Soft Tissue Flashcards
Skin is high in:
Elastin
Skeletal Mm Connective Tissue Sheaths must be able to:
- broaden during contraction of muscle
- elongate during lengthening of muscle
Nerve Sheaths allow:
- nerves to glide in central and peripheral NS
- if they can’t move=impairet efferent/afferent signals
Fascia
- Slightly mobile sheath of connective tissue
- supports all soft tissue and also attached to bone
- limited blood supply
- good tensile strength (many directions)
Fascia can affect:
- balance
- neurological status
Components of Fascia
-connective tissue and ground substance
Categories of Connective Tissue
- Dense Regular
- Dense Irregular
- Loose Irregular
Dense Regular
- parallel fibers, resist unidirectional stress
- not well hydrated or vascularized
Dense Irregular
- non-parallel; resist multidirectional stress
- stop extremes of motion
- areas of high mechanical stress
Loose Irregular
- most elastic
- greatest amount of ground substance per unit area
- good tensile strength to multi-directional stresses
- maintains space between structures for motion
- most potential for change through soft tissue mobs
Dense Regular Examples
-Ex. lig/tendons
Dense Irregular Examples
-Ex. dermis, joint capsules, periosteum, fascial sheaths, aponeuroses
Loose Irregular Examples
-Ex. SubQ, some deep fascia, muscle/nerve sheaths, supportive framework for lymph system and internal organs
Cells of Connective Tissue
- fibroblasts
- histiocytes
- macrophages
- mast cells
- plasma cells
- lymphocytes, eosinophils, leukocytes
Fibroblasts
-create collagen, elastin, reticulin and ground substance
Collagen’s dominant role:
- maintain structural integrity of various tissues
- provide tensile strength to tissues
Elastin’s dominant role:
-determines patterns of distention and recoil in most organs (skin, lungs, blood vessels and connective tissue)
Histiocytes
-phagocytic cells that become active during inflammatory conditions
Macrophages
-Cells that debride an area after trauma
Mast Cells
cells that secrete histamine (vasodilator) and heparin (anticoagulant)
Plasma Cells
-produce antibodies
Lymphocytes, Eosinophils, Leukocytes
-present during infectious disease
Gound Substance
- the midium in which connective tissue fibers lie
- maintain distance between connective tissue fibers (prevent adhesions)
-made up of mucopolysaccharides (proteoglycans and GAGs) which provide lubrication for connective tissue gliding and diffuses nutrients and waste products
Connective tissue fibers
-collagen, elastin, reticulin
Repair Process
- Inflammatory phase
- regeneration/repair phase
- remodeling/maturation phase
Inflammatory phase
- 4-6 days post injury
- histamine/bradykinin released
- phagocytosis by macrophages for cellular debris
- re-vascularization starts
- fibrin reestablish tensile strength of tissue
Regeneration/Repair Phase
- 5 days to 10-12 weeks
- collagen laid in random arrangement
- area covered by highly vascularized fibrous connective tissue
Remodeling/Maturation Phase
- 3 weeks to 12 months
- fibrous connective tissue changes
- collagen fibers align due to tension
- more organized tissue (increased tensile strength
- cross linkage between collagen fibers lead to formation of adhesions
- collagen fibers contract–>decreased motion of scar tissue
Myofascial Dysfunction
-malfunction of fascial system due to trauma, posture, inflammation that causes binding down of fascia resulting in abnormal pressures on nerves, muscle, bones, organs which create pain or malfunction throughout the body
Trigger Points may be a manifestation of:
myofascial dysfunction
Trigger Points
- discrete, focal, hyperirritable spots located in a taut band of skeletal muscle
- produce pain locally
- referred pain pattern
Tender Point
-pain at site of palpation only
Fibromyalgia
- pre-menopausal women with diffuse pain
- disturbed sleep patterns
- at least 11/18 standardized tender points
Fibromyalgia Tender points
- occiput at subocc Mm insertions
- low cervical at ant intertransferse spaces C5-C7
- trap at midpoint of upper border
- supraspin at origin above scap spine near med border
- 2nd rib at 2nd costochondral junction just lat to junctions on upper surfaces
- lateral epicondyle of humerus
- glut region in upper outer quadrant of buttocks in ant fold of Mm
- Gr troch post to trochanteric prominence
- knees at med fat pad prox to jt line
Fibromyalgia Treatment
- aerobic exercise (low load)
- address sleep disturbances
- teach pt self-management (explain condition, minimize stress to soft tissue, time management, assistive aides, mod to work/home, relaxation)
-soft tissue not big help here
Myofascial Pain Syndrome
- more specific findings than fibromyalgia
- pain limited to certain region (not specific structure)
- disturbed sleep, trigger points
- distortion of proprioception
- fatigue, strain, stress, trauma may stimulate condition
Mechanical Dysfunction
- myofascial dysfunction linked to specific cause like repetitive strain or reflex sympathetic dystrophy
- sof tissue mob more beneficial here
Myofascial Pathologies
- Fibromyalgia
- Myofascial Pain Syndrome
- Mechanical Dysfunction
Muscle Play
-assess soft tissue mobility of Mm surrounding symptomatic area with muscle bending
Skin Gliding
- at area of soft tissue restriction
- to determine direction in which most limited
- apply pressure through tips of thumbs; keep one still and use other thumb to pull away to end range
- do same all around 360*
- should feel springy soft end feel; dysfunction=hard end feel
Technique for inflam and repair stages
-broadening and shortening (exam and treatment)
Technique for remodeling stage
- lengthening
- (can still continue broadening and shortening)
Effleurage
-AKA: Stroking \:TYPES: -Palmar effleurage -knuckling -2-3 finger effleurage -fulling
Petrissage
-AKA: Kneading TYPES -hand kneading -finger kneading -alternating 2-hand kneading
Massage Indications
13
- amputations
- arthritis
- burns
- bursitis
- myositis
- facial paralysis
- inflammation
- insomnia
- pain
- postural dysfunction
- prolonged bedrest
- scar tissue/contracture
- edema (non-obstructive
Massage Counterindications
9
- obstructive edema
- Active malignancy
- thrombophlebitis
- hematoma
- non-union fractures
- post op areas
- around lacerations
- active communicable diseases
- mental disturbances
Massage and myofascial mobilization both cause:
- increased circulation of blood/lymphatic fluid
- effect on autonomic and CNS
Fibromyalgia points
18 points
