Soft Tissue Mobilization / Massage

Question 1

STM definition

Answer 1

“a mechanical manipulation of body tissues for the purpose of promoting health and well-being”

Question 2

Drawbacks

Answer 2

• time consuming! (5-7 min but most tx actually call for 20-30min)

Question 3

Benefits

Answer 3

• promotes local and systemic relaxation
• increases local blood flow
• breaks down adhesions
• facilitates venous return

Question 4

AT use of STM

Answer 4

• edema removal (POST acute phase)
• chronic back/neck injuries
• tendonitis and ITB friction syndrome
• chronic muscular injuries (scar tissue)
• athlete should NOT enjoy it
• should always be used in combo with another tx

Question 5

indications

Answer 5

• pain (POST acute cycle)
• edema
• muscle spasm
• trigger points
• adhesions/scar tissue (transverse cross friction - post tommy john UCL surg)
• anxiety
• decreased ROM

Question 6

Contraindications

Answer 6

• acute injury / local inflammation
• fever, infections (systemic/skin)
• skin conditions
• burns, open wounds
• pain caused by pressure
• DVT (don’t want to dislodge clot)
• tissue irritability
• malignancies

Question 7

Effleurage

Answer 7

• most versatile and commonly used
• “stroking”
• used to start and end massage and transition
• enhances venous flow
• deep effleurage provides some stretch to muscle
• progress depth and adapt speed of strokes (start light and go harder to accommodate skin to pressure you will apply)
• maintain contact
• superficial tissue: stimulates sensory nerves
• deep tissue: use palms/knuckles to stimulate deep tissues
• smooth, firm, continuous motion

Question 8

shingles effleurage

Answer 8

• continuous alternating (between hands) stroking
• strokes overlay each other
• one hand always in contact
• done many times to parallel the spine

Question 9

Petrissage

Answer 9

• lifting, kneading, wringing, and rolling of tissues
• targets muscle
• progress depth and alter speed of tx
• separates muscle fiber, fascia, and scar tissue
  Benefits:
• “milks” muscle of waste products
• assists with venous return
• relaxes muscle

Question 10

petrissage: basic 2 handed kneading

Answer 10

lifting and squeezing and then releasing the soft tissue with hands
alternating in rhythmical motion

Question 11

petrissage: skin rolling

Answer 11

• tissue are picked up between thumb and first 2 fingers and gently pulled away from deeper tissues
• thumbs may push forward causing rolling affect of tissue

Question 12

Tapotement

Answer 12

• percussion: gentle tapping or pounding
• hand strikes tissue at rapid rate (loose and relaxed hands)
• stimulates muscular and systemic relaxation
• desensitization of irritated nerve endings

TYPES:

• hacking/chopping (most common)
• pincement (plucking)
• cupping (thumb and fingers slightly flexed and palmar surface contracted)
• rapping (similar to hacking but uses lightly closed and loosely held fists)

Question 13

Deep transverse Friction

Answer 13

• friction, cross-friction, DTF, deep massage
• DEVELOPED EMPIRICALLY BY JAMES CYRIAX
• indicated for muscle, ligament, and tendon injury

Question 14

Proposed mechanism of action of DTF

Answer 14

• pain relief via gate control theory / endogenous opiate release
• collagen re-orientation during maturation phase
• prevention of adhesions
• separated muscle fibers
• ruptures existing adhesions –> increasing ROM
• increases local blood perfusion
  
  • increases circulation
  • dilates blood vessels = lowers BP
• warming area meanwhile = friction is key (perpendicular to structure)

Question 15

Friction

Answer 15

• to break up adhesions by way of increasing space between collagen fibers
• fingers and skin move together
• directly over lesion
  2 TYPES: transverse and friction

Question 16

Transverse Friction Massage

Answer 16

• strokes perpendicular to tissue fibers

- thumbs/fingertips stroke in opposite directions

Question 17

Circular Friction Massage

Answer 17

circular friction:

• to break up scar tissue
• to soften a healing scar
• can use circular motion with thumbs, elbow, commercial device

Question 18

DTF Treatment Protocol

Answer 18

Cyriax:

• 6-12 sessions
• alternate days
• 20’

Starkey:

• 1/day
• 5’ PRN (as long as needed)
• if targeting muscle –> want it relaxed
• for a tendosynovitis –> want it on stretch
• will be PAINFUL

Question 19

Edema Reduction Massage

Answer 19

PREP
- elevate
- lube
- postion distal to extremity
STROKE SEQUENCE
- begin proximal to edematous area to facilitate lymphatic flow proximally (too painful to start distal and push all fluid proximal)
- long, slow, deep strokes towards torso
- move more distal after every 4th or 5th stroke
TERMINATION
- remove medium
- if appropriate: AROM ex, compression wrap
- encourage pt to drink water to assist in flushing metabolic waste
- inspect area for cuts/abrasions

Question 20

Massage for event settings

Answer 20

use energizing techniques:

• light effleurage
• short tapotement
• broad area petrissage
• stretch with breath

Question 21

Massage in Therapeutic Settings

Answer 21

recovery, relaxation
use calming techniques:
- firm effleurage
- specific petrissage
- sustained tapotement (like hot tub jet)
- passive ROM
- myofascial/energetic holds