Connective Tissue Massage Lecture Notes PDF

Soft tissue manipulation Dr. Fairouz Hatem Ameen Objectives:  To define the connective tissue massage.  To know the indications and benefits of the connective tissue massage.  To realize the connective tissue zones and the organs they affect.  To know how to evaluate the patient ind...

Soft tissue manipulation Dr. Fairouz Hatem Ameen Objectives:  To define the connective tissue massage.  To know the indications and benefits of the connective tissue massage.  To realize the connective tissue zones and the organs they affect.  To know how to evaluate the patient indicated for connective tissue massage.  To differentiate between the short and long strokes.  To understand the effects of the connective tissue massage on circulation and pain.  Connective tissue: tissues that surround, protect and support all the other structures of the body. Connective tissue is the matrix that binds together the body organs and systems and provides compartments between them.  Injuries, traumas, stresses, postural deviations and gravity all affect the connective tissue causing imbalance, tightness and shortening and decreasing flexibility or even causing loss of normal mobility of the tissues.  Connective tissue massage: It is a manual, dynamic approach that releases the connective tissue restrictions and chronic tension. Indications:  Decrease pain.  Relief symptoms.  Relief tension.  Increase mobility.  Improve posture.  Enhance self awareness. General and local benefits:  Increase circulation to the treated area.  Increase energy.  Increase breathing capacity.  Applying connective tissue massage to an area of chronic pain might at first cause some discomfort, as areas of tissues that have become shortened begin to stretch and release. This discomfort decreases within few minutes.  The connective tissue massage is a specific manipulation technique applied to connective tissue close to the body surface.  The technique is applied by the therapist’s middle and ring fingers to the epidermis, and through it to deeper connective tissues which is tense or strained. Connective tissue zones:  As connective tissue is continuous, changes in normal mobility at one area reflects the other areas connected to it.  Often this change in the deeper connective tissue will be reflected on the skin, though when we apply the treatment to the zones in the skin it reflects back to the deeper connective tissues, bringing about relaxation, stretching and mobilization to the deeper tissues as well as increasing circulation and nutrition to the internal organs. Evaluation:  To detect changes in the tension of connective tissue, shortening or alteration in fluid content, the therapist performs examination by observation and palpation.  The patient is seated with thighs supported hips and knees at 90 degrees. Feet supported, hands resting on the lap and the back exposed till the gluteal cleft. The back is observed in order to note changes in the surface, watch out for:  1-The contour of the back at both sides.  2-Asymmetry caused by muscle spasm.  3-Colour of the skin.  4-Texture of the skin, to see if it is dry or harsh, which indicates a decrease in fluid content and viscosity.  5-Tuft of hair or abnormal concentration of hair growth. Then apply palpation to the back by :  1-By moving the skin against deeper fascia, using the three middle fingers tips in a semi- flexed, we apply pressure in the four directions, up and down, right and left.  2-Apply this palpation all over the back, and compare sides.  3-Apply skin rolling.  4-Apply skin gliding and bouncing. Treatment: Position of the patient:  To treat the back the patient is kept in a seated position with the legs hanging over, hips and knees is at 90 degrees, hands resting on thighs.  This is the optimum position for treatment but side lying could be used if sitting is difficult.  Position of therapist’s fingers and technique of application:  Treatment will be applied to the connective tissue zones at the back.  The middle finger is adhered to the ring finger (beside it not on it) to give it support and strength while applying the stroke, the movement should be done with the wrist leading the movement.  The fingers meet the skin with an angle of 40-60 degrees, altering the angel of application can vary the depth of the stroke or speed of the pull, example: reducing the angle or reducing the speed makes the effect more superficial.  The stroke is a pull done by the middle finger to take a slack of skin and tissue. Tension must be developed between the pads of the fingers and the patient’s skin. So lubricants cannot be used and nails should be cut. Sufficient pressure is used to achieve adherence. Connective tissue strokes:  It is preferable that we start treatment from the distal segment and move upwards. The three main segments of the back that is treated would be cervical, thoracic and lumber regions. Figure (3): (a): The three areas of the back where the connective tissues massage is applied depending on the site of dysfunction. (b): The direction of stroking in case of the venous and lymphatic supplies of the lower limb.  Short stroke “Pull and hock up”: this stroke is up to 3 cms long.  -Apply adequate adherence between the middle and ring fingers and the skin.  -Let the wrist lead the movement, the slack is taken up, making adequate stretching in the deeper layers of connective tissue.  -This should be applied without sliding movement between the skin and the finger pads.  -The patient feels a cutting or scratching sensation that is uncomfortable.  -The number of repetitions depends upon the effect achieved and patient’s reaction.  Long stroke (Pulling): this stroke is for areas more than 3 cms, probably 3-10 cms or even more.  Movement is allowed between finger pads and skin.  Adequate pressure is applied and a slack of skin is pulled up.  The fingers are drawn along the surface with constant pressure and speed.  A mobile fold of tissue should proceed the stroking fingers.  The effect of both short and long strokes will be physical, as connective tissue is stretched as well as a reflex effect on the nervous system.  Each set of strokes can be applied up to three times. Effect of connective tissue massage:  Circulatory effect:  Connective tissue massage has a local and a general effect on circulation. Local effects is produced as a result of the tensile stress placed on the connective tissue by the stroke applied as the stroke causes the mast cells present in the tissues to release histamine- like substances which produce vasodilatation.  A local axon reflex may also occur causing sensory stimulation in the skin and though arteriolar dilatation in the area of treatment.  The rise in capillary pressure may cause translation of the fluid between the tissues and affect the fluid level in the matrix of the connective tissue.  In the presence of local inflammation the circulatory increase could help resolution and remove pain producing chemicals.  General circulatory effects are produced by stimulation of the autonomic nervous system by the connective tissue massage strokes.  This can produce reflex increase in circulation in specific areas.  Recent researches showed that the circulation of the foot increased by working on the sacral segment.  However we should note that this could cause fainting in sensitive individuals due to a drop in blood pressure.  Physical effects:  The short and long strokes causes stretching if the connective tissue, which increases the mobility. Restoration of normal mobility through full excursion could be achieved without interfering with the function of adjacent structures.  Reduction of pain:  Connective tissue massage is a strong physical stimulus that produces physical trauma and release appropriate chemicals (histamine and bradykinin) which stimulate nociceptors, as well as mechanoreceptors in the connective tissue, both of which help to treat painful areas.  Large diameter delta fibers will be stimulated by the painful strokes (cutting and scratching sensation), and this will be carried to the posterior horn of the spinal cord, where they will cross the synapses at the substantia gelatenosa of rolandi where they will block the pain gate and though inhibit the forward transmission in the small diameter pain fibers, and causes inhibition of pain.  As the impulse passes to the mid brain, it will interact with the pre-aqueductal area of grey matter (PAG) and the raphe nucleus causing stimulation of the descending pain suppression system to release opiate like substances (the ᵝ-endorphins and dynorphins which inhibits the pain sensation.  The circulatory effect could also decrease pain by removal of irritating chemicals and waste products and bringing in fresh circulation and nutrients.