Soft tissue manipulation.pdf

Soft tissue manipulation Asfarina Zanudin History PT profession start with STM/massage Strokes and principle of STM used by CSP originally from Swedish massage Therapeutic STM defined as..’the manipulation of the soft tissues of the body by a trained therapist as a component of a holi...

Soft tissue manipulation Asfarina Zanudin History PT profession start with STM/massage Strokes and principle of STM used by CSP originally from Swedish massage Therapeutic STM defined as..’the manipulation of the soft tissues of the body by a trained therapist as a component of a holistic therapeutic intervention.’ Preparation Treatment room –comfortable, privacy, treatment couch, table and chair Couch-ideally adjustable couch/plinth Self preparation Stance (good posture, not often have to change position) Clothing (loose, hair/scarf tied back) Hands (clean, smooth, short nails, no accessory) Patient preparation-checking the site, remove anything, hygiene Coupling media –massage oil, creams, gels, powders Hands exercise before starting the massage Make a fist, then spread fingers and thumbs out as far as possible, hold for 5-10secs Place finger tips of one hand in contact with finger tips of other and press so tat thumbs and little fingers are as widely spread as possible Push 2,3 & 4 fingers between two adjacent fingers of the other hand. Repeat in each of both hands Place palms together with fingers and thumbs in contact and elbows bent at chest level. Slowly turn hands to point fingers to ground. Return to start position. Place the backs of the hands together, hold arms out straight and bend elbows towards chin to flex wrists. Clasp the hands with wrists crossed and elbow straight. Bend the elbow out. Keep hands firmly clasped at all times. Do not force- go only as far as is possible. Contraindications Skin infections Open wound Circulatory problems Recent injury (e.g within 48hours post injury) Tumours Acute inflammation Myositis ossificans Diabetes Alteration of skin sensations Techniques Three main components: Stroking manipulations (stroking & effleurage) Pressure or petrissage manipulations (kneading, picking up, wringing, rolling, shaking) Percussive or tapotement manipulations (hacking, clapping, beating, pounding, vibrations) Stroking Stroking movement Performed from distal to proximal towards the lymph drainage Can be performance in the opposite direction or in a cross over method This STM applied using pads of fingers, thumb, hands (alternate or each at one time) Effects of stroking Gets patient used to touch Allows assessment of the tissues and skins of the area to be treated Improves sensory analgesia Slow stroking will relax and decrease muscle tone Faster strokes will stimulate superficial blood flow, accelerate lymph drainage Used at start and end of session Effleurage Deeper than stroking Has 3 grades Grade 1-sufficient flow in superficial vessels Grade 2- affects deeper vessels Grade 3-applies to reinforced effleurage, with one hand on top of the other Can be applied in the direction of the lymph glands, or opposite, in patterns from a figure of 7 or 8, to circular or T shape Effects of effleurage Assists lymphatic and venous return Assists interchange of tissue fluid Assists removal of waste product and chemical irritants Passively stretches muscle fibres Restores mobility at tissue interfaces Light strokes decrease muscle tone Deep strokes increase muscle tone Used at start, end and in between other manipulations Kneading Tissues are compressed against underlying structures during this stroke Perform in circular movement either from proximal to distal or distal to proximal Circular movement with pressure on the upward part for about 25% of the circumference Contact must be maintained for the rest of the circle & only be lifted to move on to the next circle 3 grades: grade 1 is sufficient to influence superficial vessels and compress superficial tissues on underlying structures grade 2 affects deeper tissue drainage and will compress deep tissue on underlying structures grade 3 is applied to superimposed or reinforced strokes and may be as much as can be tolerated by the patient without producing tissue damage. Effects of kneading Stimulates venous and lymphatic flow. Increases mobility of fibrous tissues. Helps interchange of tissue fluids. Helps prepare soft tissue for exercise. Helps removal of waste products. Increases length and strength of connective tissues. Provokes somato-visceral reflex effects. Restores mobility between tissue interfaces. Picking up The tissues are compressed against underlying structures, then ‘picked up’, lifted, squeezed and released. The manipulation can be single-handed C-shape (double-handed alternate C-shape, single-handed V-shape or double-handed V-shape. For C-shape, the thumb is held away from the palm so that the web between it and the first finger form a C-shape. V-shape is when the web forms a letter V. Grading for picking up is the same as kneading with grade 3 only being used in the double-handed manipulation and will only be tolerated over very muscular areas. Effects of picking up Exactly the same as for kneading. Particularly good for mobilising soft tissues. Use after effleurage and kneading. Wringing In wringing the tissues