Muscle Assessment and Treatment Techniques

Length of a muscle

interpreted as short, normal/within normal limits, long

Strength of a muscle

graded on a scale

No muscle contraction

0/5

Muscle contraction, no movement of body part

indicates a specific level of muscle strength

seconds

exceptions exist for certain muscle groups/endurance tests

In PIR, isolate muscle

utilizing specific patient position and doctor contact points

assess for barrier

beginning of resistance

In PIR, instruct patient to gently contact the muscle

against doctor's resistance at 20% of max

isometric contraction

produced and maintained for 6 seconds

In PIR, instruct patient to relax, exhale and breathe normally

wait for patient to relax the muscle

latency period

may be up to 10 seconds in duration

new barrier/ functional length

beginning of resistance

minimum 10 seconds

prior to start of next PIR cycle until agonist achieves normal length or until no further lengthening occurs

enhance PIR results

utilizing reciprocal inhibition via antagonist contraction

RI may be used

on its own or as an addition to other methods

RI is one of the best methods used

in rehabilitation situations

In RI, the patient contracts the antagonist of the affected muscle

the muscle to be lengthened

RI is a firm contraction

for up to 10 seconds

opposite direction of the muscle being contracted

in order to increase the firing of the antagonist

In RI, following the contraction

the patient inhales and exhales fully, at which time is passively lengthened for 10 seconds

In MRT, instruct patient that procedure will most likely cause discomfort

and that bruising may occur

In MRT, palpate for an adhesion lesion

should not be used when acute inflammation is present

In MRT, select the most appropriate technique

and position the patient

In MRT, perform 3-5 passes per lesion

to effectively treat the area

In MRT and XFM, after care should include light eccentric exercise, stretching

Perform MRT every 48 hours (most will recommend)

In XFM, assess for adaptive shortening

to determine treatment effectiveness

In XFM, patient is placed in a comfortable position

with muscle bellies relaxed and supported

In XFM, doctor uses manual pressure

to apply as much pressure as the patient can tolerate

move as one unit

to ensure deep friction occurs right

In XFM, start gently

and when anesthetic effect occurs (3-5 minutes), friction deeper

In XFM, treatment discontinued if anesthetic effect does not occur

to prevent injury

Perform XFM every 48 hours

to maintain treatment schedule

In XFM, treatment discontinued if no improvement after 3 treatments

to reassess treatment effectiveness

In MRT, where is the non-contractile tissue?

Fascia, tendon, and ligament

In MRT, what two processes are used in Regeneration and Repair healing?

The process of MRT breaks the cross-links between EXISTING scar tissue fibers by inducing a controlled injury, and then managing the healing process as though the scar tissue were new.

MRT can be used on macroscopic and microscopic level?

to treat various soft tissue injuries

What is MRT NOT used to treat?

adhesion lesion, trigger points, spasticity

Describe the steps of soft tissue repair

Phases are not mutually exclusive and extensive overlap exists.

Describe the bleeding phase

All soft tissue injuries bleed, if only microscopically.

Duration of injury treatment

Usually limited to 6-8 hours post injury.

Highly vascularized tissues

Increase duration, increase volume of treatment.

Less vascularized tissues

Decrease duration, decrease volume of treatment.

Granulocytes

Released during inflammation and contribute to the inflammatory response.

Cells of inflammation

Move from the capillaries into the ground substance of the injured tissue.

Monocytes

Differentiate into macrophages for phagocytosis.

Neutrophils

Contain lysosomal anti-bacterial enzymes.

Fibrin and fibronectin

Create substratum for adhesion of various cells essential for healing.

Onset of inflammation

Rapid onset (24-48 hrs), peaks 2-3 weeks, earlier in highly vascularized tissue.

MRT (Muscle Release Technique)

Includes techniques like pin and stretch, active release technique.

Grade 1 of MRT

In shortened length with no motion.

Grade 2 of MRT

Lengthened length with no motion.

Grade 3 of MRT

Short > long with passive movement.

Grade 4 of MRT

Short > long length with active movement.

Grade 5 of MRT

Short > long active with resistance.

