STM 2

All phase goals of STM

-tissue in the same line as it is replacing

-long as the tissue its replacing

-not adhered to adjacent structures

-be of sufficient quality and qty to accept the compressive, distractive, and shearing stresses to which it will be subjected

stroke

-longer mvmt-can be along tissue lines or perpendicular

-can be superficial or deep

knead

-approximating tissue w/ scooping hand mvtmt

tapotement

-shaking/hacking

-stimulatory

trigger point

-compression on a single hyperirritable point in muscle tissue

cross friction

-short localized perpendicular stroke to restricted/irritated tissue

vibration

-shaking of the tissue

-can be stimulatory or relaxing depending on aggressiveness of technique

proliferative or fibroblastic phase

-physio response

-3/10 days to a few to several weeks

-starts when inflammatory phase ends and lasts until the qty of collagen is sufficient to replace damaged tissue

-time for re-epithelialization

-collagen production

-wound contraction

-sealing of wound thru epithelial migration

-fibroplasia occurs

-endothelial budding will form to patent blood vessels that supply the area

-wound contraction will occur as actin-rich fibroblasts contract to bring edges of the wound together

extensive scar contraction can be disfiguring and

-may limit function

proliferative/fibroblastic phase common complaints

-less symptoms at rest

-symptoms increase w/ use

-decrease in complaints of stiffness, sxs latency and palpable edema

-a decrease but mild continuance of increased temp in the area

-continuation of pain w/ contraction, stretch and palpation

-ROM still limited by sxs, but less resistance to mvmt and increasing firmness of end-feel

-may still wake them up, but w/ some mvmt and change of position are able to fall abck to sleep fairly readily

-may still have ecchymosis but is a lighter faded greenish brown

Tack n stretch

-soft tissue technique that is geared toward working a specific section of tissue

-allows one to isolate an area

-allows one to elongate tissue while protecting a lesion

tack n stretch components

-shorten the tissue

-tack the tissue in the area you want to stretch

-elongate area until you feel the stretch under the tack

tack n stretch; choosing an area

-based on acuteness

-least aggressive would be manipulating hand DISTAL to lesion if manipulating the joint distal to injury

-most aggressive would be manipulating hand PROXIMAL as your force will go thru the wound

tack thru components

-shorten the tissue

-tack the tissue in the area you want to stretch

-elongate area allowing your mobilizing hand to move over tissue in a physiological direction for desired length needing attn

edema reduction components

-shorten the joint or tissue

-place your mvmt hand (lrg surface area) distal to joint or tissue of interest

-elongate area and let your hand move the fluid toward heart by the elongation increasing the pressure under the tx hand-->mvmt of fluid

-can work in same area. Start distal and w/ each mvmt move hand more proximally, moving fluid away from site

scar teasing

-start moving scar to prevent adherence to surrounding structures

-accessory work pushing into scar, but not ON scar

-aggressiveness will be based on healing. Starting gentle and working in and under scar.

-vary: location, force, rate, amplitude and rhythm

principles of soft tissue tx (types of pt participation)

-completely passive

-STM w/ pt participation

completely passive

-PT provides all the mvmt and force while the pt does nothing

-good in more acute situations and for approximating tissues

STM w/ pt participation

-contract-relax then passive physio lengthening of soft tissues

-contract-relax then passive accy manipulation of soft tissues. Following a mm contraction, there is a brief pd in which the muscle is more easily manipulated

-contract w/ simultaneous manipulation of contralateral soft tissues. Takes advantage of sherrington's law of reciprocal inhibition

-STM w/ active mvmt during application

Sherrington's Law

-Law of reciprocal inhibition

-while contracting one mm grp the antagonist, which is in relaxation phase, is manipulated.

-good w/ more forceful tissue manipulation