Soft Tissue

Question 1

4 Types of basic tissue types

Answer 1

Muscle
nerve
epithelial
Connective tissue
- Bone
- Cartilage
- Blood Cells/ blood forming tissues
- Adipose
- Regular (tendons and ligaments)
- Irregular (Dense and loose Fascia) * focus of STM

Question 2

All connective tissues are of…

Answer 2

Mesodermal origin

Question 3

Connective tissue structures are

Answer 3

interconnected and continuous

Question 4

Layers of fascia

Answer 4

Abdomen: 3 layers
Pelvis: 5 layers

Question 5

David’s Law

Answer 5

Arrangement and specialization of connective tissues are dependent upon the stress that is placed upon them

Question 7

Regular CT tendon

Answer 7

Regular parallel bundles of collagen
formed from connective tissue within muscle
Made to withstand longitudinal forces not perpendicular stresses
*golden gate bridge

Question 8

Regular CT ligament

Answer 8

Spiral and oblique arrangement of collagen
Tough and unyielding

Question 9

Fascia (Irregular CT- dense and loose)

Answer 9

Withstands 3 dimensional stresses (form without skeleton)
Irregular arrangement of collagen and elastin fibers
Sheaths are continuous and interweaving
Superficial: thinner and more delicate allowing skin mobility
Deeper: thicker and stronger separating and supporting surrounding structures
Parallel fibers and sheaths: arranged at angles to each other to provide greater strength and extensibility
*sweater weave restriction
Space between fibers that allows movement is a “Functional Joint” -Gratz
Allows interconnection and support
Serves to attenuate and absorb shock throughout system
Enhances continuity of motion and creates smooth spiral/diagonal motion
Protects against spread of infection
Responsible for metabolite exchange in lymph system

Question 10

Skeletal Muscle

Answer 10

Collagenous fascial sheaths surround muscle fibers (endomysium), fiber bundles (Perimysium), and the whole muscle (Epimysium)
10% of muscle mass is fascia which forms the tendon

Question 11

Multifasicular Peripheral nerve

Answer 11

30-70% of a peripheral nerve is connective tissue (greatest amounts in compression zones)
Protects the neural components from damage
Nerves are the most blood thirsty

Question 12

Muscle play

Answer 12

Normal accessory mobility of a muscle
- surrounding muscles
- Neurovascular structures
- Bony structures
Lost in a dysfunctional state altering the functional capacity of those structures
*slide and glide of muscle in all directions

Question 13

Composition of fascia

Answer 13

Fibers
-Fibroblasts
-Fibers
Collagen
-Most prolific loose connective tissue fiber
-Type 1 found in tendons, ligaments, fascia, and capsules
Elastin Fibers
Nonfiber
-Extracellular Matrix

Question 14

Collagen

Answer 14

High tensile strength (3-8% creep) 50% of the strength of bone-does not move much in single fibers but lots of extensibility when in groups
half life of 300-600 (500) days (whole connective system is turned over in about 3.5 years)
Amino acids bond by covalent bonds (proline, Lysine, Glysine)- process- fibrogenesis
*cotton twisting to become strong triple helix

Question 15

Collagen Health

Answer 15

Regular stress (exercise)
Nutrition
Dependent on Vitamin C
Steroids’ impair collagen production
- Steroid inhalers/puffers for exercise induced asthma
Impaired in nerve root impingement target tissue (double crush syndrome)

Question 16

Elastin Fibers

Answer 16

Composed of the protein elastin
hydrophobic
double twist helix
Stretches 150-200%, returns with perfect recoil
Primarily in skin, cartilage, aorta, LCT, Lig Flavum

Question 17

Fibroblasts

Answer 17

Most prolific cellular structure
Synthesize all connective tissue fibers
Form hydrostatic covalent bonds to strengthen structures

Question 18

Fibroblasts (Fluid Elements)

Answer 18

Extracellular matrix (aka ground substance): Non-fibrous element of the connective tissue matrix
-viscous gel formed by fibroblasts
-comprised of:
Long chains of water and carbohydrate molecules (water is 60-70% of connective tissue content)
Proteoglycans
-Hydration of matrix
-Stabilizes collagen network
-Resists compressive forces
Glycosaminoglycans (cotton ball)

Question 19

Mobility of ground substance decrease with

Answer 19

Age
Immobility
Atrophy of muscles
Trauma

Question 20

hysteresis

Question 21

Importance of viscoelastic properties

Answer 21

Go in fast=push back
slowly sink into tissues=able to go deeper

Question 22

Tensegrity

Answer 22

Tensional integrity

Question 23

Centers, Sequences, and spirals

Question 24

Mechanical forces

Answer 24

Effect to electrical, cellular, and tissue remodeling dynamics

Question 25

Connective tissue healing
-reaction phase
-inflammatory stage
-proliferation phase
-maturation phase

Answer 25

reaction phase- 10 minutes
inflammatory stage- 10 minutes to several weeks
proliferation phase- 5 days after
maturation phase- begins at 2-3 weeks

Question 26

Scar tissue healing stages

Answer 26

3-21 days: high production of scar tissue (influence scar tissue to lay down appropriately)
6-8 weeks: Tensile strength is poor (don’t use force)
14 weeks: scar elongation poor- best at 3 weeks (harder to change scar tissue, more likely to be working on the extracellular matrix than scar tissue to allow the tissue to move more mobile)
6 mo-1 yr: 90-100% of tensile strength returns

Question 27

Effects of immobilization on Connective tissue

Answer 27

Loss of glycosaminoglycans (30-40%)
Increased rate of degeneration of mature collagen fibers
Increased proliferation of new, immature collagen fibers
Los of critical fiber distance leading to inter fiber cross linking of new fibers with existing fibers at intercept points

Question 28

Soft tissue compensations

Answer 28

Functional excursion
Accessory play
Altered end feel
Tearing
Abnormal tone
Swelling

Question 29

Soft tissue mobilization definition

Answer 29

A systematic management system for the identification and specific treatment of soft tissue dysfunction
-Emphasis is on the enhancement of functional capacity, as well as symptom reduction

Question 30

Possible effects of soft tissue mobilization

Answer 30

-Mechanical (mob of scar tissue and cross links)
-Viscoelastic (mechanical elongation)
-Hydration (lubrication and mob. of excess fluids)
-Ground substance normalization
-Neuroreflexive (neuromyofascial changes)
-Electrochemical (normalization of chemical balance)

Question 31

Specificity of soft tissue techniques

Answer 31

Directed into central aspects of identified dysfunctions
- location
- depth
- direction
- angle (from Jeremy)

Question 32

Soft tissue dysfunctions

Answer 32

Skin and superficial fascia
Myofascial
-muscle play
-muscle tone
-functional excursion
Neurovascular Mobility

Question 33

Muscle tone

Answer 33

How they are holding tension in their body