Soft Tissue Mobilization

Soft Tissue Mobilization (STM) Overview

• STM is a therapeutic modality that uses hands or instruments to improve tissue extensibility, improve movement and decrease pain.
• The main objectives are to discuss STM as a modality, describe different techniques, and examine the clinical decision-making involved.

What is STM?

• STM involves utilizing hands or devices to increase tissue extensibility.
• STM is an adjunctive treatment assisting in improving movement and decreasing pain.
• The process leverages gate control theory and the release of endorphins.
• Understanding anatomy is crucial for effective STM.

Gate Control Theory

• Pain signals can be interrupted in the substantia gelatinosa of the spinal cord.
• This area acts as a gate, potentially reducing the perception of pain.

Potential Effects of STM

• Relaxation
• Improved circulation
• Decreased pain
• Increased tissue extensibility
• Reduced adhesions
• Enhanced fluid/lymph drainage
• Potential psychological benefits

When to Use STM

• Pain management
• Addressing postural dysfunction
• Post-operative recovery
• Contracture release
• Reducing joint stiffness
• Addressing edema
• Other treatment needs

Types of STM Techniques

• Effleurage: Long gliding motions, using palmar surface of one or both hands; slow and rhythmic. Used at the beginning and end of a session.
• Petrissage: Kneading, lifting, wringing, skin rolling; alternating compression and relaxation, to mobilize deep tissue and stretch adherent fibrous tissues.
• Friction: Creates a mild inflammatory response enhancing collagen remodeling in a localized region; i.e. tendons, ligaments, and muscles are targeted. Small, circular or transverse motion is used for 5-10 minutes.
• Tapotement: Used to increase circulation, alter muscle tone and loosen mucous in the lungs (percussion). Techniques include: cupping, hacking, and tapping.

Trigger Point Techniques

• Sensitive areas can produce pain (TP).
• Active vs. latent trigger points.
• Techniques use sustained pressure (>60 seconds) for palpation.

Myofascial Pain Syndrome

• Pressure on sensitive areas (trigger points) causes localized and/or referred pain.
• Usually a chronic condition.
• Causes include increased/decreased muscle use, imbalance, and impaired posture.

Other STM Techniques

• Rolfing Structural Integration
• Reflexology
• Acupressure
• Shiatsu
• Others

How Does STM Start?

• Obtain patient consent.
• Properly drape the patient.
• Provide patient education.
• Keep hands relaxed during treatment.
• Parallel hands for superficial pressure.
• Increased hand angles for increased tissue depth.
• More contact area improves patient comfort.

Contraindications

• Thrombus, embolism
• Known malignancy
• Known infection
• Non-union fractures
• Open wounds
• Lack of sensation
• Edema related to cardiac dysfunction

Precautions

• Allodynia
• Dermatological conditions
• Fear of touch
• Psychological factors
• Anticoagulants/supplements
• Lymphedema
• Acute inflammatory condition
• Pregnancy
• Connective tissue disorders
• Hematoma
• Altered sensation
• Allergies to topical products

Potential Adverse Effects

• Increased symptoms
• Dependence on STM
• Bruising

Things to Consider

• Patient healing phase (contractile vs. non-contractile)
• Proper patient positioning
• When to end treatment in session
• Why this tissue is dysfunctional
• Determining local vs. distal issues

Considerations Continued

• Treatment goals
• Effective communication with the patient
• Obtaining patient consent
• Proper draping
• Patient's thoughts/feelings/beliefs
• Body mechanics
• Superficial to deep techniques
• Assessing treatment effectiveness
• Accurate documentation

Tools for STM

• IASTM: Instrument Assisted Soft Tissue Mobilization; various instruments including Rock Tape, HawkGrips, Graston, ASTYM, Tecnica Gavilan, Adhesion Breakers, Augmented Soft Tissue Mobilization, and Fascial Abrasion Technique
• Cupping: Acrylic, glass, or bamboo cups create suction on the skin.
• Gua Sha: Eastern medicine tool increasing circulation, improving lymphatic drainage, and decreasing pain; causes petechiae.

Research on STM

• Further research and standardization of clinical practice guidelines are needed.

Questions?

• Open-ended question for discussion.