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Questions and Answers

What are the three main components of connective tissue?

  • Blood vessels, nerves, and lymph nodes
  • Cells, fibers, and extracellular matrix (ECM) (correct)
  • Skin, muscle, and fascia
  • Bones, joints, and muscles

    • What is the primary function of elastin in connective tissue?

  • Maintains lubrication between collagen fibers
  • Provides an elastic quality that allows the tissue to stretch to its limit (correct)
  • Acts as a mechanical barrier to foreign matter
  • Provides tensile strength and structural integrity

    • What are the two main types of fascia?

    Superficial fascia and deep fascia.

    Deep fascia is also known as investing fascia.

    <p>True</p> Signup and view all the answers

    Which of the following statements is TRUE about healthy fascia?

    <p>It moves freely with other body tissues, allowing muscles to shorten and lengthen.</p> Signup and view all the answers

    What is the primary cause of fascial restrictions?

    <p>Damage to the fascia.</p> Signup and view all the answers

    Which of the following is NOT a common cause of fascial restriction?

    <p>Regular exercise</p> Signup and view all the answers

    Which of the following is NOT a common consequence of fascial restrictions?

    <p>Increased muscle strength</p> Signup and view all the answers

    Myofascial release (MFR) is a type of specialized physical and manual therapy that focuses on diagnosing and treating myofascial tension and restrictions.

    <p>True</p> Signup and view all the answers

    Which of the following is NOT a benefit of MFR?

    <p>Increase fiber affinity</p> Signup and view all the answers

    What is the Arndt-Schultz law?

    <p>Stimuli can either excite or inhibit physiological activity, depending on their strength.</p> Signup and view all the answers

    What is the difference between a trigger point and a muscle spasm?

    <p>A trigger point is contraction of a small area within a muscle, while a muscle spasm is a sudden, hard contraction of the ENTIRE muscle.</p> Signup and view all the answers

    Which of the following is a common sign or symptom of a myofascial trigger point?

    <p>Referred pain</p> Signup and view all the answers

    Satellite trigger points are primary trigger points.

    <p>False</p> Signup and view all the answers

    What are the two main types of trigger points?

    <p>Active trigger points (produce pain at rest or with motion) and inactive trigger points (produce pain only with pressure).</p> Signup and view all the answers

    Which of the following is NOT a cause of trigger points?

    <p>Ample rest and relaxation</p> Signup and view all the answers

    What is the main component of the energy crisis theory of trigger point development?

    <p>Changes in the blood supply to the muscle</p> Signup and view all the answers

    What is the primary goal of therapeutic massage?

    <p>To promote healing and improve function</p> Signup and view all the answers

    Which type of massage is most commonly used to relax and energize the body?

    <p>Swedish massage</p> Signup and view all the answers

    Reflex effects of massage are direct responses to touch that affect body functions and tissues through the nervous or energy systems of the body.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a way that massage can affect blood and lymph channels?

    <p>Massage can decrease blood flow through deeper arteries and veins.</p> Signup and view all the answers

    Massage can reduce the development of adhesions and excessive scarring.

    <p>True</p> Signup and view all the answers

    What is the primary goal of MFR?

    <p>To reduce pain and improve function</p> Signup and view all the answers

    Which of the following is a contraindication for MFR?

    <p>Fever</p> Signup and view all the answers

    What is a global contraindication for massage?

    <p>Fever</p> Signup and view all the answers

    What is the tissue barrier of resistance?

    <p>The point at which the tissue changes from a relaxed, or soft, state of give to a subtle but definitive state of resistance.</p> Signup and view all the answers

    MFR techniques are typically performed for 10-15 minutes.

    <p>False</p> Signup and view all the answers

    What is the term for the lymphatic system dysfunction that causes the accumulation of excessive lymph fluid in the subcutaneous tissues?

    <p>Lymphedema</p> Signup and view all the answers

    The primary goal of MLD is to decrease lymph production.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a benefit of MLD?

    <p>Strengthen muscles</p> Signup and view all the answers

    One contraindication for MLD is the presence of an open wound.

    <p>True</p> Signup and view all the answers

    During MLD, the patient should avoid deep breathing.