Rules of MRT

Contraindicated during acute inflammation phase.

Friction in MRT

Occurs between subcutaneous tissue layer, no friction between contact and skin, no lotion required.

Patient education in MRT

Critical for managing discomfort of treatment and potential bruising.

Dosage of MRT

No more frequent than every 48 hours.

XFM techniques

Used to break cross-linkages between new scar tissue as fibers form.

XFM not utilized for

Trigger points, spasticity, hypertonicity.

Rules for XFM

Contraindicated during acute inflammation phase, applied perpendicular to host tissue.

Friction during acute phase in XFM

Light friction should be applied.

Friction during chronic phase in XFM

Stronger friction to break existing cross-linked fibers and re-initiate the inflammatory phase.

Frequency of XFM treatment

Should be determined based on the patient's response.

Importance of anesthetic effect of XFM

Indicates if progress is being made in treatment.

Main contributors to posture

Sustained positions and posture syndromes due to repetitive activities.

Hypertonic muscles

Characterized by earlier/faster contraction and lower threshold.

Order to address issues in muscle treatment

1) Address tone 2) Trigger points 3) Length 4) THEN Strength.

Muscles prone to hypotonicity

Quads (not rectus femoris), gluteus medius and maximus, abdominals, lower and mid trapezius, serratus, infraspinatus, teres minor, upper extremity extensors, deep neck flexors.

Hyperlordosis effects on muscles

Creates anterior pelvic tilt, affecting which muscles are hypotonic and hypertonic.

Cervicogenic headache

A type of headache that originates from the cervical spine.

Erector spinae

A group of muscles that straighten and rotate the back.

Iliopsoas

A muscle group consisting of the iliacus and psoas major that flexes the hip.

Lumbar facet syndrome

A condition characterized by pain in the lower back due to facet joint dysfunction.

Sacroiliac joint sprain

An injury to the joint connecting the lower spine and pelvis.

Hip flexor strain

An injury to the muscles that help lift the knee towards the body.

Gait dysfunction

Abnormal walking patterns that can result from various musculoskeletal issues.

Hamstring strain

An injury to the muscles at the back of the thigh.

Thoracolumbar junction pain

Pain occurring at the junction between the thoracic and lumbar spine.

Osteoarthritis of knee and hip

A degenerative joint disease affecting the knee and hip joints.

Bunions

A bony bump that forms at the base of the big toe.

Vippirone

An acronym for Vitals, inspect, palpate, percussion, instrumentation, PROM and AROM, ortho tests.

Plumb line tool

A tool used to assess posture in sagittal and coronal planes.

Muscle spindle

A sensory receptor located in the belly of muscles that detects changes in muscle length.

Motor unit

A motor neuron and all the muscle fibers it innervates.

Contraction force

The force generated by a muscle during contraction, equal to the number of motor units activated.

Trigger point

A palpable band within a muscle that can cause localized pain.

Period of inhibition

The time following a muscle contraction during which the muscle is less responsive.

GTO (Golgi Tendon Organ)

A proprioceptive sensory receptor that senses changes in muscle tension.

Respiratory synkinesis

A phenomenon where inhalation enhances muscle activation.

PIR (Post-Isometric Relaxation)

A technique that involves contracting a muscle before stretching it.

IASTM (Instrument Assisted Soft Tissue Mobilization)

A treatment technique that uses instruments to mobilize soft tissue.

Chronic pain

Pain that persists for an extended period, often defined as lasting longer than three months.

Myofascial pain syndrome

A chronic pain disorder characterized by trigger points in muscles.

Fibromyalgia

A condition characterized by widespread pain lasting at least 3 months.

Tender points

Specific areas on the body that are sensitive to pressure in fibromyalgia.

Widespread Pain Index (WPI)

A measure used to assess the number of areas where a patient has experienced pain.

Symptom Severity Scale (SSS)

A scale used to evaluate the severity of symptoms in fibromyalgia.

Co-morbidities of fibromyalgia

Conditions that frequently occur alongside fibromyalgia, including migraine and chronic fatigue.

fascia

quality of life contractile tissue