Intro to soft tissue mobilization

What tissues are considered soft tissue

muscles, tendons, skin, ligament, connective tissue

anything but bone

INDICATIONS for STM

Pain

Muscle spasm

Edema

Reduced circulation

Adhesions?

Headaches

Scar tissue

Decreased ROM/flexibility, and Contractures

Muscle atrophy and weakness

DOMS

Trigger points

Myofascial pain and restrictions

Sprains/ Strains/ Tendinopathies

affective touch

interpersonal touch mediates the release of neurochemicals; improved mood/effect

contextual factors

the positive therapeutic encounter is tied to clinical outcomes; the magnitude of a response

mechanical factors

gentle stretching of neurovascular structures and muscles induces a molecular response that helps diminish intraneural edema and clearance of noxious biochemical by-products

neurological factors

stimulation of somatosensory nerves inhibits nociceptive processing

HOW does STM work maybe?

biochemical and cellular changes

reduced cellular infiltration and tissue necrosis

recovery mechanical properties of the muscle tissue function

histologically the tissue more closely resembled healthy controls

delay in massage application increases its effectiveness

reduce inflammation and promoting mitochondria biogenesis

psychological effects

hands on effect

general sedative effect

lower psycho-emotional and somatic arousal

edema effects

increase blood circulation

stimulates movement of lymphatics

enhance venous return

fluid clearance to different and unblocked lymphs

milking massage

skin rashes/irritations are BLANK for STM

precaution

hyposthesia/hyperesthesia is BLANK for STM

precaution

osteoporosis is a BLANK for STM

precaution

pregnancy is a BLANK for STM

precaution

extremely hairy areas is a BLANK for STM

precaution

Open wound, hematoma, deep bruising, burns, blisters is a BLANK for STM

contraindication

marked varicosities is a BLANK for STM

contraindication

gross edema with risk of skin tear is a BLANK for STM

contraindication

skin CA is a BLANK for STM

contraindication

septic arthritis is a BLANK for STM

contraindication

acute or chronic skin infections or DVT is a BLANK for STM

contraindication

Cellulitis is a BLANK for STM

contraindication

Constant, severe pain or pain not relieved by rest is a BLANK for STM

contraindication

Considerations for Tx

Clean, dry, and warm hands

Positioning of PT and patient

Lubricant-overcome friction and avoid skin irritation

Some lubricants contain beeswax (ask if allergic)

...

direction of stroke (toward heart?)

pressure (light or deep)

rate and rhythm

duration and frequency

changes in S/S

Effleurage

beginning stroke;

deep stroking

Petissage; 4 types

Kneading

Picking Up

Wringing

Skin Rolling

Effleurage effects

increase venous flow, lymph flow, increase mobility of the skin and subcutaneous tissue, dilation of superficial arterioles, stimulation of large diameter mechanoreceptors of skin

direct of effleurage

Always in direction of venous and lymphatic flow

pressure of effleurage

gradaully increasing throughout stroke

rate and rhythm of effleurage

About 7 inches per second Slight pause at the end of each stroke and/or near lymph glands, Slow

palmer surface of one of both hands

smaller areas = fingers or thumb of one or both hands

ALWAYS MAINTAIN CONTACT

deep stroking effleurage

More pressure to produce a mechanical effect

May help relieve pain, muscle spasm, and superficial scar tissue

Stimulates circulation in deeper tissues

Promotes relaxation which may help pain and muscle spasms

deep stroke direction

ANY direction, usually moves in one direction at a time

deep stroke pressure

greater force, want to reach deep tissues

rate/rhythm of deep stroke

Rhythm-slow to moderate, about 7”/ sec, must be rhythmic

Performed with palmar surface of one or both hands, alternately or simultaneously

Smaller areas can be treated with fingers or thumb of one or both hands

Always maintain contact

Petrissage

deeper pressure

meant to mobilize deeper structures such as muscles and tendons

different strokes of petrissage

kneading

picking up

wringing

skin rolling

kneading (petrissage)

circular motion

strong mechanical

chronic edema

distal to proximal

long axis of segment

(1 or 2 hands)

variations: all palm, finger and thumb, knuckle, squeeze

2 phases of kneading

compression and relaxation

hands move in parallel lanes to cover whole tx area

distal to proximal

slowww; circle will take 3-4 seconds to complete

picking up

to mobilize deeper tissues

usually single handed technique

grasp, squeeze muscle, whilst lifting them -think gastroc

same direction of muscle fibers

should be slowwwwwww

circular motion

wringing out

mobilize

mechanical action

grasp tissue both hands, lift and twist between fingers and thumb

wringing out speed

Slow to medium speed- 4-6” /sec on a large muscle

Reasonable pressure

skin rolling speed

4-6 seconds

skin rolling purpose

mobilize skin and subcutaneous tissues

may not be comfy, do not pinch

what is skin rolling

Lift skin and subcutaneous tissues away from deeper structures and roll them over the deeper tissues

percussion

Series of taps or blows

Relaxed wrists and hands

Used to increase circulation, stimulate peripheral nerve endings and for postural drainage

Uses a cupped hand, hypothenar eminence

„Fairly rapid rate

Hands work alternately

who developed cross friction massage

James Cyriax and russell

what is cross friction massage for

Purpose-loosen adherent fibrous tissue, aid is absorption of local edema or effusions, reduce local muscle guarding

Used to treat tendinopathies tendon should be on full stretch

Not always comfortable for the patient

thumb and index finger

do you use a lubricant for cross friction massage

NO

cross friction massage how long??

5-20 minutes

2-3x/week

how deep of strokes for cross friction massage

VERY DEEP strokes

Myofascial release

Releasing adhesions or tight fascia (connective tissue around muscles)

Superficial to deep

after myofasical release , now what?

STRETCH involved tissue

lubricant for myofascial release?

NOOO, maybe a little..

Myofascial Trigger Point

a trigger point must have referred pain to be a trigger point

typically found in postural musculature

characteristics of trigger points

persistant pain

dec ROM

palpation

twitch response

jump sign

contraction of involved muscle against a fixed resistance will be painful

GOAL of MTRP therapy

relieve pain and tightness

improve joint motion

improve circulation

eliminate perpetuating factors

how to tigger point?

static pressure or small circle

short duration 1-5 min

not comfy!

pain should dec with time

follow with stretch and educate

why do we hold trigger points over a min

first reduce blood flow

make hypoxic environment

flush it out (reflex dilation after occulsion)

Peds-Massage

sleep patterns

increased weight gain in little bebes

increase bone density in little bebes

decrease jaundice

increase serum insulin levels

decrease stress

decrease depression/anxiety in mothers (the connection)

improves brain development