Week 7- Soft Tissue Mobilization, Stretching/ROM, Other Soft Tissue Techniques Flashcards
SOFT TISSUE MOBILIZATION
SOFT TISSUE MOBILIZATION
When performing soft tissue mobilization, a lot of the time we are targeting ____________ or __________.
- muscle guarding
- trigger points (TrP)
What is muscle guarding?
Increased resting activity in the muscle
What are some possible causes of muscle guarding?
- Protective response to painful stimuli
- Neurological dysfunction
- Emotional stress, anxiety, fear
What are trigger points?
Hyperirritable area of tissue chemonociceptors and mechanonociceptors located within the muscle.
What are the 2 types of trigger points?
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
What type of trigger point do we treat in PT? Why?
- Active Trigger Point
- This is what is bringing them to PT
Why do trigger points occur?
- 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.
What is the cycle of muscle spasms/guarding?
- ) Pain
- ) Muscle Guarding
- ) Circulatory Stasis
- ) Retention of Metabolites
- ) Restricted Movement
- ) Muscle Spasm
- ) Myositis
- ) Pain
Traditionally, manual therapy is used to produce what therapeutic effects?
- pain reduction
- increased soft tissue extensibility
- improve quality of motion in a restricted area
Why do we not want to become over reliant on manual techniques to improve patients?
We want to promote independence
What are the limitations with validating manual therapy studies?
- 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.
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 _________.
- activity, rest
- motions or positions
- posture
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
- infection
- circulatory
- malignancy
- open wound
- recent fracture
- hypersensitive
- diabetes
Manual Therapy Precautions:
- Joint _________ or ___________
- Rheumatoid arthritis (if not in a flare)
- _____________
- Steroid or ____________ therapy
- effusion or inflammation
- osteoporosis
- anticoagulant
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
- light
- reinforced
- perpendicular
- patient
- 2-3 cycles per second
- 5-10 minutes
- healed, three sessions
What are the 3 proposed effects of transverse friction massage?
- Traumatic hyperemia
- Pain relief
- Assists with collagen orientation
How does transverse friction massage cause traumatic hyperemia?
- 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
How does transverse friction massage cause pain relief?
- Stimulates Type I and II mechanoreceptors, producing presynaptic anesthesia
- Gate control theory
How does transverse friction massage assist with collagen?
Assists with orientation of the collagen fibers
With transverse friction massage, patients may feel an ____________ of symptoms following first two or three sessions.
exacerbation
What are the indications for transverse friction massage?
- acute
- subacute
- chronic ligament, tendon, or muscle injuries
What are the contraindications for transverse friction massage?
- hematomas
- open skin
- frail skin
What is the difference in technique of a scar massage compared to a transverse friction massage?
Scar massage has a similar technique except not as much pressure.
What is the purpose of scar massage?
Stimulate collagen to lay down scar tissue appropriately, maintain scar mobility, and desensitize scars
What is a caution with performing scar massage?
Ensure incision is clean, dry, and intact prior to performing.
_________ provides strength to fascia, while ________ gives it its elastic properties and the ability to absorb compressive forces of movement.
- collagen
- elastin
What are the 3 types of fascia?
- ) Superficial: lying directly below the dermis
- ) Deep: surrounding and infusing with muscle, bone, nerve, blood vessels, and organs to the cellular level
- ) Visceral: deepest layer comprising the dura of the craniosacral system, which encases the CNS
What is the purpose of myofascial release?
Apply gentle sustained pressure to deep fascia to release restrictions and restore normal pain-free function
What is the theory behind myofascial release?
- 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
Initially after myofascial release, patients may experience what?
Muscle soreness
What are the 4 different myofascial release strokes?
- ) J Stroke
- ) Vertical Stroke
- ) Transverse stroke
- ) Cross-hands technique
What is ischemic compression?
Pressure is applied to center of trigger point.
What is the theory behind ischemic compression?
Sustained pressure deprives trigger point of oxygen; temporary blockage of circulation → reactive hyperemia that in turn reduces overall energy crisis and breaks pain cycle .
How long is ischemic compression performed?
