Introduction to Soft Tissue Manipulation PDF

Introduction to Soft tissue manipulation DR.FAIROUZ HATEM AMEEN SOFT TISSUE MANIPULATION BASIC SCIENCE DEPARTMENT Objectives of the lecture:  To define and know the biological back ground and function of the soft tissues.  To understand well the goals, indications and contraindications of the...

Introduction to Soft tissue manipulation DR.FAIROUZ HATEM AMEEN SOFT TISSUE MANIPULATION BASIC SCIENCE DEPARTMENT Objectives of the lecture:  To define and know the biological back ground and function of the soft tissues.  To understand well the goals, indications and contraindications of the soft tissue manipulation.  To realize the causes of soft tissue shortening and the common soft tissue disorders.  To get introduced to different soft tissue treatment modalities. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 2 Definition of soft tissue: The term soft tissue refers to tissues that connect, support or surround the structures and organs of the body. Soft tissue includes: skin, muscles, tendons, ligaments, fats, fascia, blood vessels, nerves, synovial tissues (tissues around the joints) and fibrous tissues. 24/9/2024 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 3 Biological over view of different soft tissues Skin Connective tissue Fascia 24/9/2024 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 4  Skin: It is the largest organ of the body. It is composed of three main layers.  Epidermis (outer layer).  Dermis (inner layer)  Sub cutis (fat layer). 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 5  Functions of the skin: Protection of the body. It is the first line of defense for the body. Being full of sensory nerves, the skin provides sensation of temperature, pressure and pain. It regulates the body temperature by allowing the vasoconstriction and vasodilatation of the blood vessels. (Vasodilatation: release the heat from the body) (Vasoconstriction decrease the heat loss from the body). 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 6 Evaporations: the skin allows evaporation to increase the fluid loss, though decrease the body temperature. It controls evaporation to prevent dehydration. Skin stores water and lipids such as fat, wax, cholesterol and vitamins A,D,E,K. Excretion: excretes excess minerals and water production through sweating. Absorption: it absorbs oxygen, carbon dioxide and nitrogen in small amounts. It absorbs water, oils and ointments which is effective in topical treatments. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 7  Connective tissue: Connective tissue is a strong layer made of collagen to give strength and to provide anchoring to the skin and mobility. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 8 Functions of connective tissue:  Synthesis of collagen.  Provides protection.  Enhances healing.  Facilitates mobility and glide. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 9 Fascia: A dense tridimensional web of collagenous connective tissues, connecting and surrounding all types of tissues, organs and vessels in the body. It is one continuous structure connecting muscles, bones, ligaments, tendons, arteries, veins and nerves, as well as the organs as the heart, lungs, brain, spinal cord etc…. Fascia could be easily traumatized or inflamed due to poor position or any other reason which applies abnormal pressure on it and causes malformation or damage. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 10  Functions of fascia: It provides support for vessels and nerves. It enables adjacent tissues to move upon each other while providing stability and contour. It provides fluid between structures for lubricating movement and nutrition. Provides afferent information to spinal cord and brain. Provides immunity to the body. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 11 Definition of soft tissue manipulation: Soft Tissue Manipulation is a treatment method that covers a range of hands-on interventions that all aim to improve the health condition of a soft tissue. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 12 Goals of soft tissue manipulation Restore or optimize biomechanical action by improving motion. Facilitate mobility and wellness of the soft tissues. Reduce pain. Restore or maintain normal motion and function as well as increasing physical activity. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 13 Indications of soft tissue manipulation Reduction of tenderness. Moderation of pain. Hypo mobility. Mobilization of interstitial tissue fluids. Modification of edema. Increase of local blood flow. Decrease of muscle soreness and stiffness. Prevention or break down of adhesions and Scar release. Facilitation of relaxation. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 14 Contraindication of soft tissue manipulation: Hyper mobility of joints Neurologic signs/ inflammation/ skin injury Acute inflammation Degenerative joint disease Ligament/ joint instability Congenital joint laxity Spondylosis/Osteoporosis/Osteomalacia Spinal deformity Acute disc herniation Systemic/visceral pathology Vertebro basilar insufficiency Sever diabetes and atherosclerosis 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 15 Causes of soft tissue restrictions: The soft tissues are always prone to deformation due to their locations and functions in the human body which put them at risk of shortening and restrictions. Injuries (sudden fall, jerk, movement, blows Repeated injury. Over use. Chronic inflammation. Immobilization. