Soft Tissue Flashcards
What are the two types of musculoskeletal injuries?
Primary and secondary
What are causes of primary soft tissue injuries?
Can be self-inflicted, caused by another individual or entity, or caused by the environment.
Acute, Chronic, Acute on chronic
What are causes of secondary soft tissue injuries?
Essentially the inflammatory response that occurs with the primary injury
What are healing complications for soft tissue injuries?
Abnormalities may occur and can be due to such complications as: infection, compromised circulation, and neuropathy
What are the phases of healing?
Inflammatory, proliferative, remodeling
What occurs in inflammatory phase?
Pain at rest, with active motion, and when specific stress is applied to the injured structure.
Pain if severe enough can result in muscle guarding and loss of function
How long does inflammatory phase last?
1-6 days
What occurs in proliferative phase?
Capillary growth, granulation tissue formation, fibroblast proliferation with collagen synthesis and increased macrophage and mast cell activity
How long does proliferative phase last?
5-15 days or up to 10 weeks
What is the remodeling phase?
involves conversion of the initial healing tissue to scar tissue
What is length of remodeling phase?
lengthy phase of contraction
tissue remodeling and increasing tensile strength in the wound lasts for up to a year
What are common causes for persistent chronic inflammatory response?
infectious agents, persistent viruses, hypertrophic scarring, poor blood supply, edema, repeated direct trauma, excessive tension at wound site, hypersensitivity reactions
What are reasons for soft tissue dysfunction?
adaptive shortening, loss of tissue extensibility, decrease gliding of adjacent tissues, adhesions
Hypermobility, mm imbalance, altered ROM and neural tension
What are factors causing soft tissue dysfunction?
trauma, immobilization, scar tissue, poor lymphatic drainage, metabolic dysfunctions, hypertonicity
What are precautions/contraindications to soft tissue mobilization?
Contraindications: active malignancy, non-union fractures, obstructive edema, systemic or local infection, inflammatory skin condition, acute RA, osteomyelitis, aneurysm, thrombophlebitis, open wound, site of active hemorrhage, skin hypersensitivity
Precautions: anticoagulant therapy, mental disturbances, RA
What are principles of soft tissue treatment?
Patient/client must be relaxed Tell them what to expect Use techniques in combination for increased effectiveness Consider active participation of patient Compliment treatment with HEP Assess and Reassess
What are guidelines for treatment in acute stage?
use shortening/broadening techniques with active or passive pumping
What are guidelines for treatment in sub acute stage?
shortening/broadening techniques, begin lengthening just short of resistance, pumping with increased vigor
What are guidelines for treatment in remodeling stage?
muscle stretching, increase mobility to full range
What are techniques of Hoffa massage?
Stroke in direction of muscle
strokes are light and superficial
Effleurage or stroking, pettrisage or kneading, percussion, vibration
What are goals of Hoffa massage?
Increase blood flow, relaxation
When would you initiate Hoffa Massage?
Used in initiate soft tissue intervention that could lead to further technique/interventions that are directed to the underlying tissues
What is skin gliding technique?
technique for petrissage
Can be treated with J-stroke
What is skin gliding used for?
assess movement of skin around focal point
assess quality of movement and end feel
Find site of adhesion with scar
Can get lengthening or broadening
What is J stroke?
Used to increase muscle/skin mobility
Stroke helps lengthening
J helps broadining
What is J stroke technique?
2-3 fingers or knuckles
Follow muscle in parallel direction then ‘hook’ restriction using the J stroke
What is a myofascial stroking technique?
Counterstrain applied with heel of hand while a stroke in shape of a J is applied in direction of the restriction
What is use of skin rolling?
Effective over bony prominences
Helps with lengthening and broadening
What is the skin rolling technique?
Try to gently loosen fascia when you find an area of restriction by moving tissue superior/inferior/and medial/lateral
restricted areas may look like orange peel
What is purpose of longitudinal stroking?
Enables muscle elongation and reduction of tension
Lengthening
Petrissage technique
What is technique of longitudinal stroking?
thumbs, fingers, elbow, or knuckles
Performed on muscle belly or where 2 muscles meet
Moderate to deep pressure along the muscle fibers (parallel)
What is cross fiber/cross friction massage good for?
bring inflammation to area for healing, breaking adhesions, promote proper laying down of collagen fibers and decrease pain
assist in broadening, not lengthening
What is technique for friction massage?
move transverse or perpendicular to muscle fibers and deep
usually on tendons
What is purpose of muscle bending?
used to evaluate muscle mobility in relationship to surrounding structures
allows muscle belly to broaden/lengthen
Technique for muscle bending?
muscle is grasped with both hands, pushing with the thumbs while pulling downward with the fingers
What is goal of trigger point release?
relax, release of trigger point, increase blood flow and stretch
What is treatment for trigger point?
treatment: ischemic pressure or trigger point release
hold for 1-5 minutes per point
What are theories behind trigger point release?
hyperactivity or hyperirritable spot within a taut muscle or fascia local activation of mechanical trigger point causing muscle twitch reproduces pain (referred or local)
what is goal of myofascial release?
decrease fascial restrictions and improve healing (emotionally). treat whole person
What are indications for use of myofascial release?
areas of tethered tissue resulting in adaptive shortening and muscle weakness
patient complains of areas of tightness and weakness, fatigue
What is one negative aspect of myofascial release?
muscles may return to previous dysfunctional state after healing due to stress
What is the science behind craniosacral therapy?
Series of pulses in body that ebb and flow
High rates of these pulses could indicate possible dysfunction, reason for fatigue and low immune response
What causes fluctuations of pulses in body?
changes in cerebral spinal fluid flow and pressure
What does craniosacral do to try and fix the fluctuations?
rhythmic oscillations are used to promote relaxation
What are three options for movement therapy?
PNF, Feldenkrais, Alexander
What is PNF?
use of diagonal patterns with a rotational component
stronger muscles facilitate weaker muscles
What are two other techniques PNF can be used with?
rhythmic stabilization and isometric contractions at different points in the ROM
What is the Feldenkrais method?
mvmt abnormalities develop with age, trauma, and posture changes
gentle sequencing of movement, circular movements, guided movements into pain free positions to break habitual patterns
What is the Alexander method?
improve posture and body mechanics through conscious learning
position of head and neck is primary control
What are 3 steps of Alexander treatment?
awareness of habit
inhibition of habit
conscious control of habit; integrate new one that is not dysfunctional
What is strain counterstrain?
positional release
indirect treatment
good for acute or irritable conditions
What is rolfing?
usually a series of 10 treatments to fascia to balance the body
What is positional release?
Utilizes a facilitating force (compression) to enhance the effect of the position
based on strain counterstrain
What is active release technique?
therapist applies pressure over adhesion in the tissue and the patient is asked to actively move the body part to elongate the muscle from shortening position (3-5 times/session)
