soft tissue mobilization Flashcards
what are the 3 pain mechanisms
nociceptive. (mechanical) , neuropathic, and central sensitization
describe nociceptive pain
inflammatory mediators>increased sensitivity post-injury
upregulation of new and existing channels
describe neuropathic pain
spread of nerve sensitivity due to
-change in axoplasmic flow, immune activation, intraneural edema, progressive demyelination, upregulation of ion
describe central sensitization. (4 key factors)
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
define smudging and how it might result in pain
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
Define muscle guarding and potential causes:
increased resting activity caused by protective response, neurologic dysfunction, or emotional distress (fear, anxiety, stress)
What is a trigger point and what is the difference between active and latent ones?
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
Describe Travell’s Energy deficit hypothesis
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
what are the 3 benefits of manual therapy?
pain reduction
increase in soft tissue extensibility
improved quality of motion in a restricted area
what are 3 indications for manual therapy for mechanical/MSK pain?
pain reported w/ activity that goes away at rest
pain provoked by specific actions
pain altered by change in position
List 10 absolute contraindications for manual therapy
infection + cellulitis
acute circulatory conditions
cancer
open wound
recent fracture
hematoma
hypersensitivity
advanced diabetes (uncontrolled) but consider sensation perception otherwise
RA (flared)
describe the primary indication and technique for transverse friction massage.
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
what are the proposed effects of transverse friction massage?
traumatic hyperemia (increased blood flow> flush out irritants and decrease edema pressure)
pain relief via gate ctrl theory
assists collagen alignment
describe the primary indication and technique for scar massage.
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
name the 4 types of myofascial release strokes
J stroke
vertical stroke
transverse stroke
cross-hands technique
what are the 3 types of fascia?
superficial, deep(around muscle, bone, vessels, organs), visceral (encases CNS)
what is the purpose behind myofascial release? How do you decide what stroke to use?
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
describe the primary indication and technique for ischemic compression.
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.
what are the 3 types of deep massage/STM?
Effleurage
Petrissage
Strumming
Describe effleurage technique
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
Describe petrissage purpose. What are the 4 techniques?
assist lymphatic return and fluid interchange
increase mobility of underlying tissue
kneading ,pulling/lifting, wringing, rolling
describe the primary indication and technique for retrograde massage.
typically used to reduce edema via pushing fluid back into the lymphatic system moving. distal to proximal
Describe a few of the indications and techniques for instrument assisted. soft tissue mobilization (IASTM)
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
list the 4 relative contraindications for manual therapy
joint effusion/inflammation, RA (not flared), osteoporosis, steroid or anticoagulant therapy
what are 2 proposed mechanisms for IASTM’s improvement of ROM?
1.treating adhesion>improve extensibility
2. mechanical stress on fascia> stimulates intrafascial mechanoreceptors and changes tension in tissue-related motor units
what are the 8 absolute contraindications for IASTM?
infection
open wound
unhealed sutures
blood clots
hemotoma
uncontrolled HTN
myositis ossificans
unstable fractures
