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S3 - Clinical Practice 2 > Week 7- Soft Tissue Mobilization, Stretching/ROM, Other Soft Tissue Techniques > Flashcards

Week 7- Soft Tissue Mobilization, Stretching/ROM, Other Soft Tissue Techniques Flashcards

1
Q

SOFT TISSUE MOBILIZATION

A

SOFT TISSUE MOBILIZATION

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2
Q

When performing soft tissue mobilization, a lot of the time we are targeting ____________ or __________.

A
  • muscle guarding

- trigger points (TrP)

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3
Q

What is muscle guarding?

A

Increased resting activity in the muscle

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4
Q

What are some possible causes of muscle guarding?

A
  • Protective response to painful stimuli
  • Neurological dysfunction
  • Emotional stress, anxiety, fear
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5
Q

What are trigger points?

A

Hyperirritable area of tissue chemonociceptors and mechanonociceptors located within the muscle.

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6
Q

What are the 2 types of trigger points?

A

Active Trigger Point
-symptomatic and refers pain at rest or during motion

Latent Trigger Point
-do not cause patient’s pain unless they are activated by palpation

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7
Q

What type of trigger point do we treat in PT? Why?

A
  • Active Trigger Point

- This is what is bringing them to PT

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8
Q

Why do trigger points occur?

A
  • After injury, trauma (micro or macro) of the muscle causes inflammatory cascade.
  • This inflammation causes interleukin factors, cytokines, CGRP, and lactic acid to build up.
  • Metabolites increase acidity (lowering pH) = increasing muscle spindle excitability via alpha motor neuron, gamma gain.
  • Tonic, low grade muscle contractions can lead to the trigger point.
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9
Q

What is the cycle of muscle spasms/guarding?

A
  1. ) Pain
  2. ) Muscle Guarding
  3. ) Circulatory Stasis
  4. ) Retention of Metabolites
  5. ) Restricted Movement
  6. ) Muscle Spasm
  7. ) Myositis
  8. ) Pain
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10
Q

Traditionally, manual therapy is used to produce what therapeutic effects?

A
  • pain reduction
  • increased soft tissue extensibility
  • improve quality of motion in a restricted area
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11
Q

Why do we not want to become over reliant on manual techniques to improve patients?

A

We want to promote independence

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12
Q

What are the limitations with validating manual therapy studies?

A
  • Strong placebo effect associated with laying hands on patient.
  • Many musculoskeletal conditions are self-limiting
  • Difficult to blind clinicians and patients to intervention
  • Clear-cut definitions of when one technique is preferred over another is lacking.
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13
Q

Indication for Manual Therapy:

  • Pain reported with ______ that is relieved by _____.
  • Pain that is relieved or provoked by particular ________ or __________.
  • Pain altered by changes related to sitting or standing _________.
A
  • activity, rest
  • motions or positions
  • posture
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14
Q

Manual Therapy Contraindications:

  • Systemic or localized _________
  • Acute __________ conditions (DVT, etc)
  • _________ in the area
  • ____________ at site
  • Recent ______ at site
  • Hematoma
  • ______sensitive skin
  • Advanced _______
  • Rheumatoid arthritis (if in a flare)
  • Cellulitis
A
  • infection
  • circulatory
  • malignancy
  • open wound
  • recent fracture
  • hypersensitive
  • diabetes
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15
Q

Manual Therapy Precautions:

  • Joint _________ or ___________
  • Rheumatoid arthritis (if not in a flare)
  • _____________
  • Steroid or ____________ therapy
A
  • effusion or inflammation
  • osteoporosis
  • anticoagulant
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16
Q

Transverse Friction Massage Technique:
-Begin with ______ pressure
-Use __________ finger or thumb
-Move skin over site of lesion back and forth in direction ________ to normal orientation of the fibers
-Ensure patient’s skin moves with the clinician’s finger to prevent blistering
Pressure: _______ tolerance
Speed: __-__ cycles per second in a rhythmical manner
Duration: __-__ minutes
Discontinue: once ________ or if no improvement after _____ sessions

A
  • light
  • reinforced
  • perpendicular
  • patient
  • 2-3 cycles per second
  • 5-10 minutes
  • healed, three sessions
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17
Q

What are the 3 proposed effects of transverse friction massage?

