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Physical Agents > Soft tissue mobilization > Flashcards

Soft tissue mobilization Flashcards

1
Q

Gel-to-sol model

A
  • Connective tissue is a colloidal substance
  • thixotropy
    • heat or pressure changes ground substances from a dense gel to a more liquid state
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2
Q

Piezoelectric model

A
  • Piezo (pressure) electricity exists in crystals
  • CT behaves like a crystal
  • fibroblast and fibroclast activity influenced by charge
    • reticular crystal structure with simmetric disposition of positive and negative electric charges
    • tetragonal structure (orthorombic) crystalles (dipoles) are with electric oriented charges
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3
Q

Stress strain curve

A

Viscoelastic properties of tissue

  • Viscosity: ability to resist flow
  • elasticity: ability to rebound from deformation
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4
Q

Stress strain curve: toe region

A

represents settling of the structure being tested, includes taking up slack

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5
Q

Stress strain curve: elastic zone

A

deformation within elastic group is reversible

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6
Q

Stress strain curve: plastic zone

A

usually results in permanent deformation

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7
Q

Stress strain curve: neck

A

after attaining ultimate stress the tissue begins to fail

* initally microfailure, tissues narrow (necking)

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8
Q

Stress strain curve: failure point

A

sudden decrease in stress while strain continues to rise

- decrease means that substance of the material has began to fail

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9
Q

Stress/Strain:Loading/ unloading

A
  • discrepancy: during unloading the stress is lower for any given strain than during loading
  • difference is called hysteresis represents energy lost during test
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10
Q

Stress/Strain: repeated loading

A

-stress/strain curve looks identical yet starts at the new length

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11
Q

Stress/Strain: creep

A

apply constant load to a structure and it lengthens over time
-greater length achieved with longer duration and less load

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12
Q

Stress/Strain: hysteresis

A
  • heat generated by mechanically loading structures

- increase in temp can affect mechanical properties of a structure

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13
Q

Stress/Strain: effects of speed

A

most substances stiffer with higher loading rates, will fail at higher stresses and lower strains (tear paper or tape quick)

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14
Q

Stress/Strain: effects of temp

A
  • most substances less stiff at higher temps, will fail at higher strain and lower stress
  • tissues can be heated to easier induce plastic elongation, or cooled to be more brittle and easier to tear
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15
Q

Response of myofascial tissue to immobilization

A

Loss of ground substance

  • glycosaminoglycans (GAG) and water
  • loss of interfiber lubrication
  • loss of interfiber distance
  • results in new cross links that adhere to adjacent collagen fibers
    • half life of collagen is 300-500 days half life of ground substance is 1.7-7 days
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16
Q

Traumatized vs untraumatized CT

A

Nontraumatized
- results in fibrosis
Traumatized
- results in scar tissue formation and contracture

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17
Q

Does the biomechanical model fit what we see in the clinic?

A
  • Permanent elongation of collagen fibers requires a force to achieve 3-8% fiber elongation will result in fiber tearing and inflammation
  • 1-1.5% elongation occurs after 80 minutes of continuous straining without fiber tearing
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18
Q

Muscle spindle type 1a receptors

A
  • within muscle parallel to muscle fibers
  • response to muscle stretch
  • reduction in tone of antagonist, increased tone in agonist
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19
Q

Golgi type 1b receptors

A
  • Musculotendonous junctions, attachment sites of aponeuroses, ligaments of peripheral joints, joint capsules
  • response to GTO= muscular contraction
  • response to GEO= too strong stretch only
  • tonus decrease in associated motor units
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20
Q

Pacini and paciniform type II receptors

A
  • myotendonous junctions, deep layers of joint capsules, spinal ligaments
  • respond to rapid pressure changes and vibration
  • Proprioceptive feedback for movement control
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21
Q

Ruffini type II receptors

A
  • Ligaments of peripheral joints, dura mater, outer layers of jt capsules
  • respond to sustained pressure, tangential forces ( lateral stretches)
  • inhibition of sympathetic activity
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22
Q

Interstitial type III and type IV receptors (50% high threshold, 50% low threshold)

A
  • most abundant receptor type
  • found almost everywhere
  • respond to rapid as well as sustained pressure changes; HPT, LPT
  • changes on vasodilation, plasma extravasation
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23
Q

Mechanoreceptors and local fluid dynamics: interstitial (type III & IV)

A
  • changes in vasodilation leading to changes in fascial arteriole and capillary pressure, plasma extravasation
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24
Q

Mechanoreceptors and local fluid dynamics: ruffini (type II)

A

inhibition of sympathetic activity

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25
Q

Mechanoreceptors and changes in hypothalamic tuning

A

Stimulation of interstitial mechanoreceptors will result in:

  • increases in vagal tone
  • trophotropic tuning of hypothalamus leading to more global neuromuscular, emotional, cortical & endocrine changes associated with relaxation
26
Q

Fascia capable of spontaneous contraction??

