STI 2 Unit 1: Historical Basis and Theories

Question 1

What is Soft Tissue Manipulation?

Answer 1

The forceful passive movement of the musculofascial elements through its restrictive direction(s) beginning with its most superficial layers and progressing into depth while taking into account its relationship to the joints concerned.

Question 2

What are the different Classifications of Soft Tissue Techniques?

Answer 2

• Autonomic (AKA Reflexive)
• Mechanical
• Movement

Question 3

Classifications of Soft Tissue Techniques

What is the Autonomic (AKA Reflexive) technique?

Answer 3

Those that are intended to have an effect through our superficial pressure or touch that we can stimulate the ANS via the sensory receptors of the skin and the superficial fascia

• Those effects can be seen in the area that we’re working on, as well as even in corresponding dermatologic zones

Question 4

With what patients will we use the Autonomic (AKA Reflexive) Technique?

Answer 4

This is often a good stepping stone to your more aggressive mechanical techniques

• We’ll often use them in our Acute patients and Subacute patients
• They can be great for introductory techniques for the beginning or even at the end of a treatment after you’ve done something that is painful or the patient was unconfortable

Question 5

What are some effects of Autonomic (AKA Reflexive) Technique?

Answer 5

Reduced muscle guarding, reduced tone, reduced pain, general sense of comfort and confidence in the therapist

Question 6

What are 2 different types of Autonomic Approaches?

Answer 6

• Connective Tissue Massage
• Hoffa Massage

Question 7

Classifications of Soft Tissue Techniques

What is the Mechanical technique?

Answer 7

Those that are intended to make direct change to the myofascia through a direct application of force.

• These techniques seek more mechanical or histological changes to the myofascial structures
• We’re either applying a force over a sustained period of time with the intent to make change or applying a direct force that is intended to take us past an area of restriction so that the tissue will then move better due to mechanical changes to the tissue

Question 8

Classifications of Soft Tissue Techniques

What is the Movement technique?

Answer 8

Those that are intended to change abnormal movement patterns to help the patient establish more optimal ones

• So these are techniques that often involve some form of movement re-education. This could involve tactile or verbal cues combined with other techniques

Question 9

Classifications of Soft Tissue Techniques

What is the Neuromotor Approach?

Answer 9

This is an approach advocated by ASTYM (Augmented Soft Tissue Manipulation)

• Its purpose is to stimulate tissue healing by instigating an inflammatory response through a gentle force applied through specifically designed instruments

Question 10

Neuromuscular Approach

What is Augmented Soft Tissue Manipulation (ASTYM)?

Answer 10

• A form of soft tissue manipulation used for the purpose of stimulating fibroblastic proliferation to promote healing. This is done by using specifically designed tools to “catch” and potentially break fibrotic adhesions in order to trigger an inflammatory response.
• The inflammatory response may stimulate tissue healing and debridement. Following each treatment session, patients are encouraged to maintain an active lifestyle as well as perform stretches/exercise in order to maintain controlled stresses through the healing tissues.
• The approach is considered a neuromotor approach and is used to treat a number of conditions.

Question 11

What is the correct sequence of Soft Tissue Treatment?

Answer 11

• Soft Tissue manipulation to resore tissue mobility
• Joint mobilization after soft tissue has been normalized
• Joint and soft tissue elongation
• Neuromuscular re-education to correct eberrant motion
• Postural instruction to remove levers and stresses

Question 12

Autonomic Approach

What are 3 important effects that Elizabeth Dicke (the developer) outlined for Connective Tissue Massage?

Answer 12

• Can be used to directly affect local, altered connective tissue
• Can be used to improve circulatory impairments in local tissue
• Can use specific neural pathways of the CNS to release nerve impulses to affected tissues or organs

Question 13

Autonomic Approach

Elizabeth Dicke (developer of connective tissue massage) coined the phrase “cutivisceral reflex”, what does this mean?

Answer 13

Specific organs and superficial tissues shared a common segmental innervation, of which, the highly innervated and vascularized skin is a key tactile stimulus receptor

Question 14

Autonomic Approach

What is Hoffa Massage?

Answer 14

The better known autonomic approach that is often taught, Effleurage, Petrissage, Tapotement, and Vibration

• These techniques are intended to be gentle and “light-handed”, causing as little discomfort as possible and never treating more than 15 min for the entire body for the purpose of relaxation

Question 15

Autonomic Approach

What is the importance of preparing the superficial tissues when massaging?