A
  • Traumatic hyperemia
  • Pain relief
  • Assists with collagen orientation
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18
Q

How does transverse friction massage cause traumatic hyperemia?

A
  • Increases flow of blood which in turn removes the chemical irritants of inflammation
  • Increased blood flow reduces venous congestion thus decreasing edema and pressure on pain sensitive structures
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19
Q

How does transverse friction massage cause pain relief?

A
  • Stimulates Type I and II mechanoreceptors, producing presynaptic anesthesia
  • Gate control theory
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20
Q

How does transverse friction massage assist with collagen?

A

Assists with orientation of the collagen fibers

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21
Q

With transverse friction massage, patients may feel an ____________ of symptoms following first two or three sessions.

A

exacerbation

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22
Q

What are the indications for transverse friction massage?

A
  • acute
  • subacute
  • chronic ligament, tendon, or muscle injuries
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23
Q

What are the contraindications for transverse friction massage?

A
  • hematomas
  • open skin
  • frail skin
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24
Q

What is the difference in technique of a scar massage compared to a transverse friction massage?

A

Scar massage has a similar technique except not as much pressure.

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25
Q

What is the purpose of scar massage?

A

Stimulate collagen to lay down scar tissue appropriately, maintain scar mobility, and desensitize scars

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26
Q

What is a caution with performing scar massage?

A

Ensure incision is clean, dry, and intact prior to performing.

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27
Q

_________ provides strength to fascia, while ________ gives it its elastic properties and the ability to absorb compressive forces of movement.

A
  • collagen

- elastin

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28
Q

What are the 3 types of fascia?

A
  1. ) Superficial: lying directly below the dermis
  2. ) Deep: surrounding and infusing with muscle, bone, nerve, blood vessels, and organs to the cellular level
  3. ) Visceral: deepest layer comprising the dura of the craniosacral system, which encases the CNS
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29
Q

What is the purpose of myofascial release?

A

Apply gentle sustained pressure to deep fascia to release restrictions and restore normal pain-free function

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30
Q

What is the theory behind myofascial release?

A
  • Based on principle that trauma or structural abnormalities creates inappropriate fascial strain, because of an inability of the deep fascia to absorb or distribute forces
  • Strains to deep fascia results in slow tightening of the fascia; these fascial restrictions eventually lead to postural impairments
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31
Q

Initially after myofascial release, patients may experience what?

A

Muscle soreness

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32
Q

What are the 4 different myofascial release strokes?

A
  1. ) J Stroke
  2. ) Vertical Stroke
  3. ) Transverse stroke
  4. ) Cross-hands technique
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33
Q

What is ischemic compression?

A

Pressure is applied to center of trigger point.

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34
Q

What is the theory behind ischemic compression?

A

Sustained pressure deprives trigger point of oxygen; temporary blockage of circulation → reactive hyperemia that in turn reduces overall energy crisis and breaks pain cycle .

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35
Q

How long is ischemic compression performed?

A

10-60s

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36
Q

What is soft tissue mobilization (STM)?

A

Systematic, therapeutic, and functional stroking and kneading of the body.

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37
Q

Studies show that deep massage/STM increases _______ and skin __________ of the massaged area via ___________.

A
  • circulation and skin temperature

- vasodilation

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38
Q

What are the 3 types of STM?

A
  • Effleurage
  • Petrissage
  • Strumming
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39
Q

Effleurage:

  • Generally more __________
  • Useful for initial assessment of superficial tissues
  • Gentle stroking applied to musculature
  • Possible mechanism in assisting venous and lymphatic _________ and reducing ___________
  • Evidence for this is _______
A
  • superficial
  • drainage, tension
  • limited
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40
Q

What is the technique for effleurage?

