Sot tissue Assessment and Mobilization

Question 1

What should be inspected when looking at soft tissue

Answer 1

• 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,

Question 2

Homans sign for blood clot

Answer 2

homans sign → dorsiflexion and squeeze the calf but it has a low sensitivity

Question 3

What to do when inspecting/palpating soft tissue?

Answer 3

• 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

Question 4

Is mobility of soft tissue appropriate? what to consider

Answer 4

• Consider the stage of condition (acute, subacute, chronic)
• Acute stages may not be appropriate for STM

Question 5

How to assess mobility of soft tissue?

Answer 5

• 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

Question 6

What does scar mobility do?

Answer 6

prevents adherence and breaks up scar tissue
Increases circulation and aides with better alignment of fibers being laid down

Question 7

Indications of STM

Answer 7

• 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

Question 8

Contraindications of STM

Answer 8

• 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

Question 9

Precautions (esp. with IASTM)

Answer 9

• 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

Question 10

What are the different STM treatment techniques

Answer 10

• classical massage
• retrograde
• Ironing
• perpendicular to muscle
• muscle bending
• myofascial release
• transverse friction massage

Question 11

Classical massage

Answer 11

• effleurage, petrissage

Question 12

Retrograde massage

Answer 12

with elevation:
Elevate the foot, ankle, hand
- edema control

Question 13

Ironing

Answer 13

• mobilization in fiber direction
• Use your knuckle or finger to run in the same direction

Question 14

Muscle in perpendicular to plane STM technique

Answer 14

• perpendicular plane on the calf/hamstring
• one hand stabilizes and the other pushes or pulls towards you

Question 15

Muscle bending

Answer 15

bending the hose IE pectoralis major

Question 16

Myofascial release

Answer 16

• crossed hand tech - release, lengthen tissue usually used on dorsal spine regions
• put pressure on it

Question 17

Transverse friction massage

Answer 17

Perpendicular ie UE elbow extensor tendons on a slight stretch

Question 18

Trigger point

Answer 18

Taut bands in muscle with common referral patterns

Question 19

How to release trigger points

Answer 19

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

Question 20

Trigger point release technique: ischemia pressure

Answer 20

• 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

Question 21

Trigger point release: modification press and stretch

Answer 21

• 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

Question 22

Instrument assisted soft tissue mobilization:

Answer 22

• 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

Question 23

Stroke techniques for IASTM

Answer 23

• Brush = prepping
• Sweeping
• Fan
• Cross friction

Question 24

STM follow up treatment

Answer 24

• To maintain the gains from STM
• Preform ROM, stretching techniques/activities
• Provide HEP