Answer 15

Clinicians often push right through them to get to the muscle belly, not realizing this can cause microtrauma to the fascia, pain for the patient or be the very cause of the patient’s pain

• Just a few minutes of applied effleurage may make the difference between a painful or painless treatment, provide better results and require less effort from the therapist to progress deeper

Question 16

Mechanical Approach

What is the Primary Effect of the Cross Friction Technique?

Answer 16

Primary effect on nonvascular tissues like tendons, ligaments , muscles and musculotendinous structures

Question 17

Mechanical Approach

What most likely happens with Cross Friction massage?

Answer 17

We’re triggering the inflammatory process by applying this controlled stress and even slightly damaging the tissues

Question 18

Mechanical Approach

What is the Goal with Cross Friction?

Answer 18

To stimulate the body’s natural process of healing, which would include phagocytosis or the removal of waste products, stimulating the production or stimulating the activity of fibroblasts (which are cells that lay down collagen and lay down new connective tissue).
- With this we want to create an optimal environment for healing if we compliment our cross friction with other activities that should help with optimal alignment of those collagen fibers as they lay down (that may include stretching, ecc. exercise, PROM; this depends on the injury and tolerance of the person)

Question 19

Mechanical Approach

What is Rolfing?

Answer 19

Realignment of body posture through systemic, aggressive soft tissue work

• The goal of such treatments is to help the body become more efficient in posture, balancing itself against the force of gravity.

Question 20

Mechanical Approach

With Rolfing, what does the term “Fascial Sweater” mean?

Answer 20

This is a concept showing that a fascial restriction in one area will strain areas away from the restriction and cause abnormal movement patterns

Fig. 2.2 (page 23)

Question 21

Mechanical Approach

With the Rolfing Technique, how is treatment delivered?

Answer 21

Treatment is delivered in 10 standardized, 1-hour sessions with the potential of a “post-ten”, a system of advance Rolfing. Post-table work is often followed up with a movement approach

Question 22

Mechanical Approach

What is Trager?

Answer 22

The use of oscillations to free up inert tissues and inhibit contractile tissues

• These movements are gentle and very passive. Often using traction, rotation, active movements and oscillations
• The purpose of this techniques is to provide increased mobility to tissue and give movement sense of effortlessness. Such techniques are usually applied in supine

A second aspect of his treatment not covered in MF1 but that should be mentioned, is Mentastics. During Mentastics, instruction is provided in active movements for the purpose of neuromuscular re-education and coordination. Once learned Mentastics should be used in daily life for to maintain freer movement, flexibility, tension relief and maintain more normal movement patterns

Question 23

Mechanical Approach

What are is Neural Tension?

Answer 23

MF technique for treatment of peripheral nerve entrapment neuropathies

Question 24

Mechanical Approach

What is Myofascial Release?

Answer 24

A technique to release adhesions between layers of fascia to help those layers move independently

• The technique itself uses gentle, sustained stretching applied to fascia with the intention of releasing adhesions that may have formed due to trauma or postural mal-alignment. This not only may lead to improved motion but improved circulation, nerve conduction and a better sense of well being

Question 25

# Mechanical Approach What are the 2 different Myofascial Techniques?

Answer 25

- Direct - Indirect

Question 26

# Mechanical Approach What is Direct Myofacial Release?

Answer 26

These improve mobility of soft tissue with an application of slow, controlled, mechanical stress that supply directly into a restriction - Can be done passive or active

Question 27

# Mechanical Approach What is Indirect Myofacial Release?

Answer 27

These require less force and a longer duration hold. It is very gentle - Better for patients that are tender or guarded or those patients that arent responding to the direct techniques

Question 28

What are different types of Movement-Based Techiniques?

Answer 28

**PNF** - Diagonal patterns **Aston Patterning** - Emphasis on "soft hands" - Body position is important for both patient and provider **Feldenkrais** - Movement approach, aimed at correcting inefficient movement patterns believed to be contributing to secondary dysfunction - Motor learning approach -"Awareness through movement": pt. receive verbal commands designed to weaken old movement patterns to establish new ones. -"Functional integration" **Alexander** - Developed in order to help difficulty with voice projection - Ideas on efficiency on posture "3 Stages of conscious learning" -Habit awareness -Habit inhibition -Habit conscious control

Question 29

What do Movement-Based Techniqes focus on?

Answer 29

They are focusing on minimizing abnormal movement patterns or eliminating abnormal movement patterns to help the patient create more optimal, efficient patterns of movement