A
  • Strokes distal to proximal along the line of the body part being massaged
  • Employ whole body movement and firm contact
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41
Q

Petrissage:

  • Assist ________ and ________ return
  • Assist fluid __________
  • Increase ________ of underlying tissue
A
  • venous and lymphatic
  • interchange
  • mobility
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42
Q

What are the techniques used for petrissage?

A

Kneading- compressed against underlying structures
Pulling/lifting- compressed then lifted and squeezed
Wringing- tissues are lifted and squeezed with alternative hand pressure
Rolling- tissues are lifted and rolled between fingers and thumbs (skin or muscle)

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43
Q

Retrograde massage is typically used to reduce _________. We want to use ______ with this. With sustained pressure we go ________ to ____________.

A
  • edema
  • lotion
  • distally to proximally
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44
Q

What is the intention of retrograde massage?

A

Push the fluid back towards the lymphatic system and assist with edema control.

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45
Q

What are some special precautions for vulnerable patients with STM?

A
  • patients may have difficulty understanding STM intention and what it entails
  • suffered previous trauma related to touch
  • BE SENSITIVE to non-verbal communication and response
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46
Q

ROM/STRETCHING

A

ROM/STRETCHING

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47
Q

What is flexibility?

A

Ability to move a joint smoothly and easily through an unrestricted, pain-free ROM

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48
Q

What 3 things determine flexibility?

A
  • muscle length
  • joint integrity
  • extensibility of periarticular soft tissues
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49
Q

Does functional ROM = full or normal ROM?

A

Not necessarily, functional ROM is enough ROM for functional activities

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50
Q
  • Decreased flexibility leads to decreased mobility or restricted motion caused by adaptive shortening of ___________.
  • Decreased flexibility may impair muscle performance and can lead to ________ limitations and ________ restrictions.
  • Decreased flexibility can range from mild muscle shortening to irreversible __________.
A
  • soft tissues
  • activity, participation
  • contractures
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51
Q

What are some potential causes for decreased flexibility?

A
  • Prolonged immobilization
  • Sedentary lifestyle
  • Postural malalignment and muscle imbalances
  • Impaired muscle performance (weakness) associated with MSK or neuromuscular disorders
  • Tissue trauma resulting in inflammation and pain
  • Congenital or acquired deformities
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52
Q

Immobilization can lead to:

  • Decay of _________ protein
  • Decreases in muscle fiber __________
  • Decrease in number of __________
  • Decrease in intramuscular capillary __________
A
  • contractile
  • diameter
  • myofibrils
  • density
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53
Q

As a immobilized muscle atrophies, an increase in what tissue in the muscle occurs?

A

Fibrous and fatty tissue, leading to weakness and restricted ROM

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54
Q

Would we rather have a patient immobilized in a shortened or lengthened position and why?

A

Lengthened, immobilization in a shortened position decreases the muscle’s capacity to produce maximum tension at its normal resting length as it contracts.

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55
Q

________ formation can also occur with immobilization because of greater cross-linking between disorganized collagen fibers.

A

Adhesion

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56
Q

Is ROM the same as stretching?

A

NO

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57
Q
  • ROM interventions are administered to _________ joint and soft tissue mobility to minimize loss of tissue flexibility and contracture formation; not improve ROM.
  • Stretching is used to ________ ROM
A
  • MAINTAIN

- increase

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58
Q

What are the 3 types of ROM?

A
  • PROM
  • AROM
  • AAROM
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59
Q

What are the indications for PROM?

