ST, MFR & INR Flashcards
What is an indirect technique?
A technique that takes tissues away from the restrictive barrier
What is a direct technique?
A technique that takes tissues toward the restrictive barrier
Which types of technique are commonly a direct technique?
Soft tissue, muscle energy and HVLA
Which types of techniques are mostly an indirect technique?
Balanced ligamentous tension, facilitated positional release and counter strain
Which two techniques are both an indirect and direct technique?
Myofascial release and Still’s technique
What are the components of soft tissue?
Fascia, muscles, organs, nerves, vasculature, lymph vessels, tendons, ligaments and aponeuroses
What are the components of fascia?
Fascia, muscles, organs, nerves, vasculature and lymph vessels
Which components of soft tissue are NOT in fascia?
Tendons, ligaments and aponeuroses
Soft tissue is
All the tissue in the body that is not hardened by the processes of ossification or calcification such as bones and teeth
What is soft tissue technique?
A direct technique that usually involves local stretching, linear stretching, deep pressure or traction
History of soft tissue technique
Used by AT Still especially deep inhibitory pressure
Soft tissue proposed mechanism of action
Relaxes hypertonic muscles and reduces spasm by decreasing alpha motor neuron activity
Stretches and increases the elasticity of shortened fascial structures
Improves local tissue nutrition, oxygenation and removal of metabolic wastes
Identifies areas of restricted motion, tissue texture abnormalities and sensitivity
Improves local systemic immune system
Provides a general state of relaxation
Provides a general state of tonic stimulation by stimulating the stretch reflex in hypotonic muscles
What are the indications of soft tissue technique?
Somatic dysfunction (TART findings)
Clinical conditions present that would benefit from soft tissue techniques
In adjunct to other OMT
What are some clinical conditions that would benefit from soft tissue?
Hypertonic muscles, excessive tension in fascial structures and abnormal somato-somatic or somato-visceral reflexes
When using ST in adjunct to other OMT you
Identify areas of somatic dysfunction
Observe tissue response to application of manipulative technique
Provide a general state of relaxation
Provide a general state of tonic stimulation
Prepare tissues for other types of manipulation
What are the most serious reactions to ST?
Ecchymosis (bruising), acute muscle spasm or post procedure muscle soreness
What are some absolute contraindications for ST?
Lack of consent
Skin or soft tissue is not intact (traumatized, friable, easily torn)
Absence of somatic dysfunction
What are some relative contraindications of ST that can be observed on the skin?
Contagious skin diseases, acute burns, painful rashes, abscesses or cellulitis and skin cancers
What are some relative contraindications of ST that can be observed on fascia?
Acute fasciitis or acute fascial tears
What are some relative contraindications of ST that can be observed on muscle?
Acute muscular strains, myositis or muscle neoplasms
What are some relative contraindications of ST that can be observed on ligaments?
Acute ligamentous strain or acute ligamentous inflammatory disorders
What are some relative contraindications of ST that can be observed on bone?
Acute fracture, osteomyelitis, primary or secondary bone tumors and osteoporosis
What are some relative contraindications of ST that can be observed in vasculature?
Hematoma, deep venous thrombosis and coagulopathy
What are some relative contraindications of ST that can be observed on the viscera?
Infection, neoplasm, organomegaly of the liver or spleen, gastric or bowel obstruction or distention, acute or undiagnosed abdominal pain, and pelvic pain
What are some relative contraindications of ST that can be observed on joints?
Septic joint or instability/collagen disorders
What are the three principals of ST treatment?
Traction/stretching, kneading and inhibition
Traction/stretching in reference to ST means
Origin and insertion of the myofascial structures being treated are longitudinally separated
Kneading during ST tx
Rhythmic, lateral stretching of the myofascial structure
Origin and insertion are held stationary, the central portion is stretched like a bowstring
Inhibition during ST tx
Sustained deep pressure over a hypertonic myofascial structure
ST basic treatment
Pt should be comfortable and relaxed
Physician should be in a comfortable position and able to minimize energy expenditure and able to use body weight to affect the
Initially forces are gentle and of a low amplitude (1-2 secs stretching with 1-2 sec rest)
After response is evaluated force & amplitude may be increased
Forces should be comfortable for the pt and pt may experience discomfort as in a good stretch
Physician hands should NOT slide over skin or create friction
Technique continued until desired effect is achieved and the soft tissue’s amplitude and extension has reached a maximum
What is myofascial release (MFR)?