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 16  Common disorders of soft tissues Hypertonic fascia: fascia that becomes dense, hard and fibrotic over time due to overuse. Hypertonia is the inability of a body structure as muscles, ligaments, nerves or joint to relax when it needs to. It is mainly due to trigger points or hypertonic muscle causing pain. Joint stiffness: could be a result of swelling, infection or immobility. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 17  Common disorders of soft tissues Muscle spasm: tight painful muscles due to micro injuries or over exhaustion of the muscle. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 18  Common disorders of soft tissues Muscle tightness: mild shortening of the muscle due to decreased range of motion or immobility. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 19  Common disorders of soft tissues Muscle contractures: moderate or severe shortening of muscle that results in limitation of range of motion of the joint. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 20  Common disorders of soft tissues Muscle cramps: it is often due to over exercising, standing or lying down for long periods of time, it usually lasts for few minutes. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 21  Common disorders of soft tissues  Adhesions: a band of connective tissue that binds two parts of tissue together where they should remain separate. Adhesions may appear as thick sheets of tissue similar to plastic wraps or as thick fibrous bands. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 22  Common disorders of soft tissues  Tendon adhesions: loss of tendon glide, it is very common and could be mild, and treated by soft tissue manipulation, or sever and needs surgery. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 23  Common disorders of soft tissues  Scar tissue adhesions: thickened bands of fibrous tissues that adhere together forming a scar, it limits motion and function. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 24 Common disorders of soft tissues  Fibrotic adhesions: contractures can develop as the result of a chronic inflammation leading to fibrotic changes of the soft tissues and it restricts its motion. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 25 Common disorders of soft tissues  Soft tissue contractures: shortening developed from scar tissue, muscles, tendons, joint capsule or skin. Contractures caused by fibrosis of tissues are very difficult to reduce. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 26 Common disorders of soft tissues  Myofascial pain syndrome: is a chronic pain disorder, where trigger points are present in the muscles causing referred pain. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 27 Common disorders of soft tissues  Fibromyalgia: is a disorder characterized by widespread musculoskeletal pain, fatigue and painful tender points. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 28 Common disorders of soft tissues  Trigger points: a point in the body which causes referred pain to another part of the body when pressure is applied to it. It is characteristic for myofascial pain syndrome 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 29 Common disorders of soft tissues  Tender points: extremely sensitive spots on the body that elicit pain when sufficient pressure is applied. Tender points are characteristic for fibromyalgia. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 30 Factors that might predispose to soft tissue injury:  Age: age changes the flexibility, it increases at 2-6 years, then decreases at 6-12, then increases 18-22, and then decrease again.  Bad habits: prolonged sitting, standing, mal posture.  Genetic factors: flexibility is more in females than males.  Hormonal: hormonal factors increases the flexibility in females than males. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 31  Stretching Mobilization. Massage. Myofascial release. Myofascial trigger point therapy. Connective tissue massage. Positional release. Scar tissue release. Neural mobilization. Muscle energy technique. Acupressure. Acupuncture. Chiropractic therapy. Osteopathy. Traction. Shiatsu. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 32  The growing need for manual therapy: Manual therapy is widely needed nowadays The skillful techniques applied manually makes the manual therapist a healer and gives him the advantage over traditional physical therapy modalities.  A manual technique requires training to gain its skills, a three months of application and training is a very acceptable period to make a good manual therapist. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 33  Application of body mechanics while manipulating: Use the correct treatment table height. Wear adequate and appropriate clothing and footwear. Keep your head up and your back straight. Lunge from your legs as opposed to bending from your hips. Maintain a centre of gravity to conserve biomechanical energy and also use it to its full potential. 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 34  Let’s recap 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 35 9/24/2018 DR. FAIROUZ HATEM AMEEN, PHD. BASIC SCIENCE DEPARTMENT 36