STM & MFR Flashcards

1
Q

glycoaminoglycans (GAG’s) of the ground substance functions as what?

A
  • Lubricant & buffer
  • helps determine cohesiveness, viscosity & rigidity of the tissues
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2
Q

How many times is the J-Stroke performed?

in what direction?

A

2-3 times

in the direction of the restriction

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3
Q

 Ground substance mobility decreases with:

A
  1. age
  2. immobility
  3. muscle atrophy/trauma (“dehydration”)
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4
Q

Causes of Soft Tissue Restrictions:

A
  1. intermolecular cross-linking
  2. scar tissue adhesions
  3. ground substance dehydration
  4. lymphatic stasis & interstitial swelling
  5. neuro-reflexive/muscle guarding
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5
Q

What is fascia composed of?

A

irregular sheaths of collagen & elastin fiber

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6
Q

STM indications:

A
  1. decrease soft tissue mobility
  2. adaptive shortening
  3. soft tissue injury (not acute)
  4. scar release
  5. pain
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7
Q

Soft tissue restrictions are defined via…

A
  • depth & direction (using face of clock, quadrants).
  • Look for:
    • decreased excursion
    • hard end-feel
    • tissue feeling crunchy, leathery, lumpy or gristly feeling
  •  Soft tissue layer concept (“peeling
    layers of an onion”):
    • Superficial layers are evaluated & treated before the deeper layers; allows the therapist to exert the least amount of force to treat the deeper restrictions.
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8
Q

during TFM cascading technique, assisting hand providing STRETCH or TENSION is place where?

A

assisting hand is in BEHIND of treating hand

(treatting hand is moving in the direction of the restriction)

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9
Q

True or false:

Ground substance consistency influences collagen fiber formation.

A

True

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10
Q

Which STM technique assesses skin’s ability to lift from the underlying structures?

A

Skin rolling:

Restricted areas will feel painful & skin will be difficult to lift from underlying tissues.

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11
Q

increased resistance to movement in fascia occurs due to what?

A
  1. Reduction in GAG’s within the ground substance occurs with immobilization.
  2. Dehydration leads to a decrease in lubrication & critical fiber distance.
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12
Q

Manual therapy documentation

A
  • Patient position: prone, supine or sitting; make sure to mention that proper draping was used.
  • Type of manual therapy: be specific on type of massage, STM or MFR.
  • Treatment location(s): be specific
  • Duration (min): if more than 1 body part was treated, specify duration for each body part.
  • Patient’s response to treatment: ie. decrease pain decrease tightness, increase ROM etc.
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13
Q

Cascade of STM Treatment Techniques

A
  1. Position yourself so that the technique can be applied toward the restriction. (DIRECT technique).
  2. First, put tissues around the restriction on slack (”passive tissue shortening”).
  3. If not successful after 10 seconds, put the tissues around the restriction on stretch to create tension/traction (”passive tissue lengthening”).
  4. Unlocking Spiral: Use if the restriction is NOT responding to the sustained pressure & assisting hand techniques.
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14
Q

a band or sheet of connective tissue, primarily collagen, basement membrane of the
dermis to the periosteum, that attaches, stabilizes, encloses, and separates muscles and other internal organs:

A

fascia

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15
Q

STM contraindications:

A
  1. malignancy
  2. aneurysm
  3. acute RA
  4. fracture
  5. localized infections
  6. inflammatory skin conditions
  7. ostemyelitis (infection of bone)
  8. sites of hemorrhage
  9. obstructive edema
  10. advance osteoporosis
  11. hypermobile joint segment

An aneurysm is an excessive localized enlargement of an artery caused by weakness in the arterial wall.

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16
Q

How does STM affect tissues?

A
  1. Some elongation occurs via removal of the inherent crimp within the fiber & its visco-elastic properties.
  2. Breaking of covalent bonds & fibers occurs when greater force is placed in the tissue.
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17
Q

A whole body evaluation & treatment
approach that looks for fascial strain(s) in the body that can create pain & malfunctions throughout out the body that do NOT always follow a dermatomal pattern.

A

Myofascial Release (MFR)

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18
Q

Dysfunctional tissue that needs to be treated feels…

A
  • hard end feel
  • feels hard, hot or tender
  • feels crunchy, leathery, lumpy or gristly
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19
Q

RED flags:

A
  • Fever > 100/chills/night sweats
  • Unexplained wt loss >10 lbs within 3 mos
  • Malaise & loss of appetite
  • Rest/night pain (not relieved with rest or awakens pt at night)
  • Saddle anesthesia/changes in bowel &
    bladder function
20
Q

MFR techniques:

A
  1. Sub-occipital release: headaches &
    upper cervical pain. 5 min.
  2. Cross hand release: 5 min.
  3. Lumbosacral decompression: 5 min
  4. Myofascial stretching: 5 min in each fascial barrier
21
Q

STM techniques:

A
  1. Skin gliding
  2. Finger sliding
  3. Skin rolling
  4. Bony contours
22
Q

Patient preparation to STM:

A
  • explain purpose of treatment
  • patient position (comfortable & access to body part)
  • patient instruction (to breath & imagine tissue “melting like butter” to try to soften or relax the area)
  • use specific force (precise depth, angle & direction) directly on the restriction at their end range.
23
Q

Which STM technique assesses soft tissue restriction along the bony contours (iliac crest, scapula, patella etc).

