Soft Tissue Mobilization

What is fascia?

 Connective tissue found throughout the body.

 “Keeps everything together”

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

 Deep fascia holds muscle and organs in place

 Fascial dysfunctions result from physical trauma, inflammation, infection, postural dysfunction, articular restriction and 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)

 Stretches the fascial system of the body

 Breaking up the fascial adhesions relieves mobility restrictions and pain

Myofascial trigger points

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

They are different, but both can cause myofascial pain patterns

indications of Myofascial

 Positive finding on myofascial mapping

 Decreased fascial glide or compromised mobility

 Joint hypomobility

 Soft tissue tension

 Postural deviations

 Dynamic limitations in range

precautions/contraindication of Myofascial

 Systemic disorder

 Malignancy

 Nonunion fracture

 Cardiopulmonary impairment

Identifying Fascial Dysfunctions

One hand is the fulcrum.  The other hand is adjacent to it.  Light gliding/sliding motion applied in a medial lateral direction, superior/ inferior direction and clockwise/counter clockwise.

Restrictions are detected due to lack of tissue mobility and treated systematically.  Fulcrum hand stays in central location

Myofascial spreading

 Indirect Technique

• Affects subcutaneous fascia. 

• Releases local restrictions. 

Procedure: 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

Progression

 Proximal to Distal

 Static Postural Dysfunction to Dynamic Postural Dysfunction

 Most severe postural dysfunction to Least severe postural dysfunction

 Soft tissue MFR to Articular MMR

Strain/Counterstrain   (SCS)

 Also called positional release therapy.  This is an indirect technique

 In response to 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 it may be in a neutral position.

 In SCS, the tissue is moved away from the barrier/strain on one or more planes (toward the least restricted movement). 

 Hopefully, this causes a release phenomenon which causes the tissues to relax and allow an increase in the range of motion past the original limitation.

Stuck Drawer analogy

 Often, yanking the drawer open doesn’t work.

 Push the drawer back in, find a smoother route (jiggle it) and them pull out again

How does is cross friction believed to work

­Acts as a local anti-inflammatory agent or anesthetic

­Softens inflamed scar tissue

Commonly used for patellar tendonitis and lateral epicondylitis

Contraindications of cross friction

 Inflammation caused by infection

 Traumatic arthritis of the elbow

 Bursitis

 Rheumatoid arthritis

 Pressure on nerve

Treatment Guidelines

 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

What is 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.

Increased blood flow to the area which helps relieve the trigger point and decrease pain.

No medicine/substance is introduced into the body

Some patients will feel almost immediate relief

Contraindications of dry needling

1) a patient with needle phobia; 2) an unwilling patient; 3) a patient who is unable or unwilling to give consent; 4) a patient with a history of abnormal reaction to needling or injection; 5) in a medical emergency; 6) a patient who is on anticoagulant therapy, or who has thrombocytopenia; and 7) into an area or limb with lymphoedema.

Relative contraindications include, but are not limited to, abnormal bleeding tendencies, a severely compromised immune system (eg. cancer, HIV, hepatitis, etc.), vascular disease, diabetes mellitus, pregnancy, frail patients, epilepsy, allergy to metals or latex, children, and individuals taking certain prescriptive medications (eg. significant mood altering medication, blood thinning agents, etc.). "

Adverse Effects of DN

 Lack of systematic gathering of information regarding dry needling and acupuncture.

 Difficulty drawing conclusions on adverse effects due to limited reporting and different techniques

 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.

How cupping works

Specialized cups are placed on the skin to create a suction.  The theory is that the suction draws out toxins are increases blood flow to target areas

Cups can be 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.

contraindication of 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

adverse effect of cupping

 Infection, bruising, bleeding, burns, pain