Soft Tissue Mobilization (STM) - The George Washington University - Spring 2025 PDF

Soft Tissue Mobilization PT 8313 – Spring 2025 Erin Baumann, PT, DPT, OCS Adapted and updated from 2024 Objectives 1. Discuss soft tissue mobilization as a therapeutic modality 2. Describe different types of soft tissue mobilization techniques 3. Disc...

Soft Tissue Mobilization PT 8313 – Spring 2025 Erin Baumann, PT, DPT, OCS Adapted and updated from 2024 Objectives 1. Discuss soft tissue mobilization as a therapeutic modality 2. Describe different types of soft tissue mobilization techniques 3. Discuss the clinical decision making involved in soft tissue mobilization What is it exactly? Utilization of hands, or device, in improving tissue extensibility Adjunctive treatment that can assist with improving movement and decreasing pain How? Gate control theory Endorphins Need to know anatomy! Gate Control Theory Source: https://www.youtube.com/watch?v=oQLFfvGM7nI Potential effects Relaxation Improved circulation Decreased pain Increased tissue extensibility Decrease adhesions Increase fluid/lymph drainage Psychological benefit Why would we use STM? Pain Postural dysfunction Post-surgery Contracture Joint stiffness Edema Others? Types of STM Effleurage Petrissage Friction Tapotement Effleurage Goal: improve circulation, reduce muscle tone, relieve muscle spasm, promote general relaxation Technique: Long gliding motion with palmar surface of one or both hands Slow, rhythmic Used at beginning and end of session Petrissage Comes from the French word petrir “to knead” Goal: mobilize deep tissue, stretch adherent fibrous tissues, increase blood flow Technique: Kneading, lifting, wringing, skin rolling Alternating compression/relaxation Friction Goal: to create a mild inflammatory response and enhance collagen remodeling in a localized region i.e. tendons, ligaments, joint capsule, muscles Technique No medium Small circular or transverse motion 5-10 minutes Tapotement Goal: to increase circulation, alter muscle tone, loosen mucous in lungs (percussion) Techniques: Cupping: will provide vibrations to loosen mucous Hacking: using edge of hands Tapping Others Other Resources Effleurage https://www.youtube.com/watch?v=iKs19Ckksek Petrissage https://www.youtube.com/watch?v=yaDYWYCpvEM Tapotement https://www.youtube.com/watch?v=dXMDzanUkxc Friction https://www.youtube.com/watch?v=SIB4wSKEr-k Trigger Point Techniques Sensitive areas that can produce pain Active vs. latent Palpation? Rathbone et al., 2017 Technique: Sustained pressure for >60 seconds Myofascial Pain Syndrome Pressure on sensitive areas (TPs) cause localized and/or referred pain Most likely a chronic condition Causes Increased/decreased muscle use, imbalance Impaired posture Stress Others Other techniques of STM Rolfing Structural Integration Reflexology Acupressure Shiatsu Others Reflexology Chart From Academy of Natural Health Sciences Website How do we start?! ASK FOR CONSENT Drape appropriately Patient education How do we start?! Keep hands relaxed Parallel alignment keeps pressure more superficial Angling hands can create more pressure – increased tissue depth More contact area = greater patient comfort Contraindications Thrombus, embolism Known malignancy* Known infection Non-union fractures Open wounds Lack of sensation Edema associated with cardiac dysfunction Precautions Thoughts? Precautions Allodynia Pregnancy Dermatologic conditions Connective tissue disorders Fear of touch Hematoma Psychological factors Altered sensation Anticoagulants Allergies to topical products medications/supplements Others? Lymphedema Acute inflammatory condition Potential Adverse Effects Increased symptoms Dependence on STM Bruising https://i0.wp.com/bemyhealer.com/wp-content/uploads/2016/05/ Gua_Sha_Massage_Aftermath.jpg?resize=363%2C321 Things to Consider What phase of healing are we in? Contractile vs non-contractile Pt positioning When to complete this in a tx session Why is this tissue dysfunctional? Local vs distal issue Considerations Continued Goal of the treatment? Communication with pt Consent Draping Pt’s thoughts/feelings/beliefs Body mechanics Superficial to deep How to assess effectiveness Documentation More “tools” for your toolbox! (literally)  IASTM RockTape HawkGrips Graston Tecnica Gavilan Functional and Kinetic Treatment and Rehab Adhesion Breakers Augmented Soft Tissue Mobilization Fascial Abrasion Technique Cheatham, S. W., Baker, R., Kreiswirth, E. (2019). Instrument assisted soft tissue mobilization: A commentary on clinical practice guidelines for rehabilitation professionals. The International Journal of Sports Physical Therapy, 14 (4), 670. What? And why? Tools to assist in STM Mechanical advantage with instrument Saves PT hands Cupping Used for thousands of years Application of cups to cause a suction to the skin Acrylic, glass, bamboo Adjunctive therapy http://time.com/4443105/cupping-rio- olympics-michael-phelps/  Gua Sha Eastern medicine tool Goal: increase circulation, improve lymphatic drainage, decrease pain Causes petechiae https:// www.thedetoxmarket.com/ products/crystal-contour-gua-sha Cheatham, S. W., Baker, R., Kreiswirth, E. (2019). Instrument assisted soft tissue mobilization: A commentary on clinical practice guidelines for rehabilitation professionals. The International Journal of Sports Physical Therapy, 14 (4), 670. Cheatham, S. W., Baker, R., Kreiswirth, E. (2019). Instrument assisted soft tissue mobilization: A commentary on clinical practice guidelines for rehabilitation professionals. The International Journal of Sports Physical Therapy, 14 (4), 670. Cheatham, S. W., Baker, R., Kreiswirth, E. (2019). Instrument assisted soft tissue mobilization: A commentary on clinical practice guidelines for rehabilitation professionals. The International Journal of Sports Physical Therapy, 14 (4), 670. What does the research have to say? Questions?