Soft Tissue & Myofascial Release

Question 1

stress

Answer 1

the force that attempts to deform a connective tissue structure

Question 2

strain

Answer 2

the percentage of deformation of a connective tissue

Question 3

hysteresis

Answer 3

difference between loading & unloading characteristics represents energy lost in connective tissue system

Question 4

creep

Answer 4

connective tissue under a sustained, constant load will elongate (deform) in response to the load

Question 5

bind

Answer 5

palpable restriction of connective tissue mobility (tissue texture change)

Question 6

ease

Answer 6

direction in which the CT may be moved most easily during deformational stretching

palpated as a sense of tissue “looseness” or laxity or greater degree of mobility

Question 7

fascial continuity

Answer 7

fascial restrictions in 1 area of body will create CT restrictions (pulls) at a distance away from site of initial restriction

result: abnormal myofascial & joint mobility

Question 8

Hooke’s Law

Answer 8

strain (deformation) placed on an elastic body is in proportion to stress placed upon it

Question 9

Wolff’s Law

Answer 9

bone will develop according to the under stresses placed upon it

connective tissue works around strains

Question 10

Sherrington’s Law

Answer 10

when a muscle (agonist) receives a nerve impulse to contract, its antagonists simultaneously receive an impulse to relax

Question 11

somatic dysfunction

Answer 11

the impaired or altered function of skeletal, arthroidal & myofascial structures & their related vascular, lymphatic & neural elements

Question 12

direct omt

Answer 12

go towards & eventually through restrictive barrier

Question 13

indirect omt

Answer 13

go away from restrictive barrier

Question 14

soft tissue

Answer 14

a system of diagnosis & treatment directed toward tissues other than skeletal or arthrodial elements

direct: facilitates improvement of articular motion

technique types: perpendicular, longitudinal, inhibitory

Question 15

integrated neuromusculoskeletal release (INR)

Answer 15

treatment system in which combined procedures are designed to stretch & reflexively release patterned soft tissue & joint related restrictions

Question 16

myofascial release (MFR)

Answer 16

a form of myofascial treatment that engages continual palpatory feedback to achieve release of myofascial tissues (direct or indirect)

Question 17

direct MFR

Answer 17

identify restrictive barrier in myofascial tissues

engage restrictive barrier w/ a loaded, constant, directional force until tissue releases & motion is restored

Question 18

indirect MFR

Answer 18

tissue position of ease is identified

engage w/ directed pressure & guide tissues along line of least resistance until free movement of all tissues is achieved

Question 19

Fascia

Answer 19

a complete system w/ blood supply, fluid drainage & innervations

composed of irregularly arranged fibrous elements of varying density

involved in tissue protection & healing of surrounding systems

Question 20

what is NOT fascia?

Answer 20

tendons, ligaments, aponeurosis

Question 21

Fascial Anatomy

Answer 21

connective tissue layers are mostly composed of collagen fibers & elastin fibers

contained in amorphous matrix of HYDRATED PROTEOGLYCANS which mechanically link collagen fiber networks in these structures

Question 22

what are the components of fascia?

Answer 22

ECM: 95%

cells: 5%

Question 23

the 4 layers of fascia

Answer 23

pannicular fascia
axial & appendicular fascia
meningeal fascia
visceral fascia

Question 24

Pannicular Fascia

Answer 24

outermost layer of fascia derived from somatic mesenchyme & surrounds entire body (not orifices)…outer layer is adipose & inner layer is membranous/adherent to outer portion

Question 25

Axial & Appendicular Fascia

Answer 25

investing layer is internal to pannicular layer & fused to panniculus, surrounds all of muscles & periosteum of bone & peritendon of tendons (continues from head to toe) what is cut during fasciotomy

Question 26

Meningeal fascia

Answer 26

surrounds the nervous system includes the dura

Question 27

Visceral fascia

Answer 27

surrounds the body cavities (pleural, pericardial & peritoneum)

