Biophysical Agents Exam 2

what is soft tissue mobilizaition

the intentional and systematic mechanical manipulation of soft tissues to promote heath and healing

-application of manual or instrument assisted pressure to soft tissue to improve flexibility, function, and overall well being

what are the different soft tissue types/techniques

-general massage

-transverse friction

-scar massage

-ischemic compression

-myofascial mobilizaition

-soft tissue release

-manual lymphatic drainage

-IASTM

what are common impariments treated with soft tissue

-adhesions/scars

-decreased mobility

-trigger points

-tendionpathy

-muscle strains/tears

-lymphedema

-pain

-muscle gaurding

what are precautions to soft tissue

-low BP

-joint instability

-impaired sensation

-fragile skin

-cancer

-severse atherslerosis

-severe varicose veins

-certain medications (ones that alter sensation or blood circulation)

-recent psychological trauma

-advanced diabetes

-acute RA

what are the contraindications

-infection that may spread by skin or lymph

-acute inflammation

-bleeding

-blood clotting disorders

-open wound

-edema (if unexplained)

-presence of a thrombus

-over a healing fracture

what are the different kinds of therapeutic effects

-biomechanical effects

-physiological effects

-neurological effects

-psychological effects

what are the biomechanical effects

mechanical pressure on tissues

-decrease tissue adhesion

-increase muscle compliance

-increase range of joint motion

-decrease passive stiffness

-decrease active stiffness

what are the physiological effects

changes in tissue or organ

-increase blood flow

-increase skin blood circulation

-increase parasympathetic activity

-increase relaxation hormones

-decrease stress hormones

what are the neurological effects

reflex stimulation

-decrease neuromuscular excitability

-decrease pain

-decrease muscle tension or spasm

what are the psychological effects

increased relationship between the body and mind

-increase relaxaiton

-decrease anxiety

is a decrease in muscle stiffness a long term or short term effect

short term

when is it helpful for ROM

when used with other techniques

-less effective when used in isolation

does soft tissue increase skin/muscle temp

yes

-can increase intramuscular temperature to 2.5 and quickly return to baseline

how does soft tissue decrease muscle tension

reduction in neuromuscular excitability

how does soft tissue decrease pain

-may activate neural gating mechanism

-can increase serotonin

-less pain, improved function in combination with exercise and postural/body mechanics

how is the evidence for soft tissue

major design flaws in existing reserach studies

-small sample size

-no follow ups

-no randomization

-clinical effectiveness

-case studies or case series

what kind of relief does soft tissue provide

may offer short term relief, but should be used in conjuction with other interventions for long term improvement

what is the evaluation

-patient history

-tests and measures (pain, ROM, strength, various others)

-observation

-palpation

what goes into treatment planning/decision making

-informed consent

-identify impairments (pain, decreased ROM, poor muscle perfomance)

-functional/activity limitations

-selection of STM techniques

-other PT intervenions

what are good guidelines to follow

-maintain a professinal demeanor

-good boundaries (draping)

-good verbal communication

-when necessary, have a witness

-document consent

how do you assess pts response during treatment

-ask specific questions - get feedback from the patient)

-observe pts non verbals

what do you do after treatment

reassess

-pain

-mobility

-function

what are trigger points

a hyperirritable spot in skeletal muscle that is associated with a hypersenstive palpable nodule in a taut band

what are trigger points characterized by

-tense bands

-focal-assymetrical distribution (regional bands or focal tenderness)

what is seen with trigger points

-rigid muscle palpation

-restricted ROM/muscle stiffness

-muscle weakness

what are the possible mechanisms of trigger point

-energy crisis theory

-motor end plate hypothesis

what is the cycle of trigger point formation

-muscle overload

-abnormal release of acetylcholine (muscle can't relax)

-influx of calcium into sarcomeres

-localized contraction of affected sacromeres

-contraction knots (develops into trigger point)

-increase in metabolic demands

-local ischemia (sends out pain signals)

-energy crisis

-pain

what is myofascial pain syndrome

condition associated with trigger points

-muscular pain disorder involving pain referred by trigger points either local or distal to the painful site

-often misdiagnosed or poorly diagnosed (Often as a muscle strain)

what are the characteristics of myofascial pain syndrome

-non inflammatory

-local pain and stiffness

-hyperirritable palpaple nodues (send pain other places)

what is the epidemiology of MPS

associated with several pain conditions including:

