Soft Tissue Mobilization

massage

_____ therapy is effective in promoting:

- local and systemic relaxation

- increasing local blood flow

- movement of soft tissue restrictions

- encouraging lymph and venous return

relaxation massage

intent: relax, move fluid, wellness

styles: swedish, spa, sport

technique: gliding, kneeding, friction, percussion, holding

clinical massage

intent: specific goals such as releasing muscle spasm

styles: myofascial trigger point, strain-counterstrain

technique: direct pressure, skin rolling, resistive stretching, manual stretching, cross friction

movement reeducation

intent: induce freedom of motion

styles: PNF

technique: contract relax, passive/resistive stretching

energy work

intent: free energy blockage

styles: acupressure, craniosacral, therapy

technique: smoothing, direct pressure, holding, rocking, traction

recreational massage

•variety of manual techniques designed to relieve stress, promote relaxation, and general wellness in person with no health problems

therapeutic massage

variety of manual techniques to reduce stress, mobilize structures, relieve pain and swelling, prevent deformity, and promote functional independence in persons with health problem

CT

supports and connects the other tissues of the body

- consists of cells (fibroblasts) and ECM (manual therapy increases activity of fibroblasts)

- composition of EC material differentiates the various types

collagen

tensile strength

elastin

tissue flexibility

GAGs

Glycosaminoglycans; large protein molecules and water binding substances between the fibers of the Dermis

collagen, elastin, GAGs, and water

what are the 4 components of the ECM of CT?

dense regular

tendons and ligaments

dense irregular

aponeurosis, joint capsules, periosteum, retinaculum, ITB, dermis of skin, fascial sheaths

loose irregular

superficial fascia, muscle and nerve sheaths, and internal organ sheaths

inflammatory stage

24-38 hours

- STM in this stage to decrease edema

- light massage

- move protein/lymph in

granulation stage

2-14 days

- STM to decrease edema

- avoid overproduction of scar tissue

- gentle exercise

fibroblastic stage

1-12 weeks

- ideal for STM, more aggressive

- lots of collagen production

- stage starts 3-5 weeks for tendons

- lengthen/break adhesives

maturation stage

up to 18 months

- collage bonds are strong

- harder to change

- more aggressive (IASTM)

- realign "spaghetti" so you can move efficiently

immobilization; trauma

effects of _____ and _____ on CT

- permanent loss of GAGs and H2O

- collagen synthesis degradation

- irregular laying down of collagen and cross links (decreased mobility/contractile strength)

- ligaments, tendons, and joint capsules weaken

- altered sensory input

- EXERCISE HELPS TO MAINTAIN GAINS OF STM

muscle

the effects of immobilization and trauma on _____ tissue

- loss of sarcomere/muscle weight

- decreased protein, mitochondria, and enzymes

- increased fibrosis at musculotendinous junction in healing tissue (knots)

- muscle contusions heal with scar tissue made of dense irregular CT

- decreased muscle extensibility

tensegrity

balance of compression and tensile forces on connective tissue

- if one part weakens the other parts make up for it

benefits

_____ of manual therapy/STM

- movement maintains balance between collagen synthesis and degradation

- movement activates alignment of fibroblasts and myofibroblasts in the direction of stress

- facilitates GAG production, thus maintains inter-fiber distance and lubrication

- restore gliding between layers of tissue

- neurophysiological benefit due to rich proprioceptive content of fascia

mechanical

_____ effects of STM

- movement of venous and lymph flow, hematoma, lung secretions, intestinal contents

- mobilization of muscle fibers, tendons and tendons in sheath, skin and subcutaneous tissue, scar tissue, adhesions, stretches CT

reflex

mechanical effects are always accompanied by some _____ effects

- mechanical stimulus more effective = reflex stimulus less effective (dampens guarding reflex)

temp; sweating; resistance

massage increases skin _____, _____, and decreases ____ to electrical current

toughen

pressure can _____ but also soften the skin

physiologic effects

- increases skin temp

- increases skin and muscle blood flow

- increases flow of nutrients and removal of wastes

- stimulation or inhibition of healing process

- increase parasympathetic activity

- increase relaxation hormones

- decreases stress hormones

- decreases HR, RR, BP if systemic relaxation

- increases venous and lymphatic flow

psychological effects

increases relaxation

decreases anxiety

releases endorphins in the brain

one on one treatment (patient gains confidence clinician)

light slow stroking

evokes systemic relaxation

fast deep strokes

increases blood flow to area

increasing; increasing

mechanical vibratory massage is though to produce vascular changes by _____ BP without _____ HR, therefore hypothetically increasing SV

true

T/F: massage is less effective in decreasing muscular recovery time, but may be effective (2 hrs post) in reducing amount of DOMS

neurologic effects

- decreased neuromuscular excitability (only during and only muscles being massaged)

