Soft Tissue Mobilization Techniques

Soft Tissue Mobilization

• Soft tissue mobilization is a manual therapy technique focused on soft tissues.
• It's used to address pain, muscle guarding/spasm, ROM limitations, scar mobilization, fluid mobilization, and muscle stimulation.
• Short-term improvements in pain, ROM, and function are possible.
• Mechanisms involve neurophysiological effects, yet high-quality evidence for more than transient tissue changes is lacking.
• The technique involves "talking to the patient's nervous system through your hands." (Modern Pain Podcast)

Objectives

• Understand indications and contraindications for soft tissue mobilization.
• Demonstrate ability to perform common soft tissue mobilization techniques.

Mechanisms, Indications, and Contraindications

• Mechanisms: Claims to break fascial restrictions and scar tissue lack evidence. Evidence suggests increased fibroblast activity and neurophysiological effects.
• Indications: Pain, muscle guarding/spasm, ROM limitations, scar/fluid mobilization, and muscle stimulation are common uses.
• Contraindications: Skin conditions (open sores), infections, fever, suspected DVT/clotting disorders, phlebitis, active bruising, and congestive heart failure.

Precautions

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

Soft Tissue Mobilization Techniques

• Overview: Techniques include effleurage, petrissage, trigger point, pin and stretch, cross-friction.
• Effleurage: Gentle, broad strokes for relaxation, circulation, and warming up tissues.
• Petrissage: Deeper pressure, kneading, slow, rhythmic strokes to reduce tension/spasm and modulate pain.
• Trigger Point Therapy (AKA Trigger Point "Release"): A "hyperirritable spot" in a skeletal muscle, painful on compression or stretch, causing referred pain. Palpation is unreliable. Tenderness and pain reproduction is more reliable.
• Trigger Point Therapy (Steps): Find the painful band, apply tolerable (5-6/10) pressure, hold until discomfort eases (30-60 seconds), increase pressure (5-6/10), and repeat 2-4 cycles.
• Pin and Stretch: Trigger point pressure with a stretch in the opposite muscle line of force, holding for 5-10 seconds, relaxing for 2-5 seconds, and repeating 5-10 times.
• Cross Friction Massage: Applying force perpendicular to the tissue fiber orientation (using stacked fingers) in a "strumming" motion to treat hypersensitive connective tissues.

Instrument Assisted Soft Tissue Mobilization (IASTM)

• IASTM uses instruments like Graston, ASTYM, Gua Sha, or scraping tools (metal, plastic, or stone).
• May stimulate fascia and fibroblasts.
• Instruments enhance vibratory perception and make changes in the tissue's texture easier to distinguish.
• Claims of breaking fascial restrictions and scar tissue lack evidence, but some evidence relates to increased fibroblast activity.
• Techniques involve brushing, sweeping, fanning, and strumming.

Techniques

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

This quiz covers the principles and techniques of soft tissue mobilization, focusing on its mechanisms, indications, and contraindications. Understand how these manual therapy techniques can enhance pain management and improve range of motion. Test your knowledge on the evidence supporting these practices.