-migraines

-whiplash

-shoulder pain

-epicondylalgia

-carpal tunnel syndrome

-LBP

-pelvic pain

-knee pain

-plantar heel pain

-post mastectomy

what kind of pain do trigger points have when stimulated

reffered pain when stimulated

-duration of pain is variable

what are the pain descriptors of trigger points

-deep, aching, burning

-at times perceived as superficial

what is the intensity of a trigger point correlated with

the degree of irritability

what is a condition associated with TrP

fibromyalgia

what is fibromyalgia

-rheumatic disorder

-generalized pain in all 4 quadrants for > 3 months

what are the disease characterticis of fibromyalgia

-stifness

-fatigue

-sleep disturbance

-tender points (11 of 18)

-negative lab findings (diagnosis exclusion)

what are the 2 scales used to grade fibromyalgia

symptom seversity (SS)

-somatic symptoms

-waking unrefrshed

-cognition

-fatigue

0-12 points

widespread pain index (WPI)

-1 point for each 19 areas where pain present in past week

0-19 points

what is the diagnosis of fibromyalgia using the two scales

-WPI of at least 7 and SS scale of at least 5

or

-WPI of 3-6 and SS scale of at least 9

what is the managment for fibromyalgia

1. restore restful sleep

-low level antidepressent (Elavil)

-muscle relaxer (flexeril)

-sleep hygine

2. injection to tender points

3. PT- massage/STM, aerobic exercise, stretching, patient education, biofeedback

4. education on staying active and sleeping

in active TrPs, what is the pts tenderness

very tender on palpation and possibly at rest

in latent TrPs, what is the pts tenderness

pai on deep palpation

in tender points, what is the pts tenderness

tender generalized pain

in active TrPs, what is the pts pain/restricted ROM

-pain with movement

-restricted ROM

in latent TrPs, what is the pts pain/restricted ROM

-no pain with movement

-ROM may be restricted

in tender points, what is the pts pain/restricted ROM

-may/may not be painful with movement

-hypermobility

in active TrPs, what is the pts referred pain

usually has referred pain pattern

in latent TrPs, what is the pts referred pain

does not typically have referred pain pattenr

in tender points, what is the pts referred pain

no referred pain pattern

in active TrPs, what is the pt awareness of trigger point

patient confirms presence

in latent TrPs, what is the pt awareness of trigger point

presence not known unless probed- does not cause clinical pain complaints

how do you identify a trigger point

-Subjective complaints/history, pain drawings

-Palpation: flat, pincer

-Referred pain pattern (RPP)

-Local twitch response

-Should correlate with other eval findings (ROM, MMT, Posture...)

what is the most commonly reported criteria of trigger points

-spot tenderness

-referred pain

-local twitch response

-pain recognition

-limited ROM

-jump sign

what is the most common combination used to diagnosis a trigger point

spot tenderness and local twitch response

what is the medical management of trigger points

Injections of procaine

Medications: limited evidence and unclear benefit

Dry Needling: "insertion & manipulation of a fine/flexible needle into TrP to produce a local twitch response (LTR), resulting in muscle relaxation"; state practice acts determine who is qualified to do this

what PT interventions are used for trigger points

-general massage techniques

-TrP pressure release

-direct fascial techniques

-PROM/self stretches

-modalities

-dry needling

-addressing any perpetuating factors

-teach self managment techniques

what are common errors for TrP

-pressure applied too quickly and too much

-pressure exceeds patient pain tolerance

-pressure not maintained on TrP

-insufficent depth

-passive stretch omitted ( have to couple with exercise)

-perputuating factors not addressed

what are the general massage techniques

-basic efferuage

-rolling petrissage

-circular friction

-beating percussion

what are general guidelines for massages

-maintain contact

-regulate pressure as appropiate

-area defined by muscle groups or anatomical landmarks

-stoks can be done 1 handed or 2 handed or using diff parts of hand

-you are assessing and treating simultaneously

what is effleurage

-Gliding strokes

-Light strokes: accustoms pt to your touch, relaxing, return stroke

-Deep strokes: affect circulation, begin to see mechanical effects

what is effleurage technique

-Hands should be relaxed

-Stroke begins "light" and deepens over the bulkiest part of the muscle, then finishes "light"

-Return stroke should be light

what is petrissage

kneading manipulaitons

-force is away from the body

what is the purpose of petrissage

-increase soft tissue mobility

-increase circulation

-decrease pain

what is petrissage technique

many ways to perform

-goal is to lift and squeeze/mobilize the soft tissue

-don't pinch !

what are the types of petrissage

-basic 2 handed kneading

-one handed kneading

-circular 2 handed petrissge

-alternating fingers to thumb petrissage

-skin rolling

what is friction

-fingers and skin move over deeper tissues

-creates superficial heating

-compressive force

-creates movement between deeper tissues

-usually ciricular motions performed

-2-3 cycles then glide to next spot and repeat

-increase depth gradually- work through superficial layers to the deep tissue

-can be done with fingers, thumb, knuckle, heel of hand, elbow

what did the study about the effects of sports massage on performance and recovery find

