Sot tissue Assessment and Mobilization Flashcards
What should be inspected when looking at soft tissue
- swelling/edema → is it local/diffuse; UL/BL
- Skin, Color, Scars, Trophic Changes/changes in the tissue (poor circulation/diabetes associated), incisions, wounds, Infection, Cellulitis, varicose veins
- Muscle: atrophy or hypertrophy
- DVT: wells DVT CPR,
Homans sign for blood clot
homans sign → dorsiflexion and squeeze the calf but it has a low sensitivity
What to do when inspecting/palpating soft tissue?
- Temperature → is it warm, red, infection
- edema/swelling (pitting,brawny etc.) tape measure
- Muscles: pain, note abnormal tone, increased guarding/spasm or decreased tone
- Trigger points: taut bands in muscles with pain referral patter
Is mobility of soft tissue appropriate? what to consider
- Consider the stage of condition (acute, subacute, chronic)
- Acute stages may not be appropriate for STM
How to assess mobility of soft tissue?
- Superficial = skin on fascia; skin roll (commonly done in LS TS region)
- Mid to deeper layers: fiber direction, multidirectional (different planes) - This is the mobility of the deeper fascia around the muscles, May detect trigger points - taut bands in muscles
What does scar mobility do?
prevents adherence and breaks up scar tissue
Increases circulation and aides with better alignment of fibers being laid down
Indications of STM
- To increase circulation and nutrition to tissue
- Decrease muscle spasm, relaxation of tissue
- Increase extensibility of tissue to restore ROM
- Scar tissue mobilization adn alignment
- Prevent/break up adhesions
- Prevent contractures
- Deactivate trigger points
- Assist in resolution of fluid accumulation
- Retrograde massage for edema
- Enhance healing- stimulate fibroblast activity and collagen production
Contraindications of STM
- DVT, thrombophlebitis
- Bleeding disorders
- Inflammatory skin conditions
- Localized infection - prevent it from spreading
- Hematoma - don’t increase bleeding
- Myositis ossificans → hematoma that califices (don’t want to be digging right over ti)
- Open wounds, non-coapted (ends are not together) surgical incisions
- Unhealed fractures
- significant , acute trauma
Precautions (esp. with IASTM)
- Complex regional pain syndrome (RSD)
- allodynia = any stimulus is painful
- severe , acute pain
- Over metal implants and screws
- Recent injection with corticosteroids
- Anticoagulant drug therapy
- Fluoroquinolones (levofloxacin, cipro) antibiotics,
- Varicose veins
- Diabetes- may not feel how hard your pressure is
- Any condition where soft tissue is weakened or compromised
What are the different STM treatment techniques
- classical massage
- retrograde
- Ironing
- perpendicular to muscle
- muscle bending
- myofascial release
- transverse friction massage
Classical massage
- effleurage, petrissage
Retrograde massage
with elevation:
Elevate the foot, ankle, hand
- edema control
Ironing
- mobilization in fiber direction
- Use your knuckle or finger to run in the same direction
Muscle in perpendicular to plane STM technique
- perpendicular plane on the calf/hamstring
- one hand stabilizes and the other pushes or pulls towards you
Muscle bending
bending the hose IE pectoralis major
Myofascial release
- crossed hand tech - release, lengthen tissue usually used on dorsal spine regions
- put pressure on it
Transverse friction massage
Perpendicular ie UE elbow extensor tendons on a slight stretch
Trigger point
Taut bands in muscle with common referral patterns
How to release trigger points
Consistent pressure - blanche your own nail bed gives about 4kg/cm
Grades:
- 1 = they will state it hurts
- 2 = grimace
- 3 = withdraw
- 4 = wont allow palpation
Trigger point release technique: ischemia pressure
- Apply deep pressure to muscle to occlude blood flow,
- release pressure allows influx of blood and relaxation of muscle
- Though may produce additional tissue hypoxia
Trigger point release: modification press and stretch
- Gentle digital pressure on trigger point
- Apply gentle stretch to muscle until tissue barrier felt
- As stretch is held, fell muscle tension release allowing more stretch/ROM
- Repeat press and stretch to gain tissue length as tolerate
- Believe to restore contracted sarcomeres to normal resting length
Instrument assisted soft tissue mobilization:
- Instrument to assist STM (Skin, fascia muscles, tendons)
- Indication, contraindications and precautions are the same for STM
- Consider stage of condition
- Monitor tissue and patient reactivity (should not be painful)
- After Rx may see petechiae red/purple dots - bleeding from small capillaries under skin
Stroke techniques for IASTM
- Brush = prepping
- Sweeping
- Fan
- Cross friction
STM follow up treatment
- To maintain the gains from STM
- Preform ROM, stretching techniques/activities
- Provide HEP