A
  • acute, inflammed tissue

- patient is not able to or not supposed to actively move a segment of the body

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60
Q

Goals for PROM:

  • Maintain joint and connective tissue ______
  • Minimize the effects of the formation of _________
  • Maintain mechanical _________ of muscle
  • Assist ___________ and __________ dynamics
  • Enhance synovial movement for cartilage _________ and diffusion of materials in the joint
  • Decrease or inhibit _____
  • Assist with the healing process after injury or surgery
A
  • mobility
  • contractures
  • elasticity
  • circulation and vascular
  • nutrition
  • pain
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61
Q

Passive motion does NOT do what?

A
  • prevent atrophy
  • increase strength or endurance
  • assist circulation to the extent that active does
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62
Q

What are the indications for AROM/AAROM?

A
  • Patient able to contract the muscles actively w/ or w/out assistance.
  • AAROM: patient has weak musculature and can’t move through desired ROM (usually against gravity).
  • When a segment is immobilized for a period of time, AROM is used below and above to maintain the areas in as normal condition as possible.
  • No significant inflammation or contraindication to AROM.
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63
Q

Goals for AROM:

  • Maintain physiological _________ and ________ of the participating muscles
  • Provide ________ feedback from the contracting muscles
  • Provide a stimulus for bone and joint tissue integrity
  • Increase _________ and prevent thrombus formation
  • Develop coordination and motor skills for _________ activities
A
  • elasticity and contractility
  • sensory
  • circulation
  • functional
64
Q

What are some limitations of AROM?

A
  • For string muscles, AROM does not maintain or increase strength.
  • Does not develop skill or coordination except in the movement patterns used.
65
Q

What are some ROM precautions/contraindications?

A
  • When motion is disruptive to the healing process.
  • Immediately after acute tears, fractures, and surgery.
  • When patient response or the condition is life-threatening.
66
Q

What is the purpose of stretching?

A
  • Restore or increase the extensibility of the muscle-tendon unit.
  • Regain or achieve the flexibility and ROM required for necessary or desired functional activities.
67
Q

How should stretching be done in early rehab compared to late rehab?

A
  • Early rehab- Manual stretching and joint mobs may be the most appropriate.
  • Late rehab- Self-stretching and self mobilization exercises performed independently by a patient.
68
Q

What does it mean if you get a PROM of 130 degrees and AROM of 150 degrees?

A

The patient doesn’t trust you. Give them active stretches

69
Q

How do we make ROM gains permanent?

A

It must be used on a regular basis.

70
Q

What are the 3 types of stretching?

A
  • Passive
  • Active assisted
  • Active
71
Q
  • Mechanisms for stretch-induced gains in ROM include __________ and _______ changes.
  • Changes are the result of increased muscle ____________ or decreased muscle ____________.
  • Increased ROM following a stretch may be the result of a change in an individual’s _________ of the sensation associated with stretch.
A
  • biomechanical and neural
  • extensibility, stiffness
  • tolerance
72
Q

Both contractile and non-contractile tissues have _______ and ________ qualities. Only non-contractile tissues have __________ properties.

A
  • elastic and plastic

- viscoelastic

73
Q

Deformation (stretch) begins as ___________ of fibrils and fibers before complete failure of the tissue occurs. __________ capabilities allow the tissue to respond to repetitive and sustained loads if time is allowed between bouts. If remodeling time is not allowed, tissue ________ may occur.

A
  • microfailure
  • remodeling
  • failure
74
Q

During stretch, mechanical disruption of the cross-bridges occurs as the filaments slide apart, leading to abrupt lengthening of the __________. If longer lasting, more permanent (plastic) length increases are to occur, what must be done?

A
  • sarcomeres

- Stretch force must be maintained over an extended period of time.

75
Q

What is the major sensory organ of the muscle and is sensitive to quick and sustained stretch?