-no improvement in sport perfomance

-small benefit with DOMS

-improvement in flexibility

helps with mobility and soreness but NOT performance

what is a trigger point pressure release

sustained digital pressure, direct inhibitory pressure, static friction, acupressure, progressive pressure technique

-a non gliding technique with its compressive force applied perpendicularly to the structure

what is the TrP pressure release technique

-apply gentle, gradually increase pressure : increase in resistance, patient discomfort

-precise control over direction and force

-pressure maintained : palpable tension release ; finger advance slightly ; can be 30 sec - 2 mins; typically 60-90 sec

-follow with a stretch

-often incorporate petrissage strokes and stripping

what does the research say about trigger point compressin and passive stretching

-may inhibit: pain and reflex motor and autonomic CNS responses

-small increase in ROM

-possible anti-inflammatory action

levator scapula referral pattern

what is the levator scapula TrP pressure release

-treating the upper TrP

-the lower TrP is located at the superior angle of scap

-to stretch: neck flex, rot, and SB to opposite side

-stabilize scap when stretching

levator scapulae stretch

suboccipital pain referral pattern

what is the suboccipital release (SOR)

-upward pressure of fingers into suboccipitals

-gentle traction to take up the slack

-as fingers sink into tissue, take up the slack and repeat sequence

-follow with manual stretch

suboccipital stretch

trapezius pain referral pattern

what is the upper trapezius TrP release

-TrP often found at just lateral to angle of neck

-pincer or flat palpation can be used

upper trap stretch

what do you need to assess with a pt has TMJ pain

-masseter

-temporalis

-lateral ptyergoid

what would the pt present with when they have TMJ pain

-pt complains of headaches, tooth pain, ear pain, jaw pain

-forward head posture, bruxism (grinding of teeth), teeth clenching

masseter pain referral pattern

temporalis pain referral pattern

what is the masseter TrP release

-RPR: eyebrow, ear, TMJ, upper and lower teetch

-use pincer palpation

-very easy and very effective

-assess opening ROM

piriformis pain referral pattern

quadriceps pain referral pattern

hamstrings pain referral pattern

what is myofascial release

hands on soft tissue technique, facilitation a stretch into a restricted area (soft tissue while someone is stretching)

-sustained pressure

-hold for 60-90 seconds

-move into new tissue barrier and repeat

-do as needed

-can be active or passive

-STM with movemnt

-same concept as trigger point STM

what are direct fascial techinques

-sweeps/muscle stripping

-clearing

-releases

-friction

-bending

deeper pressure techinques - often combining effleurage and petrissage

what is muscle stripping/sweeps

-1 hand or finger stabilizes

-1 hand or finger mobilizes

-slow sweep along the length of the muscle

-thumg, finger, knuckle, heel of hand, forearm, elbow

what is lumbar release technique

-take up the slack

-hold until it releases

-repeat last 2 steps until an end feel is reached

-working through layers

-direction of stretch may change depending on feedback of muscle

what does the evidence say about myofascial release

may help with movement and pain, but current research does not provide convincing evidence that it works by impacting tissue stiffness

what are self care instructions

-correct self stretches

-AROM exercises

-moist heat

-self STM

-ergonimic and posture education

what are different tools for PT and patient

-tennis balls

-lacrosse balls

-thera cane or body back buddy

-foam roll

what are the effects of self STM on ROM

-short term benefits

-foam roller: 2-5 sessions , 30-60 seconds

-roller massage: 2-5 sessions, up to 2 minutes

-better effects when combined with stretching

what are the effects of self STM on muscle recovery and soreness

reduces pain and can reduce muscle performance decrements post intense exercise

what is important to know about the use of STM

-beneficial tool in care

-consider when to use based on anatomy, impairments, diagnosis, and contextual factors

-consider the balance of active vs passive treatment

-not everyone needs STM

what is trigger point dry neendling

an invasive technique to treat TrP

what is the preliminary research about TrP dry needling

-improves pain

-reduces muscle tension

-normalizes endplate dysfunction

-facilitates accelerated return to active rehab

what is dry needling

a skilled intervtion performed by a PT that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular and connective tissues

-used to mangage musculoskeletal pain and movemnt impairments

-based upon western medical concepts

-requires at PT examination and diagnosis to accurately use

what is acupuncture

family of procedures involving the stimulation of points on the body using a variety of techniques

-involves penetrating the skin with thin, metallic needles that are manipulated by the hands or by electrical stimulation

-treats along meridians

-based on traditional chinese medicince and focuses on restoring imblances in Qi, Yin, and Yan, five elements

-national exam for licensure