Week 5 : STT Flashcards
soft tissue therapy is adjunctive
it prepares tissue for controlled loading- reorganise collagen
give a few examples of types of STT
Massage • Soft tissue mobilisation • Connective tissue techniques • Myofascial techniques • Muscle energy techniques • Dry needling • neural mobilisation
Why do we do STT
Soft tissue abnormalities may
– Be a cause of pain
– Adversely affect neuromuscular control
increased muscle tone, CT thickening and; pain producing TPs
– deceased muscle power & performance
– Result in abnormal muscle activation
STT important Rx component to correct inhibited healthy activation patterns
STT indications
- increased muscle tone
- reduced ROM
- active or latent trigger points- refer pain in regular pattern or inhibit local muscle contraction
- abnormal thickening of CT
- prevention of scar/poor tissue mobility
- swelling/oedema post injury or disease process- lymph drainage
- need for muscle relaxation or stretching
- enhance recovery post activity
benefits of STT
-Increase ROM
-Increase circulation & nutrition to damaged tissue
-Reduce post-exercise muscle tone
Post strenuous exercise - decrease DOMS
-Deactivate symptomatic trigger points
-Preventative – athletic population
– Regular STT - assists to identify ST abnormalities
that could lead to injuries
STT effects
Effects are not en)rely clear but proposed to have
– Physiological effects
– Therapeutic effects
• Promote healing
• Restore normal function esp post injury • Enhance performance
• Different techniques have ‘different mechanisms’
– You need to be able to select the ‘right one’! • AND avoid the ‘wrong one’!!!
• As well as target the correct spot…. STT impacts upon (Goats, 1994; Brukner & Khan, 2012) – Arterial and venous blood flow
– Blood clotting process
– Oedema
– Lymphatic drainage
– Properties of connective tissue
– Properties of muscle
– Soma)c nervous system
– Autonomic nervous system
– Psychological…
How does STT work
Arterial blood flow
– Massage dilates superficial blood vessels
– increased “ blood flow rate (for approx 1 hour post massage – longer with vasodilator drugs)
• Combination of local response (histamine release) & cardiac stroke volume (improved venous return)
• Venous blood flow
– Promotes venous return – “ cardiac stroke volume
Blood clotting
– Evidence to show decreased incidence of DVT
– Not mediated en)rely by mechanical processes • Massage increases fibrolysis
• ! arm massage can reduce DVT in leg!!!
• Blood enzyme concentration
– Deep massage ! sufficient muscle damage to elevate
blood enzyme concentrations
• *Care as may confound diagnoses/measures based on these substances
CT
– Can improve CT flexibility
pre athletic activity – Transverse friction
• Mobility of ligaments, tendons & muscles, adhesion forma)on
• Pain reduction in overuse injuries of knee
• Encourages correct realignment of collagen fibrils
What to do
Assessment of ST via ROM + palpation (precise & systematic!) to identify
– Abnormal tension
– Focal abnormalities (trigger points)
• Consider proximal & distal contributions – Spinal & mysofascial TP referral
• Pain may be due to inhibitory effect of
– Inflammation, active trigger points, pain behaviour Consider the region you are treating
• Consider the desired Rx outcomes
• Select your technique(s) appropriately
– Correct techniques – Correct )ming of
techniques
– Post treatment exercise
• Continuation of Improvement beyond the hands on Rx..
considerations
Infection control
– Clean hands, nails, jewellery, hair
• Equipment
– Towels, pillows
– Lubricants (be aware of allergies)
• Comfort ! protects pa)ent’s skin & body hair
• “ ability to palpate tissue during Rx
• Treatment area
– Pa)ent comfort & your
comfort • Draping
– Consider temperature… • Hand contact
– Make sure it is effective & suited to technique
positioning for treatment
Consider pa)ent positioning
– Comfort
– Op)mal therapeu)tic effect
• Place “target tissue” in ideal position
– May be relaxed (lax) or on stretch (tensioned)
– May start relaxed & move tissue into tensioned position
treating under stretch
Number of advantages
– Focal sites of abnormality more easily palpable
– Myofascial trigger points • More clearly evident
• More intense referral
– Increased neural mechanosensitivity • Assists palpation of ST abnormalities
– Enhanced effectiveness of rupturing abnormal cross-links in collagen fibres
• Enhanced healing
ganter king scale for grading STT depth
slide 32
GK scale
Postacute lesions
– Grade I – without pain to gauge response to Rx without sense of tissue resistance
• IA depth
– Progression to IB then IIB approx 1 week post
injury
– Chronic lesion
• IIC or IIIC
Combined treatment
STT is just one aspect!
• Make sure you don’t neglect the follow ups…
– Sustained stretching to facilitate restoration of muscle length
• HEP
– Correction of muscle strength, relaxation,
neurodynamic imbalance
– Correction of technique for athlete • To avoid further complications
STT safety
STT is mostly a safe & effective technique that is liked by patients
BUT
• Some precautions & contraindications to be aware of
