VCU DPT - Agents (Soft Tissue Mobilization)

_________ is mechanical manipulation of soft tissue by the hands; special techniue to enhance recovery and improve fn of mm, tendon, lig, fscia

soft tissue mobilization

STM is useful as ___________ to other interventions

adjunct

what sort of things comprise soft tissue

muscles, fascia, tendons, ligaments

what does soft tissue mobilization DO (5)

breaks down adhesions

- big ticket item

relaxes muscle tension

reduces edema

decreases pain

restores functionality

difference in massage and soft tissue mobilization

goal of STM is to resotre normal function to the affected areas

it is more specific

and tries to create long term change

name some clinical indications to STM (6)

decreased mm/CT extensibility

interittment MSK pain

postural pain

pain provoked by certian positions/movement

spasm

edema

spasms

mm tightness

myofascial restrictions

scar mobility

trigger points

pain modulation

tensions headaches

mm stress/tension

edema

WHAT ARE ALL THESE

pathologies that STM addresses

3 main therapeutic effects of STM

mechanical

physiological

psychological

what is the mechanical purpose of STM (4)

to icnrease viscoelastic properities of tissue

improves pliability of CT

transforms scar tissue

increase venous and lymph flow

what are the physiological purposes of STM

relaxation

improve circulation

stimulation

why can STM do both relaxation or stimulation

relaxation: superficial, slow, steady movement

stimulation: quick, brisk movements

how, physiologically, can STM promote relaxation

decreased alpha motor neuron excitability

decreased BP/HR

how can STM help, psycholgically

creates mental relaxation and stress reduction

stimualtes endogenous opiods and endorphins

- pain relief

helps create bond between PT and pt

simple caring touch

STM psycholgically can help by pain relief. what two mechanisms might STM work to provide pain relief

endogenous opiods

endorphins

8 key effects of STM:

1. modulate ______

2. ______ ROM

3. muscle __________

4. stretching/looseing of __________

5. _________ muscle activation

6. increased ______ and ______ flow

7. edema _________

8. theraputic ____________

1. modulate PAIN

2. IMPROVE ROM

3. muscle RELAXATION

4. stretching/loosening of ADHESIONS

5. IMRPOVE muscle activation

6. increased VENOUS and LYMPH flow

7. edema CONTROL

8. thetaputic ALLIANCE with Pt and pt

STM contraindications (9)

acute inflammation

systemic infection/infection

open skin

DVT

cancer

fx

hematoma

pregnancy

ciculatory issues

if at high risk for DVt, then we should/should not STM

should NOT

could dislodge it

patient comes in and they have been having really bad calf cramping post TKR, and ask if they can get STM work done on it

what do you do

do NOT massage, refer out

what are some precautions to STM (7)

joint inflammation

RA

neuro signs

osteoporsis

hypermobility

pregnancy (bc hypermobility)

our pressure we apply!

what is the biggest precaution to worry about with STM

our pressure we apply!

not just applying pressure to the tissue we are targeting, but everything below it too

we can not forget structures around the area. what are some vulnerable areas with neurovasc tissue we must take caution near

brachial plexus

popliteal fossa

general outline of session (roughly 8 steps)

clear red flags/contraindications

position patient

clean area

test sensation, skin rolling

effleurage

petrissage

effleurage

clean skin, reassess skin rolling and sensation

what is effleurage

it is rhytmic, long strokes

has constant contact

use at the beginning and end of a massage

when are the best times to use effleurage

to start a session and end a session, helps you ease in and out

what is importantabout contact with effleurage and petrissage

constant contact

why do we do effleurage

it provides relaxation, good for a warmup

helps with pain, muscle tension

stimulates sesnory nerves

identify tissue restriction

we can use ___________ to get the following benefits:

relaxation

decrease pain, muscle tension

stimulate sensory nerves

identify any tissue restrictions

effleurage

which comes first, effleurage or petrissage

effleurage

E comes before P in the alphabet

what are 4 key points about effleurage

always complete it first and last

strokes move along the direction of fibers, towards heart

use lotion

2 hands used, or hand over hand

with effleurage, we want to

always complete it ____________ in session

strokes completed ______ direction of muscle fibers, towards ______

use ________

use _____ hands

start/end

along, heart

lotion

2

kneading refers to ___(effluerage/petrissage)___, while continous stroke refers more to ____(effluerage/petrissage)_____

kneading: petrissage

continous: effleurage

why do we do petrissage

free adhesions between muscle and fascia

assist venous/lymph return

assist removal of waste product

why do we do__________?

