10 Soft Tissue Mobilization

what is soft tissue mobilization?

mechanical manipulation of soft tissue by the hands, used to enhance recovery and improve function of muscles, ligaments, tendons, fascia

effects of STM?

breaks down adhesions

relaxes muscle tension

reduces edema

decreases pain

restores functionality

massage vs soft tissue mobilization

massage: temporary relief of muscle tension/relaxation

mobilization: restore normal function to affected areas - specific eval, assessment and tx of soft tissue

what are clinical indications for soft tissue mobilization?

decreased muscle and connective extensibility

intermittent MSK pain

pain that is altered by postural changes

pain relieved/provoked by particular motions or positions

muscle spasm

edema

indications for STM

muscle spasm

muscle tightness

myofascial restrictions

scar mobility

trigger points

pain modulation

tension headaches

stress/tension in muscles

tendonitis

edema

what are the therapeutic effects of STM

3 purposes:

1. mechanical

2. physiological

3. psychological

mechanical effects of STM

increases viscoelastic properties

improves pliability of CT

transforms scar tissue

increases venous/lymph flow

physiological effects of STM

relaxation - decreased alpha motor neuron excitability, decreased BP/HR

improved circulation

stimulation

psychological effects of STM

mental relaxation, stress reduction

stimulation of endogenous opioids and endorphins

helps create bond between patient and therapist

simple caring touch may promote feelings of wellbeing

what are the key effects of STM

1. modulate pain

2. improve ROM

3. muscle relaxation

4. stretching/loosening of adhesions

5. improve muscle activation

6. increased venous + lymphatic flow

7. edema control

8. therapeutic alliance

STM contraindications

acute inflammation

systemic infection or infection in tx area

open or irritated skin

malignancy

DVT

recent trauma/fracture

osteomyelitis

over the abdomen during pregnancy

hematoma in tx area

acute circulatory condition

pain unrelieved by rest, severe pain, extensive radiation of pain

skin hypersensitivity

STM precautions

joint effusion or inflammation

RA

presence of neurologic signs

osteoporosis

hypermobility

pregnancy

what is effleurage?

rhythmic, long strokes; direction of muscle fibers and towards heart

constant contact

why do we do effleurage?

relaxation, warm-up

pain, muscle tension

stimulates sensory nerves, prepares for deeper work

can ID tissue restriction

T/F petrissage is always completed first/last

F, effleurage

what is petrissage?

kneading, lifting of tissues to get into deeper tissue

why do you do petrissage?

freeing adhesions between muscles and fascia

assist venous/lymph return

assist removal of waste products

for petrissage how many reps in an area

3-4 reps then move

direction for petrissage

with or against direction of fibers (less lotion required)

what are common strokes for petrissage?

kneading, picking up, wringing, skin rolling

what is friction?

cross-friction/transverse friction

collagen alignment

when do you use friction

adhesions (tendons, scar tissue)

muscle spasm - stretch tissue and increase circulation

trigger points

what are some key points for friction

movement can be transverse, parallel, circular

1 small area at a time

subacute/chronic conditions in remodeling phase

fairly aggressive

usually no lubricant

documentation as STM for muscle, TFM/CFM for tendon

what is myofascial release?

melting of myofascia

low-load, long duration stretch to restore fascia length

gentle, sustained pressure to fascia at end range

why do you do myofascial release

release fascial restrictions, decrease pain and restore movement

what are examples of MFR?

long axis stretching - arm pulls and leg pulls

cross-hand longitudinal stretching

suboccipital release

foam roller/balls for self MFR

T/F myofascial release has better ROM, posture and QOL measures than manual therapy

T

T/F myofascial release can help with spasticity

T

T/F myofascial release can decrease pain and improve flexibility and postural control

T, but more studies needed

T/F foam rolling does not support immediate + prolonged recovery

F, it does, tx should last more than 120 sec/muscle group and type of roller does not matter

what is ischemic compression

compression applied to trigger point to create local ischemia - theory is hyperemia is induced and pain receptors are modulated

ischemic compression goals

relieve muscle tension and pain

increase pressure pain threshold

improve muscle elasticity

what is the optimal procedure for ischemic compression according to literature?

1. use pressure pain threshold (point where uncomfortable pressure becomes pain)

2. apply constant compression force until pain subsides

3. do not release the compression and repeat steps above up to 3x

T/F multiple sessions are required to improve PPT, reduce pain, alter biomechanical properties of muscle fibers

F, only single is needed

T/F repetition of ischemic compression = therapeutic effect

T

literature and ischemic compression

immediate and short term benefits for shoulder pain and function

IC and cuppin had the same results for cervical ROM and PPT in upper trap

preparing to STM

pt ed and consent

protect modesty

protect clothing

specific to technique/area

what to assess for with your hands

tissue quality

edema

scar tissue

restrictions

what are some key points for STM?

pt ed - let them know that it might not be super comfortable, use with other interventions

being and end with effleurage

maintain contact/therapeutic touch with pt

consider the whole pt

with edema, start distal then work proximal

apply force in direction of fibers

should not be painful (maybe slight discomfort)

stretching must follow to maintain gains!