Soft Tissue Mobilization Techniques

Soft Tissue Mobilization

• Overview: Soft tissue mobilization is a manual therapy technique targeting soft tissues.
• Objectives: The objectives involve understanding indications and contraindications for soft tissue mobilization, and demonstrating the ability to perform common soft tissue mobilization techniques.
• Efficacy: Short-term improvements in pain, range of motion (ROM), and function are observed. However, high-quality evidence for more than temporary changes in tissue characteristics is lacking. Neurophysiological effects are key, as practitioners interact with the patient's nervous system.
• Indications:
  • Pain
  • Muscle guarding/spasm
  • Range of motion (ROM) limitations
  • Scar mobilization
  • Fluid mobilization
  • Muscle stimulation
• Contraindications:
  • Skin conditions (open wounds, rash, burns, etc.)
  • Infection
  • Fever
  • Suspected deep vein thrombosis (DVT)/clotting disorder
  • Phlebitis
  • Active bruising
  • Congestive heart failure

Precautions

• Altered skin sensation
• Immune system disorders
• Around fractures or joint instability

Soft Tissue Mobilization Techniques

• Effleurage: Gentle, broad strokes for relaxation and circulation, warming up tissues.

• Petrissage: Deeper pressure, kneading motions, slow and rhythmic to decrease tension and spasm and aid pain modulation.

• Trigger Point Therapy (AKA Trigger Point "Release"): Targeting "hyperirritable spots" within a taut band of skeletal muscle, which are painful to compress or stretch. This can lead to typical referred pain patterns. Tenderness and pain reproduction from palpation are usually most reliable than the palpation method itself.

  • Find painful band of tissue
  • Apply pressure at a tolerable level (5-6/10 typically)
  • Maintain pressure until discomfort eases (30-60 seconds)
  • Increase pressure to 5-6/10
  • Repeat 2-4 cycles

• Pin and Stretch: Trigger point pressure is applied while stretching the opposite muscle line of force. Hold 5-10 seconds, relax 2-5 seconds, and repeat 5-10 repetitions.

• Cross Friction Massage: Force is applied perpendicular to the fiber orientation of hypersensitive connective tissues using stacked fingers, like strumming.

Instrument Assisted Soft Tissue Mobilization (IASTM)

• Utilizing tools such as Graston®, ASTYM®, Gua Sha, which may be made of metal, plastic, or stone.
• Technique aimed at stimulating fascia and fibroblasts, which increases vibratory perception and assists in easily identifying changes in tissue texture.
• Mechanisms of IASTM: Claims of breaking fascial restrictions and scar tissue are made, but there is not high quality evidence to support it. Some evidence demonstrates increased fibroblast activity and neurophysiological effects.

IASTM Techniques

• Brushing

• Sweeping

• Fanning

• Strumming

• Techniques may have additional movement to enhance the effects.