- to free adhesions b/t mm and fascia

- assist with venous/lymph return, waste product removal

petriassage

key points of petrissage (3)

3/4 reps in one area, then MOVE

less lotion needed

may be with or against direction of fibers

with petrissage, do we want to:

a) do a few reps in one spot and then move

b) complete one spot fully, then move to another

A

with effluerage, we want to

- do _________ reps in one spot before moving on

- need _______ lotion than efflurage

- move __(with/against)_____ the fibers

3-4

less

either!

kneading, wringing, picking up, and skin rolling are all examples of _______

petrissage

match description with the stroke type

a) kneading

b) picking up

c) wringing

d) skin rolling

1) grasp muscle and lift away, while working towards heart

2) small, slow, specific, circular

3) pick skin up and roll it

4) lift and release tissue with opposing forces of the hands

WHAT TYPE OF STM DO THESE ALL FALL UNDER

a) 2

b) 1

c) 4

d) 3

PETRISSAGE

does friction massage feel good

it better not

what is friction massage trying to accomplish

collagen aligment, trying to get it to become parallel

also called cross friction, transverse friction

what three things would lead you to do friction massage

adhesions

muscle spasms

trigger points

what type of adhesions leads to friction massage

tendons, scar tissue

with friction massage,

a) movement is in what motion?

b) do you do many areas at once?

c) what phase of healing is this best in

d) is it aggressive or gentle

e) lotion or no lotion

f) you document it as STM for _________, but TFM for _______

a) transverse, paralle, circular

b) 1 small area at a time

c) subacute/chronic conditions

d) aggressive

e) no lotion

f) muscle, tendon

what is myofascial release

it is "melting"

low load, long duration stretch for fascia length

gentle presure to the fascia at its endrange

why do we do myofascial release (3)

to release fascial restriction

decrease pain

increase ROM

name some examples of myofascial release

the long axis stretching, with arm pulls and leg pulls

cross hand longitudinal stretch

suboccipital release

foam rollers/balls

in general what does the research look like for myofascial release

it is positive

- neck pain, UE spasticity, LBP all see benefits

what is ischemic compression, for trigger points

compression is applied to trigger point in order to create local ischemia

ischemica decreases blood flow, so upon release there is a big influx

how is ischemic compression supposed to work

you stop the tissue blood flow, and then when it returns the big influx of blood is beneficial to healing

what are 3 goals of ishcemic compression for trigger points

relieve muscle tension/pain

increase pressure pain threshold

improve muscle elasticity

with ishcmeic compression for trigger points, then goal is to:

relieve ______ and _____

increase the __________

improve muscle _______

tension and pain

pain pressure threshold

elasticity

expalin pain pressure threshold, and how it is modulated with ischemic compression

pain pressure threshold: it is when the patient begins to be uncomfortable as pressure initiaites pain

here, we go to this spot and then sit until it is no longer painful. then, we push more until we ge tthere again and go more and more

can ischemic compression help with shoulder pain and neck pain

yes it can! research says so

what are some important things to do with STM preparation

patient education and consent

proper draping, clothing, positioning

want patient to be in position they can relax in, be in for a while

what is one key thing to do for good body mechanics as a PT

avoid putting pressure through hyperextended joints

basic procedure for STM (could read this if you want)

plan, bring all supplies

hand hygeine

saftey: remove jewelry, short fingernails

comfort: drape and position the patient properly, make sure they are comfortable

mechanics: use good mechanics, avoid hyperextension

communicate: have constant, open, and professional communication with the patient

lotion: be warm

focus area: stay to the TX area

assess the tissue with firm contact

document the area, position, techniques, time, response

billing: generally as MT

what is the general way to bill for STM

for time, and usually as Manual therapy

what does listen to your hands mean

listen for anything they tell you about the tissue quality, edema, scar tissue, etc

why is patient education important

to protect them and you, let them know what to expect

esp w things like friction, may not be comfortable

ALSO let them know STM is used WITH other things

we should begin and end with ______

effelurage

(E before P in the alphabet)

do we maintain contact w patient, or make sure to give them breaks

maintain contact

what does it mean to consider whole patient

think of other anatomical structures in area besides target tissue

if edema is present, we should start __________

distally

force is typically applied in ___________ of fibers

same direction

t/f: STM should always be comfortable for patient

false

should rarely be painful, but may be uncomofrtable

- exception of cross friction, ischemic compression

is stretching important for patients with STM

yes!!! esp if improve ROM is goal

what is best way to get better at doing STM

practice