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STM > Intro to STM Lecture > Flashcards

Intro to STM Lecture Flashcards

1
Q

Manual Therapy: Still

A

Osteopathy, abnormal structure

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2
Q

Manual Therapy: Cyriax

A

Musculoskeletal diagnosis

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3
Q

Manual Therapy: Mennell

A

Joint mobilization and massage

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4
Q

Manual Therapy: Katenborn and Maitland

A

joint mobilization

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5
Q

Bodywork & Massage

A 
Traditional Swedish Massage
Connective Tissue Massage
Structural Integration (Rolf)
Manual and movement 
- trigger paint therapy (travell)
- shiatsu (acupuncture points)
- reflexology 
- trager (oscillations)
- therapeutic "touch" and Reiki
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6
Q

Connective Tissue Cells

A
  • fibroblasts and fibrocytes
  • epithelial cells
  • macrophages, neutrophils
  • mast cells (release histamines)
  • plasma cell proteins
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7
Q

Connective Tissue Extracellular Matrix

A 
Fibers
- collagen (type I): loose and dense
- elastin
- reticulin
Ground substance
- viscous gel-like medium 
- H20
-GAGs
- suspends collagen fibers
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8
Q

Name 3 types of connective tissue

A

dense regular
dense irregular
loose irregular

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9
Q

Which type of connective tissue is most difficult to redirect? how can it be done?

A

dense regular connective tissue.

perpendicular friction to break up unwanted fibers

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10
Q

How soon can you start soft tissue mobilization to produce normal collagen remolding?

A

Not day 1 –> P.R.I.C.E.

On day 2-4 –> proliferation stage may have begun

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11
Q

What type of connective tissue are ligaments and tendon? What are its characteristics?

A

Dense Regular

Dense parallel collagen fibers
Proportionally less ground substance
Not highly vascular.

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12
Q

What type of connective tissue are joint capsules, dermis, aponeuroses, high-stress fascial sheaths (ie lumbodorsal fascia?) What are its characteristics?

A

Dense Irregular

Multidirectional collagen fibers
Resists multidirectional stressers

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13
Q

What type of connective tissue is superficial fascia, muscle and nerve sheaths, internal supportive network?What are its characteristics?

A

Loos Irregular

Sparse, multidirectional fibers
more elastin and ground substance
viscoelastic properties
most likely affected by external forces

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14
Q

What is fibrosis?

What causes fibrosis?

A
  • excessive connective tissue formation (cross linking)
  • stimulated by low-grade irritation (overuse/postural stress/ movement dysfunction)
    -involves a larger tissue than mere adhesions
    (ie restriction in abdomen can restrict shoulder flexion)
  • impedes structure and function of healing and neighboring tissue
  • progresses with time immobilized
  • fibrosis can spread to neighboring tissues
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15
Q

What is Stage I of connective tissue repair?
Time frame?
Events?
Relevance to STM?

A

Inflammation

0-48 hours +

Events:
homeostasis
inflammation
phagocytosis and leukocytosis

Relevance:
STM may disrupt homeostasis

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16
Q

What is Stage II of connective tissue repair?

A

Proliferation

2-4 days - 2 to 3 weeks.

Events:
Re-epithelialization
Granulatoin and vascularization
Collagen synthesis and fibroplasia
Contraction of the defect/wound

Relevance:
STM may disrupt contracture and stimulate increased collagen synthesis

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17
Q

What is Stage III of connective tissue repair?

A

Remodeling
3 weeks to 12 months

Events:
collagen lysis and synthesis
fiber reorientation
scar maturation continues >1 year

Relevance:
Tensile forces affect new fiber orientation
Adhesions inhibit fiber reorientation
Scar is weaker than skin

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18
Q

Effects of Immobilizatoin on connective tissue?

A
  • adhesions, fibrous infiltrate, and fibrous development
  • loss of ground substance
  • decrease mobility (longer immobilization, longer recovery time)
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19
Q

Effects of immobilization on muscle?

A
  • sarcomere loss (not likely to cause adaptive shortening)
  • fatty intrusion and fibrosis
  • cross bridge adhesion (more likely to be the cause)
  • affects neighbor muscles in parallel and series
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20
Q

Parasympathetic response to STM

A
  • reduce depression and anxiety
  • reduce related measures: BP, HR, RR, lactates, pain

Evidence:

  • decreased depression in 17 RTCs
  • RTC reflexology decreases anxiety in CA pts
  • RTC DECREASES SHORT TERM ANXIETY IN POST-OP PATIENTS
  • decreases anxiety, HR, cortisol in psych in-pts
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21
Q

What are the physiological effects of STM?

