Agents - Soft Tissue Mobilization

mechanical manipulation of soft tissue by the hands; specialized manual therapy technique widely utilized in PT to enhance recovery and improve function of mm, tendons, ligaments, and fascia

soft tissue mobilization (STM)

does soft tissue mobilization need to be therapeutically necessary?

yes

is soft tissue mobilization useful as the primary intervention or more so as a adjunct to other interventions as part of a comprehensive tx plan

the latter

what comprises soft tissue

mm, fascia, tendons, and ligaments

____ can assist in restoration of structures, function, and activity performance

soft tissue massage

how can soft tissue massage assist in restoration of structures, function, and activity performance

• breaks down adhesions

• relaxes muscle tension

• reduces edema

• decreases pain

• restores functionality

“Manipulations of the soft tissues of the body . . . for the purpose of producing effects on the nervous, muscular, and respiratory systems and the local and general circulation of the blood and lymph.”

massage

“A specific assessment, evaluation, & treatment of soft tissues for the purpose of creating beneficial effects on the nervous, MSK, lymph, & circulatory systems.”

soft tissue mobilization

the goal of ______ is relaxation and temporary relief of muscle tension

massage

the goal of ______ is to restore normal function to affected areas

soft-tissue mobilization

clinical indications for STM

• decreased muscle and/or connective extensibility

• intermittent MSK pain

• pain that is altered by postural changes

• pain relieved/provoked by particular motions or positions

• muscle spasm

• edema

pathologies commonly addressed by STM

• muscle spasms

• muscle tightness

• myofascial restrictions

• scar mobility

• trigger points

• pain modulation

• tension headaches

• stress/tendon in mm

• tendonitis

• edema

the 3 therapeutic effects/ purposes of STM

• mechanical

• physiological

• psychological

the following describe the (psychological//mechanical//physiological) purpose of STM:

• increases viscoelastic properties (ie extensibility)

• improves pliability of connective tissue

• transforms scar tissue

• increases venous/lymph flow

mechanical

the following describe the (psychological//mechanical//physiological) purpose of STM:

• relaxation (via slow, superficial stroking of skin)

• decreased alpha motor neuron excitability

• decreased BP/HR

• improved circulation

• stimulation (via quick, brisk action)

physiological

the following describe the (psychological//mechanical//physiological) purpose of STM:

• mental relaxation, stress reduction

• stimulation of endogenous opioids + endorphins ?

• helps create bond b/w pt and therapist

• simple caring touch may promote feelings of general wellbeing

the following are key effects of ____:

1. modulate pain

2. improve rom

3. muscle relaxation

4. stretching/loosening of adhesions

5. improve muscle activation

6. increased venous + lymphatic flow

7. edema control

8. therapeutic alliance

STM

contraindications of STM

STM precautions

rhythmic, long strokes with constant contact

effleurage

why use effleurage

• relaxation/warm-up

• pain, muscle tension

• stimulates sensory nerves, prepares for deeper work

• can ID tissue restriction

T/F: effleurage should always be completed first and last

true

effleurage strokes should be along the direction of ______ and toward ____

muscle fibers; heart

should you use lotion for effleurage

yes

for effleurage, use 2 hands or hand-over-hand; can also use _____

other body parts

“kneading,” lifting of skin/tissues is called what

petrissage

_____ can be used to…

• free adhesions b/w muscle and fascia

• assist venous/lymph return

• assist removal of waste products

petrissage

petrissage involves ___ reps in one area before moving on

3-4

(more//less) lotion is required for petrissage

less

T/F: petrissage may be with or against direction of fibers

true

4 common strokes of petrissage

kneading, wringing, picking up, skin rolling

“small, slow, specific, circular” describes which of the 4 common petrissage strokes

kneading

“lift and release tissue with opposing forces of the hands” describes which of the 4 common petrissage strokes

wringing

“grasp muscle and lift away, work toward heart where possible” describes which of the 4 common petrissage strokes

picking up

“picking up the skin and rolling it, generally less lotion” describes which of the 4 common petrissage strokes

skin rolling

______ used to be called “transverse friction” but isn’t referred to that way much anymore since it doesn’t have to be transverse

cross-friction

cross-friction is used for ____ alignment

collagen

what 3 reasons would cross-friction be used for

1. adhesions (tendons, scar tissue)

2. muscle spasms (stretch tissue, increase circulation)

3. trigger points

T/F: cross-friction movement can be transverse, parallel, or circular

true

how many areas should you target at a time with cross-friction

1 small area at a time

use cross-friction for acute, subacute, or chronic conditions

subacute/chronic conditions in remodeling phase

cross-friction is fairly (gentle//aggressive)

aggressive

cross-friction usually has (lubricant//no lubricant)

no lubricant or very little, b/c we want lots of friction for therapeutic effect

documentation as ___ for muscle, TFM/CFM for tendon

STM (soft tissue mobilization)

myofascial release (MFR) is (high//low) load, (short//long) duration stretch to restore fascia length

low; long

myofascial release (MFR) involves (gentle//firm), (brief//sustained) pressure to fascia at ____ range

gentle; sustained; end

MFR is (gentle//firm)

gentle

MFR involves (brief//sustained) pressure

sustained

MFR is done at ____ range

end

what 3 reasons do we do MFR for

• release fascial restrictions

• decrease pain

• restore movement

examples of myofascial release (MFR)

does the type of foam roller used make a difference?

no

(any should decrease pain and increase rom the same)

ischemic compression for trigger points involves compression applied to a trigger point to create (local//systemic) ischemia

local

once ischemic compression trigger point is released, theory is that _____ is induced and pain receptors are modulated

hyperemia

(higher blood flow than normal)

what are 3 goals of ischemic compression for trigger points

1. relieve muscle tension + pain

2. increase pressure pain threshold (PPT)

3. improve muscle elasticity

should soft tissue mobilization (STM) for pressure point be excessively painful? why?

no, b/c this will cause muscle to cease up, which stops you from gaining a therapeutic effect

procedure for ischemic compression for trigger points using pressure-pain threshold

1. apply pressure until pt says it just starts to hurt, hold constant compression here until pain subsides (no more than 3’)

2. maintain pressure and push in more, until pt says it just starts to hurt again, hold constant compression here until pain subsides

3. once more push in to pain threshold, maintain compression until the pain diminishes (3x total)

with ischemic compression for trigger points, how many sessions does it take to see big results?

a single session showed significantly improved results in the literature

STM positioning

basic procedural guidelines for STM part 1

basic procedural guidelines for STM part 2

use your ___ to assess tissue quality, edema, scar tissue, and restrictions during STM

hands

key points of STM

note: multiple videos linked at the end of the PPT