Soft tissue mobilization

What is fascia?

connective tissue found throughout the body

“Keeps everything together”

subcutaneous fascia

the layer of connective tissue located between the skin and the deep fascia

deep fascia

holds muscles and organs in place

fascial dysfunctions 

results from physical trauma, inflammation, infection, postural dysfunction, articular restriction and external/internal body torsion

myofascial pain patterns

myofascial release

a set of soft tissue techniques aimed at relieving soft tissue from abnormal grip of tight fascia (myofascial restriction)

stretches the fascial system of the body

breaking up the fascial adhesions relieves mobility restriction and pain

myofascial trigger points

hyperirritable spots on skeletal muscle associated with hypersensitive palpable nodule in a taut band

is myofascial release the same as trigger points?

they are different, but both can cause myofascial pain patterns

indications

positive findings on myofascial mapping

decreased fascial glide or compromised mobility

joint hypomobility

soft tissue tension

postural deviations

dynamic limitation in range

precautions/contraindications

systemic disorder

malignancy

nonunion fracture

cardiopulmonary impairment

identifying fascial dysfunction

one hand on fulcrum; other hand adjacent to it

light gliding/sliding motion applied in a medial lateral direction, superior/inferior direction and clockwise/counterclockwise 

restrictions are detected due to lack of tissue mobility and treated systemically. fulcrum hand stays in central location

myofascial spreading

indirect technique

• affects subcutaneous fascia

• releases local restrictions

procedure for myofascial spreading

hands are placed side by side over the affected area and then pulled apart

tissues are spread until the resistance is felt

tension maintained until the resistance yields

ex: cervical spine or low back

myofascial mobilization

direct technique

directly pushing on the tissue (hyper irritated band or trigger point)

progression

proximal → distal

static postural dysfunction → dynamic postural dysfunction

most severe postural dysfunction → least severe postural dysfunction

soft tissue MFR → articular MFR

what are other tools to assist with myofascial release?

foam rollers

direct technique to release myofascial…

Strain/counterstrain (SCS)

also called positional release therapy

indirect technique

the tissue is moved away from the barrier/strain on one or more planes (towards the least restricted movement)

What happens to the muscles in the response to an injury?

a muscle typically responds by developing a protective spasm and adhesive fibrosis. the spasm can lead to inflammation and reduced elasticity. the muscle responds in a protective manner as if there is still strain although may be in a neutral position

what can SCS result in/cause?

a release phenomenon which causes the tissues to relax and allow an increase in the ROM past the original limitation

example of SCS

if there is a limitation in the soft tissue of the biceps that limits extension…

1. place the arm in flexion. consistently determine the position of least pain wuth less pressure at the affected tissue

2. let it rest for 90 seconds

3. slowly and passively move into elbow extension

stuck drawer analogy

often, yanking the drawer open doesn’t work… push the drawer back in, find a smoother route (jiggle it) and then pull it out again

purpose of cross friction (how does it work)

acts as a local anti-inflammatory agent or anesthetic

softens inflamed scar tissue

• (Davidson et al showed that compression of a healing tendon stimulates fibroblastic proliferation)

commonly used for patellar tendonitis and lateral epicondylitis

contraindications for cross friction

inflammation caused by infection

traumatic arthritis of the elbow

bursitis

rheumatoid arthritis

pressure on nerve

treatment guidelines for cross friction

diagnostic movements and palpation must identify the tissue at fault and the exact location

the therapists’ fingers and pts skin must move simultaneously to avoid damage to the skin

DFM must be applied perpendicular to the tissue fibers

apply DFM in a large enough sweep to treat the entire affected area

the muscle belly or tendon must be on slack

apply for 10 min after anesthesia is reached

typically, 6-12 sessions every other day

dry needling

monofilament needle is inserted into a trigger point

insertion of needle (and possible slight movement of it by clinician) causes twitch of muscles and release of endorphins by body

inc blood flow to the area which helps relieve the trigger point and dec pain

no medication/substance is introduced into the body

some patients will feel almost immediate relief

DN should not be administered in the following pt scenarios:

• pt w/ needle phobia

• unwilling pt

• pt who is unable or unwilling to give consent

• pt w/ history of abnormal reaction to needling or injection

• in a medical emergency

• pt who is on anticoagulant therapy or who has thrombocytopenia

• into an area or limb w/ lymphedema

contraindications for dry needling

abnormal bleeding tendencies

severely compromised immune system (cancer, HIV, hepatitis, etc.)

vascular disease

diabetes mellitus

pregnancy

frail pts

epilepsy

allergy to metals or latex

children

individuals taking certain prescriptive medications (significant mood-altering meds, blood thinning agents, etc.)

adverse effects from dry needling

how does cupping work?

specialized cups are placed on the skin to create a suction

the theory is that the suction draws out toxins and increases blood flow to target areas

cups are made of glass, plastic, bamboo, porcelain, etc

wet cupping includes slight incision being made into the surface of the skin after the cups have been removed

contraindications from cupping

excessive dry or cracked skin

open wound or ulcer

lymphedema

pacemaker

fractured bone

dislocated joint

bleeding disorders

pts w/ fear of blood or bleeding

severe anemia

muscle dystrophy

adverse effects from cupping

infection

bruising

bleeding

burns

pain

evidence from cupping

low moderate evidence in musculoskeletal and sports rehabilitation; useful intervention bc it dec pain levels and improves blood flow to area w/out adverse effects

“Dry cupping therapy was not superior to sham cupping for improving pain, physical function, mobility, quality of life, physiological symptoms or medications used in people with non-specific chronic low back pain”