Soft Tissue Mobilization Techniques

Soft Tissue Mobilization

• Soft tissue mobilization is a manual therapy focused on soft tissues.
• Objectives for this topic are to understand indications and contraindications, and how to perform common techniques.

Mechanisms, Indications, Contraindications

• Soft tissue mobilization can improve pain, range of motion, and function in the short term.
• There isn't strong evidence it has lasting effects on tissue characteristics; however, there are neurophysiological effects.
• This therapy involves communicating with the patient's nervous system.
• Indications include pain, muscle guarding/spasm, range of motion limitations, scar mobilization, fluid mobilization, and muscle stimulation.
• Contraindications include skin conditions (open wounds, rash), infection, fever, suspicion of deep vein thrombosis (DVT) or clotting disorders, phlebitis, active bruising, and congestive heart failure.

Precautions

• Precautions include altered skin sensation, immune system disorders, and areas around fractures or joint instability.

Soft Tissue Mobilization Techniques

• Techniques include effleurage, petrissage, trigger point therapy (also called trigger point "release"), pin and stretch, and cross-friction massage.

Effleurage

• Gentle, broad strokes are used to relax, circulate blood, and warm-up tissues.

Petrissage

• Deeper pressure, kneading, and slow, rhythmic movements decrease tension and spasms and modulate pain.

Trigger Point Therapy

• Also known as "trigger point release" or "trigger point release therapy"
• A trigger point is a hyperirritable spot in a taut band of skeletal muscle. Pain from a trigger point can refer to other locations.
• Palpating trigger points can have variable reliability and validity; tenderness and pain reproduction are more reliable markers.
• The process involves finding the painful band, applying a tolerable level of pressure (usually not over 5-6/10), maintaining pressure until discomfort eases (30-60 seconds), and increasing pressure to 5-6/10, then repeating 2-4 times

Pin and Stretch

• Apply pressure to a trigger point, simultaneously stretching the opposing muscle line of force.
• Hold the stretch for 5-10 seconds, relax for 2-5 seconds, and repeat 5-10 times.

Cross Friction Massage

• This technique is used on hypersensitive connective tissues.
• Stacked fingers are used apply force perpendicular to the tissue fiber orientation.
• The movement is like "strumming" back and forth.

Instrument Assisted Soft Tissue Mobilization (IASTM)

• Techniques include Graston®, ASTYM®, Gua Sha, or "scraping."
• Tools are made from various materials like metal, plastic, or stone.
• Instruments aim to directly stimulate fascia and fibroblasts.
• They increase vibratory perception.
• Changes in tissue texture are easier to distinguish.

Mechanisms (Instrument-Assisted Soft Tissue Mobilization)

• Claims about breaking fascial restrictions and scarring aren't widely supported by evidence.
• Some evidence suggests increased fibroblast activity.
• Claims are based on neurophysiological effects

Techniques (Instrument-Assisted Soft Tissue Mobilization)

• Techniques include brushing, sweeping, fanning, and strumming.
• These movements enhance the effects of soft tissue mobilization.