Question 28

importance of fascia

Answer 28

provides for mobility & stability of MSK system (elastic & contractile) helps maintain balance & assists in production/control of motion

Question 29

contractile elements of fascia

Answer 29

myofibroblasts

Question 30

healing elements of fascia

Answer 30

macrophages & mast cells

Question 31

sensory functions of fascia

Answer 31

fascia contains mechanoreceptors-stretch receptors for muscles & proprioceptors (balance)

Question 32

C fibers

Answer 32

involved in sensing pain (mechanical, thermal, chemical)

Question 33

Indications for soft tissue

Answer 33

diagnostic tool to identify areas of restricted motion, tissue texture changes, & sensitivity

Question 34

outcome of soft tissue technique

Answer 34

improve local & systemic immune response general state of relaxation enhance circulation to local myofascial structures to get general state of tonic stimulation

Question 35

relative contraindications for soft tissue technique

Answer 35

acute injuries (if stretch injured muscle, tendon, ligament or joint capsule) severe osteoporosis

Question 36

absolute contraindications for soft tissue technique

Answer 36

``` fracture or dislocation neurological entrapment syndromes serious vascular compromise local malignancy local infection bleeding disorders lack of patient consent ```

Question 37

indications for MFR/INR

Answer 37

somatic dysfunctions (soft tissue or joint restriction) when muscle energy is contraindicated when counterstrain may be difficult secondary to patient inability to relax

Question 38

relative contraindications for MFR/INR

Answer 38

``` infection of soft tissue or bone fracture, avulsion, or dislocation metastatic disease soft tissue injury (hematoma, open wounds) post op patient w/ wound dehiscence instability of cervical spine DVT or anti-coagulation therapy ```

Question 39

absolute contraindications of MFR/INR

Answer 39

absence of somatic dysfunction lack of patient consent

Question 40

what is the most absolute contraindication?

Answer 40

lack of patient consent

Question 41

steps of ST/MFR/INR

Answer 41

``` setup position activating force release enhancing maneuvers signs of therapeutic response finishing position re-evaluation for TART changes in identified region ```

Question 42

goals of soft tissue (TART)

Answer 42

T: stretch & increase elasticity, improve local tissue nutrition & removal of metabolic wastes A: return symmetry & normalize tone for hypertonic muscles/muscle spasm R: normalize neurologic activity & improve abnormal somato-somatic & visceral reflexes T: release fascia to improve myofascial restrictions

Question 43

principles of soft tissue tech

Answer 43

pt & physician comfort initial applied forces are gentle & low amplitude force applied RHYTHMICALLY for 1-2 seconds increase amplitude, same rate of application

Question 44

soft tissue stretch

Answer 44

parallel traction-increase distance between origin & insertion of muscle

Question 45

soft tissue knead

Answer 45

perpendicular traction-repetitive pushing of tissue perpendicular to muscle fibers

Question 46

soft tissue inhibition

Answer 46

push & hold perpendicular to fibers @ musculotendinous parts of hypertonic muscle hold until relaxation of tissue

Question 47

MFR activating forces

Answer 47

inherent forces respiratory cooperation patient cooperation

Question 48

MFR treatment endpoint

Answer 48

continuous application of activating forces no longer produces change

Question 49

MFR springing

Answer 49

place hands on dysfunction & apply variable degrees of pressure/frequency of force causes springing in structure which activates release of tissues

Question 50

4 ways to use respiratory force

Answer 50

full cycle of respiratory effort particular phase of respiration breath holding coughing or sniffing

Question 51

INR release enhancing maneuvers

Answer 51

to make treatment process more efficient: ``` breath holding prone & supine-arm swing R/L cervical rotation isometric limb & neck movements patient evoked movement from cranial nerves ```

Question 52

document OMT in SOAP note

Answer 52

OSE in Objective Somatic Dysfunctions found in Assessment OMT performed/recommended in Plan