Agents - 21 - Soft Tissue Mobilization

soft tissue mobilization

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

ADJUNCT

STM is useful in ___________ to other interventions as part of a comprehensive treatment plan

muscles, fascia, tendons, ligaments

what is soft tissue comprised of?

• breaking down adhesions

• relaxes muscle tension

• reduces edema

• decreases pain 

• restores functionality

STM can assist in the restoration of structures, function, and activity performance by: (5)

massage

______ is more of a temporary relief of muscle tension, for the purpose of relaxation

restore normal function to affected areas

the goal of soft tissue mobilization is to ________________________

• decr muscle/CT extensibility

• intermittent MSK pain

• pain altered by postural changes

• pain relieved/projokes by particular motions or positions

• muscle spasms

• edema

clinical indications for STM: (6)

• muscle spasms

• muscle tightness

• myofascial restrictions

• scar mobility

• trigger points

• pain modulation

• tension headaches 

• stress/tension in muscles 

• tendonitis 

• edema 

pathologies commonly addressed by STM: (read) 

• mechanical

• physiological

• psychological

the therapeutic effects of STM serve three purposes:

mechanical

the _________ purpose of STM:

• increases viscoelastic properties

• improves pliability of CT

• transforms scar tissue

• increases venous flow

pressure & heat application 

the mechanical purpose of STM is a direct result of our _________ and _____________

physiological 

the _________ purpose of STM:

• relaxation

• improved circulation

• stimulation 

depends on the PACE of your massage - slow (relax) or quick (stimulate)

relaxation and stimulation are both under physiological purpose of STM but are opposites: why?

alpha motor neuron excitability, BP/HR

the relaxation part of the physiological purpose of STM aims to decrease ___________ and ___________

psychological

the _________ purpose of STM:

• mental relaxation and stress reduction

• stimulation of endogenous opioids and endorphins

• helps create bond between pt and PT

• simple caring touch may promote feelings of general well being

• modulating pain

• improve ROM

• muscle relaxation

• stretch/loosen adhesions

• improve muscle activation

• increase venous flow

• edema control

• therapeutic alliance

the 8 KEY EFFECTS of STM are:

• acute inflammation 

• systemic infection

• open or irritated skin 

• malignancy 

• DVT

• recent trauma/fx

• osteomyelitis

• over abdomen during pregnancy

• hematoma in tx area

• acute circulatory condition

• pain unrelieved by rest, severe pain, and or extensive radiation of pain 

• skin hypersensitivity 

CONTRAINDICATIONS to STM are: 

• joint effusion or inflammation

• RA

• presence of neurologic signs

• osteoporosis

• hypermobility

• pregnancy

• OUR PRESSURE (we can put patients at risk)

PRECAUTIONS to STM are:

PRESSURE

our __________ can put patients in danger - think about where neurovasculature is!

CALF CRAMPING  - DO NOT MASSAGE

___________ is an indication that someone is potentially prone to/having a DVT 

effleurage

________ is the rhythmic easing in and easing out that warms up sensory nerves and prepares tissue for deeper work

BEFORE AND AFTER

effleurage should always be done ______________

heart

effleurage should be done in long strokes along the direction of muscle fibers and towards the _________

tissue restriction 

effleurage can be used to ID __________

petrissage

__________ is the deeper work that is the “kneading”/lifting of skin and tissues

muscle and fascia

the purpose of petrissage is to free adhesions between _______ and _______, assist lymph/venous return

with

effleurage should be (with/against/both) the direction of the muscle fibers

both 

petrissage should be (with/against/both) the direction of the muscle fibers

• kneading

• wringing

• picking up

• skin rolling

the four common strokes of petrissage are:

kneading

________ stroke: small, slow, specific, (s)circular

picking up

________ stroke: grasp muscle and lift away, work towards heart where possible

wringing 

________ stroke: lift and release tissue with opposing forces of the hands 

skin rolling

________ stroke: picking up the skin and rolling it; generally less lotion

petrissage

(effleurage/petrissage) requires less lotion

effleurage

(effleurage/petrissage) requires more lotion

contact

with effleurage or petrissage, your goal is to always be in __________ with the patient

friction

______ can be done in cross or transverse direction, produces heat and helps restore collagen alignment

• adhesions

• muscle spasms

• trigger points

friction is beneficial for what three things: 

T

T/F: with friction massage, you usually don’t need much lubricant

F; SUBACUTE AND CHRONIC conditions in the REMODELING phase

T/F: friction is used in acute conditions in the inflammatory phase

• tennis elbow

• biceps long head tendon

two common areas for friction massage:

myofascial release 

___________ is low load long duration stretch to restore fascia length, with gentle sustained pressure to the fascia at end range 

• release fascial restriction

• decr pain

• restore movement

the three purposes of myofascial release:

restrictions

myofascial release depends on ________ ; muscles will guide your hands

T

T/F: lit review for MFR shows that it is beneficial 

ischemic compression

_______________ on trigger points creates a local loss of blood with goals to relieve muscle tension and pain, increasing pain threshold, and improving muscle elasticity

pressure pain threshold PPT

______________ is where uncomfortable pressure turns into pain - going past this point causes muscle guarding

take pressure to pain, apply pressure until pain subsides (no more than 3 min) repeat up to 3x 

the optimal procedure for ischemic compression is: 

1. take pressure to _______

2. apply constand compression until __________ (no more than ___ min)

3. do not release compression - repeat up to ___x

T

T/F: some lit reviews found that ischemic compression and dry needling and cupping had similar results

DRAPE and POSITION

make sure to _______ and _______ a pt well when setting up!!!

HYPEREXTEND 

when you are doing STM, to protect yourself, make sure not to _______ your own joints 

firm, continuously

when doing STM, use _____ contact and ________ assess response!!!

5-15 min

STM is typically done for ___-___ min

LISTEN 

________ to your hands!!! they will tell you so much 

distally

if edema is present, begin STM _________

T

T/F: STM force is typically applied in the direction of fibers

PAINFUL     *except for IC/friction potentially 

STM may be uncomfortable, but should not be _________ *

STRETCHING

_____ must follow STM to maintain the gains

ecchymosis

nothing during STM should cause ___________

guarding , face 

pain can lead to ______ - assess the non-verbals as well! look at their _____

practice

it is important to ________ STM to learn it well

*look at all the videos in the slides

*look at all the videos in the slides