    <p>False</p> Signup and view all the answers

    What is the primary goal of INIT?

    <p>To reduce pain and improve function</p> Signup and view all the answers

    What is the first step in the INIT sequence?

    <p>Ischemic compression</p> Signup and view all the answers

    The goal of ischemic compression is to increase circulation to the trigger point.

    <p>False</p> Signup and view all the answers

    The strain-counter strain (SCS) technique is performed in the position of greatest comfort for the patient in order to reduce pain, spasm, and loss of range of motion.

    <p>True</p> Signup and view all the answers

    What is the term used to describe the impaired function of related components of the somatic system, including the skeletal, arthrodial, and myofascial structures?

    <p>Somatic dysfunction.</p> Signup and view all the answers

    The lower crossed syndrome is characterized by tightness in the anterior muscles and weakness in the posterior muscles.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a benefit of strain-counter strain (SCS)?

    <p>Increases muscle overactivity</p> Signup and view all the answers

    The spray and stretch technique uses a coolant liquid to achieve a brief and rapid cutaneous cooling, which can help to reduce pain before stretching.

    <p>True</p> Signup and view all the answers

    Which of the following is NOT a contraindication for SCS?

    <p>Muscle strain</p> Signup and view all the answers

    What is the first step in the SCS procedure?

    <p>Identify the worst tender point.</p> Signup and view all the answers

    Anterior tender points are typically treated with the affected body part in flexion.

    <p>True</p> Signup and view all the answers

    The spray and stretch technique is often used for the treatment of chronic pain.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a common type of scar tissue release technique?

    <p>Deep friction</p> Signup and view all the answers

    Kinesio taping is a technique used for pain management and to assist body healing.

    <p>True</p> Signup and view all the answers

    What is the primary effect of kinesio taping on lymphatic function?

    <p>Improved lymph circulation</p> Signup and view all the answers

    Kinesio tape is made with latex.

    <p>False</p> Signup and view all the answers

    Which type of kinesio tape application is commonly used to treat pain points and trigger points?

    <p>Spacetape</p> Signup and view all the answers

    Acupuncture is considered a traditional Chinese medicine practice.

    <p>True</p> Signup and view all the answers

    Which type of acupuncture is used for the treatment of myofascial syndrome?

    <p>Dry needling</p> Signup and view all the answers

    What is the primary aim of acupressure?

    <p>To reduce pain</p> Signup and view all the answers

    In traditional Chinese medicine, Qi is considered a vital energy force that flows through the body.

    <p>True</p> Signup and view all the answers

    What is the main contraindication for acupuncture?

    <p>Clinically manifest clotting disorder</p> Signup and view all the answers

    Acupuncture needles are thick and sharp.

    <p>False</p> Signup and view all the answers

    What is the primary indication for acupuncture?

    <p>Treating a variety of pain conditions</p> Signup and view all the answers

    There are 14 major meridians in the body.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a Yang organ in traditional Chinese medicine?

    <p>Heart</p> Signup and view all the answers

    Acupuncture can be used to treat both acute and chronic pain.

    <p>True</p> Signup and view all the answers

    Acupuncture is a relatively new treatment modality that has only recently gained popularity in the West.

    <p>False</p> Signup and view all the answers

    Study Notes

    Manual Therapy (BASPT 218)

    • Manual therapy is a skilled, specific hand-on approach to diagnose and treat soft tissue and joint structures.
    • The goal is to decrease pain, improve joint range and alignment, improve contractile and non-contractile tissue repair, improve extensibility and stability, and facilitate function.
    • The musculoskeletal system is a chain of components: osseous, soft tissue (muscle, fascia, ligaments), and neural (central and peripheral).
    • Manual therapy is a science of somatic diagnosis, not just technique
    • It treats functional disturbances in the spine or extremity joints and abnormal muscle function, including shortening, weakening, and imbalance of muscles.

    Types of Tissues

    • Connective tissue
    • Epithelial tissue
    • Muscle tissue
    • Nerve tissue

    Connective Tissue (CT)

    • Maintains the form of the body and organs, providing cohesion and support.
    • Connects cells and tissues
    • Has three components: cells, fibers, and extracellular matrix (ECM)

    Myofascial System

    • Myo (muscle) and fascia (band)
    • Fascia is a three-dimensional, weblike matrix that supports all body structures (muscles, bones, nerves, organs).
    • It is a continuous, innervated, and sensory organ for stability and motion.
    • Fascia adapts its arrangement and density based on local and tensional demands.
    • Fascia interlocks and connects muscle groups.

