soft tissues combined

Functional Massage is a combo of what?

Motion and Massage

Non-painful joint motions are comprised of what two movements?

Angular and Translatoric

What are the goals of functional massage?

-Manage musculotendinous and periarticular soft tissue pain

-Manage tissue tension

What does functional massage aid in management of?

-Impaired segmental and/or joint motion

-Impaired muscle function/performance

-Impaired neural dynamics

Management of pain in functional massage includes what?

-Gait mechanism

-Modulation of chemical irritants

-Modulation of pain by the inclusion of pain referring periarticular and articular structures

Management of musculotendinous and periarticular tension in functional massage includes what?

Tension due to:

-Elastic and viscoelastic stiffness

-Fibrosis following injury or aging

-Trigger points/Muscle bands

-Stiffness

What are the indications of functional massage?

-Pain

-Soft tissue edema

-Muscle guarding

-Chronic or acute muscle tightness

-Soft tissue adhesion

What are the contraindications of functional massage?

-Extensive CT weakness

-Bleeding disorder

-Extensive muscle guarding

-Inflammatory episodes

-Osteophytosis

-Fear in movement

What is the application of functional massage?

-Promote tissue elongation or approximation

-Use different hand contacts based on goals

-Moved passively, active assisted, or actively

-Avoid pulling skin!

-No oils or creams used!

When is shortening FM used?

When the MTU or periarticular ST are sensitive to lengthening

What are some injuries in which you would use shortening FM?

Acute muscle strains, partial MTU tears, painful tendonitis

In what direction do you massage when shortening?

Directed toward the origin of muscles or lesion if necessary, which helps promote healing

How should you massage during shortening FM?

Compression while extending the wrist for example. Shorten muscles while stroking.

When is lengthening FM used?

When the MTU or periarticular ST are painful, tight, or restricting active/passive movement

What are some injuries in which you would use lengthening FM?

Physiological shortening, guarding, spasms

How should you massage during lengthening FM?

Go from proximal to distal. Compress the muscle tissue while flexing wrist for example

What are the three main effects trigger points have?

Autonomic, Chemical, and Neuroplastic effects

What is the chemical effect?

-Certain chemical environments yield more nociceptive activity

-Painful tissues tend to be: Hypoxic, More acidic, increased cytokines

How do trigger points affect the chemical effect?

-Low pH

-Low O2

-Vasoconstriction

-Excessive acetylcholine

How does manual therapy affect the autonomic effect?

-Can affect autonomic functions like vascularity, blood pressure, and heart rate

-Nociceptive stimulus from a trigger point can accompany autonomic vasoconstriction

What is the neuroplastic effect?

Persistant nociceptove activity leads to primary afferent nociceptors showing increased responsiveness to natural stimuli

Hyperalgesia

increased sensitivity to pain

Allodynia

Pain due to a stimulus that does not normally provoke pain

IRS Acronym

I - Intense

R - Repeated

S - Sustained

What is a trigger point?

A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band.

What is the 3 criteria for identification of a trigger point?

Hyperirritable, Palpable taught band, referred pain on compression

Muscle ischemia and hypoxia results from what?

-Unaccustomed eccentric exercise

-Eccentric exercise in unconditioned muscle

-Concentric exercise that does fiber damage

What is an active trigger point?

Pain at rest with more symptoms with palpation but does not require palpation

What is a latent trigger point?

No pain at rest but pain with palpation

What are satellite trigger points?

Secondary and develop in the same muscle or nearby muscle as the primary active trigger point

Techniques of trigger point

Ischemic compression, ischemic compression with elongation, strain counter-strain

What are the different PNF techniques?

Rhythmic initiation, combo of isotonic, isotonic reversal, rhythmic reversal, rhythmic stabilization, contract-relax, hold relax, quick stretch

Define PNF

A method of promoting the response of the neuromuscular mechanism by stimulation of the proprioceptors

Define proprioceptive

Receiving stimulation within the tissues of the body

PNF

proprioceptive neuromuscular facilitation

Existing ______ can be further developed

potential

Movements must be _______, ________, and ______ oriented

specific, functional, and goal

Stronger body parts ______ weaker body parts

strengthen

PNF manual contact

Use a lumbrical grip which allows stable pain free contact

PT body mechanics

-At end of desired movements

-Mirror image of patient's movements

-Allows resistance to come from trunk and pelvis

What is the optimal resistance?

the most pt can tolerate and still do accurately

What are the two types of isotonic movements?

concentric and eccentric

Isometric cue?