A

1) increase circulation, decrease edema & lymphedema
2) parasympathetic response, promote relaxation, decrease anxiety
3) analgesia, decrease pain and discomfort
4) metabolism
5) increase connective tissue mobility or length; prevent fibrosis
6) function

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22
Q

What’s a measurable outcome for increase circulation, decrease edema & lymphedema?

A

increased blood flow, skin temp, tcO2; decreased girth

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23
Q

What’s a measurable outcome for parasympathetic response, promote relaxation, decrease anxiety?

A

decreased HR, BP, RR, anxiety medication

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24
Q

What’s a measurable outcome for analgesia, decrease pain and discomfor?

A

VAS, pain scales, pressure tolerance, analgesic use

25
Q

What’s a measurable outcome for metabolism?

A

serum levels, cell counts, spO2

26
Q

What’s a measurable outcome for increase connective tissue mobility of length; prevent fibrosis?

A

increased ROM (joint, muscle, fascial mobility), other related functions

27
Q

What’s ameasurable outcome for function?

A

functional scales (ie oswestry, FIM, DASH)

28
Q

Evidence for Analgesic Outcomes

A

pain relief and/or increased function after massage vs placebo or control

  • LBP: decreased LBP after massage vs STM/posture/exercise/placebo and increased function after massage therapy/ STM/posture/exercise vs placebo
  • Neck pain: increased function and decreased pain at 4-10 weeks BUT NO CHANGE AT 6 MONTHS VS CONTROL
  • Cancer: decreased pain and anxiety IN SHORT TERM AFTER MASSAGE
29
Q

Evidence for Circulatory Effects

A

Normal response: reactive hyperemia (capillary dilation)

Increase blood flow vs skin temperature:

  • petrissage increases both (cohort)
  • petrissage increased temperature but not blood flow (cohort)
  • acupressure increases LE and trunk blood flow (case control)

Decrease Edema:

  • RETROGRADE MASSAGE and finger wrapping decrease volume
  • decreased post exercise swelling
  • decrease ankle and pain

May assist increase in lymph motility:
- only support is case study and opinion

30
Q

Evidence for Analgesic Effects

A

Proposed processes:

  • decreased edema thus pressure on nerve endings (cohort)
  • parasympathetic nervous system response (cohort)
  • substance P- a CNS neurotransmitter mediating pain (with shiatsu decreased pain and sub P in fibromyalgia)
  • Gate control (not really applicable n clinical setting)
  • pain and muscle spasm: the pain-spasm cycle
  • chemical mediators
31
Q

Biomechanical Effects

A

Endorphins (increase in pts with myalgia after CTM)

Serotonin and dopamine:

  • increase with decreased pain and depression in LBP pts
  • increases with decreased pain in breast CA pts

Cortisol associated with pain and anxiety:

  • no change in cortisol in CA
  • decreased cortisol in psych in-pts

*cognitive thought can affect cortisol levels

32
Q

Visceral Effects

A

May stimulate reflex peristalsis

Cupping (Chest PT) to increase lung secretion

Acupuncture meridians:
- acupuncture increased LE and trunk blood flow in PVD

Head Zones:

Reflexology (decrease pain and anxiety in CA pts)

33
Q

Immunologic & Metabolic Effects

A

lymphocyte protection and immune response :

  • decreased lymphocyte/helper T loss in HIV+ peds
  • increased lymphocyte/helper T in breast CA

Insulin:
- increased insulin/IGF and wt in preterm neonates

Creatine Kinase:
- decreases CK and post exercise soreness but NO INCREASE IN MUSCLE FUNCTION IN NORMALS

34
Q

Muscle and Connective Tissue Effects of Massage

A

Theories:
1) Thixotropy: fluid stiffness affects movmeent (like ketchup bottle)

2) Viscoelastic tissue elongation due to stretch:
- no effect on birth perineal trauma
* takes 30 minues to change length of connective tissue. we dont actually do that in the clinic.
3) Neuromuscular relaxation effect
- massage reduces EMG activity AFTER EXERCISE

4) increased fibroblast activity
5) surgical scar reduction?

35
Q

Gene Expression Effects

A

Altered expression of fibrin related gene immediately after massage

Altered expression of inflammation-related gene during recovery hours later
- may attenuate inflammatory process and speed healing (1RTC)

36
Q

Connective Tissue Effects of Myofascial Manipulation

A

Theories

Fibrous and cross bridge adhesion reduction

  • collagen reorientaton (skin thickness changes. decreased adipose)
  • bundle orientation (ligaments TFM)
  • MAY free neighbor muscles to function
37
Q

Muscle and Connective Tissue Effects of STM: outcomes and selected evidence

A

Increased ROM, joint motion; decreased stiffness:

  • increased ROM and function in knee OA
  • petrissage decreases stiffness in bikers
  • increases shoulder ROM and functon

Increase in strength:

  • increased grip in CTS
  • strength associated with pain
  • with friction, decreased fatigue effect on grip strength
38
Q

Adverse effects?