A

Bony Contours Assessment

24
Q

One of the functions of fascia is shock absortion and transmition of mechanical forces. “Because we are not meant to be acontainer of energy, we are a conductor of energy.”

A

Dr. Quijano

25
Q

Functions of fascia:

A
  1. Separates muscles and structures to allow independent function while joining them as a functional unit
  2. Shock absorption & transmission of mechanical force.
  3. Exchange of metabolites between fibrous
    elements, the circulatory & lymphatic systems.
  4. Stores energy in adipose tissue.
  5. Protect against the spread of infection.
  6. Allows for muscle play (normal muscle mobility in relation to surrounding structures).
26
Q

What is the pt going to experience durinf the application of the STM J-stroke technique?

A

Patient might experience a burning/pulling sensation from the treatment.

27
Q

How many times is the STM vertical stroke technique performed?

in what direction?

in what position?

A

2-3 times in the direction of the restriction

position the area in stretch

28
Q

What does a myofascial release feel like?

A
  • burning/ripping sensation, pulsation tingling or heat
  • Symptoms often intensify as the release occurs, then decrease/dissapear when it is complete
29
Q

Which STM technique is used to determine precise location & direction of
restriction?

A

Finger gliding

30
Q

What STM techniques must be followed if
there is no change after 10 seconds?

A

Cascading

31
Q

Elements of connective tissue:

A
  1. Elastin fibers
  2. Reticulin fibers
  3. Fibroblast: “fiber producing”
  4. Collagen fibers: in fascia, tendons, ligaments & joint capsules. High tensile
  5. Ground substance:“fluid element” vicous gel made of H2O and carbohydrate.
    • composed mainly of glycoaminoglycans (GAG’s), proteoglycans & tropocollagen
32
Q

STM techniques that is performed 3-5x that can be use to trace/clear borders of iliac crest, medial border of scapula, spinous process, ischial tuberosity etc.

A

Bony contour

33
Q

How do we know what to treat in STM?

A
  • Normal tissues = springy end feel
  • Dysfunctional tissues:
    • hard end feel
    • feels hard, hot or tender
    • feels crunchy, leathery, lumpy or gristly
34
Q

What is the ground substance composed of?

A
  • “fluid element” vicous gel made of H2O and carbohydrate:
  • composed mainly of glycoaminoglycans (GAG’s), proteoglycans & tropocollagen
35
Q

What is Intermolecular Cross-linking?

A
  1. Reduction in GAG’s within the ground substance occurs with immobilization.
  2. Dehydration leads to a decrease in lubrication & critical fiber distance.
  3. End result: increased resistance to movement
36
Q

Which STM technique is used to initially determine the general regions of restrictions (quadrant) and assess skin’s extrinsic mobility to slide in relation to underlying structures?

A

Skin gliding

37
Q

What do you assess during STM sking gliding technique?

A

quality of extensibility & end feel.

38
Q

Other STM techniques:

A
  • Vertical stroke
  • Transverse stroking (90 degrees)
  • Scar release: use two hands (2-3 min) in the direction of greatest restriction
  • Bony contour:
39
Q

Breaks up cross-links in the fascia & increase tissue mobility.

A

STM, J stroke technique

Performed 2-3x in the direction of restriction with a torque at the end of the motion using 2 or 3 fingers, knuckle or elbow with counter-pressure from heel of other hand.

40
Q

Of the four types of tissue, which one is fascia?

  1. Connective
  2. Epithelial
  3. Muscle
  4. Nervous
A

connective tissue

41
Q

Which layer of fascia is thicker and stronger?

A

deep layers

superficial layers: thinner & more delicate

42
Q

during TFM cascading technique, the assisting hand providing SLACK is placed where?

A

assisting hand is IN FRONT the treating hand (treatting hand is moving in the direction of the restriction)

43
Q

What do you tell the pt prior to myofascial release?

A
  1. purpose of treatment
  2. sensations they may feel: burning /ripping sensation, pulsation, tingling or heat
  3. Drink 5-8 glasses of water
44
Q

used to break up cross-restrictions of the collagen of the fascia

A

Soft Tissue mobilization

45
Q

Where do you want to be in the stress/strain curve during STM?

A

Plasticity region

46
Q

How many times do you perform STM tranverse stroking technique?

what is the position of the therapist’s hands?

A

Up to 10 times

MCP flexes in 90 degrees

47
Q

How long do you apply STM scar release?

what is the position of the hands?

A

2-5 minutes

Use 2 hands: bottom hand is for direction & top hand applies the force.