A system of diagnosis and tx first described by AT Still and his early students which engages continual palpatory feedback to achieve release of myofascial tissues
Can be applied as direct, indirect or combined technique
History of MFR
AT Still was fascinated by fascia
1980’s Drs Peckham, Chila and Ward created the biomechanical (focused on anatomy) and fascial continuum model (focused on fascia)
1990s Dr O Connel created the bioenergetic model (focused on cells)
What is fascia?
A thin sheath of fibrous tissue enclosing a muscle or other organ
What does fascia do?
Surrounds, protects, provides structure to organs, blood vessels, bone, nerve fiber, muscles (to the tiniest myofibril)
It has nerve cells to sense stress or injury and has the ability to contract in reaction
What does MFR do?
Interacts with the fascia and the tissue it surrounds to improve homeostasis and innate healing
What are the different force effects?
Stress, viscosity, plastic deformation, elastic deformation, strain, creep and hysteresis or stress strain
What is stress (force effect)?
The effect of a force normalized over an area
What is viscosity (force effect)?
Capability of a solid to continually yield under stress with a measurable rate of deformation
What is plastic deformation (force effect)?
A stressed, formed or molded tissue preserves its new shape
What is elastic deformation (force effect)?
A stressed, formed or molded tissue recovers its original shape
What is strain (force effect)?
A change in shape as a result of stress
What is creep (force effect)?
The continued deformation of a viscoelastic material under constant load over time
What is hysteresis or stress-strain (force effect)?
A CT response to loading and unloading where the restoration of the final length of the tissue occurs at a rate and to an extent less than during deformation (loading) representing energy loss in the CT
MFR techniques address somatic dysfunction by (MFR indications)
Normalizing motion, relieving edema, re-establishing symmetry, relieving pain, aiding circulatory and lymph function, normalizing neuroreflexive activity, supporting visceral fxn, restoring bioenergetic balance and supporting homeostatic fxn
What are the absolute contraindications of MFR?
Lack of consent and absence of somatic dysfunction
What are the relative contraindications of MFR?
Extreme caution should be exercised in pts with fractures, open wounds, soft tissue or bony infections, abscesses, deep venous thrombosis (threat of embolism), anticoagulation, disseminated or focal neoplasm, recent post-operative conditions over the site of proposed tx (wound dehiscence) and aortic aneurysm
There have been no reports of complications from MFR however,
Overly aggressive interventions are counterproductive
After receiving MFR tx pts commonly experience
Post tx soreness similar to post exercise soreness especially in the first 1-2 treatments
Those with what disorders may experience flare ups in association with MFR tx?
Autoimmune, inflammatory and rheumatic disorders
What are the principles of diagnosis when using MFR?
The area of somatic dysfunction is evaluated in multiple planes of motion, determining position of ease and restrictive barrier (somatic dysfunction is named for the position of ease)
During MFR if your hands move superiorly on the thoracolumbar fasica (as an example) then what motion will occur?
Flexion
During MFR if your hands move inferiorly on the thoracolumbar fasica (as an example) then what motion will occur?
Extension
During MFR if your hands move to the left on the thoracolumbar fasica (as an example) then what motion will occur?
Right rotation
During MFR if your hands move to the right on the thoracolumbar fasica (as an example) then what motion will occur?
Left rotation
During MFR if your R hand moves inferior and L superior on the thoracolumbar fasica (as an example) then what motion will occur?
Side bending right
During MFR if your L hand moves inferior and R superior on the thoracolumbar fasica (as an example) then what motion will occur?
Side bending left
MFR principles of treatment
Pt should be comfortable and relaxed
Physician should be in a comfortable position (same as ST)
Engage tissues by adding light compression
Once a diagnosis is made a decision is made to tx in an indirect or direct manner
Continue to hold tissue until relaxation or creep of underlying tissues is sensed
Consider using a release enhancing mechanism such as breathing
Once relaxation is noted release the tissues and re-evaluate TART findings
Integrated neuromuscular release
Release enhancing maneuver
Activating the musculature below where the hands are treating the myofascia can untether the dysfunction
Used with direct myofascial release as a release enhancing maneuver
Summary of ST technique
Direct and repetitive technique
Low force and amplitude which progressively increases
Summary of MFR technique
Direct or indirect non-repetitive technique
3 dimensional diagnosis and treatment
May use release enhancing maneuvers such as breathing