10-60s
What is soft tissue mobilization (STM)?
Systematic, therapeutic, and functional stroking and kneading of the body.
Studies show that deep massage/STM increases _______ and skin __________ of the massaged area via ___________.
- circulation and skin temperature
- vasodilation
What are the 3 types of STM?
- Effleurage
- Petrissage
- Strumming
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 _______
- superficial
- drainage, tension
- limited
What is the technique for effleurage?
- Strokes distal to proximal along the line of the body part being massaged
- Employ whole body movement and firm contact
Petrissage:
- Assist ________ and ________ return
- Assist fluid __________
- Increase ________ of underlying tissue
- venous and lymphatic
- interchange
- mobility
What are the techniques used for petrissage?
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)
Retrograde massage is typically used to reduce _________. We want to use ______ with this. With sustained pressure we go ________ to ____________.
- edema
- lotion
- distally to proximally
What is the intention of retrograde massage?
Push the fluid back towards the lymphatic system and assist with edema control.
What are some special precautions for vulnerable patients with STM?
- 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
ROM/STRETCHING
ROM/STRETCHING
What is flexibility?
Ability to move a joint smoothly and easily through an unrestricted, pain-free ROM
What 3 things determine flexibility?
- muscle length
- joint integrity
- extensibility of periarticular soft tissues
Does functional ROM = full or normal ROM?
Not necessarily, functional ROM is enough ROM for functional activities
- 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 __________.
- soft tissues
- activity, participation
- contractures
What are some potential causes for decreased flexibility?
- 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
Immobilization can lead to:
- Decay of _________ protein
- Decreases in muscle fiber __________
- Decrease in number of __________
- Decrease in intramuscular capillary __________
- contractile
- diameter
- myofibrils
- density
As a immobilized muscle atrophies, an increase in what tissue in the muscle occurs?
Fibrous and fatty tissue, leading to weakness and restricted ROM
Would we rather have a patient immobilized in a shortened or lengthened position and why?
Lengthened, immobilization in a shortened position decreases the muscle’s capacity to produce maximum tension at its normal resting length as it contracts.
________ formation can also occur with immobilization because of greater cross-linking between disorganized collagen fibers.
Adhesion
Is ROM the same as stretching?
NO
- 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
- MAINTAIN
- increase
What are the 3 types of ROM?
- PROM
- AROM
- AAROM
What are the indications for PROM?
- acute, inflammed tissue
- patient is not able to or not supposed to actively move a segment of the body
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
- mobility
- contractures
- elasticity
- circulation and vascular
- nutrition
- pain
Passive motion does NOT do what?
- prevent atrophy
- increase strength or endurance
- assist circulation to the extent that active does
What are the indications for AROM/AAROM?
- 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.
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
- elasticity and contractility
- sensory
- circulation
- functional
What are some limitations of AROM?
- For string muscles, AROM does not maintain or increase strength.
- Does not develop skill or coordination except in the movement patterns used.
What are some ROM precautions/contraindications?
- When motion is disruptive to the healing process.
- Immediately after acute tears, fractures, and surgery.
- When patient response or the condition is life-threatening.
What is the purpose of stretching?
- Restore or increase the extensibility of the muscle-tendon unit.
- Regain or achieve the flexibility and ROM required for necessary or desired functional activities.
How should stretching be done in early rehab compared to late rehab?
- 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.
What does it mean if you get a PROM of 130 degrees and AROM of 150 degrees?
The patient doesn’t trust you. Give them active stretches
How do we make ROM gains permanent?
It must be used on a regular basis.
What are the 3 types of stretching?
- Passive
- Active assisted
- Active
- 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.
- biomechanical and neural
- extensibility, stiffness
- tolerance
Both contractile and non-contractile tissues have _______ and ________ qualities. Only non-contractile tissues have __________ properties.
- elastic and plastic
- viscoelastic
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.
- microfailure
- remodeling
- failure
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?
- sarcomeres
- Stretch force must be maintained over an extended period of time.
What is the major sensory organ of the muscle and is sensitive to quick and sustained stretch?