    Elements of Fascia

    • Collagen: provides strength and structural integrity
    • Elastin: provides elasticity, allowing stretch and absorbing tensile force
    • Ground substance: a viscous fluid that provides lubrication and distance between collagen fibers. It is made up of Glycosaminoglycans (30%) and Water (70%).

    Types of Fascia

    • Superficial fascia: beneath the skin, connecting it to underlying tissue
    • Deep fascia: surrounds muscles, tendons, ligaments; providing support, protection, and lubrication, and plays a role in postural stabilization.
    • Meningeal fascia: surrounds the nervous system and brain.
    • Visceral fascia: surrounds lungs, heart and abdominal organs.

    Superficial Fascia

    • Thin fibrous layer beneath the skin
    • Allows normal sliding action between skin and underlying tissues.
    • Passageway for blood vessels and nerves
    • Insulates, thermoregulation, and circulation.
    • Can hold inflammatory exudates
    • Damage manifests as shortening and tightness.

    Deep Fascia

    • Tough, tight, and compact
    • Covers muscles, tendons, ligaments, and aponeuroses.
    • Provides protection and lubrication
    • Transfers force during muscle contraction
    • Involved in postural stabilization

    Healthy Fascia

    • Adaptable to change and moves freely with other tissues.

    Causes of Fascial Restriction

    • Poor posture
    • Injury/trauma to surrounding tissues
    • Inflammation
    • Inactivity
    • Overuse

    Consequences of Fascial Restriction

    • Reduced flexibility
    • Limited motion
    • Myofascial (trigger point) pain
    • Muscle weakness
    • Neural symptoms (numbness, tingling)
    • Postural deviations and misalignments
    • Autonomic imbalance
    • Recurring injuries
    • Headaches
    • Unbalanced load transfer

    Myofascial Release (MFR)

    • Skilled hand-on technique for diagnosis and treatment of myofascial tension and restrictions.
    • Converts ground substance to a more fluid state, allowing fibers to slide.
    • Increases extensibility of tissues, leading to improved flexibility and range of motion.
    • Improves circulation & waste removal
    • Reduces pain
    • Improves general well-being

    Indications of MFR

    • Various musculoskeletal issues (facial, hip, knee, ankle, etc.)
    • Systemic issues like headaches, nerve issues (nueralgia), etc.

    Trigger Points (TrPs)

    • Hyperirritable spot within a taut band of a skeletal muscle.
    • Painful on compression, stretch, overload or contraction
    • Referred pain at a location distant from the trigger point.

    Difference between Trigger Point and Spasm

    • Spasm is a sudden, hard contraction of the entire muscle.
    • Trigger point is a small, localized area of muscle contraction.

    Myofascial Syndrome (MFS)

    • A general term encompassing all symptoms from trigger points.

    Myofascial Pain Syndrome (MPS)

    • When pain is the primary symptom of MFS.
    • A complex psychological and physiological event representing chronic pain syndrome.

    Signs and Symptoms of Myofascial Trigger Points

    • Palpable taut bands (or nodules) in skeletal muscles.
    • Hyperirritable spots within the taut bands
    • Local twitch response
    • Referred pain
    • Pain on contraction
    • Physical dysfunctions (e.g., muscle weakness, inhibition, increased motor irritability (spasm), muscle imbalance).

    Trigger Point Classification

    • Primary/central: Located in the center of the muscle.
    • Secondary/satellite: Response to primary trigger points in nearby muscles.

    Diffuse Trigger Points

    • Develop along lines of altered stress and strain patterns.
    • May involve entire quadrant of the body.
    • Secondary to multiple central trigger points.

    Active and Latent Trigger Points

    • Active: pain at rest and motion/pressure. Stimulated by increased muscle activity.
    • Inactive/ latent: no pain at rest, but pain with pressure. Potentially due being less stimulated.

