Lecture 6 - Soft Tissue Mobilization 2

Muscle Dysfunction and Injury

Loss of mobility (tone and/or length)

Muscle Tissue Properties

Composed of contractile and non-contractile elements!

Non-Contractile Components

1. Endomysium

2. Perimysium

3. Epimysium

Endomysium

Innermost layer that separates individual muscle fibers

Perimysium

Middle layer that encases fiber bundles

Epimysium

Outermost layer that encases entire muscle

Contractile Components

Actin and Myosin

- Give muscle ability to contract/relax

Muscle Play

Muscle's ability to move independently from surrounding structures

- Ability to trace specific fibers

- How well specific fibers slide between one another

Muscle Tone

Amount of passive resistance to motion present in muscle

How is muscle tone evaluated?

- Actual muscle length assessment

- Palpable resting activation of the muscle (STM)

Central Hypertonicity

Abnormal increased tone due to neurological reasons

- Common post-stroke

- Spasticity + Rigidity

Spasticity

Impaired ability of damaged motor neurons to regulate descending pathways

- Velocity dependent

- Increased speed = Increased tone

What happens if you try to move a spastic patient thru their ROM?

They move back quickly, as the muscle spindle contracts

Rigidity

Increased resistance throughout entire ROM

- Not affected by speed of movement

General Hypertonicity

Muscle Guarding; Protective mechanism

- Tight but flexible muscle

General Hypertonicity Causes

- Injury

- Excessive hypermobility (protective)

- Pain

- Fatigue (muscle spasm)

General Hypertonicity: Therapeutic Goal

Improve STRENGTH

- NOT flexibility

Trigger Points

Localized, painful, or sensitive areas in skeletal muscle

- Associated w/ palpable nodules

- In taut bands of muscle fibers

Trigger Points: EMG

Spontaneous electrical activity at sites

- While adjacent muscle tissues are silent

Latent trigger point

Asymptomatic unless palpated

Active trigger point

Tender point in muscle can:

- Restrict muscle lengthening

- Restrict contraction

- Refer pain in muscle/limb/nerve pattern

Active trigger point characteristics

Symptomatic without palpation

- DIRECTLY related to problem at hand

Trigger Points: Causes

1. Direct Trauma

- Injury to muscle

2. Acute overload

- Too much too soon, inefficient movement patterns

3. Chronic Overload

- Prolonged, static postures

- Muscular fatigue and failure

Trigger Points: Energy Crisis

Supply/Demand issue!

- Increased muscle work = Increased demand

- Reduces oxygen in and around muscle

- Activation of nociceptors

Dry-needling

Microtrauma to trigger point space increases blood flow to that area

Trigger Points: Subjective Pain

Sensitized nociceptors described as DEEP ACHING PAIN

- Present w/ common referral factors

STM effect on trigger points

1. Helps regulate tone

2. Localized increase in blood flow

3. Inhibits sympathetic NS

Muscle spasm cycle

Reflex muscle contraction --> More restricted movement

- THEN circulatory stasis, pain, and overall spasm!

Musculotendinous Junction

Where muscle belly becomes tendon

- Common site for injury/inflammation

- Common site for muscle tears

Musculotendinous Junction: Primary Function

Transmit force between muscle + tendon!

Musculotendinous Junction: Blood Flow

Muscle needs blood flow, whereas tendon needs LESS

Tenoperiostial Junction

Where tendon attaches to bone

- Common site of avulsion fracture

STM and Muscle Intervention

- Increase blood flow

- Maintain soft tissue mobility

- Affect fiber orientation (when complimentary)

Adhesions

Can lead to muscle limitations/damage

Muscle Fiber Orientations

1. Parallel

2. Convergent

3. Pennate

4. Fusiform

5. Spiral

6. Circular

Muscle Play Assessment

Perpendicular deformation

- Define borders

- DO NOT move over muscle, just pushing it

- To see how well it moves

Muscle Tone Assessment

Strumming

- Sliding OVER muscle

- Finding trigger points

- Feeling differences

Muscle Play Interventions

1. Parallel Strokes:

- Steam roller

- Bear Claw

- Splaying

- Forearm

2. Perpendicular Deformation

Bone expectation

Hard consistency, clearly defined border

Bone difficulty

Difficuly to locate bony contours when superficial tissue is TENSE

- Muscles tense up when patients are seated or unsupported

Bony Contour vs Prominence

Contour = Overall shape/outline of bone

- i.e. Borders of scapula

Prominence = Distinct, localized projection of bone

- i.e. Tibial tuberosity