- decrease pain via removal of edema and waste (mechanical/chemical pain)

- decrease pain via sensory stimulation (activates sensory nerves, inhibits pain by stimulating T cells which gate pain)

- decrease muscle spasm or tension (pain-spasm-pain cycle, reduces mechanical pain by interrupting muscle spasm)

negative effects of stress

stress-pain-stress cycle

suppression of immune system

increased sympathetic drive

relaxation

massage can promote _____

- increased parasympathetic drive

- endorphin release

contraindications to massage

malignancy (active cancer)

inflammatory skin conditions (psoriasis, eczema, dermatitis)

acute fracture

hemorrhage sites

obstructive edema (blocking venous return)

heart failure (too much venous return)

clotting or bleeding disorders (hemophilia, factor 5)

acute rheumatic conditions

localized infection (prevent spread through body)

suspected thrombophlebitis

DVT

varicose veins

abdomen during pregnancy

24 hours after scuba diving (nitrogen bubbles)

precautions to massage

intoxication or drug use

severe psychosis

decreased sensation

hypermobile joint segments (CT disorder)

osteoporosis

degenerative changes

skin disorders

sensitive superficial tissues (eyes, lymph nodes, superficial nerves)

possible adverse effects

post massage soreness and malaise (toxins in bloodstream)

ecchymosis (bruising)

nerve damage

rhabdomyolysis (release of protein into bloodstream and leads to kidney failure)

cervical- headache/vertigo/dizziness

contact

you should maintain ____ once treatment is started

slow; rapid; slow

_____ movements to start --> _____ and light or ____ and heavy ---> slow and gentle to end

medium

used to decrease friction between the patient's skin and the clinician's hand

- more should be used on hairy areas

- friction massage: more medium may interfere with treatment

- during petrissage: some mediums interfere with kneading and lifting

effleurage

stroking of the skin

superficial, rhythmic stroking

- contours the body or relates to direction of underlying muscles

congruent with lymph and venous return

when performed with fingertips: stimulates sensory nerves

when performed with palm of hand: stimulates deeper tissues

beginning; end

light effleurage is performed at the _____ and ____ of massage or between petrissage or therapeutic strokes

petrissage

- lifting and kneading of skin, subcutaneous tissue, and muscles

- performed with fingers or hands moving in the same or opposite directions

- skin and underlying tissues are lifted between thumb and fingers or fingers and palm and gently rolled and kneaded in the hand

- often performed without lotion or very light medium

- frees adhesions by stretching and separating muscle fiber, fascia, and scar tissue

- assisting with venous return and milking out waste products

friction massage

- goal is to mobilize tissues often fascia/muscle/tendon and separate adhesions that restrict movement and cause pain

- facilitates local blood perfusion

- not necessarily a pleasing or relaxing treatment

- circular or perpendicular motions with fingertips/thumbs

- effective in treating trigger pts.

transverse/cross friction

- applied with thumbs or fingertips stroking the tissue across the fiber direction

- can use elbow, pisiform, instruments for deeper/larger areas

- begin lightly and then move to firmer strokes

- muscle/tendon should be placed in relaxed position

- should be avoided in acute conditions

- effective in tendonitis or other joint adhesions

skin rolling

- use fingers or thumb to lift and separate the skin from the underlying tissue (petrissage technique)

- roll skin between fingers noting restriction

- lift skin and move it in the direction of the restriction

- reduces superficial myofascial adhesions

tapotement

Also known as percussion; movements consisting of short, quick tapping, slapping, and hacking movements.

- respiratory therapy: for pulmonary hygiene

- sports massage: stimulate blood flow

- promotion of relaxation and desensitization of irritated nerve endings

myofascial release techniques

- involves effleurage, petrissage, and friction with stretching muscles and fascia

- tries to obtain relaxation and elongation of tense and/or adhered tissues

- no structured pattern, specific to each technique

arm pull/leg pull

stretches large areas of fascia

- grasp extremity proximal to joint, apply gentle traction

acupressure

a traditional Chinese touch therapy involving finger pressure applied to specific areas of the body to restore the flow of qi (balance between yin and yang)

- 12 meridians in the body named according to the body part which they are associated with

myofascial trigger points

trigger points are taut bands on tissue

- may be found in muscle, tendons, fascia, ligaments and capsules surrounding joints, in periosteum, and in the skin

- can be latent (painful w/o referral) or activate and cause referred pain

- local twitch with pressure = trigger point

- perform small friction-like circular motions over the point (30s-5+ min)

edema reduction stroke sequence

begin proximal to edematous area

long slow strokes towards torso

gradually move distal every 4th/5th stroke