration

48
Q

Squeeze Kneading

A
  • Tissues pressed upward and lifted away from the underlying tissues, squeezed, then allowed to relax
  • Lumbrical grip
  • Usually performed on larger muscles
  • Thumb and finger pads for smaller muscles
49
Q

Finger Pad Kneading

A
  • aka Digital Kneading
  • Basic palmar kneading but performed with one or more finger pads.
  • Can work in phase or out of phase down each side
  • Best for small to medium areas of irregular shape
50
Q

Thumb Pad Kneading

A

-Same as with finger pads

-Useful for fusiform muscles
(Wrist flexors or extensors
Anterior tibial muscles)

-Useful for small areas
Hand
Foot
Face

51
Q

Reinforced Kneading

A
  • Two-handed technique
  • One hand reinforces the other
  • Basic palmar kneading technique with one hand on top of the other
  • Useful for lumbar region or larger patients
  • Typically palm but can be performed with thumbs or finger pads
52
Q

Knuckle Kneading

A

-Useful for small areas where greater depth of pressure is required
Sole of the foot

  • Uses the dorsal surface of middle or proximal phalanges
  • Closed fist
  • Same circular motions
  • Clockwise is easier
53
Q

Petrissage: Picking Up

A
  • Grasping and squeezes muscles while simultaneously lifting them away from the underlying tissues then releasing them
  • Performed in a circular motion
  • Same direction as the fibers (long axis)
  • Purpose: Mobilizing individual or groups of muscles through a mechanical action on the fibers.
  • Also facilitates normal joint and limb function
54
Q

Picking Up Basic technique

A
  • Single hand or double hand
  • Tissue is picked up with whole hand with the thumb abducted
  • Lumbrical grip
  • Squeezed during first half, released during second half.
  • Upward and inward in circular motion
55
Q

Picking Up Rate and Depth

A

Rate:

  • Slow, 1-3 seconds per cycle
  • Duration: 20 – 60 seconds
  • Continuous and rhythmic
  • Whole muscle belly treated

Depth:

  • Deep and hard pressure required to pick up tissue
  • Not as deep as compression kneading
56
Q

Petrissage: C-Kneading

A
  • Variation of Picking-up

- Muscle tissue is bent in to a “C”

57
Q

Petrissage: Wringing

A

Tissues are lifted with both hands then compressed alternately between the fingers and thumb of opposite hands

Purpose: mobilizing individual muscles or groups of muscles

Increase muscle mobility due to “twisting” motion imparted on tissues resulting in significant mechanical action on the fibers

Facilitate normal joint and limb function

58
Q

Wringing Basic Technique

A 
Hands along the middle of the muscle with thumbs abducted
Tissues grasped with both hands
Lifted
Wrung out
Then relaxed

Movement is up and down the long axis of the muscle

59
Q

Wringning Rate and Depth

A

Rate:

  • Slow, 1-3 seconds per cycle of compression/release
  • Duration: 20 – 60 seconds or more
  • 4-6 inches per second
  • Even rhythm

Depth:

  • Deep stroke
  • Sufficient pressure to lift muscle and compress it
  • Do not pinch the tissue
60
Q

Petrissage: Skin Rolling

A

Skin and subcutaneous tissue are rolled over deeper structures

Purpose:

  • Mobilize skin and subcutaneous tissues
  • Improve circulation in area
  • Evaluate areas of discomfort (Osteopathic)
61
Q

Skin Rolling Basic Technique

A

Hands side by side

Extended fingers draw skin towards the thumb lifting a fold of skin between fingers and thumbs

“Crawl” fingers along while thumbs trail lifting skin a long the way

Do not use a medium!

62
Q

Skin Rolling Rate and Depth

A

Rate:

  • Slow
  • 4-6in per second
  • do not pinch the tissues

Depth:

  • Skin and subcutaneous tissues
  • Cannot be done on all body parts
63
Q

Primary Effects of Petrissage: Circulation

A
  • Relieves congestion in small capillary beds
  • Stimulates flow of lymphatic tissue
  • Vasodilation in the skin
64
Q

Primary Effects of Petrissage: Muscles

A
  • Increases blood supply
  • Decreases metabolic waste products
  • Relaxes muscle and decreases pain
  • Can improve scar tissue mobility
  • Promotes normal joint and limb function
65
Q

Effects of Petrissage: Skin and Subcutaneous tissue

A
  • Increase blood supply
  • Decrease inflammation
  • Promotes elasticity

May see a reactive hyperemia with this stroke

66
Q

Therapeutic Use of Petrissage

A 
Facilitate deep and superficial circulation
Mobilize muscle contractures
Mobilize scar tissue
Help resolve chronic edema
Relieve muscle pain and fatigue
Promote relaxation
67
Q

Contraindications of Petrissage

A

-Acute trauma – Always
(Use Effleurage)

  • Muscles that are known to be torn - Always
  • Skin diseases such as acute dermatitis, psoriasis or other infectious skin diseases - Usually
  • Damage to blood vessels
  • Hyper or hypotonic limbs - Usually
  • Cancer in or near area being treated - Always
  • Bacterial infections in or near area being treated - Always
68
Q

How to start a massage?

A

1) Ask about allergies first!

2) Stroking
- Superficial to deep

3) Efflurage
- Supericial to deep

4) Petrisage
(Kneading, picking up, wringing, skin rolling)

5) Efflurage
6) Stroking
7) Tap!

Soft Tissue (8 decks)

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