SSTM MT1 Flashcards
Local tissue dimension
this decribes what happens with the tissue that is manipulated/ treated by the therapist and also how the tissue reacts
this system includes soft tissue structures such as: skin, muscles, ligaments, tendons, joint structures and the different fluid systems
structures can be influenced by manipulation in the following three ways:
1. during the healing process after injury, e.g decreases swelling/ improve tensile strenght
2. changes in the phy and mech characteristics of tissues, thus the bio mech structure e.g improve ROM
3. Local changes in the dynamics of fluids e.g decrease swelling/ improve oxygenation
Neurological dimension
manual effects have an effect on 3 areas:
motor system and neuro-muscular response
altered pain sensation
reflexive autonomous changes
the manual technique/ event has the following effects:
stimulates proprioceptors
cognition
voluntary movement
manual techniques can influence different neurological and neuro-muscular conditions such as:
post musculoskeletal injury (with resulting neuro-muscular impairment)
rehab after central nervous system injury
re-education of posture and movement
management of pain
psycho-physiologic dimension
the effects of touch and manipulation on the patient’s emotions and thoughts are examined here
the manual event / touch may lead to psychological processes
emotions result in a somatic response, e.g changes in muscle tone
Importance of movement after soft tissue injury:
blood and lymphatic flow are stimulated
normal connective tissues homeostasis is achieved
improves healing process and health of tissue
normal vascular regeneration
correct alignment of collagen
improves/ prevents excessive cross linkages and adhesions
hence: movement/ mobilisation: grading depending on the phase of healing is of utmost importance for:
normal structural and functional characteristics of muscles and collagen tissue
this tissue can function better during daily functional activities
Fluid dynamics: Intro
there are a number of fluid systems in the body.:
blood
interstitial fluid
lymph
synovial fluid
cerebrospinal fluid (CSF)
flow of these systems is dependent on the pressure gradient within and between the various fluids
while manual techniques affect a number of fluid systems, only blood, lymphatic fluid and synovial fluid
manual techniques are used to improve the flow in the following instances:
inflammation after trauma/ injury
oedema
effusion of joints
ischaemic conditions (compartment syndrome)
manual techniques are used to improve the flow in the following instances:
in detail
- manual techniques also remove obstructions in tissue which in turn improves normal flow of fluids
- normal flow in the fluid systems regenerates via:
heart pump
muscle pump
resp pump
movement - hydrostatic pressure: pressure of fluid within tissue
- hydrokinetic transport: movement of fluid as a result of pressure gradient, assisted by mechanical forces
factors influencing flow within the fluid systems:
intrinsic factors:
-refers to factors within tissue itself
-e.g during the inflammatory process; increased fluid pressure in muscles after exercise
extrinsic factors:
-refers to the effect from adjacent tissue or structures obstructing blood or lymph supply and drainage
-e.g local structural abnormalities e.g
musculoskeletal and myofascial abnormalities
effect of manual techniques on blood flow
blood flow in muscles is influences by intrinsic and extrinsic forces such as muscle contractions and intermittent compression
manipulation techniques which influence blood flow are:
-active pumping techniques”
muscle’s own fluid pumping mech activated
indication: muscles that are ischaemic or swollen, or during inflammation.
results in deeper drainage
method: muscle in shortened position, intermittent contraction and relaxation, sub maximal contraction
passive pumping techniques:
external compression improves flow in a relaxed muscle
two methods: intermittent external compression and static and rhythmic stretch (i.e physiological joint movements)
effect on flow is influences by: speed, force, frequency and direction of forces applied
effect of manual techniques on lymphatic flow
lymphatic formation and flow are influences by intermittent tissue compression and passive and active movements
increased lymphatic flow indicates increased diffusion and filtration between blood/ interstitial and lymph components
increased lymphatic flow within and around a damaged area facilitates the healing process and assists in decreasing pain
physical effect of manual techniques on tissue
tension forces compression rotation bending shearing forces combined forces
tension forces
lengthening force, extension, longitudinal stretch
results in increased collection of collagen; thus the tissue has better quality and strength
minimal effect on flow of fluid
compression
shortening and broadening of tissue
increased pressure within tissue
good pumping effect and improves flow of fluid
rotation
complex mechanical effect on tissue
combination of compression and progressive lengthening of fibres furthest from rotation axis
more articulation techniques
bending
anatomically refers to: F, E, SF
compression on concave aspect and lengthening at convex aspect
aim: use as tension force in order to lengthen and also stimulate flow of fluid
shearing forces
especially with joint articulation
combination of tension and compression forces
combined forces
simultaneous application of a number of forces e.g F and rot
with every force being applied there is a build-up of tension on the tissue
may be more effective that 1 movement
what are examples of manual stretches?
