Soft Tissue & Myofascial Release Flashcards
stress
the force that attempts to deform a connective tissue structure
strain
the percentage of deformation of a connective tissue
hysteresis
difference between loading & unloading characteristics represents energy lost in connective tissue system
creep
connective tissue under a sustained, constant load will elongate (deform) in response to the load
bind
palpable restriction of connective tissue mobility (tissue texture change)
ease
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
fascial continuity
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
Hooke’s Law
strain (deformation) placed on an elastic body is in proportion to stress placed upon it
Wolff’s Law
bone will develop according to the under stresses placed upon it
connective tissue works around strains
Sherrington’s Law
when a muscle (agonist) receives a nerve impulse to contract, its antagonists simultaneously receive an impulse to relax
somatic dysfunction
the impaired or altered function of skeletal, arthroidal & myofascial structures & their related vascular, lymphatic & neural elements
direct omt
go towards & eventually through restrictive barrier
indirect omt
go away from restrictive barrier
soft tissue
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
integrated neuromusculoskeletal release (INR)
treatment system in which combined procedures are designed to stretch & reflexively release patterned soft tissue & joint related restrictions
myofascial release (MFR)
a form of myofascial treatment that engages continual palpatory feedback to achieve release of myofascial tissues (direct or indirect)
direct MFR
identify restrictive barrier in myofascial tissues
engage restrictive barrier w/ a loaded, constant, directional force until tissue releases & motion is restored
indirect MFR
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
Fascia
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
what is NOT fascia?
tendons, ligaments, aponeurosis
Fascial Anatomy
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
what are the components of fascia?
ECM: 95%
cells: 5%
the 4 layers of fascia
pannicular fascia
axial & appendicular fascia
meningeal fascia
visceral fascia
Pannicular Fascia
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
Axial & Appendicular Fascia
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
Meningeal fascia
surrounds the nervous system
includes the dura
Visceral fascia
surrounds the body cavities (pleural, pericardial & peritoneum)
importance of fascia
provides for mobility & stability of MSK system (elastic & contractile)
helps maintain balance & assists in production/control of motion
contractile elements of fascia
myofibroblasts
healing elements of fascia
macrophages & mast cells
sensory functions of fascia
fascia contains mechanoreceptors-stretch receptors for muscles & proprioceptors (balance)
C fibers
involved in sensing pain (mechanical, thermal, chemical)
Indications for soft tissue
diagnostic tool to identify areas of restricted motion, tissue texture changes, & sensitivity
outcome of soft tissue technique
improve local & systemic immune response
general state of relaxation
enhance circulation to local myofascial structures to get general state of tonic stimulation
relative contraindications for soft tissue technique
acute injuries (if stretch injured muscle, tendon, ligament or joint capsule)
severe osteoporosis
absolute contraindications for soft tissue technique
fracture or dislocation neurological entrapment syndromes serious vascular compromise local malignancy local infection bleeding disorders lack of patient consent
indications for MFR/INR
somatic dysfunctions (soft tissue or joint restriction)
when muscle energy is contraindicated
when counterstrain may be difficult secondary to patient inability to relax
relative contraindications for MFR/INR
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
absolute contraindications of MFR/INR
absence of somatic dysfunction
lack of patient consent
what is the most absolute contraindication?
lack of patient consent
steps of ST/MFR/INR
setup position activating force release enhancing maneuvers signs of therapeutic response finishing position re-evaluation for TART changes in identified region
goals of soft tissue (TART)
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
principles of soft tissue tech
pt & physician comfort
initial applied forces are gentle & low amplitude
force applied RHYTHMICALLY for 1-2 seconds
increase amplitude, same rate of application
soft tissue stretch
parallel traction-increase distance between origin & insertion of muscle
soft tissue knead
perpendicular traction-repetitive pushing of tissue perpendicular to muscle fibers
soft tissue inhibition
push & hold perpendicular to fibers @ musculotendinous parts of hypertonic muscle
hold until relaxation of tissue
MFR activating forces
inherent forces
respiratory cooperation
patient cooperation
MFR treatment endpoint
continuous application of activating forces no longer produces change
MFR springing
place hands on dysfunction & apply variable degrees of pressure/frequency of force
causes springing in structure which activates release of tissues
4 ways to use respiratory force
full cycle of respiratory effort
particular phase of respiration
breath holding
coughing or sniffing
INR release enhancing maneuvers
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
document OMT in SOAP note
OSE in Objective
Somatic Dysfunctions found in Assessment
OMT performed/recommended in Plan