A
  • muscle soreness
  • goose bumps or clamminess (abnormal sympathetic nervous system response)
  • unexpected neurological signs (paraesthesia) ==> reposition and continue
  • speech or mental status changes
  • nausea and/or vomiting
  • significant or sudden vital signs changes
  • chest, abdominal, or other unexpected pain
39
Q

Sports Outcomes

A
  • for pitcher’s forearm neuropathy in return to sport

- PRE-SPRINT SPORTS MASSAGE HAD NO POSITIVE EFFECT

40
Q

PT Indications for STM

A
  • pain
  • edema
  • impaired ROM
  • impaired strength
  • postural malalignment
  • impaired movement/function
41
Q

Outcomes in Pediatrics

A
  • reduced pain and itching in pediatric burn patients

- higher mental development scores after massage in low birth weight neonates vs kangaroo carry

42
Q

Contraindications to STM: general principles

A
  • monitor patient’s respose
  • treatment area: general vs regional
  • technique: deep/vigorous vs superficial/gentle
  • endangerment sites: ie Anterior neck, femoral triangle
  • MUST TAKE VITALS AT EVAL
43
Q

Types of Contraindications

A
  • Acute Inflammation
  • Areas of Lost integrity
  • communicating pathologies
  • cardiac/circulatory disorders
  • clotting disorders and anticoagulants
  • area of altered sensation
  • impaired cognition/communication
44
Q

Area; depth/technique limited by:

inflamation

A

regional; all

45
Q

Area; depth/technique limited by:

areas of lost integrity

A

regional; deep and or superficial

46
Q

Area; depth/technique limited by:

communicating pathologies

A

general or regional; all

47
Q

Area; depth/technique limited by:

cardiac/circulatory disorders

A

regional; deep

48
Q

Area; depth/technique limited by:

area of altered sensation

A

regional; deep

49
Q

Area; depth/technique limited by:

impaired cognition/ communication

A

general or regional; all

50
Q

What technique to palpate following layers?

1) superficial: epithelium & subcutaneous tissue
2) middle: subcutaneous tissue extensibility
3) deep: muscle, tendon, deep fascia

A

1) light touch, temperature, shear
2) skin rolling, superficial mobility
3) compression, muscle play

51
Q

Traditional Massage

A
  • static contact (possibly away from area of pain)
  • to prepare patient
  • Effleurage
  • stroking
  • Petrissage
  • kneading and compression
  • Precussion
  • Vibration
52
Q

Direction of Strokes

A
  • direction of force optimized by body mechanics
  • generally in line with forearm
  • generally comes with weight shift
  • parallel to muscle fibers (stroking, stripping) to lengthen
  • perpendicular to muscle (strumming, bending) to break up adhesions
  • circular
  • distal to proximal. massage begins at proximal segment to assure venous flow.
  • retrograde massage for edema reduction
53
Q

Sequence of Strokes

A
  • relaxing to start
  • superficial to deep
  • proximal segement before distal segments
  • how to end depends on whats next in plan of care.
54
Q

Pressure and Depth Varies

A
  • palpated tissue
  • body surfaces
  • tissue type and person
  • direction: proximal deep, distal light
  • vary during massage: (start superficial > progressively deeper> end superficial)
  • vary with stroke: effleurage, petrissage, friction
  • moderate pressure essential for SNS effects
55
Q

Duration

A

Local:

  • impairment-outcome based:
  • soft tissue release: 5-90seconds
  • edema reduction: 5-30 minutes
  • transverse friction massage 60-90sec total

General:
- 30-45 minutes or more

56
Q

Effleurage

A
  • slow stroking
  • performed with: molded hands, finger/thumbs, knuckles, forearm, first webspace (2 hand, shingle, tree branches)
  • purpose and expected outcomes?
57
Q

Stroke Rate and Speed

A
  • Vary with purpose:
  • fast to invigorate (pre-sport)
  • slow to relax or assess soft tissue
  • Vary with stroke:
  • effleurage 15/min
  • petrissage 30-90/min
  • friction 90-150/min
  • Vary with direction
  • slow for initial proximal stroke
  • faster distal return
  • Rhythmic to relax and communicate
58
Q

Petrissage

A

(for edema reduction and muscle relaxation, increase circulation, decrease pain, decrease swelling)

  • kneading, wringing, and rolling
  • performed with: 2 hand, 1 hand, web spaces, pinch grasp, thumb (direct compression, 1-hand extremity kneading, J strokes)

STM (2 decks)

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