A

-Muscle spindles

76
Q

Stretch Reflex:

  • When a stretch force is applied, muscle spindles sense the length changes and activate the stretch reflex by increasing tension in the muscle being _________
  • When the stretch reflex is activated in a muscle being lengthened, inhibition in the muscle on the opposite side of the joint may occur (_________ inhibition)
  • ________ applied, ____-intensity, prolonged stretch is preferable to minimize activation of the stretch reflex
A
  • stretched
  • reciprocal
  • slowly applied, low-intensity
77
Q

______________ function is to monitor changes in tension of muscle-tendon units.

A

-Golgi tendon organ (GTO)

78
Q

When tension develops, the GTO fires and _______ tension in the muscle-tendon unit being stretched (autogenic inhibition), enabling a muscle to be elongated against less muscle tension.

A

decreases

79
Q

If a low-intensity, slow stretch force is applied, the ______________ (muscle spindles) is less likely to be activated as the GTO fires and inhibits tension

A

stretch reflex

80
Q

What is creep?

A

When a load is applied for an extended period of time, the tissue elongates and does not return to its original length.

81
Q

Can complete recovery from creep occur?

A

Yes, but not as rapidly as a single strain.

82
Q

Permanent changes in length is dependent on what 2 things?

A
  • Amount of deformation (load)

- Length of time deformation is maintained

83
Q

Is there a minimum load that is needed for deformation (stretch)?

A
  • Yes, below the minimum load will not cause deformation.

- The greater the applied load, the fewer number of cycles needed for deformation.

84
Q

What are some indications for stretching?

A
  • ROM limited secondary to adhesions, contractures, scar tissue leading to functional limitations
  • Restricted ROM may lead to structural deformities which are otherwise preventable
  • Muscle weakness and shortening of opposing tissues led to limited ROM
  • As component of total fitness program
  • Prior to and after vigorous exercise
85
Q

Stretching Contraindications:

  • ______ end feel
  • Recent ________ in the area
  • Acute _________ or ________ in the area
  • Hematoma in the area
  • _______mobility in the area
  • __________ tissues enable a patient with paralysis or severe muscle weakness to perform a functional activity
A
  • hard
  • fracture
  • inflammation or infection
  • hypermobility
  • shortened
86
Q

What are the 4 broad categories of stretching exercises?

A
  • Static stretching
  • Cyclic stretching
  • Ballistic stretching
  • Proprioceptive neuromuscular facilitation (PNF) stretching
87
Q

What are some parameters to consider when streteching?

A
  • Alignment
  • Stabilization of the body during stretching
  • Intensity (magnitude)
  • Duration
  • Speed
  • Frequency
  • Mode (type) of stretch
  • Integration of neuromuscular inhibition or facilitation and functional activities into stretching programs
88
Q

Proper alignment of the patient and the muscles and joints to be stretched is necessary for patient comfort and _________ during stretching. Alignment influences the amount of tension present in the soft tissue.

A

stability

89
Q
  • To achieve an effective stretch, it is imperative to stabilize the _______ or ________ attachment site of the muscle-tendon unit being elongated.
  • In manual stretching, the physical therapist commonly stabilized the _________ and move ___________
  • In self-stretching, often the ________ attachment is stabilized as the _________ segment moves.
A
  • proximal or distal
  • proximal and move distally
  • distal, proximal
90
Q

______-intensity stretching (coupled with a _______-duration; low load long duration stretch) results in optimal rates of improvement in ROM without exposing tissues to excessive loads and potential injury.

A
  • low-intensity

- long-duration

91
Q

Duration of stretch must be put in context with other stretching parameters, including ________,_________, and ______ of stretch.

A

intensity, frequency, and mode

92
Q

What is progressive static stretching?

A
  • Shortened soft tissues are held in a comfortably lengthened position until a degree of relaxation is felt by the patient or therapist.
  • Then the tissues are incrementally lengthened even further and again held in the new end-range position for an additional duration of time.
93
Q

What is cyclic stretching?

A

A relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied.

94
Q
  • Static stretching= more _______
  • Cyclic stretching= more ________

Why would you pick one over the other?

A
  • time
  • reps

-patient irritation

95
Q
  • What is dynamic splint?

- What is serial casting?

