ST, MRF, INR Lecture and LAB

Question 1

Difference between soft tissue and fascia?

Answer 1

Soft tissue has tendons, ligaments, aponeuroses included

Question 2

Components of Fascia?

Answer 2

Fascia
Muscles
Organs
Nerves
Vasculature
Lymphatic vessels

Question 3

What is soft tissue?

Answer 3

Everything not hardened by ossification

Question 4

Is soft tissue technique direct or indirect?

Answer 4

Direct

Question 5

What are the 3 soft tissue techniques?

Answer 5

Lateral (perpendicular) , linear(parallel), and inhibitory

Question 6

AP Still used which technique a ton?

Answer 6

Deep inhibitory

Question 7

MOA of soft tissue?

Answer 7

Relaxes hypertonic muscles and reduces spasm by decreasing alpha motor neuron activity
Stretches and increases the elasticity of shortened fascial structures
Improves local tissue nutrition, oxygenation, and removal of metabolic wastes

Question 8

Soft tissue Indications?

Answer 8

Hypertonic muscles
Excessive tension in fascial structures
Abnormal somato-somatic or somato-visceral reflexes

Question 9

Soft tissue safety reactions?

Answer 9

Ecchymosis (bruising)
Acute muscle spasm
Post-procedure muscle soreness

Question 10

Soft tissue absolute contraindications?

Answer 10

Lack of consent
Skin or soft tissue is not intact (traumatized, friable [easily torn])
Absence of somatic dysfunction

Question 11

Soft Tissue: ContraindicationsRelative

Answer 11

Skin
   Contagious skin diseases
   Acute burns
   Painful rashes
   Abscess or cellulitis
   Skin cancers
Fascia
   Acute fasciitis
   Acute fascial tears
Muscle
    Acute muscular strains
   Myositis
   Muscle neoplasms
Ligament
   Acute ligamentous strain
   Acute ligamentous inflammatory disorders

Question 12

Soft tissue linear technique description

Answer 12

Traction/Stretching
Origin and insertion of the myofascial structures being treated are longitudinally separated
1-2 seconds stretching, 1-2 seconds rest
Physician hands should not slide over skin or create friction.
After response is evaluated, force and amplitude may be increased.

Question 13

Soft tissue lateral technique description

Answer 13

Kneading
Rhythmic, lateral stretching of the myofascial structure
Origin and insertion are held stationary, the central portion is stretched like a bowstring
1-2 seconds stretching, 1-2 seconds rest
Physician hands should not slide over skin or create friction.
After response is evaluated, force and amplitude may be increased.

Question 14

Soft tissue inhibition technique description

Answer 14

Sustained deep pressure over a hypertonic myofascial structure

Question 15

Is MFR direct or indirect?

Answer 15

Either one

Question 16

MFR proposed MOA?

Answer 16

Interacts with the fascia and the tissues it

surrounds to improve homeostasis and innate healing

Question 17

MFR indications

Answer 17

Normalizing motion
Relieving edema
Reestablishing symmetry
Relieving pain
Aiding circulatory and lymphatic function
Normalizing neuroreflexive activity
Supporting visceral function
Restoring bioenergetic balance
Supporting homeostatic function

Question 18

MFR Absolute Contraindications

Answer 18

Lack of consent

Absence of somatic dysfunction

Question 19

MFR: Relative Contraindications

Answer 19

Extreme caution should be exercised in patients with:Fractures
Open wounds
Soft tissue or bony infections
Abscesses
Deep venous thrombosis (threat of embolism)
Anticoagulation
Disseminated or focal neoplasm
Recent postoperative conditions over the site of proposed treatment (wound dehiscence)
Aortic aneurysm

Question 20

MFR compications?

Answer 20

Patients commonly experience post treatment soreness similar to post-exercise soreness, especially in the first 1-2 treatments
Those with autoimmune, inflammatory, and rheumatologic disorders may experience flare-ups in association with MFR treatment

Question 21

MFR extension direction?

Answer 21

Hands moved inferiorly

Question 22

MFR flexion direction?

Answer 22

Hands moved superiorly

Question 23

MFR right rotation direction?

Answer 23

Hands moved to the left

Question 24

MFR left rotation direction?

Answer 24

Hands moved to the right

Question 25

MFR Sidebending right direction?

Answer 25

Right hand inferior, left superior

Question 26

MFR Sidebending left direction?

Answer 26

Left hand inferior, right superior

Question 27

MFR technique description?

Answer 27

Engage tissues by adding light compression Continue to hold tissue until relaxation or creep of underlying tissues is sensed. Consider using a release enhancing mechanism, such as breathing

Question 28

What is INR

Answer 28

Integrated neuromuscular release. Use movement of the limbs to help move the fascia.

Question 29

What is INR done in tandom with?

Answer 29

MFR, typically with a direct.

