ST, MRF, INR Lecture and LAB Flashcards
Difference between soft tissue and fascia?
Soft tissue has tendons, ligaments, aponeuroses included
Components of Fascia?
Fascia Muscles Organs Nerves Vasculature Lymphatic vessels
What is soft tissue?
Everything not hardened by ossification
Is soft tissue technique direct or indirect?
Direct
What are the 3 soft tissue techniques?
Lateral (perpendicular) , linear(parallel), and inhibitory
AP Still used which technique a ton?
Deep inhibitory
MOA of soft tissue?
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
Soft tissue Indications?
Hypertonic muscles
Excessive tension in fascial structures
Abnormal somato-somatic or somato-visceral reflexes
Soft tissue safety reactions?
Ecchymosis (bruising)
Acute muscle spasm
Post-procedure muscle soreness
Soft tissue absolute contraindications?
Lack of consent
Skin or soft tissue is not intact (traumatized, friable [easily torn])
Absence of somatic dysfunction
Soft Tissue: ContraindicationsRelative
Skin
Contagious skin diseases
Acute burns
Painful rashes
Abscess or cellulitis
Skin cancers
Fascia
Acute fasciitis
Acute fascial tears
Muscle
Acute muscular strains
Myositis
Muscle neoplasms
Ligament
Acute ligamentous strain
Acute ligamentous inflammatory disordersSoft tissue linear technique description
Traction/Stretching
Origin and insertion of the myofascial structures being treated are longitudinally separated
1-2 seconds stretching, 1-2 seconds rest
Physician hands should not slide over skin or create friction.
After response is evaluated, force and amplitude may be increased.
Soft tissue lateral technique description
Kneading
Rhythmic, lateral stretching of the myofascial structure
Origin and insertion are held stationary, the central portion is stretched like a bowstring
1-2 seconds stretching, 1-2 seconds rest
Physician hands should not slide over skin or create friction.
After response is evaluated, force and amplitude may be increased.
Soft tissue inhibition technique description
Sustained deep pressure over a hypertonic myofascial structure
Is MFR direct or indirect?
Either one
MFR proposed MOA?
Interacts with the fascia and the tissues it
surrounds to improve homeostasis and innate healing
MFR indications
Normalizing motion Relieving edema Reestablishing symmetry Relieving pain Aiding circulatory and lymphatic function Normalizing neuroreflexive activity Supporting visceral function Restoring bioenergetic balance Supporting homeostatic function
MFR Absolute Contraindications
Lack of consent
Absence of somatic dysfunction
MFR: Relative Contraindications
Extreme caution should be exercised in patients with:Fractures
Open wounds
Soft tissue or bony infections
Abscesses
Deep venous thrombosis (threat of embolism)
Anticoagulation
Disseminated or focal neoplasm
Recent postoperative conditions over the site of proposed treatment (wound dehiscence)
Aortic aneurysm
MFR compications?
Patients commonly experience post treatment soreness similar to post-exercise soreness, especially in the first 1-2 treatments
Those with autoimmune, inflammatory, and rheumatologic disorders may experience flare-ups in association with MFR treatment
MFR extension direction?
Hands moved inferiorly
MFR flexion direction?
Hands moved superiorly
MFR right rotation direction?
Hands moved to the left
MFR left rotation direction?
Hands moved to the right
MFR Sidebending right direction?
Right hand inferior, left superior
MFR Sidebending left direction?
Left hand inferior, right superior
MFR technique description?
Engage tissues by adding light compression
Continue to hold tissue until relaxation or creep of underlying tissues is sensed.
Consider using a release enhancing mechanism, such as breathing
What is INR
Integrated neuromuscular release. Use movement of the limbs to help move the fascia.
What is INR done in tandom with?
MFR, typically with a direct.