are compressed against underlying structures, then one hand pulls towards the physiotherapist and the other hand pushes away. Fingers and thumb can be used in wringing with the tissues being compressed between them. The tissue is then lifted and pulled towards you with one hand and pushed away from you with the other. Full hands are also used in this stroke. There are only two grades for wringing: 1 and 2. Grade 1 is usually applied to finger strokes only with grade 2 using the whole hand. There is no grade 3 as it would be too painful to tolerate. Effects of wringing These are as stated for kneading. Wringing is particularly good for separating superficial and deep adherent tissue. Rolling In this manipulation both hands are used. Contact is made with both palms and the thumbs are held away from the fingers; the tips of the thumbs are close to, or touch, each other. The fingers pull the tissue towards the thumbs and then the thumbs squeeze and lift to push the tissue away There are two types of rolling – skin rolling and muscle rolling. In muscle rolling, the roll action is not so marked and the action is more push with fingers and pull back with the thumbs. Skin rolling is grade 1 and muscle rolling is grade 2. Again, there is no grade 3 because it would be too painful. Effects of rolling These are as stated for kneading. Rolling also mobilises scar tissue. When performed slowly it has a stretch effect on the tissues being manipulated. Shaking In this manipulation muscle or more superficial tissue can be shaken from side to side. The tip of the thumb and tips of one or more fingers are used when treating small areas. The full length of thumb and all fingers are used in larger areas. In a very large area, such as the buttocks or thighs, the whole flat hand can be placed on the area and after applying gentle compression shaken. In the final type of shaking – whole limb shaking – the leg or arm is lifted, gently supported and then shaken. Grade 1 shaking is used to describe thumb and fingertip shaking; grade 2 applies to full thumb and fingers and also to flat hand; grade 3 is whole limb shaking. Effects of shaking This manipulation produces a feeling of invigoration and stimulation. Increases tissue mobility. Assists in breaking down tissue adhesions. Stimulates lymphatic and venous flow. Helps prepare soft tissues for stretch and exercise. Hacking To perform this manipulation the arms are held abducted with the elbows bent. The area to be massaged is then hit by the medial border of the hands and/or fingers. The action is produced by pronation and supination of the radio-ulnar joints. It is important that the practitioner’s shoulders and hands are relaxed and not held in any tension. The rhythm of all percussion strokes should be practised to ensure it is consistent. Grade 1 uses only the medial borders of the fingers; grade 2 uses medial borders of hands and fingers; grade 3 uses the medial borders of hands and fingers more deeply and slowly. Effects of hacking Stimulates local circulation. Stimulates muscle tone. Gives generalised feeling of stimulation. Provokes muscle and tendon reflexes. Light strokes effect superficial tissue. Deeper strokes aid the evacuation of the lungs. Clapping To perform this stroke the hands are held loosely cupped and the area is struck by the palmar aspect of the hands and fingers. The action is produced by alternately flexing and extending the wrist joints. Grade 1 clapping is very superficial, often called skin clapping. This is used at a fairly fast pace with minimal contact. Grade 2 is deeper, slower and firmer, and grade 3 clapping is very firm and may involve elbow, as well as wrist, action. Effects of clapping These are the same as listed for hacking with the exception of provoking tendon or muscle reflex. Beating This form of tapotement involves the use of lightly clenched fists to hit the area. The action involved is wrist flexion and extension with the finger/palmar area making contact with the treatment area. Grade 1 beating is performed at a fast rate, with fairly light contact. Grade 2 is slower with firmer contact and grade 3 is deeper, with varying rates Effects of beating The effects are identical to clapping. Pounding In this stroke the hands are held in lightly clasped fists with the thumbs resting against the first fingers. The action is to pronate and supinate the radio-ulnar joints and make contact with the patient using the ulnar border of the hand. Grade 1 of this stroke applies to fast rate, light contact. Grade 2 is used for slower rate with firmer contact and grade 3 is deeper, with varying rates. Effects of pounding These are exactly the same as listed for clapping. Vibrations In this manipulation the tissues are pressed and moved up and down, or away from and towards the manipulator and then released. At the same time small oscillations of the whole arm produce a trembling effect. A single hand or both hands may be used, and hands should be held slightly in flexion. Grade 1 applies to light rapid movements. Grade 2 is firmer and slower with more tissue movement, and grade 3 is as firm a pressure as can be tolerated and in a very slow action. Effects of vibrations Stimulates muscle tone. Stimulates local circulation. Provides feeling of well-being.