2 - Soft Tissue Mobilization

Gua sha

• Means scraping, spooning, or coining

• Believed to release unhealthy bodily matter from blood stasis withing sore, tired, stiff or injured mm areas to stimulate new oxygenated blood flow to the areas - this promotes metabolic cell repair, regeneration, healing, and recovery

• Strokes are performed along pathways or meridian lines of the body

Gratson technique

• Hx: attribut3ed to David Graston developed a set of instruments after he suffered a knee injury

• Rx: insert from lecture

Fascia

A sheet or band of fibrous connective tissue enveloping, separating, or binding together mms, organs, and other soft tissue structures

What can be treated about IASTM?

• Spastic diplegia - CP

• Lateral epicondylitis

• Achilles tendinitis

• Posterior shoulder tightness

• Mastectomy related scarring

• TKR

• Plantar fasciosis

Contraindications or IASTM

• DVT

• Open wounds

• Infection

• Skin sensitivity

• Blood thinners

• Patient tolerance

• Sensory deficits

• CHF (with edema)

• Osteomyelitis

• Sutures/staples in the area

• Myositis ossificans

• Hematoma

What is fascia, what is its function, and where is it located?

CT found throughout the body

• Functions to keep everything together

• Subcutaneous layer btwn the skin and deep fascia

What is the function of deep fascia?

Holds mms and organs in place

What causes fascial dysfunction?

• Physical trauma

• Inflammation

• Infection

• Postural dysfunction

• Articular restriction

• External/internal body torsion

Myofascial release

A set of soft tissue techniques aimed at relieving soft tissue from the abnormal grip of tight fascia (myofascial restrictions)

What is the function of myofascial release?

• Stretches the fascial system of the body

• Relieves mobility restrictions and pain

Myofascial trigger points

Hyperirritable spots on skeletal mm associated with hypersensitive palpable nodules in a taut band (different than MF restrictions but both can cause pain)

Indications for soft tissue mobilization (myofascial release)

• Positive finding on myofascial mapping

• Decreased fascial glide or compromised mobility

• Joint hypomobility

• Soft tissue tension

• Postural deviations

• Dynamic limitations in range

Precautions and contraindications for soft tissue mobilization (myofascial release)

• Systemic disorder

• Malignancy

• Nonunion fracture

• Cardiopulmonary impairment

How can fascial dysfunctions detected?

• One hand is the fulcrum (stay in central location) the other hand is adjacent to it

• Light gliding/sliding motion to find lack of tissue mobility and treated systematically

Myofascial spreading

• Indirect technique that affects the subcutaneous fascia and release local restrictions

• Hands are placed side by side over the affected areas then pulled apart

• Tissues are spread until resistance is felt

• Tension maintained until resistance yields

How should soft tissue mobilization be progressed?

• Proximal to distal

• Static postural dysfunction to dynamic postural dysfunction

• Most severe postural dysfunction to least severe postural dysfunction

• Soft tissue MFR to articular MFR

Strain/counterstrain (SCS)

• AKA positional release therapy - an indirect technique

• In response to injury, a mm typically responds by developing a protective spasm and adhesive fibrosis - this can lead to inflammation an reduced elasticity

• The mm responds in as if there is stills train despite a neutral position

• Tissue is moved away from the barrier/strain on one or more planes (toward the least retrsicted mvmt)

• The aim is for the tissues to relax and there to be inc ROM

Example of SCS

1) Place the arm in flexion. Consistently determine the position of least pain with less

pressure at the affected tissue

2) Let it rest for about 90 seconds

3) Slowly and passively move into elbow extension

*Mimics a stuck drawer where it might not pull out if yanked but will if jiggled and pulled out smoother

Cross Friction

 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 later epicodylitis

Contraindication for cross friction

• Inflammation caused by infection

• Traumatic arthritis of the elbow

• Bursitis

• Rheumatoid arthritis

• Pressure on nerve

Treatment guidelines for Deep Friction Massage (DFM)

1. Diagnostic movements and palpation must identify the tissue at fault and the exact

location

2. The therapist’s fingers and the patient’s skin must move simultaneously to avoid

damage to the skin

3. DFM must be applied perpendicular to the tissue fibers

4. Apply DFM in a large enough sweep to treat the entire affected area

5. The muscle belly or tendon must be on slack

6. Apply for 10 minutes after anesthesia is reach

7. Typically 6-12 sessions every other day

Dry needling

• Monofilament needle is inserted into a trigger point

• Insertion of needle and possible slight movement by clinician causes mm twitch and release of endorphins

• Increases blood flow to area that helps release trigger point and dec pain

• No medicine/substance used

• There is sometimes instant relief

Dry needling contraindications

• Needle phobia

• Unwilling patient

• Patient who is unwilling to give consent

• History of abnormal reaction to needling/injection

• Medical emergency

• Pt on anticoagulant therapy (or thrombocytopenia)

• Area with lymphoedema

Potential adverse affects to dry needling

Possible adverse effects

• Bleeding

• Bruising

• Piece of monofilament left in skin

• Pneumothorax, pain

• Syncope/vasovagal response

• Nausea, nerve injury, seizures

• Moderate to severe side effects (pneumothorax, nerve injury, seizures, etc.) are very uncommon

Cupping

Specialized cups (glass, plastic, bamboo, porcelain) on the skin to create suction that draws out toxins and inc blood flow

*Wet version includes slight incision after cups are removed

Contraindications to cupping

• Excessive dry or cracked skin

• Open wound or ulcer

• Lymphedema, pacemaker

• Fractured bone

• Dislocated joint

• Bleeding disorders

• Patients with fear of blood or bleeding

• Severe anemia

• Muscle dystrophy

Potential adverse effects to cupping

• Infection

• Bruising

• Bleeding

• Burns

• Pain

Cupping therapy has low to moderate evidence in musculoskeletal and sports rehabilitation and might be used as a useful intervention because it decreases the pain level and improves blood flow to the affected area with low adverse effects.

True, despite limited research comparing it to sham cupping

Petechiae should be reported to the supervising PT.

True