Soft Tissue Mobilization

What structures are “soft tissue”?

• Muscle

• Fascia

• Tendons

• Ligaments

What does STM assist with?

• Breaking down adhesions

• Relaxing muscle tension

• Reduce edema

• Decrease pain

• Reestablish proper joint function

• Restores functionality

Define mechanical effects of STM.

• Effects as a result of pressures/movements of PTs or tools

• Decrease restrictions & adhesions

• Improves circulation & lymphatic flow 

Define physiological (reflexive) effects of STM.

• Contact with the body initiates impulses that are transmitted to one organ by afferent nerve fibers then back to another organ by efferent nerve fibers

Relaxation reflex effect vs Stimulation reflex effect.

• Relaxation → slow/superficial strokes → decrease muscle tension

• Stimulation → quick/brisk action → contract superficial tissue

Define physiological effects of STM.

• Psychological response to being touched

• Creating a bond b/w patient & PT

What does STM increase?

• Flexibility

• Circulation

• Mobility of tissues

• Healing 

What does STM decrease?

• Neuromuscular excitability

• Pain

What are indications of STM?

• Altered neural reflex

• Joint restrictions

• Impaired muscle

• Edema

What are absolute contraindications of STM?

• Recent trauma/fracture

• Open or recently healed wounds

• Hematoma

• Local/systemic infection

• Cellulitis

• Osteomyelitis 

• Fever

• Malignancy

• Blood clotting disorders

• DVT

• Advanced DM

What are relative contraindications of STM?

• CHF → LE chronic edema

• New scar tissue

• Joint effusion/inflammation

• Joint hypermobility & diseases causing it

  • RA, Down Syndrome

• Severe osteoporosis

• Severe varicosities

• Radiation therapy (3-6 months)

• Neurological injury

• Skin conditions

• Some medications

• Severe pain

Define effleurage.

• Identifies tissue restriction & treatment 

• Beginning & ending stroke

• Slow, stroking movement 

• Increasing pressure over time 

• Acclimates patient to PT

• About 30-60 seconds

Define petrissage.

• Identifies tissue restriction and treatment

• Firm pressure

• Mobilize muscle, tendon, fibrosis, & chronic edema

• Increase skin elasticity

• About 3-5 minutes

What are the 4 common strokes of petrissage?

1. Kneading

2. Wringing

3. Picking up

4. Skin rolling

Define friction massage.

Generates heat in tissue

Define deep friction massage (DFM).

• Transverse or circular pattern for 5-10 min

• Break up adhesions/scar tissue, realign collagen fibers, increase blood flow

What should you allow for when positioning your patient for STM?

• Relaxation

• Support

• Access

How do you properly position a patient in prone?

• Pillows under abdomen & ankles

• Towel rolls under shoulders/arms

• Towel roll under forehead if no cut-out

How do you properly position a patient in supine?

• Pillows under head & knees

• Towel rolls under shoulders/arms if needed

How do you properly position a patient in sidelying?

• Pillows under head

• Pillows to support topmost UE/LE

What are some housekeeping rules of STM for the PT?

• Short nails

• Warm hands

• Firm contact

• No hyperextension

• Use your body

What are the steps of performing STM (ladder)?

1. Clear red flags (contraindications)

2. Drape/position patient

3. Clean area with alcohol

4. Assess sensation & capillary refill

5. Assess with skin rolling

6. Apply cream/lotion

7. Effleurage

8. Petrissage

9. Effleurage

10. Wipe off cream/lotion

11. Assess with skin rolling 

12. Clean area with alcohol

13. Assess sensation & capillary refill