A

Lumbodorsal fascia-study on fresh cadavers
- performed repeated dynamic and static traction loading
-confirmed concepts of creep, hysteresis, and stress relaxation
-also found ligament contraction> when repeatedly stretch & held at a constant length tissue increased its resistance
Fascia cruris in humans with electron photomicroscopy study:
- smooth muscle cells embedded within collagen fibers
- intrafascial capillaries, autonomic nerves and sensory endings
-Concluded- ANS regulated fascial pre-tension

27
Q

Myofibroblasts

A
  • formed from fibroblasts
  • contain smooth muscle actin fibers
  • can actively contract
  • seen in Dupuytren’s contractures, RA, early wound healing
  • Also seen in healthy skin, spleen, uterus, ovaries, circulatory vessels and periodontal ligaments
28
Q

Types of soft tissue mobilization

A
  • Passive stretching
  • non-thrust joint manipulation
  • proprioceptive neuromuscular facilitation
  • myofascial release
  • trigger point release
  • spray and stretch
  • Active release (ART)
  • transverse friction massage
  • tool assisted soft tissue mob (ASTYM, graston, augmented soft tissue mob)
  • strain counterstrain
29
Q

Myofasical release

A

Purpose:
-to relieve soft tissue from abnormal grip of tight fascia
Background:
- fascia: CT that surrounds all bodily tissue ( muscle, tendon, nerves, bone, organ etc)
-composed primarily of collagen with some elastic fibers
-fascial restrictions will limit movement of underlying tissue

30
Q

Myofascial release fixed techniques

A
  • localize the restriction
  • move into direction of restriction
  • progress from superficial to deep
  • tissues stretched gently until a resistance to further stretch is felt
  • hold stretch position until soft tissue is felt to relax; this is the release
  • stretch further to take up the slack into a deeper restriction
  • continue until no further stretch is tolerated
31
Q

Myofascial release fixed technique examples

A
  • Cranial base release

- pec major release

32
Q

Myofasical release research lacking

A
  • one study looked at several combos of interventions for treating myofascial pain and trigger points and found no clear cut best alternative
  • other study did leg pull vs contract relax to inc hip flexion ROM and contract relax was found to be more effective than leg pull
33
Q

Myofasical release trigger point release techniques

A

apply progressive pressure to the TP

  • 30 sec to 2 mins
  • superficial to deep
  • flat vs pincer palpation
34
Q

Myofasical release trigger point release techniques: myofascial stretching

A
  • Place muscle at end range
  • while exhaling allow muscle to realx and elongate
  • hold new position during inhalation
  • repeat exhalation holding 20-45 sec
  • allow muscle to relax rather than be stretched
  • must avoid positive stretch sign PSS
35
Q

Myofascial release: spray and stretch technique

A
  • Used to deactivate gamma spindle response
  • uses vapocoolant spray
  • technique
  • pt relaxed, muscle in slight tension
  • spray bottle- 12 to 18 inches above skin
  • spray at 30 degree angle to skin
  • spray from above TP into RPP area
  • spray in parallel sweeps covering muscle
  • apply gentle stretch to elongate muscle
  • repeat 3 times
36
Q

Myofascial release: active release technique

A
  • Pin muscle to be elongated
  • move into lengthened position
  • active vs passive functional mvmt patterns
    • direct technique: move into restriction
    • indirect technique: move away from restriction
37
Q

Patient and therapist position

A
  • Efficiency
  • pillows
  • use of BW, weight shifting, and lever arms to maximize effect
38
Q

Occiput release

A

-Patient: supine
- PT: place fingertips on occipital bone
-tech: move laterally to medially along occiput bony contour layer technique sup to deep, may move med to lateral but less commonly restricted
FMP: nodding, head rotation toward and away
Use: improves OA nodding, rotation, for headaches, everyone with forward head

39
Q

Cervical lamina release

A

pt: supine
PT: fingertips on C-spine lamina
Technique: move proximal to distal along cervical spine to release restrictions
-FMP: nodding, head rotation toward to relax and away to stretch
-Use: improves all cervical motions

40
Q

Upper trap/levator scapulae release

A
  • pt: supine
  • PT: standing at pts head one hand webspace prox to pts AC or carpals on spine of scapula medially, other hand contact occiput and C2
  • Technique: apply inferior force to scapula to stabilize UT or LS. other hand rotates head passively away to stretch
  • FMP: rotate head away
  • Use: improves UT and LS mobility
41
Q

Subscapularis release

A
  • pt: supine
  • PT: stands next to pt one hand uses either fist or digit 2-3 on subscapularis other hand grips distal humerus
  • tech: while stabalizing scapula from abduction passively (or actively) elevate pts UE (ER>IR)
  • use: improves UE elevation, ER, subscapularis flexibility
42
Q

