Soft Tissue Mob Techniques Flashcards
Transverse Friction (TF) Massage/Cross friction technique
- begin with light pressure
- use thumb or reinforced finger
- move skin over sit of lesion back and forth in direction perpendicular to normal orientation of fibers
- ensure patient’s skin moves with the clinician’s fingers to prevent blistering
TF Massage:
Pressure, Speed, Duration, and Discontinue
- pressure: pt tolerance
- speed: 2-3 cycles per second in a rhythmical manner
- duration: 5-10 minutes
- discontinue: once healed or if no improvement after 3 sessions
Proposed effects of TF massage: Traumatic hyperemia:
- increases flow of blood and lymph which in turn removes the chemical irritant by products of inflammation
- increased BF reduces venous congestion thus decreasing edema and pressure on pain sensitive structures
Pain relief from TF massage:
- stimulates type 1 and type 2 mechanoreceptors, producing presynaptic anesthesia
- Gate control theory
Caution of TF massage
patient may feel an exacerbation of symptoms following first 2-3 sessions
How does TF massage assist with collagen?
it assists with orientation of the collage fibers
Indications for TF massage
acute, subacute, or chronic ligament, tendon, or muscle injuries
Contraindications for TF massage
hematomas, open skin, frail skin
TF massage minimally supported for _______ for tendinitis, but lack of support more due to low quality of evidence and lack of RCTs
pain relief
-conclusions are limited by the small sample size of the includes RCTs
Scar massage technique
similar technique to TF massage except not as much pressure
Purpose of Scar massage:
to stimulate collagen to law down scar tissue appropriately, maintain scar mobility, and desensitize scars as needed
Caution of scar massages
ensure incision is clean, dry, intact prior to performing
_______ provides strength to the fascia, _____ gives it its elastic properties, and the ability to absorb compressive forces of movement
Collagen
elastin
Three types of fascia:
superficial
deep
visceral
superficial fascia
lying directly below the dermis
deep fascia
surrounding and infusing with muscle, bone, nerve, blood vessels, and organs to the cellular level
visceral fascia
deepest layer comprising the dura of the craniosacral system, which encases the CNS
Myofascial release is based on the principle that..
trauma or structural abnormalities creates inappropriate fascial strain, because of an inability of the deep fascia to absorb or distribute forces
Strains to deep fascia results in _________ of the fascia; these fascial restrictions eventually lead to ________ impairments
slow tightening
postural
Myofascial release purpose
apply gentle sustained pressure to deep fascia to release restrictions and restore normal pain-free function
Myofascial release after care:
patient may experience muscle soreness initially after treatment
What are the Myofascial release strokes?
- J stroke
- Vertical stroke
- Transverse stroke
- Cross-hands technique
Ischemic compression technique pressure and duration
- pressure: applied to center of trigger point
- duration: 10-60 seconds
If patient reports lessening of local and referred pain, clinical can repeat treatment, if pain does not change may need to..
adjust pressure or switch technique
Theory behind ischemic compression
sustained pressure deprives trigger point of oxygen; temporary blockage of circulation–> reactive hyperemia that in turn reduces overall energy crisis and breaks pain cycle
Soft tissue mobilization (STM) definition:
systematic, therapeutic, and functional stroking and kneading of the body
Studies show deep massage/STM increases __________ and skin __________ of the massaged area via vasodilation
circulation
temperature
Type of STM:
- effleurage
- petrissage
- strumming
Effleurage “general massage”
- superficial
- used in initial assessment of superficial tissues
- gentle stroking applied to muscle
- possible mechanism in assisting venous and lymphatic drainage and reducing tension
- limited evidence
Effleurage technique
- strokes distal to proximal along the line of the body part being massage
- employ whole body movement and firm contact
Ischemic compression pressure: Ask pt how it feels halfway through:
- getting better –>
- getting worse –>
- same –>
- getting better –> maintain or increase pressure
- getting worse –> let off a bit
- same –> maintain
Petrissage
- assist venous and lymphatic return
- assist fluid interchange
- increase mobility of underlying tissue
Petrissage techniques
- kneading
- pulling/lifting
- wringing
- rolling
Petrissage–Kneading technique
compressed against underlying structures
- press down with palm of hand and do little circles
- upstroke –> pressure
- downstroke–> let off
Petrissage– Pulling/Lifting
compressed then lifted and squeezed
Petrissage– Wringing
tissues are lifted and squeezed with alternative hand pressure
Petrissage– Rolling
tissues are listed and rolled between fingers and thumbs (skin or muscle)
Strumming
using fingers- perpendicular to fibers, back and forth with maintained pressure
Retrograde massage
- used to reduce edema
- with sustained pressure go distally to proximally
- intention is to push the fluid back towards the lymphatic system and assist with edema control
3 techniques of functional massage
- soft tissue without motion
- soft tissue with passive pumping
- soft tissue with active pumping
Soft tissue without motion
- Hands stay in contact with skin while hands and skin move together over muscle
- Direction of force parallel to muscle fibers and total stroke time is 5-7 seconds
Soft tissue with passive pumping
- Place muscle in shortened position and with one hand place tension on muscle parallel to muscle fibers
- Other hand passively lengthens muscle and simultaneously gradually releases pressure from hand in contact with muscle
Soft tissue with active pumping
- Place muscle in lengthened position and with one hand place tension on muscle fibers perpendicular to muscle fibers
- Other hand guides limb as patient actively shortens muscle, as muscle shortens gradually release pressure from hand in contact with muscle
What should you do when doing any STM?
- drape patient
- use lotion
- pin fascia/skin in opposite direction
- appropriate, graded level of intensity and depth
- communicate with patient
- elicit feedback from the patient often
Special Precautions for Vulnerable Patient
- Patients may have difficulty understanding soft tissue mobilization intention and what entails
- Suffered previous trauma related to touch
- BE SENSITIVE to non-verbal communication and response
