Soft tissue mobilization

STM definition

Assessment, evaluation, and treatment of soft tissues to create benefits for the nervous, MSK, lymph, and circulatory systems

Goal is to restore normal function to affected areas

Massage definition

Manipulation of body’s soft tissues to produce effects on nervous, muscular, and circulation systems

Goal is temporary relief of tension, relaxation

STM MOA

Breaks up adhesions, reduces muscle tension, reduces edema, decreases pain, restores function

STM indications

Pt presents with decreased extensibility, intermittent MSK pain, pain changed with posture or motions, muscle spasm, and edema

Physiological effects of STM

Relaxation, decreased alpha motor neuron excitability, decreased BP/HR, improved circulation, stimulation of region

Mechanical effects of STM

Improved tissue extensibility, changes scar tissue, increases venous and lymph flow

Psychological effects of massage

Stress reduction, relaxation, release of endogenous opioids and endorphins, bond between pt and therapist, sense of wellbeing

STM contraindications

Acute inflammation, systemic infection, open wounds, malignancy, DVT or at risk for DVT (post-op), recent trauma or fx, osteomyelitis, hematoma, acute circulatory condition, severe pain

STM precautions

Joint effusion or inflamation, RA, neurologic signs, osteoporosis, hypermobility, pregnancy, pressure applied by therapist

Effleurage

Long, rhythmic strokes with constant contact to skin. Designed to ‘warm-up’ the area prior to deeper pressure

Strokes should be parallel to muscle fibers and directed towards the heart

A transition stroke used both at the beginning and end of massage therapy

Petrissage

Deeper pressure strokes that can lift, roll, and/or knead tissue and fascia

Strokes can occur parallel to or against direction of muscle fibers

Designed to free fascial adhesions, improve circulation of blood/lymph, and help push out metabolic waste products

Kneading

Petrissage stroke that uses small, slow, specific, and circular motions in a small area

Wringing

Petrissage stroke that lifts and releases tissue with opposite motion of hands, similar to squeezing out a towel

Pick-up

Petrissage stroke that grasps and lifts muscle away from underlying tissue

Should be worked in direction of heart when possible

Skin rolling

Pinching skin and rolling it between fingers

Generally uncomfortable for pt

Friction massage

Includes cross-friction/transverse friction

Designed ot help align collagen fibers, reduce adhesions, stretch tissue surrounding spasms and trigger points

Fairly aggressive application with minimal lubricant. Should be uncomfortable but not painful

Myofascial release (MFR)

Gentle, sustained pressure applied to trigger points at end range. Designed to provide LLLD stretch to underlying fascia and improve extensibility

Can be applied manually or with foam roller, lacrosse ball, etc.

Ischemic compression for trigger points

Compression applied to TPs to create local ischemia

Theory of action is flooding of blood into space (hyperemia) and modulation of pain receptors

Designed ot relieve tensiona nd pain, increase pressure pain threshold (PPT), and improve muscle elasticity

Should not be applied for more than 3 minutes