A

Dynamic Splint
-Maintains limb position at end range and often applied for 8-10 hours
Serial Casting
-Cast applied for 5-7 days then removed and new one reapplied with limb in newly gained ROM position

96
Q

Slow speed stretches help to minimize __________ and reduce risk of ______ to tissues and post stretch muscle _________.

A
  • muscle tension
  • injury
  • soreness
97
Q

What type of stretching is generally not recommended for elderly or sedentary individuals, as well as individuals with MSK pathology or chronic contractures?

A

Ballistic Stretching

98
Q

What is ballistic stretching?

A

High velocity movements thought to cause greater trauma to stretched tissues and greater muscle soreness.

99
Q

Which is better, static stretching or ballistic stretching?

A

Both shown to improve flexibility equally.

100
Q

What is frequency?

A

Number of bouts (sessions) per day or per week a patient carries out a stretching regimen.

101
Q

Frequency needs to allow time to rest between sessions for tissue ______ and to minimize __________.

A
  • healing

- soreness

102
Q

What is mode of stretch?

A

Form of stretch or manner in which stretching exercise is carried out.

103
Q

What are some categories of mode?

A
  • Manual
  • Mechanical
  • Self-stretching
  • Passive
  • Assisted
  • Active stretching
104
Q

What type of stretching may be most appropriate in the early stages of a stretching program when we want to determine patient response to intensities or duration.

A

Manual Stretching

105
Q

When is passive manual stretching appropriate?

A

If the patient cannot perform self-stretching safely/effectively

106
Q

When is assisted manual stretching appropriate?

A

If patient has poor control of the body segment.

107
Q

_____-stretching is when the patient carries it out independently after careful instruction and supervision.

A

Self

108
Q

________ stretching involves utilizing a piece of equipment or device to assist with stretching.

A

Mechanical

109
Q

What is the duration of mechanical stretching?

A

15-30 minutes to 8-10 hours

110
Q

Is mechanical or manual stretching shown to be more effective and comfortable?

A

Mechanical

111
Q

What is PNF stretching?

A

Proprioceptive Neuromuscular Facilitation (PNF)
-Integrates active muscle contractions into stretching with intention of inhibiting muscle activation of the muscle being stretched and to keep it relaxed.

112
Q

Is PNF designed to affect the contractile elements of a muscle or the non-contractile connective tissues?

A

Contractile elements of a muscle.

113
Q
  • When is PNF stretching MORE APPROPRIATE?

- When is PNF stretching LESS APPROPRIATE?

A
  • More appropriate when muscle spasm limits motion.

- Less appropriate for stretching long-standing, fibrotic contractures.

114
Q

What are the requirements for PNF stretching to be performed?

A
  • Normal innervation and voluntary control of either the shortened muscle or the muscle on the opposite side of the joint.
  • Patient is cognitively intact enough to follow directions.
115
Q

Is PNF or static stretching shown to yield greater gains in ROM?

A

PNF

116
Q

What are the 2 main types of PNF stretching?

A
  • Antagonist Contraction/ Hold-Relax (HR)

- Agonist Contraction/ Contract Relax

117
Q
  • In PNF stretching the “_________” is the range-limiting muscle (shortened muscle being stretched).
  • The “_________” is the muscle opposite the range-limiting target muscle (prime mover in that direction)
A
  • Antagonist

- Agonist

118
Q

PNF stretching uses either ________ inhibition or _________ inhibition.

A
  • autogenic

- reciprocal

119
Q

Autogenic inhibition involves contraction of the range limiting muscle (__________) to allow for a stretch.

A

antagonist

120
Q

Autogenic inhibition relies on the body’s self regulatory mechanisms of the _____ in order to protect structures. What is an example of this?

A
  • GTOs

- Trying to lift something that you think is 2lbs, but is really 100lbs.