- passive stretch
2. active muscle stretches
passive stretch:
the patient is entirely relaxed while the muscle in being stretched
method: stretch or lengthen the muscle passively (in direction opposite to the action of the muscle, and including all joints in the path/ course of that muscle) using an external force (PT)
passive muscle stretches influenced by:
- speed of stretch
- power/ force of stretch
- duration of stretch
- method of stretch/ type of stretch
- cyclical stretch
- oscillatory stretch
speed of stretch:
slowly and evenly applied in order to allow for viscous changes in the tissue
give sufficient time for muscle to lengthen
what are the dangers of fast stretches
power/ force of stretch:
depends on phase of healing when stretch is applied
inflammation: weak tensile strength in tissue; regenerating tissue can easily be disrupted. minimal or no stretches
during regeneration/ remodelling phase: slow decrease of tensile strength of tissue
the amplitude and strength of the applied stretch depends on:
a) amount of discomfort experienced by the patient
b) level of tissue damage (e.g manner of injury, clinical signs and symptoms)
c) “acuteness” of injury (dependent of healing process)
duration of stretch:
influenced by: force applied breadth and length of muscle level/amount of tissue damage inflammation formation of scar tissue
suggested time for stretch of muscle-tendon unit: 30-60 sec
BUT: duration of stretch depends on palpation and the feeling of change in length of the tissue
method of stretch/ type of stretch:
as a result of the complec anatomical organisation of connective tissue and muscle-tendon junction
apply different forces in order to achieve desired stretch, e.g lengthen together with SF
cyclical stretch
smaller force applied: 1st 4 cycles only to 10% past the muscles length at rest
has a building-up effect on tissue
oscillatory stretch
decreased discomfort during stretch
small oscillatory stretches added at the end of ROM
- active muscle stretches
the pt uses muscle contraction in order to stretch a muscle
method:
stretch/ lengthen the muscular-tendinous unit by using patient’s own muscle power
stretch/ lengthen the muscle passively to full length
request that the patient isometrically contracts muscle in the lengthened position- no pain
contraction up to 15 sec for creep effect
pt relax muscle and takes/ lengthens muscle into further ROM
contract- relax phases to be repeated 3-4 times while gradually lengthening muscle
active stretch is based on visco-elasticity of the tissue. thus: active stretches are only effective in muscular structures
could also use combination forces in order to stretch all compartments
contra-indications for active muscle stretched
no active stretches within 1st few days after injury (inflammatory stage)
forceful contraction and stretches only during late regeneration- and remodelling phase
why does a person experience/ feel pain?
pain is usually caused by tissue injury of inflammation, the damaged or inflamed tissue directly exiting the nerve membranes
this local occurence activates a range of reactions in the spinal cord and higher brain centres which in turn regulate and modulate the experience of pain. the experience is dependent on various factors
how do manual techniques achieve pain reduction?
pain is not a system by itself but rather connected to the healing- and behavioural processes of the body and individual.
3 dimensions:
local tissue level by direct stimulation of the damaged area
the neurological dimension by acticvation of the ‘gating mech
the psycho-physiological/ psychological dimension by psycho-dynamic and emotional effects of touch
pain gate theory (level of spinal cord)
suppression of nociceptive input at dorsal horn (spinal cord), also known as “sensory gating”
simultaneous add of other stimuli e.g. active or passive movement as well as vibration, stimulate mechano-receptors (i.e sensory stimulation of e.g cutaneous/ skin, myofacial and articular receptors) which block nociceptive unput by closing the pain gate on spinal cord level
thus pt experience less or no pain. this block occurs on pre and post synaptic level
manual techniques thus bring relief by activating the spinal component of pain gate mech.
modulation of this afferent act however happens on different levels in the CNS (e.g higher centres)
on higher levels -stimulation of endogenous anti-nociceptive systems
endogenous opoids are released by the brain (higher centres) during passive movements (PMs) of a joint and during any pleasurable activities.
these endogenous opiods (the body’s own pain suppression) also includes the pain gate mech and thus the experience of pain is reduced or blocked
effect of blocking conduction
there is a progressive reduction of firing of small and large diameter normal joint afferents after one or two mins of sustained or repeated joint movements
+- 30 sec of repeated mechanical stimuli lead to fast and complete conduction block of desensitised nociceptors
this research hence suggests that PM’s may decrease pain perception momentarily
hysteresis effect on neural firing
repeated or sustained movements and movements at end of range stretch peri-articular soft tissues and thus increase ROM. the increase in range can be attributed to creep deformation.
after creep derormation there is significant decrease/ total arrest of firing occurs in the large or small diameter joint afferents, as well as in the desensitised nociceptors
changes in axoplasmic flow and transport
axoplasma is responsible for the nutriment and optimal function of neural structures.
it is also responsible for the transference of nerve growth factor which in turn is responsible for the regulation and production of neuro peptides (e.g substance P and somatostatin)
according to Butler PM’s can restore faulty axoplasmic flow by e.g:
dec the sensitivity of the target tissue (energy demands form target tissue thus dec and less energy is demanded from the axoplasma)
improved intraneural circulation
inhibition of reflex muscle spasm
a lesion of the joint may result in hyperactivity of the surrounding muscle
fusimotor firing and thus intrafusal firing is maintained at a high frequency resulting in a shortened position.
muscle fibres then become hyper-sensitive to incoming stimuli and as a result of the sustained contraction the joint structures are firmly compressed
this in turn impedes movement
PMs may improve the range and decreases perception of pain as they inhibit the reflex spasm
the move created mech impulsed which decrease fusimotor neuron firing
stretching of the muscle (by movement) leads to tension in the tendon itself
the golgi tendon inhibits fusimotor neural firing and thus relaxes the intra- and extrafusal fibres.
another hypothesis suggests that type III mechanoreceptors have a reflex inhibitory effect on the associated muscles of the joint
what is the somatopsyche sequence?
refers to the body as a source of the sensory experience and its psychological influences
MT can have effects on local tissue physiology and repait, but is also patterned somatic responses and psychological changes.
what are the psychological changes post MT?
mood changes
changes in perception of body image
behavioural changes
what are patterned somatic responses?
general changes in muscle tone increase pain tolerance altered autonomic and visceral act facilitation of healing processes facilitation of self-regulation
manipulation as a sensory experience
proprioceptors:
main receptor influenced by MT
found in muscles, tendons, joint capsules, ligaments and skin
function: convey information about the mechanical state of the body, length of muscles, force of muscle contraction, velocity of movement etc