"Stay here, no motion"

Concentric cue?

"Pull your body part up"

Eccentric cue?

"Let me pull you back slowly"

What is irradiation?

The predictable spreading of the muscle contraction to weaker muscle groups in the trunk or extremity when a demand is placed on stronger groups

Stronger helps weaker!!

Pain and PNF

Never work into pain or increase pain. Never work beyond pain free ROM! Modify the activity if needed!

What is PNF approximation?

The compression of a segment to increase muscular response and promote stability

What is approximation used for?

Promote stabilization, facilitate weight bearing and contraction of antigravity muscles, upright rxns, and resist motions

What is PNF traction?

The elongation of a segment to increase muscular response and promote movement or enhance stabilization

What is traction used for?

Facilitate motion, aids in elongation, resists some motions, helps with joint pain

What is the general rule with approximation and traction?

Approximation is used WITH gravity and traction is used with ANTI-gravity

What does a quick stretch do?

-Stretch reflex

-Allows quick and stronger muscle response

Quick stretch contraindications

Pain, fractures, ortho procedures

PNF patterns

Diagonal patterns are mass movement patterns that were observed to be used in most purposeful activities. Two diagonal movements (D1 flexion and extension, and D2 flexion and extension)

Rhythmic initiation purpose

-Improve patient's awareness of movement

-Help initiate movement

-Teaching new patterns

-Increase speed of movement

Rhythmic initiation application

Use passive, active, and resistive components

Combo of isotonics purpose

-Teach new patterns for troubled patient

-Improve eccentric contraction

-Improve coordination

-Increase strength and AROM

Combo of isotonics application

1. Take muscle back into shortened range

2. Stabilizing contraction

3. Then have patient move back into the pattern (Eccentric), then pull back into starting position (concentric)

Isotonic reversal purpose

-Improve strength and ROM

-Teach reversal of direction

-Improve coordination

-Increase endurance

Isotonic reversal application

1. Start direction of movement into stronger pattern

2. "pull up" or "push up"

3. Resistance is slowly increased with each changing direction

Always keep one hand on patient when changing postions

Rhythmic stabilization purpose

-Improve strength and endurance

-Improve ROM and reduce tightness

-Develop co-contraction

-Decrease pain

Rhythmic stabilization application

1. "hold" or "stay there"

2. Resistance slowly builds

3. resistance changes slowly always maintaining isometric contraction

Contract relax purpose

Increase PROM when NO PAIN is present; relaxation

Hold relax purpose

Decrease pain, relax of spasm, improve PROM

Quick stretch purpose

-Initiate voluntary motion

-Increase strength of voluntary motion

-Aid in learning

-Speed up movement

-Delay fatigue

Upper extremity D2 movements

1. Flexion-Abduction-ER

2. Extension-Adduction-IR

Upper extremity D1 movements

1. Flexion-Adduction-ER

2. Extension-Abduction-IR

Lower extremity movements

1. Flexion-Adduction-ER

2 Extension-Abduction-IR

What are the three pillars?

Evidence, ethics, law

Principle #1

Physical therapists shall respect the dignity and rights of all people

Principle #2

PTs shall be trustworthy and compassionate in addressing the rights and needs of patients

Principle #3

PTs shall be accountable for making sound professional judgements

Principle #4

PTs shall demonstrate integrity in their relationships with patients and others

Principle #5

PTs shall fulfill their legal and professional obligations

Principle #6

PTs shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behavior

Principle #1 and 2 meanings

-Patients must be informed about:

Nature of a technique, alternatives, risks and benefits, consent!

Patient considerations

Expectations, beliefs, comfort level

Practitioner considerations

YOUR comfort level, PTA training, insurance coverage, team comfort

Things you MUST document

-Informed consent

-Prescription

-Subjective/objective deficits

-Specifics of treatment

-Patient response