Soft tissue assessment and management Flashcards
Adapted Cook and Pardum’s model
if you load normal tissue with appropriate stress you will get tissue adaptations that will lead to alterations of the tissue and will make it more robust. However, if you use to much exercise, the excessive stress starts to cause derogations to the tissue causing pain
soft tissue aetiology- overuse and misuse
overuse is performing a task with a frequency that does not allow the tissues to recover and symptoms may be due to lack of muscle strength or endurance. Misuse- using improper form equipment which may put abnormal stress on tissue
soft tissue aetiology- abuse and disue
abuse is having excessive force going through normal tissue. Disuse occurs after taking period of time without training resulting in decondition or altered neuromuscular control
soft tissue aetiology- intrinsic and extrinsic
intrinsic- inside the body- age, genetic predisposition, coordination, previous rehab
extrinsic-outside the body- training levels, environmental factors (temp, altitude), equipment
soft tissue symptoms for
muscle tear, ligament tear, tendon disorder, all have pain, sudden onset of pain during activity, swelling, inability to carry on with function, cardinal signs of inflammation
body chart- aggs- things that would stress muscle/ ligament that will cause it to elongate, ligament- could be ROM of exercises
what happens if you overload a tendon
gradual onset (RC may be throwing), aggs- things that stress the tendon, eases- relaxes tendon
what is the limitations of PRICE
tissue need stress to heal, early activity can lead to a better healing, early mobilization improves likelihood of better outcomes
what does POLICE stand for
protection, optimal loading, ice, compression ,elevations
Mechanotherapy- loading tissue
contracting muscle, stressing tendon, if joint/bone- would use weight bearing
Mechanotherapy- stimulates cellular response
produce more tissue- make tissue more robust and resilient
Mechanotherapy- tissue adapts, tissue improve structure, tissue able to maintain homeostasis-
adapts- if we keep loading the tissue- switch cell on repeatedly, structures- better able to do its function, homeostasis- less pain
the healing process of soft tissue
remodelling phase- formation of intra and extra molecular cross linkages between collagen fibres. Aim of treatment is to restore viscoelastic properties by promoting hysteresis, creep and plastic deformation
how can you Ax muscle and tendon tissue
AROM/PROM- differential diagnosis, length- normal length, strength- oxford scale- through full ROM, isometric- looking for pain provation, palp for tenderness- feel for lesion, power, motor control/ patterning- proprioception components
how an you assess ligaments
length- end feel and pain response- Accessory test
soft tissue treatment techniques
specific soft tissue mobilization- SSTM- lengthen and mobilize tissue, deep transverse friction- pushing down into muscles and push side to side- need to be careful you don’t rub the skim, muscle lengthening- stretching, trigger point (Trp) myofascial release, EXERCISE
SSTM
mobilises the tissue, may do it at same time as you lengthen tissue, amy be moving to sideways or push into muscles- accessory, the aim is to reduce pain alloing pain free function, not as effective as exercises- less force and therefore less stimulus
SSTM- alter regeneration and remodelling phase
pain relief, collagen remodelling and ground substance, affects visco-elastic properties, pain in theory- less pain
SSTM- physiological SSTM
self stretch, therapist stretch, oscillate (stretch to end range) using maitlands grading or static hold
SSTM- accessory SSTM
direct pressure, bowing- pushing it sideways or inwards, transverse mobilisation
SSTM- combined SSTM
this technique is for later stage or less irritable (low SIN) and uses a physiological and accessory technique combined
deep transverse friction
applies force perpendicular to fibres orientation, bering about numbing 5-8 mins and then deeper friction than 10 reps- stimulate small degree of damage
how does deep transverse friction work
break down adhesions, increased blood supply- traumatic hyperemia, activates cells in this area, helps re-orientate fibres- repair tissue in more robust way
contraindications and precautions to DTFM and SSTM
open wounds, clotting disorder, DVT, skin infections, active inflammation, growth plates, skin disorders, possible Ca, foreign body/implant, fragile skin condition, RhA, spondyloarthropathies, bursitis, neural tissue
graded mobilisation
determined by SIN factor- high SIN low dose, low SIN- more dose, position in range, guide dose- early, middle, later
graded mobilization- grades
grade 1- small amplitude, grade 2- larger amplitude but not into resistance, grade 3- large amplitude- but foes into resistance, grade 4- small amplitude but movement goes into resistance, grade 1 ad 2 limited by pain, when do they start to get uncomfortable- pain?
what are the grades determined by
position in the range, relationship to resistance and pain, amplitude