121
Q

Autogenic inhibition occurs in stretched muscle in the form of a _________ in the excitability due to inhibitory signals sent from the ______ of the same muscle (antagonist) allowing it to relax and be stretched farther.

A
  • decrease

- GTOs

122
Q

Describe how autogenic inhibition works.

A
  • Tension causes activation of Ib afferent fibers within the GTOs
  • Afferent fibers send signals to the spinal cord causing activation of inhibitory interneurons within the spinal cord
  • Interneurons place an inhibitory stimulus upon the alpha motoneuron
  • Decreasing the nerves’ excitability and decreasing the muscles’ efferent motor drive in the antagonist
123
Q

Reciprocal inhibition involves contraction of the muscle opposite range limiting muscle (__________) to allow for a stretch.

A

agonist

124
Q

How do agonists and antagonists work in regards to reciprocal inhibition?

A

When one contracts, the other relaxes and is thus inhibited in order to prevent the muscles from working against one another.

125
Q

_________ inhibition occurs in the antagonist muscle when the opposite muscle (agonist) is contracted voluntarily.

A

Reciprocal

126
Q

In reciprocal inhibition, _______ activity in the antagonist muscle decreases in order to maximize the contraction of the agonist force.

A

neural

127
Q

Describe how reciprocal inhibition works.

A
  • Ia afferent fibers from agonist enter the spinal cord and give off collateral branches that interact with interneurons in the spine
  • Interneurons send signals to the alpha-motorneuron in the GTOs of the antagonist muscle
  • Effect of this connection is inhibitory and causes relaxation of the antagonist muscle
128
Q

Antagonist Contract/ Hold Relax (HR) Procedure:

  • Range-limiting target muscle (___________) is first lengthened to the point of tissue resistance or to the extent that is comfortable for the patient
  • Patient then performs a prestretch, end-range, submaximal isometric contraction (for about __-__ seconds) of the range limiting target muscle (antagonist)
  • Followed by voluntary ________ of the range-limiting target muscle (antagonist)
  • Limb is then moved into the new range as the antagonist muscle is elongated

-THIS USES __________ INHIBITION

A
  • antagonist
  • 5-10s
  • relaxation

-AUTOGENIC

129
Q

Agonist Contraction/Contract Relax (CR) Procedure:
-Range-limiting target muscle (________) is first lengthened to the point of tissue resistance or to the extent that is comfortable for the patient
Patient submaximally isometrically contracts the muscle opposite the range-limiting muscle (_______) (for about 5-10 seconds) of the range limiting target muscle (antagonist)
Followed by voluntary __________ of the range-limiting target muscle (antagonist)
Limb is then moved into the new range as the antagonist muscle is elongated

THIS USES ___________ INHIBITION

A
  • antagonist
  • agonist
  • relaxation

-RECIPROCAL

130
Q

When would you use agonist contraction/contract relax (CR)?

A
  • When muscle guarding restricts muscle lengthening and joint movement.
  • Useful when patient cannot generate a strong, pain-free contraction of the antagonist.
131
Q

When is agonist contraction/contract relax (CR) less effective?

A
  • Less effective in reducing chronic contractures.

- Less effective if a patient has close to normal flexibility.

132
Q

What should be done after stretching?

A
  • Use the new available ROM after stretching to allow patient to elongate the hypomobile structures actively
  • To achieve permanent increases in ROM and reduce functional limitations must integrate functional activities and use the gained range on a regular basis
133
Q

What must be done as ROM approaches normal to maintain appropriate balance of strength between agonists and antagonists.

A

Muscles must be strengthened

134
Q

How long do gains in flexibility and ROM last after cessation of stretching?

A

4 weeks

135
Q

OTHER SOFT TISSUE TECHNIQUES

A

OTHER SOFT TISSUE TECHNIQUES

136
Q

What is IASTM?

A

Instrument Assisted Soft Tissue Mobilization

-Process in which the clinician uses a hand-held instrument to perform manual techniques.