Question 30

ST Thoracic prone pressure

Answer 30

``` Place thenar and hypothenar eminence on paravertebral muscles opposite the side you are standing Keeping your elbows straight and using own body weight, engage soft tissues with a ventral force and move out laterally creating a perpendicular stretch ```

Question 31

ST Thoracic: Prone Pressure with Counterpressure

Answer 31

``` Place thenar eminence and thumb of caudal 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 ```

Question 32

ST Thoracic: Subscapular Stretch

Answer 32

``` Take patient’s arm, on the side being treated, and place it behind the back • Place fingers around medial border of scapula • Engage the tissue ventrally then give gentle and upward traction, pulling scapula away from rib cage, on for 1 2 seconds, off for 1 2 seconds until muscle relaxation is perceived ```

Question 33

ST Upper Thoracic with Shoulder | Block, Lateral Recumbent

Answer 33

``` Standing at side of table facing patient • Inferior hand passes under patient’s arm and contacts paravertebral muscles • Superior 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 stretch for 1 2 seconds, off 1 2 seconds, repeat until relaxation perceived ```

Question 34

ST Lower Thoracic Under the | Shoulder, Lateral Recumbent ST

Answer 34

F orearms contacting the axilla and iliac crest, fingers contact medial aspect of the erector spinae • Elbows spread apart, elongating distance between the shoulder and the hip; • Traction the paraspinal muscles laterally. • Lean back to provide lateral force, on for 1 2 seconds, off for 1 2 seconds until muscle relaxation is perceived

Question 35

ST Paraspinal Inhibitory Technique

Answer 35

``` Place finger pads over the paraspinal tissues. • Apply gentle, firm pressure to engage the tissues. • Continue pressure until release occurs. ```

Question 36

Lumbar: Prone Pressure

Answer 36

``` 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 own body weight, engage soft tissues with a ventral force and move out laterally creating a perpendicular stretch for 1 2 seconds, off for 1 2 seconds until tissue relaxation is perceived. ```

Question 37

Lumbar: Prone Pressure with | Counterleverage

Answer 37

``` Using inferior hand, grasp ASIS on other side of patient • Place thenar & hypothenar eminence of superior hand on the paraspinal muscles • Pull posteriorly on the ASIS and apply anterolateral pressure on lumbar paraspinal muscles in a repetitive rhythmic fashion holding the stretch for 1 2 seconds, then off for 1 2 seconds, repeating until muscle relaxation is perceived ```

Question 38

Lumbar: Paraspinal Perpendicular Stretch, Lateral Recumbent

Answer 38

``` At side of table facing patient Reach over patient’s back and place finger pads on the paravertebral muscles • Engage tissues with a ventral force and move out laterally to create a perpendicular stretch for 1 2 seconds, off for 1 2 seconds until muscle relaxation is perceived. ```

Question 39

C Spine: Bilateral Forearm Fulcrum Forward Bending

Answer 39

``` Arms are crossed under patient’s head and hands placed palm down on patient’s shoulders • Repetitively flex patient neck, giving a longitudinal stretch of the paravertebral muscles 1 2 seconds on, 1 2 seconds off ```

Question 40

C Spine: Cradling with Traction, Supine

Answer 40

``` Fingers placed under patient’s neck bilaterally on paraspinal muscles, just lateral to the spinous process • Engage soft tissue with anterior and lateral force • Longitudinal traction exerted by moving cephalad along the soft tissues, not sliding on skin, holding for 1 2 seconds, off for 1 2 seconds, repeating until muscle relaxation is perceived. ```

Question 41

Head & C Spine: Suboccipital Release

Answer 41

``` Finger pads are placed in the suboccipital region • Apply anterosuperior pressure – Kneading : pressure may be slowly and rhythmically applied until tissue texture changes occur. – Inhibition: Apply a constant inhibitory pressure until tissue texture changes occur. ```

Question 42

Prone Lumbosacral MFR/INR

Answer 42

Physician place one hand with pinky just superior to the LS junction, thenar & hypothenar eminence lateral to one of the SI joints and the contralateral finger pads on the lateral aspect of the other SI joint Activating forces: • MFR: Inherent and respiratory • INR: REMs leg flex/extend, IR/ER

Question 43

Scapulothoracic | SD MFR

Answer 43

``` 1. Pt: lateral recumbent, involved shoulder up. 2. Physician: faces the patient’s front contacting the scapula posteriorly with both hands (superior hand stabilizes anterior and posterior aspect of scapula). 3. Assess the ease and restrictions of the 6 scapular motions. Flexion/Extension Abduction/Adduction Protraction/retraction 4. Apply direct or indirect myofascial release technique ```

Question 44

Cervical MFR/INR

Answer 44

``` Setup: pt. supine; cup the region of greatest TART with finger pads (no pressure with thumbs) • Gently add traction to engage the hypertonic tissues • Assess flexion/extension, rotation, & sidebending. Activating forces: • MFR: Inherent and respiratory • INR: REMs eye, tongue & UE movement ```