Piriformis release

A
  • pt: prone, knee flexed to 90 degrees
  • PT: standing on involved side, place PIP of index finger (PIP/DIP flexed) over muscle, other hand grasps distal tibia
  • tech: apply slow and progressive deeper pressure on most tender part of piriformis, may wind or unwind, oscillate, LE into IR/ER, using assisting hand
  • Use: improves hip IR, tx piriformis syndrome
43
Q

Friction massage effect musculoskeletal structure of:

A
  • ligaments
  • tendons
  • muscle
44
Q

Friction massage purpose

A
  • Loosen adherent fibrous tissue (scar)
  • aid in absorption of local edema or effusion
  • reduce local muscle spasm
  • treat chronic inflammation in tendon
45
Q

Friction massage indications

A 
Muscular lesions
- recent trauma
- long-standing scars
- lesion at musculotendinous junction
Tendinous lesions
- tendons with a sheath> move tendon within its sheath
- tendons without sheath
ligamentous lesion
- recent sprain 
- chronic sprain
46
Q

Friction massage used prior to & in conjunction with other interventions

A
  • minor muscle tear
  • ligamentous tears
  • tendinous tears
47
Q

Friction Massage research lacking

A

DTFM for treating tendonitis
-ITBFS
-DTFM combines w/ rest, stretching, cryotherapy and TUS
-No statistical difference after four sessions of DTFM
-ECRT
-No statistical difference after 9 sessions of DTFM compared w/ other modalities
TFM on shoulder impingement
-Intervention – TFM, Cold, TENS, Ther. Ex.
-Group treated w/ TFM had increased AROM, PROM, less pain, increased function earlier than control group.

48
Q

Friction massage contraindications

A
  • inflammation due to bacterial action
  • traumatic arthritis of a joint
  • ossification or calcification in soft tissue structures
  • bursitis
  • RA
  • pressure on nerves
49
Q

Friction massage relief of pain

A
  • may be due to modulation of nociceptive impulses at spinal cord level
  • due to concurrent activation of mechanoreceptors in tissues closes the gate to painful stimulus
  • may stimulate diffuse noxious stimuli that imparts inhibitory controls
50
Q

Friction massage effect on CT repair

A
  • gentle TFM applied during early inflammation may inc rate of phagocytosis
  • TFM during early remodeling can lead to formation and remodeling of collagen
  • initally TFM must be light. as healing progresses TFM can be more intense
  • friction prevents adhesion formation and ruptures unwanted adhesions
  • friction induces a traumatic hyperemia > produces vasodilation and inc BF to area
51
Q

Friction massage technique

A
  • Right spot must be found
  • therapists fingers and pt’s skin move as one
  • friction across fibers, with sufficient sweep
  • must be deep enough
  • pt must adopt a suitable position
  • muscle must be relaxed while being frictioned
  • tendon with sheath must be kept taught
52
Q

Tool assisted STM

A
  • Uses specifically designed tools to assist with STM
  • tool held at 30 degrees and 60 degree angle to target tissue
  • tool slid along target tissue from superficial to deep feeling for irregularities in soft tissue
  • continue 3-5 mins
  • reassess
53
Q

Purpose of tool assisted STM

A
  • remove adhesions
  • reduce tone
  • enhance fibroblast proliferation
  • improve circulation
54
Q

Hamstring tool assisted STM

A

-pt prone
PT standing on involved side
- tech: move tool in direction that restriction is felt (generally prox to dist or reverse) repeat for 3-5 mins
- use: improve SLR, sciatic nerve mobility

55
Q

ITB tool assisted STM

A

pt: sidelying
technique: move tool in direction of restriction
- use: improve hip IR, ITB friction syndrome, PF syndrome, trochanteric bursitis

56
Q

Strain counterstrain

A
  • Relieve pain by reduction and arrest of continuing inappropriate proprioceptor activity (muscle spindle)
  • This is accomplished by markedly shortening malfunctioning muscle spindle by applying mild strain to antagonist
  • inappropriate strain reflex is inhibited by application of counter strain
    • joint dysfunction leads to muscle length imbalance
57
Q

Strain counterstrain: tender points

A
  • deep within muscle, tendon, ligament, or fascia

- measure 1cm or less across

58
Q

strain counterstrain tx

A

-Locate and palpate the tender point
Have pt. rate as 10 on 0 – 10 scale
-Move patient into a position of ease or comfort. (markedly shorten the tissue) Pt pain should decrease to 3/10
-Maintain the position for a minimum of 90 seconds.
-Slowly return to neutral position
-Retest tender point

59
Q

Posterior cervical strain counterstrain

A

-pt supine
PT standing/sitting at head of pt hands under occiput
- tech: bring upper c-spine into slight extension to release tension on upper cervical musculature hold 90 sec
-use: occipital HA, upper cervical pain

60
Q

Trap/levator strain counterstrain

A
  • Pt.: Supine
  • PT: Standing/sitting at pt’s head. One hand palpates for active trigger point in UT/LS. Other hands under pt’s head
  • Technique: Slowly SB head toward painful side to slacken the mm. Hold 90 sec. -Release
  • Use: UT/LS trigger point

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