Soft Tissue Mobilization (wk 7) Flashcards
What is defined as increased resting activity in the muscle?
muscle guarding
What a 3 possible reasons for muscle guarding?
- Protective response to painful stimuli
- Neurologic Dysfunction
- Emotional stress, anxiety, fear
What is an active trigger point?
symptomatic and refers pain at rest or during motion (we we are treating)
What is an passive trigger point?
do not cause patient’s pain unless they are activated by palpation
What is Travell’s Energy deficit hypothesis of trigger points?
- Injury/trauma of muscle cause inflammatory cascade (interleukin, cytokines, lactic acid build up)
- Metabolites increase acidity (lower pH) increasing muscle spindle excitability
- Tonic, low grade muscle contraction -> can lead to trigger point
What are 3 therapeutic effects of manual therapy?
- Pain reduction
- Increase soft tissue extensibility
- Improve quality of motion in a restricted area
What 3 musculoskeletal indications for manual therapy?
- Pain reported with activity and that is relieved by rest
- Pain that is relieved or provoked by particular motions or positions
- Pain altered by changes related to sitting or standing posture
Contraindications of manual therapy?
- Systemic or localized infection
- Acute circulatory conditions (DVT, etc)
- Malignancy in the area
- Open wound at site
- Recent fracture at site
- Hematoma
- Hypersensitive skin
- Advanced diabetes
- Rheumatoid arthritis (if in a flare)
- Cellulitis – infection of skin
Precautions of manual therapy?
- Joint effusion or inflammation
- Rheumatoid arthritis (if not in a flare)
- Osteoporosis
- Steroid or anticoagulant therapy
Describe transverse friction massage. Pressure Speed Duration Discontinue
- back and forth in direction perpendicular to normal orientation of the fibers
Pressure - patient tolerance
Speed - 2-3 cycles/second
Duration - 5-10 min
Discontinue - once healed of if no improvement after three sessions
Describe the traumatic hyperemia of transverse friction massage.
- Increases flow of blood which in turn removes the chemical irritants of inflammation
- Increased blood flow reduces venous congestion thus decreasing edema and pressure on pain sensitive structures
Describe the pain relief from transverse friction massage.
- Stimulates type I and type II mechanoreceptors, producing presynaptic anesthesia
- Gate control theory
- Caution: Patient may feel an exacerbation of symptoms following first two to three sessions
Effect of transverse friction massage on collagen?
Assists with orientation of the collagen fibers
Indications of using transverse friction massage?
acute, subacute, or chronic ligament, tendon, or muscle injuries
Contraindications of transverse friction massage?
hematomas, open skin, frail skin
Describe scar massage
caution -
Similar technique to transverse cross friction massage (perpendicular to scar) except not as much pressure
caution - ensure incision is clean, dry, intact prior to performing
What is the purpose of scar massage?
Purpose - to stimulate collagen to lay down scar tissue appropriately (avoid hypertrophic and keloid scars), maintain scar mobility, and desensitize scars as needed
Which fascia layer is the deepest layer comprising the dura of the craniosacral system, which encases the central nervous system?
Visceral
Which fascia layer is lying directly below the dermis?
Superficial
Which fascia layer is surrounding and infusing with muscle, bone, nerve, blood vessels, and organs to the cellular level?
Deep
What is the theory behind the need for myofascial release?
o Strains to deep fascia results in slow tightening of the fascia; these fascial restrictions eventually lead to postural impairments
Myofascial Release Purpose:
o Apply gentle sustained pressure to deep fascia to release restrictions and restore normal pain-free function
After Myofascial Release patient may experience what?
Muscle soreness initially after treatment
What are 4 types of myofascial releases?
o J stroke
o Vertical Stroke
o Transverse stroke
o Cross-hands technique
What is ischemic compression?
Pressure applied to center of trigger point
What is the theory of ischemic compression?
- sustained pressure deprives trigger point of oxygen;
- temporary blockage of circulation -> reactive hyperemia (blood rushes to area) that in turn reduces overall energy crisis and breaks pain cycle
Duration of ischemic compression?
10-60 seconds
If pain does not change during ischemic compression, what should clinician do?
if pain does not change may need to adjust the pressure or switch the technique
What is the soft tissue mobilization effleurage?
- Generally more superficial
- Useful for initial assessment of superficial tissues
- Gentle stroking applied to musculature
Possible mechanism of effleurage?
mechanism in assisting venous and lymphatic drainage and reducing tension
What is the technique of effleurage?
- Strokes distal to proximal along the line of the body part being massaged
- Employ whole body movement and firm contact
What is the soft tissue mobilization petrissage used for?
- Assist venous and lymphatic return
- Assist fluid interchange
- Increase mobility of underlying tissue
Petrissage technique: Kneading
compressed against underlying structures
Petrissage technique: Pulling/lifting
compressed then lifted and squeezed
Petrissage technique: Wringing
tissues are lifted and squeezed with alternative hand pressure
Petrissage technique: Rolling
tissues are lifted and rolled between fingers and thumbs (skin or muscle)
What is retrograde? Technique? Intention?
- Typically used to reduce edema
- Use lotion
- With sustained pressure go distally to proximally (move only in one direction)
- Intention is to push the fluid back towards the lymphatic system and assist with edema control
T/F Should always communicate with patient about techniques being used as well as elicit feedback often.
True
What is the purpose of a cross friction massage?
Method?
- maintain mobility within the soft tissue structures of ligament, tendon, and muscle
- prevent adherent scars from forming
- Proper alignment of tissues
- Deep and transverse to tissue
What is the theory behind myofascial release?
inappropriate fascial strain -> Strains to deep fascia results in slow tightening of the fascia -> these fascial restrictions eventually lead to postural impairments
What is the purpose of myofascial release?
Applying gentle sustained pressure to deep fascia to release restrictions and restore normal pain-free function
Name 4 types of myofascial release?
- j-stroke
- vertical
- transverse (when get to end, lift hands up and bring back to starting)
- cross hands (parallel to muscle fibers)
Describe the theory behind ischemic massage?
How long do you hold?
Temporary blockage of circulation -> deprives the trigger point of oxygen, rendering them inactive and breaking the pain-spasm-pain cycle
hold - 10-60 seconds but can be applied for longer
What is the purpose of general massage?
- Increase skin temperature and blood flow to the area
- promoting muscle relaxation.
- Assist venous and lymphatic return
What are two types of general massage?
- effleurage
2. petrissage
What are the __ types of petrissage?
- Kneading (use palms)
- Wringing (pulling and pushing tissue)
- Rolling (both hands in same direction at same time)
- Strumming (strum back and forth across muscle)