137
Q

IASTM has a positive impact on the resynthesis and organization of ________.

A

collagen

138
Q

IASTM minimizes force used by the ___________ but maximizes the force delivered to the ______.

A
  • practitioner

- tissues

139
Q

What are the goals of IASTM?

A
  • remove scar tissues
  • stimulate tendons and muscles
  • promote return to normal function
140
Q

Has IASTM been shown to have an effect on inflammation related factors?

A

No, but it’s shown to be effective at reducing exercise-induced inflammation.

141
Q

Microvascular and capillary ____________, along with localized ____________ can occur with IASTM.

A
  • hemorrhage

- inflammation

142
Q

IASTM increases ______ and ________ supply to the injured area and migration of _________. New collagen is synthesize and realigned, which enables turnover and regeneration of the injured tissue.

A
  • blood and nutrient

- fibroblasts

143
Q

Can IASTM reduce pain and increase ROM?

A

Yes

144
Q

What is the primary dosage and angle for IASTM?

A
  • 20-120s

- 30-60 degrees

145
Q

Why is sufficient fluid intake required before and after IASTM application.

A

Fluid assists the blood supply to the injured tissue to facilitate delivery of O2 and nutrients.

146
Q

What are some possible side effects of IASTM?

A
  • Bruising

- Soreness

147
Q

What are the relative contraindications for IASTM?

A
  • Cancer
  • Kidney dysfunction
  • Pregnancy
  • RA
  • Varicose veins
  • Osteoporosis
  • Lymphedema
  • Fracture
  • Chronic regional pain syndrome
  • Use of certain medications (anticoagulants, steroids, NSAIDs)
148
Q

What are the absolute contraindications for IASTM?

A
  • Open wound
  • Unhealed suture sites
  • Thrombophlebitis
  • Uncontrolled hypertension
  • Skin infection
  • Hematoma
  • Myositis ossificans
  • Unstable fractures
149
Q

What is dry needling?

A

Skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissuesfor the management of neuromusculoskeletal pain and movement impairments.

150
Q

What is dry needling typically used to treat?

A
  • Muscles
  • Ligaments
  • Tendons
  • Subcutaneous fascia
  • Scar tissue
151
Q

What are the 4 most common dry needling techniques?

A

Deep Dry Needling
-needle is pierced deep into the muscle/target tissue, local twitch response often elicited
Superficial Dry Needling
-only the skin overlying the target tissue is pierced
Needle Manipulation
-winding or pistoning of needle in treatment area
Intramuscular electrical stimulation
-E-stim applied wwith needle in treatment area

152
Q

What are some proposed mechanisms of dry needling?

A
  • Langevin researched cell stress via winding of needles which lead to remodeling cyto-architecture, protein synthesis, and virtually micro healing
  • Opioid-formation from various cells can be stimulated by dry needling (immune cells, keratinocytes, fibroblasts).
  • A-delta pain to reverse changes via C-fiber pain (gate control)
153
Q

What is the difference between acupuncture and dry needling?

A

Acupuncture

  • Targets specific “meridians” on the body
  • “Meridians” thought to connect internal organs in the body and are intended to open up one’s energy flow

Dry Needling
-Targets specific muscle/structure thought to be involved in impairment and pain

154
Q

What is cupping?

A

Applying a cup to create suction over a painful area.

155
Q

What is cupping thought to do?

A
  • Mechanically- increases blood circulation

- Physiologically- activate immune system and stimulate mechanosensitive fibers for pain reduction (gait control)

156
Q

With cupping, it stimulates increased blood flow, eventually leading to capillary ________ and ____________ (red/bruising).

A
  • rupture

- ecchymosis

157
Q

Macrophages phagocytize the ________ in the extravascular space which leads to cascade of effects ultimately resulting in production of antioxidants, anti-inflammatories, and neuromodulatory effects.

A

RBCs

S3 - Clinical Practice 2 (13 decks)

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