-Muscle spindles
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
- stretched
- reciprocal
- slowly applied, low-intensity
______________ function is to monitor changes in tension of muscle-tendon units.
-Golgi tendon organ (GTO)
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.
decreases
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
stretch reflex
What is creep?
When a load is applied for an extended period of time, the tissue elongates and does not return to its original length.
Can complete recovery from creep occur?
Yes, but not as rapidly as a single strain.
Permanent changes in length is dependent on what 2 things?
- Amount of deformation (load)
- Length of time deformation is maintained
Is there a minimum load that is needed for deformation (stretch)?
- Yes, below the minimum load will not cause deformation.
- The greater the applied load, the fewer number of cycles needed for deformation.
What are some indications for stretching?
- 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
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
- hard
- fracture
- inflammation or infection
- hypermobility
- shortened
What are the 4 broad categories of stretching exercises?
- Static stretching
- Cyclic stretching
- Ballistic stretching
- Proprioceptive neuromuscular facilitation (PNF) stretching
What are some parameters to consider when streteching?
- 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
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.
stability
- 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.
- proximal or distal
- proximal and move distally
- distal, proximal
______-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.
- low-intensity
- long-duration
Duration of stretch must be put in context with other stretching parameters, including ________,_________, and ______ of stretch.
intensity, frequency, and mode
What is progressive static stretching?
- 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.
What is cyclic stretching?
A relatively short-duration stretch force that is repeatedly but gradually applied, released, and then reapplied.
- Static stretching= more _______
- Cyclic stretching= more ________
Why would you pick one over the other?
- time
- reps
-patient irritation
- What is dynamic splint?
- What is serial casting?
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
Slow speed stretches help to minimize __________ and reduce risk of ______ to tissues and post stretch muscle _________.
- muscle tension
- injury
- soreness
What type of stretching is generally not recommended for elderly or sedentary individuals, as well as individuals with MSK pathology or chronic contractures?
Ballistic Stretching
What is ballistic stretching?
High velocity movements thought to cause greater trauma to stretched tissues and greater muscle soreness.
Which is better, static stretching or ballistic stretching?
Both shown to improve flexibility equally.
What is frequency?
Number of bouts (sessions) per day or per week a patient carries out a stretching regimen.
Frequency needs to allow time to rest between sessions for tissue ______ and to minimize __________.
- healing
- soreness
What is mode of stretch?
Form of stretch or manner in which stretching exercise is carried out.
What are some categories of mode?
- Manual
- Mechanical
- Self-stretching
- Passive
- Assisted
- Active stretching
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.
Manual Stretching
When is passive manual stretching appropriate?
If the patient cannot perform self-stretching safely/effectively
When is assisted manual stretching appropriate?
If patient has poor control of the body segment.
_____-stretching is when the patient carries it out independently after careful instruction and supervision.
Self
________ stretching involves utilizing a piece of equipment or device to assist with stretching.
Mechanical
What is the duration of mechanical stretching?
15-30 minutes to 8-10 hours
Is mechanical or manual stretching shown to be more effective and comfortable?
Mechanical
What is PNF stretching?
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.
Is PNF designed to affect the contractile elements of a muscle or the non-contractile connective tissues?
Contractile elements of a muscle.
- When is PNF stretching MORE APPROPRIATE?
- When is PNF stretching LESS APPROPRIATE?
- More appropriate when muscle spasm limits motion.
- Less appropriate for stretching long-standing, fibrotic contractures.
What are the requirements for PNF stretching to be performed?
- 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.
Is PNF or static stretching shown to yield greater gains in ROM?
PNF
What are the 2 main types of PNF stretching?
- Antagonist Contraction/ Hold-Relax (HR)
- Agonist Contraction/ Contract Relax
- 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)
- Antagonist
- Agonist
PNF stretching uses either ________ inhibition or _________ inhibition.
- autogenic
- reciprocal
Autogenic inhibition involves contraction of the range limiting muscle (__________) to allow for a stretch.
antagonist
Autogenic inhibition relies on the body’s self regulatory mechanisms of the _____ in order to protect structures. What is an example of this?
