soft tissue mobilization

Question 1

what are the 3 pain mechanisms

Answer 1

nociceptive. (mechanical) , neuropathic, and central sensitization

Question 2

describe nociceptive pain

Answer 2

inflammatory mediators>increased sensitivity post-injury
upregulation of new and existing channels

Question 3

describe neuropathic pain

Answer 3

spread of nerve sensitivity due to
-change in axoplasmic flow, immune activation, intraneural edema, progressive demyelination, upregulation of ion

Question 4

describe central sensitization. (4 key factors)

Answer 4

changing the sensory processing in the CNS:
impaired descending inhibition with overacting facilitatory pathways, temporal summation of second pain, and long-term potentiation of pain synapses

Question 5

define smudging and how it might result in pain

Answer 5

After an injury, a pt may stop using a body segment, the disuse causes a less detailed mental map. When the person goes to perform an action, the body doesn’t recognize it well so it elicits pain as a protection mechanism

Question 6

Define muscle guarding and potential causes:

Answer 6

increased resting activity caused by protective response, neurologic dysfunction, or emotional distress (fear, anxiety, stress)

Question 7

What is a trigger point and what is the difference between active and latent ones?

Answer 7

it’s a hyperirritable area of tissue chemo and mechanoreceptors within a muscle
active: produces pain at rest or motion whereas latent produces pain in response to palpation

Question 8

Describe Travell’s Energy deficit hypothesis

Answer 8

After an injury, the inflammation cascade starts> cytokines and lactic acid buildup> metabolites lower pH and increase muscle excitability> this constant slight tension can snowball into a trigger point

Question 9

what are the 3 benefits of manual therapy?

Answer 9

pain reduction
increase in soft tissue extensibility
improved quality of motion in a restricted area

Question 10

what are 3 indications for manual therapy for mechanical/MSK pain?

Answer 10

pain reported w/ activity that goes away at rest
pain provoked by specific actions
pain altered by change in position

Question 11

List 10 absolute contraindications for manual therapy

Answer 11

infection + cellulitis
acute circulatory conditions
cancer
open wound
recent fracture
hematoma
hypersensitivity
advanced diabetes (uncontrolled) but consider sensation perception otherwise
RA (flared)

Question 12

describe the primary indication and technique for transverse friction massage.

Answer 12

tendonitis/tendonosis

Move perpendicular to lesion at a pressure that matches pt tolerance, perform 2-3 cycles/sec rhythmically for 5-10 min
discontinue once healed or after 3 sessions w/o improvement

Question 13

what are the proposed effects of transverse friction massage?

Answer 13

traumatic hyperemia (increased blood flow> flush out irritants and decrease edema pressure)
pain relief via gate ctrl theory
assists collagen alignment

Question 14

describe the primary indication and technique for scar massage.

Answer 14

used for scars to stim appropriate collagen alignment, maintain mobility and desensitize scars

Move perpendicular to the lesion at w/ moderate pressure (less than TFM), perform 2-3 cycles/sec rhythmically for 5-10 min

Question 15

name the 4 types of myofascial release strokes

Answer 15

J stroke
vertical stroke
transverse stroke
cross-hands technique

Question 16

what are the 3 types of fascia?

Answer 16

superficial, deep(around muscle, bone, vessels, organs), visceral (encases CNS)

Question 17

what is the purpose behind myofascial release? How do you decide what stroke to use?

Answer 17

if trauma or structural abnormalities produce tension in the fascia (causing postural changes), these effects can be treated by manually releasing said tension via gently sustained pressure

strokes are interchangeable and what you use will be based on the pt

Question 18

describe the primary indication and technique for ischemic compression.

Answer 18

pressure directly applied to trigger points w/ intention of reactive hyperemia (consequential blood flow) that breaks the pain cycle

hold @ level of pt tolerance for 10-60 sec; repeat if pain/referred pain lessens and adjust or switch techniques as needed.

Question 19

what are the 3 types of deep massage/STM?

Answer 19

Effleurage
Petrissage
Strumming

Question 20

Describe effleurage technique

Answer 20

Think Swedish massage w/ distal to proximal strokes;
more gentle and superficial than others, a possible mechanism in assisting lymphatic and venous drainage and reducing tension
-limited research

Question 21

Describe petrissage purpose. What are the 4 techniques?

Answer 21

assist lymphatic return and fluid interchange
increase mobility of underlying tissue

kneading ,pulling/lifting, wringing, rolling

Question 22

describe the primary indication and technique for retrograde massage.

Answer 22

typically used to reduce edema via pushing fluid back into the lymphatic system moving. distal to proximal

Question 23

Describe a few of the indications and techniques for instrument assisted. soft tissue mobilization (IASTM)

Answer 23

many the same as the manual ones with special emphasis on scar tissue, pain, and limited ROM

technique: 20-120 sec at an angle between 30 and 60 degrees
with appropriate fluid intake before AND after

Question 24

list the 4 relative contraindications for manual therapy

Answer 24

joint effusion/inflammation, RA (not flared), osteoporosis, steroid or anticoagulant therapy

Question 25

what are 2 proposed mechanisms for IASTM's improvement of ROM?

Answer 25

1.treating adhesion>improve extensibility 2. mechanical stress on fascia> stimulates intrafascial mechanoreceptors and changes tension in tissue-related motor units

Question 26

what are the 8 absolute contraindications for IASTM?

Answer 26

infection open wound unhealed sutures blood clots hemotoma uncontrolled HTN myositis ossificans unstable fractures