ST Thoracic prone pressure
Place thenar and hypothenar eminence on paravertebral muscles opposite the side you are standing Keeping your elbows straight and using own body weight, engage soft tissues with a ventral force and move out laterally creating a perpendicular stretch
ST Thoracic: Prone Pressure with Counterpressure
Place thenar eminence and thumb of caudal hand over the thoracic paravertebral muscles opposite the side you are standing • Place hypothenar eminence of cephalad hand on paravertebral muscles on the same side you are standing
ST Thoracic: Subscapular Stretch
Take patient’s arm, on the side being treated, and place it behind the back • Place fingers around medial border of scapula • Engage the tissue ventrally then give gentle and upward traction, pulling scapula away from rib cage, on for 1 2 seconds, off for 1 2 seconds until muscle relaxation is perceived
ST Upper Thoracic with Shoulder
Block, Lateral Recumbent
Standing at side of table facing patient • Inferior hand passes under patient’s arm and contacts paravertebral muscles • Superior hand contacts anterior portion of shoulder to give counterforce. Drape patient’s arm over your arm. • With both hands, engage soft tissues ventrally and move out laterally to create a stretch for 1 2 seconds, off 1 2 seconds, repeat until relaxation perceived
ST Lower Thoracic Under the
Shoulder, Lateral Recumbent ST
F orearms contacting the axilla and iliac
crest, fingers contact medial aspect of the
erector spinae
•
Elbows spread apart, elongating distance
between the shoulder and the hip;
•
Traction the paraspinal muscles laterally.
•
Lean back to provide lateral force, on for 1
2 seconds, off for 1 2 seconds until muscle
relaxation is perceived
ST Paraspinal Inhibitory Technique
Place finger pads over the paraspinal tissues. • Apply gentle, firm pressure to engage the tissues. • Continue pressure until release occurs.
Lumbar: Prone Pressure
Place thenar and hypothenar eminence on paravertebral muscles opposite the side you are standing • Place other hand on top of hand contacting the muscles • Keeping your elbows straight and using own body weight, engage soft tissues with a ventral force and move out laterally creating a perpendicular stretch for 1 2 seconds, off for 1 2 seconds until tissue relaxation is perceived.
Lumbar: Prone Pressure with
Counterleverage
Using inferior hand, grasp ASIS on other side of patient • Place thenar & hypothenar eminence of superior hand on the paraspinal muscles • Pull posteriorly on the ASIS and apply anterolateral pressure on lumbar paraspinal muscles in a repetitive rhythmic fashion holding the stretch for 1 2 seconds, then off for 1 2 seconds, repeating until muscle relaxation is perceived
Lumbar: Paraspinal
Perpendicular Stretch,
Lateral Recumbent
At side of table facing patient Reach over patient’s back and place finger pads on the paravertebral muscles • Engage tissues with a ventral force and move out laterally to create a perpendicular stretch for 1 2 seconds, off for 1 2 seconds until muscle relaxation is perceived.
C
Spine: Bilateral Forearm
Fulcrum Forward Bending
Arms are crossed under patient’s head and hands placed palm down on patient’s shoulders • Repetitively flex patient neck, giving a longitudinal stretch of the paravertebral muscles 1 2 seconds on, 1 2 seconds off
C
Spine: Cradling with
Traction, Supine
Fingers placed under patient’s neck bilaterally on paraspinal muscles, just lateral to the spinous process • Engage soft tissue with anterior and lateral force • Longitudinal traction exerted by moving cephalad along the soft tissues, not sliding on skin, holding for 1 2 seconds, off for 1 2 seconds, repeating until muscle relaxation is perceived.
Head & C
Spine: Suboccipital
Release
Finger pads are placed in the suboccipital region • Apply anterosuperior pressure – Kneading : pressure may be slowly and rhythmically applied until tissue texture changes occur. – Inhibition: Apply a constant inhibitory pressure until tissue texture changes occur.
Prone Lumbosacral MFR/INR
Physician place one hand with pinky
just superior to the LS junction, thenar &
hypothenar eminence lateral to one of the SI
joints and the contralateral finger pads on the
lateral aspect of the other SI joint
Activating forces:
•
MFR: Inherent and respiratory
•
INR: REMs leg flex/extend, IR/ER
Scapulothoracic
SD MFR
1. Pt: lateral recumbent, involved shoulder up. 2. Physician: faces the patient’s front contacting the scapula posteriorly with both hands (superior hand stabilizes anterior and posterior aspect of scapula). 3. Assess the ease and restrictions of the 6 scapular motions. Flexion/Extension Abduction/Adduction Protraction/retraction 4. Apply direct or indirect myofascial release technique
Cervical MFR/INR
Setup: pt. supine; cup the region of greatest TART with finger pads (no pressure with thumbs) • Gently add traction to engage the hypertonic tissues • Assess flexion/extension, rotation, & sidebending. Activating forces: • MFR: Inherent and respiratory • INR: REMs eye, tongue & UE movement