- GTOs
- Trying to lift something that you think is 2lbs, but is really 100lbs.
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.
- decrease
- GTOs
Describe how autogenic inhibition works.
- 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
Reciprocal inhibition involves contraction of the muscle opposite range limiting muscle (__________) to allow for a stretch.
agonist
How do agonists and antagonists work in regards to reciprocal inhibition?
When one contracts, the other relaxes and is thus inhibited in order to prevent the muscles from working against one another.
_________ inhibition occurs in the antagonist muscle when the opposite muscle (agonist) is contracted voluntarily.
Reciprocal
In reciprocal inhibition, _______ activity in the antagonist muscle decreases in order to maximize the contraction of the agonist force.
neural
Describe how reciprocal inhibition works.
- 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
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
- antagonist
- 5-10s
- relaxation
-AUTOGENIC
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
- antagonist
- agonist
- relaxation
-RECIPROCAL
When would you use agonist contraction/contract relax (CR)?
- When muscle guarding restricts muscle lengthening and joint movement.
- Useful when patient cannot generate a strong, pain-free contraction of the antagonist.
When is agonist contraction/contract relax (CR) less effective?
- Less effective in reducing chronic contractures.
- Less effective if a patient has close to normal flexibility.
What should be done after stretching?
- 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
What must be done as ROM approaches normal to maintain appropriate balance of strength between agonists and antagonists.
Muscles must be strengthened
How long do gains in flexibility and ROM last after cessation of stretching?
4 weeks
OTHER SOFT TISSUE TECHNIQUES
OTHER SOFT TISSUE TECHNIQUES
What is IASTM?
Instrument Assisted Soft Tissue Mobilization
-Process in which the clinician uses a hand-held instrument to perform manual techniques.
IASTM has a positive impact on the resynthesis and organization of ________.
collagen
IASTM minimizes force used by the ___________ but maximizes the force delivered to the ______.
- practitioner
- tissues
What are the goals of IASTM?
- remove scar tissues
- stimulate tendons and muscles
- promote return to normal function
Has IASTM been shown to have an effect on inflammation related factors?
No, but it’s shown to be effective at reducing exercise-induced inflammation.
Microvascular and capillary ____________, along with localized ____________ can occur with IASTM.
- hemorrhage
- inflammation
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.
- blood and nutrient
- fibroblasts
Can IASTM reduce pain and increase ROM?
Yes
What is the primary dosage and angle for IASTM?
- 20-120s
- 30-60 degrees
Why is sufficient fluid intake required before and after IASTM application.
Fluid assists the blood supply to the injured tissue to facilitate delivery of O2 and nutrients.
What are some possible side effects of IASTM?
- Bruising
- Soreness
What are the relative contraindications for IASTM?
- Cancer
- Kidney dysfunction
- Pregnancy
- RA
- Varicose veins
- Osteoporosis
- Lymphedema
- Fracture
- Chronic regional pain syndrome
- Use of certain medications (anticoagulants, steroids, NSAIDs)
What are the absolute contraindications for IASTM?
- Open wound
- Unhealed suture sites
- Thrombophlebitis
- Uncontrolled hypertension
- Skin infection
- Hematoma
- Myositis ossificans
- Unstable fractures
What is dry needling?
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.
What is dry needling typically used to treat?
- Muscles
- Ligaments
- Tendons
- Subcutaneous fascia
- Scar tissue
What are the 4 most common dry needling techniques?
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
What are some proposed mechanisms of dry needling?
- 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)
What is the difference between acupuncture and dry needling?
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
What is cupping?
Applying a cup to create suction over a painful area.
What is cupping thought to do?
- Mechanically- increases blood circulation
- Physiologically- activate immune system and stimulate mechanosensitive fibers for pain reduction (gait control)
With cupping, it stimulates increased blood flow, eventually leading to capillary ________ and ____________ (red/bruising).
- rupture
- ecchymosis
Macrophages phagocytize the ________ in the extravascular space which leads to cascade of effects ultimately resulting in production of antioxidants, anti-inflammatories, and neuromodulatory effects.
RBCs
