Soft Tissue Mobilization Techniques

Soft Tissue Mobilization

• Soft tissue mobilization is a manual therapy targeting soft tissues
• It aims to improve pain, range of motion (ROM), and function
• Short-term improvements are common but long-term effects are not fully supported by high-quality evidence
• Techniques work by impacting the patient's nervous system, according to the modern pain podcast
• This approach is used to treat muscle guarding, spasms, limited range of motion, scar tissue, fluid mobilization, and muscle stimulation.

Objectives

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

Mechanisms, Indications, & Contraindications

• Mechanisms: Claims to break fascial restrictions and scar tissue are not supported by evidence. Some studies support increased fibroblast activity and neurophysiological effects.
• Indications: Pain, muscle guarding/spasm, ROM limitations, scar mobilization, fluid mobilization, muscle stimulation
• Contraindications: Skin conditions (open wounds, rashes, burns), infections, fever, suspected DVT/clotting disorders, phlebitis, active bruising, congestive heart failure

Precautions

• Altered skin sensation
• Immune system disorders
• Areas around fractures or joint instability

Soft Tissue Mobilization Techniques

• Effleurage: Gentle, broad strokes for relaxation, circulation, and warming up tissues
• Petrissage: Deeper pressure, kneading, slow rhythmic motions to decrease tension and spasm, and modulate pain
• Trigger Point Therapy: Also known as "Release," involves targeting a hyperirritable spot (trigger point) in a muscle associated with a taut band. Pressure is applied until pain subsides. This technique can be unreliable.
  • Find the painful band of tissue
  • Apply pressure at a tolerable level (5-6/10)
  • Hold until discomfort eases (30-60 seconds)
  • Increase pressure to 5-6/10
  • Repeat 2-4 cycles
• Pin and Stretch: Pressure applied to the trigger point with a stretch in the opposite muscle direction. Hold for 5-10 seconds, relax for 2-5 seconds, and repeat 5-10 times.
• Cross Friction Massage: Used for hypersensitive connective tissues; use stacked fingers to apply pressure perpendicular to the fiber orientation with a "strumming" back and forth motion

Instrument Assisted Soft Tissue Mobilization (IASTM)

• Uses instruments like Graston®, ASTYM®, Gua Sha to stimulate fascia and fibroblasts, increasing vibratory perception and allowing for easier detection of changes in tissue texture
• Techniques include brushing, sweeping, fanning, and strumming