    Theories of Trigger Point Pathophysiology:

    • Motor endplate theory
    • Energy crisis theory
    • Increased Metabolism: Needs more energy.
    • Localized Ischemia (inadequate blood flow leading to tissue damage)
    • Calcium Imbalance (can't enter myosin/actin)
    • Inflammation: (a response to repair)

    Causes of Trigger Points (cont.)

    • Acute Myofascial pain (trauma, strain)
    • Postural Stress (awkward positions)
    • Vitamin and mineral insufficiencies
    • Metabolic disorders
    • Psychological Factors (stress, anxiety, depression)
    • Ageing
    • Chronic infections
    • Lack of sleep
    • Weight gain
    • Congenital malformation

    Benefits of Strain and Counterstrain (SCS)

    • Neurological changes
    • Proprioceptive theory: Restoring appropriate motor control (muscle function).
    • Altered fibroblast responses: Reducing inflammation

    Traditional Chinese Medicine

    • Acupuncture
    • Dry needling
    • Acupressure
    • Reflexology
    • Cupping

    Fundamentals of Acupuncture

    • Meridian system: 12 major meridians to circulate Qi (life force) through the body which links organs.
    • Yin and Yang theory: Interrelated (and opposing) forces that are essential for balance. Yin (receiving) and Yang (expressing).

    Manual Lymphatic Drainage (MLD)

    • Gentle, manual technique that enhances lymph circulation to reduce edema and related problems

    Lymphedema

    • Accumulation of excess lymph fluid in the tissues.
    • May result from primary (developmental) lymphatic abnormalities, or secondary (secondary) to infections, injuries, surgeries, or other conditions.

    Kinesio Taping

    • Method using flexible therapeutic tape to improve muscle function, joint function, pain reduction, etc
    • The tape supports to improve circulation, reduce pain and re-educate muscles/joints.

    Scar Tissue Release Therapy

    • Gentle techniques and manipulations can decrease scar tissue's impact.
    • Aims to loosen collagen fiber linkages, improve function and reduce pain.

    Precautions for Immature Scar Tissue

    • Handle very gently.
    • Avoid techniques for which there is an increase in tissue redness or pain.
    • Massage not to be performed on any open wounds.

    Contraindications for Treatments

    • Acupuncture: Life-threatening diseases, Epilepsy, Psychosis, (etc.)
    • MLD: Acute infections, active untreated malignancies, acute deep vein thrombosis, cardiac insufficiency, renal failure, etc.
    • Kinesio Taping: Open wounds, unhealed scars, infections, cancer, etc.
    • SCS: Systemic localized infection, open wounds, acute nerve root compression, etc.

    Techniques in Manual Therapy, Acupuncture and Other methods

    • Ischemic compression (IC): part of integrated neuromuscular inhibition technique (INIT)
    • Strain-counter strain (SCS): Part of integrated neuromuscular inhibition technique (INIT)
    • Muscle energy technique (MET): part of integrated neuromuscular inhibition technique (INIT)
    • Massage Techniques: Various types, like transverse, deep touch, J stroking, and others
    • Spray and stretch technique: Utilizing cold sprays to reduce muscle tension
    • Dry needling: Acupuncture points with needles to modulate pain/discomfort
    • Kinesio-Tape: Application of elastic tape for various purposes
    • Electrostimulation acupuncture: Acupuncture with electrical stimulation
    • Acupressure: Applying pressure to specific acupuncture points
    • Cupping: Creating suction with cups to improve blood flow and alleviate pain
    • Electrophysical agents: such as LASER, ultrasound, etc.
    • Laser acupuncture: Using laser therapy coupled with acupuncture
    • Cryostretch: Applying cold to reduce pain/spasm
    • Injections: Injections using saline, anesthetics, steroids, for treatment
    • Exercise: Stretching, Strengthening, and exercises for posture correction
    • Psychotherapy: Mental health support
    • Hydrotherapy: Water-based therapies
    • Functional assessment: Identifying dysfunction, to inform/guide other treatments
    • Myofascial Release: Address fascia stiffness
    • Manual Lymphatic Drainage (MLD): Improving lymphatic flow and treating edema.
    • Scar tissue release: Addressing scar-related pain/restrictions.

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