Soft Tissue Mob Techniques

Question 1

Transverse Friction (TF) Massage/Cross friction technique

Answer 1

• begin with light pressure
• use thumb or reinforced finger
• move skin over sit of lesion back and forth in direction perpendicular to normal orientation of fibers
• ensure patient’s skin moves with the clinician’s fingers to prevent blistering

Question 2

TF Massage:

Pressure, Speed, Duration, and Discontinue

Answer 2

• pressure: pt tolerance
• speed: 2-3 cycles per second in a rhythmical manner
• duration: 5-10 minutes
• discontinue: once healed or if no improvement after 3 sessions

Question 3

Proposed effects of TF massage: Traumatic hyperemia:

Answer 3

• increases flow of blood and lymph which in turn removes the chemical irritant by products of inflammation
• increased BF reduces venous congestion thus decreasing edema and pressure on pain sensitive structures

Question 4

Pain relief from TF massage:

Answer 4

• stimulates type 1 and type 2 mechanoreceptors, producing presynaptic anesthesia
• Gate control theory

Question 5

Caution of TF massage

Answer 5

patient may feel an exacerbation of symptoms following first 2-3 sessions

Question 6

How does TF massage assist with collagen?

Answer 6

it assists with orientation of the collage fibers

Question 7

Indications for TF massage

Answer 7

acute, subacute, or chronic ligament, tendon, or muscle injuries

Question 8

Contraindications for TF massage

Answer 8

hematomas, open skin, frail skin

Question 9

TF massage minimally supported for _______ for tendinitis, but lack of support more due to low quality of evidence and lack of RCTs

Answer 9

pain relief

-conclusions are limited by the small sample size of the includes RCTs

Question 10

Scar massage technique

Answer 10

similar technique to TF massage except not as much pressure

Question 11

Purpose of Scar massage:

Answer 11

to stimulate collagen to law down scar tissue appropriately, maintain scar mobility, and desensitize scars as needed

Question 12

Caution of scar massages

Answer 12

ensure incision is clean, dry, intact prior to performing

Question 13

_______ provides strength to the fascia, _____ gives it its elastic properties, and the ability to absorb compressive forces of movement

Answer 13

Collagen

elastin

Question 14

Three types of fascia:

Answer 14

superficial
deep
visceral

Question 15

superficial fascia

Answer 15

lying directly below the dermis

Question 16

deep fascia

Answer 16

surrounding and infusing with muscle, bone, nerve, blood vessels, and organs to the cellular level

Question 17

visceral fascia

Answer 17

deepest layer comprising the dura of the craniosacral system, which encases the CNS

Question 18

Myofascial release is based on the principle that..

Answer 18

trauma or structural abnormalities creates inappropriate fascial strain, because of an inability of the deep fascia to absorb or distribute forces

Question 19

Strains to deep fascia results in _________ of the fascia; these fascial restrictions eventually lead to ________ impairments

Answer 19

slow tightening

postural

Question 20

Myofascial release purpose

Answer 20

apply gentle sustained pressure to deep fascia to release restrictions and restore normal pain-free function

Question 21

Myofascial release after care:

Answer 21

patient may experience muscle soreness initially after treatment

Question 22

What are the Myofascial release strokes?

Answer 22

• J stroke
• Vertical stroke
• Transverse stroke
• Cross-hands technique

Question 23

Ischemic compression technique pressure and duration

Answer 23

• pressure: applied to center of trigger point

- duration: 10-60 seconds

Question 24

If patient reports lessening of local and referred pain, clinical can repeat treatment, if pain does not change may need to..

Answer 24

adjust pressure or switch technique

Question 25

Theory behind ischemic compression

Answer 25

sustained pressure deprives trigger point of oxygen; temporary blockage of circulation--> reactive hyperemia that in turn reduces overall energy crisis and breaks pain cycle

Question 26

Soft tissue mobilization (STM) definition:

Answer 26

systematic, therapeutic, and functional stroking and kneading of the body

Question 27

Studies show deep massage/STM increases __________ and skin __________ of the massaged area via vasodilation

Answer 27

circulation | temperature

Question 28

Type of STM:

Answer 28

- effleurage - petrissage - strumming

Question 29

Effleurage "general massage"

Answer 29

- superficial - used in initial assessment of superficial tissues - gentle stroking applied to muscle - possible mechanism in assisting venous and lymphatic drainage and reducing tension - limited evidence

Question 30

Effleurage technique

Answer 30

- strokes distal to proximal along the line of the body part being massage - employ whole body movement and firm contact

Question 31

Ischemic compression pressure: Ask pt how it feels halfway through: - getting better --> - getting worse --> - same -->

Answer 31

- getting better --> maintain or increase pressure - getting worse --> let off a bit - same --> maintain

Question 32

Petrissage

Answer 32

- assist venous and lymphatic return - assist fluid interchange - increase mobility of underlying tissue

Question 33

Petrissage techniques

Answer 33

- kneading - pulling/lifting - wringing - rolling

Question 34

Petrissage--Kneading technique

Answer 34

compressed against underlying structures - press down with palm of hand and do little circles - upstroke --> pressure - downstroke--> let off

Question 35

Petrissage-- Pulling/Lifting

Answer 35

compressed then lifted and squeezed

Question 36

Petrissage-- Wringing

Answer 36

tissues are lifted and squeezed with alternative hand pressure

Question 37

Petrissage-- Rolling

Answer 37

tissues are listed and rolled between fingers and thumbs (skin or muscle)

Question 38

Strumming

Answer 38

using fingers- perpendicular to fibers, back and forth with maintained pressure

Question 39

Retrograde massage

Answer 39

- used to reduce edema - with sustained pressure go distally to proximally - intention is to push the fluid back towards the lymphatic system and assist with edema control

Question 40

3 techniques of functional massage

Answer 40

- soft tissue without motion - soft tissue with passive pumping - soft tissue with active pumping

Question 41

Soft tissue without motion

Answer 41

- Hands stay in contact with skin while hands and skin move together over muscle - Direction of force parallel to muscle fibers and total stroke time is 5-7 seconds

Question 42

Soft tissue with passive pumping

Answer 42

- Place muscle in shortened position and with one hand place tension on muscle parallel to muscle fibers - Other hand passively lengthens muscle and simultaneously gradually releases pressure from hand in contact with muscle

Question 43

Soft tissue with active pumping

Answer 43

- Place muscle in lengthened position and with one hand place tension on muscle fibers perpendicular to muscle fibers - Other hand guides limb as patient actively shortens muscle, as muscle shortens gradually release pressure from hand in contact with muscle

Question 44

What should you do when doing any STM?

Answer 44

- drape patient - use lotion - pin fascia/skin in opposite direction - appropriate, graded level of intensity and depth - communicate with patient - elicit feedback from the patient often

Question 45

Special Precautions for Vulnerable Patient

Answer 45

- Patients may have difficulty understanding soft tissue mobilization intention and what entails - Suffered previous trauma related to touch - BE SENSITIVE to non-verbal communication and response