Soft Tissue & Myofascial Release Lab

Question 1

Treatment of soft tissue

Answer 1

o Engage the tight soft tissue elements/barriers
o Apply treatment technique
o Wait for tissue to release (wait for tissue creep) then reengage barrier
o After treatment, reassess

Question 2

Thoracic: Lower Thoracic Under
the Shoulder, Lateral
Recumbent

Answer 2

Patient: Lateral recumbent with side to be treated up

• Physician: Standing at side of table facing patient
• Finger pads placed on paravertebral muscles, lateral to the spinous processes
• Engage muscle with ventral force and move out laterally to give perpendicular stretch

Question 3

Hip Myofascial Release

Answer 3

-Patient: Supine
-Physician: Stand on same side of hip being treated
-Flex hip and knee to 90°, with caudad hand contacting the ankle and cephalad hand monitoring the knee
-Test IR/ER to determine direction of laxity and restriction
-Indirect Tx: Move hip into position of laxity (ease), apply
compression or traction along femur, follow tissue release
-Direct Tx: Move hip into restriction and apply gentle
force until tissue release is completed

Question 4

C-spine: Cradling with

Traction, Supine

Answer 4

-Fingers placed under patient’s neck bilaterally on
paraspinal muscles, just lateral to the spinous process
-Engage soft tissue with ventral and lateral force
-Apply a cephalad force to induce longitudinal traction
-Repeat above steps by repositioning hands to contact
different levels of the cervical spine

Question 5

Thoracic: Subscapular Stretch

Answer 5

-Patient: Prone
-Physician: Standing at side to be treated
-Take patient’s arm, on the side being treated, and place it
behind their back
-Place fingers around medial border of scapula
-Engage the tissue upward and laterally, pulling scapula
away from rib cage

Question 6

Thoracic: Prone Pressure

Answer 6

Patient: Prone
-Physician: Standing at side of table opposite the side to be
treated
-Place thenar and hypothenar eminence on paravertebral
muscles opposite the side you are standing
-Place other hand on top of hand contacting the muscles
-Keeping your elbows straight and using your own body
weight, engage soft tissues with a ventral force and move
out laterally to induce a perpendicular stretch
-Repeat by repositioning hands on different levels of the
thoracic spine

Question 7

C-spine: Contralateral Traction,

Supine

Answer 7

-Physician: At side of table opposite side being treated
-Caudad hand reaches across and contacts paravertebral
muscles on side opposite of where you are standing (make sure to be lateral to spinous processes, not on them)
-Cephalad hand rests on patient’s forehead to stabilize head
-Engage tissue with ventral force and continue to apply
traction moving ventrally and slightly laterally creating a
perpendicular stretch

Question 8

C-spine: Suboccipital Release

Answer 8

-Finger pads placed in suboccipital region (find occipital
ridge and move inferiorly until fingers fall into suboccipital
region)
-Apply upward pressure into tissues and hold

Question 9

Superior Popliteal

Space/Hamstring Myofascial Release

Answer 9

-Patient: Supine
-Physician: Stand on same side of leg being treated
-Bend knee to 90° with foot flat on table, opposite leg
straight
-Use finger pads on either side of the superior aspect of the popliteal space and introduce spreading force to load the fascia, test in multiple planes- IR/ER, Clockwise/Counterclockwise, Superior inferior
-Engage barriers stacking either direct or indirect until
tissue release occurs

Question 10

For most cervical procedures what are the positions of the patient and physician?

Answer 10

-Patient: supine position for all cervical treatments
-Physician: At head of table (except on contralateral
traction treatment)

Question 11

Thoracic: Upper Thoracic with
Shoulder Block,
Lateral Recumbent

Answer 11

Patient: Lateral recumbent with side to be treated up
-Physician: Standing at side of table facing patient
-Caudad hand passes under patient’s arm and contacts
paravertebral muscles
-Cephalad hand contacts anterior portion of shoulder to give counterforce. Drape patient’s arm over your arm.
-With both hands, engage soft tissues ventrally and move
out laterally to create a perpendicular stretch

Question 12

Cervical traction

Answer 12

• One hand cradles occiput (bottom of the back of the head)
• Other hand grasps gently below chin
• Exert cephalad traction with both hands. Keep head neutral or slightly flexed. Avoid extension (lean back and slightly pull with both hands)

Question 13

C-spine: Forward Bending
(Bilateral Fulcrum),
Supine

Answer 13

-Arms are crossed under patient’s head and hands placed
palm down on patient’s shoulders
-Flex patient’s neck to induce a longitudinal stretch of the
paravertebral muscles
-A rhythmical pattern or a constant force is applied until
tissue is softer and lengthened.

Question 14

Perpendicular Traction

Answer 14

force directed away from the longitudinal axis

Question 15

C-spine: Forward Bending
(Unilateral Fulcrum),
Supine

Answer 15

-Use one hand to flex patient’s neck in order to slide the
other arm under patient’s head with hand palm down on
opposite shoulder
-Keeping the neck in flexion, rotate the patient’s head
toward and away from the elbow of the arm that is under the patient’s head to assess for the direction of tension.
-Rotate the patient’s head toward the direction of tension. A rhythmical pattern to the technique or a constant force is
applied until tissue is softer and lengthened.
-Repeat on opposite side of cervical spinal tissue

Question 16

Treating myofascial release

Answer 16

o Engage the tight myofascial elements/barriers
o Apply treatment technique
o Wait for tissue to release/creep then reengage barrier
o Repeat previous step and continue to reengage barrier until no more tissue release/creep occurs
o After treatment, reassess for improvement of tissue compliance and quality

Question 17

Lumbar: Paraspinal

Perpendicular Stretch

Answer 17

-Patient: Lateral recumbent position with side to be treated
up
-Physician: At side of table facing patient
-Reach over patient’s back and place finger pads on the
paravertebral muscles
-Engage tissues with a ventral and lateral force to create a
perpendicular stretch
Modification: This stretch can also be performed by bracing the ASIS with the caudad hand and inducing a ventral stretch with the cephalad hand

Question 18

Parallel Traction

Answer 18

force directed parallel to muscle and fascial components, causing overall increase in length of the structure

Question 19

Thoracic: Prone Pressure with

Counterpressure

Answer 19

Patient: Prone
-Physician: Side of the table
-Place thumb and thenar eminence of caudad hand over the thoracic paravertebral muscles opposite the side you are standing
-Place hypothenar eminence of cephalad hand on
paravertebral muscles on the same side you are standing
-Engage tissues with a ventral force and then move the
hands in the direction in which the fingers are pointing,
creating a longitudinal stretch

Question 20

Lumbar: Prone Pressure

Answer 20

-Patient: Prone
-Physician: Standing at side of the table opposite the side
being treated
-Place thenar and hypothenar eminence of one hand on
patient’s lumbar paravertebral muscle on side opposite you
-Place other hand’s thenar eminence over the other hand
-Keep elbows straight and exert a gentle ventral and lateral force using your body weight to induce a perpendicular stretch
-Repeat the above steps along the lumbar spine

Question 21

Lumbar: Prone Pressure with

Counterleverage

Answer 21

Patient: Prone
-Physician: Stand at side of table opposite the side being
treated
-Thenar eminence of cephalad hand contacts paravertebral muscles on the side opposite you
- Caudad hand gently grasps patient’s ASIS on the side
opposite of you. Gently lift it towards the ceiling in order to
create the counterleverage
-Cephalad hand will engage tissues ventrally and move out laterally creating a perpendicular stretch
-Repeat by repositioning caudad hand along the
paravertebral lumbar musculature