Management of Soft Tissue

why is touch so powerful in PT?

touch may decrease physiological response to stress, was shown to decrease BP and improve sleep quality in females (30 min massages for 3 weeks) and babies that received 15 mins of therapeutic touch averaged 47% more weight gain per day than control group

how does touch build the therapeutic alliance?

aids in creating meaningful conversation, demonstrates engagement by the provider, and increases patient participation, can be a crucial element in reinforcing constructs of patient centered care

what is the definition of therapeutic touch?

intentional and skilled use of hand to assess and influence tissue of the body, integrating clinical reasoning with sensory input

what is the 7 step palpation method?

approach that includes: (PALPATE)

• position

• anatomy

• level

• purpose

• ascertain

• tweaking

• evaluate

describe the position step of PALPATE

comfortable position for operator and patient

describe the anatomy step of PALPATE

incldues mental visualization, recall of anatomical models or cadaveric slides, mastery = knowing relationships of structures

describe the level step of PALPATE

includes layered palpation, appreciation of the depth of palpation and pressure

describe the purpose step of PALPATE

know the intent of the palpation, therapeutic in nature for both examination and intervention

describe the ascertain step of PALPATE

determine what palpation is telling you, is the information relevant, is it painful? does it add to the examination hypothesis?

describe the tweak (fine tune) step of PALPATE

consider the amplitude, asymmetry, severity, and irritability of symptoms, qualitative feedback like tissue rigidity, temperature, density, and also in manipulation of joints

describe the evaluate step of PALPATE

includes internal feedback, metacognition, and potential soft tissue state pre and post treatment

what should be observed when evaluating soft tissue?

skin changes, posture, muscle symmetry (bulk, tone, atrophy), edema and effusion

what are the structures that should be felt for in layered palpation?

differences between skin, tendon, muscle, nerve, fascia, ligaments, and joint capsule

what should be assessed while palpating?

the SINSS- severity using the numeric pain scale, irritability, nature, stage (and stability)

describe how to perform palpation

start in the region of pain but away from the focal area of pain, go superficial to deep, broad contact to focused, start with bony landmarks to tendons to muscles to ligaments to joint line, also can palpate for nerves and pulses and to be aware of these structures to avoid discomfort

what is the treatment purpose of soft tissue mobilization?

to treat postural restrictions, edema, tissue immobility, response to touch/therapeutic alliance, scar mobility, (increase ROM and decrease pain, and improve joint motion when followed up with additional interventions)

what are treatment effects of soft tissue mobility?

localized increase in blood flow, improve scar mobility, decrease stress, temporary decrease in BP, increase in lymphatic draining, may increase urinary output due to increase in blood flow and relaxation, pain reduction (all related to parasympathetic function)

what are negative effects of STM?

adversity to touch, anxiety, increase autonomic response (sympathetic) like sweating, dizziness, nausea

what are contraindications for STM?

thrombophlebitis, open wound, edema due to kidney, heart, lymph obstruction, acute injury (24-48 hours), infection, new scar tissue, healing fracture

what are precautions of STM?

decrease sensation, cancer, decreased circulation, decreased skin nutrition, compromised immune system

what should be considered about patient set up?

patient should be in a relaxed/comfortable position, appropriate draping, use of pillows and towels

what should be considered about therapist set up?

table height, patient proximity, body mechanics, athletic stance/base of support, use the torso

what are the different myofascial soft tissue techniques?

trigger point, swedish (efflourage, petrissage), cross friction (criax friction)

describe efflourage

STM technique that uses long gliding strokes that are parallel to the fiber alignment, is a preparatory technique

describe petrissage

a STM technique that uses kneading (lift, wring, or squeeze of tissue), manipulation of tissue perpendicular to the fiber alignment

describe cross friction/transverse friction

STM technique that is used for tissue/scar mobility in the remodeling phase, has an analgesic effect, and common in tendinopathies, is performed perpendicular to the tissue, uses a small surface area

describe inhibitive pressure/trigger point release

STM technique that uses compression of tissue with or without movement, applied gradually as the pain decreases, 30-90 second hold

what are examples of inhibitive pressure?

suboccipital release (with or without distraction)

what is the grading scale used for tenderness of soft tissue?

graded on a scale of +1 to +4, with +1/4 being the least tender and +4/4 the most

what reaction corresponds to +1/4 T (or grade ¼ tenderness)?

tenderness with no physical response

what reaction corresponds to a +2/4 T (or grade 2/4 tenderness)?

tenderness with grimace, wince, and/or flinch

what reaction corresponds to a +3/4 T?

tenderness with withdrawal (positive jump sign)

what reaction corresponds to a +4/4 T?

a non-noxious stimuli (superficial palpation, gentle percussion) results in patient withdrawal or patient refusal to be palpated due to pain

what should be included in documentation of soft tissue assessments?

soft tissue restrictions, any noted trigger points, and structures that are sensitive to palpation

what should be included in documentation of soft tissue treatments?

the structures treatment, the method of treatment, tolerance to treatment and response to treatment, the skin pre and post, and duration of treatment