CA Student Conclave CA Student Conclave /17/16. Intro to upper quarter DYNAMIC SOFT TISSUE MOBILIZATION. Yousef Ghandour PT, MOMT, FAAOMPT

Transcription

1 CA Student Conclave 2016 Intro to upper quarter DYNAMIC SOFT TISSUE MOBILIZATION by Mesa College San Diego Ca. April 9, CA Student Conclave 2016 DYNAMIC SOFT TISSUE MOBILIZATION Professional and Voluntary Affiliation 1

2 California State University-Long Beach 1985 Part I, Part Time Residency Program (MOMT) OGI Part II Part Time Certification Program Fellow on the American Academy of Orthopedic Manual Physical Therapy (AAOMPT) 1994 Part time Instructor with Ola Grimsby Institute 1992 Member of Board of Examiners with the Ola Grimsby Institute MSM Director Physiotherapy Associates 2002 Voluntary Clinical Faculty UCSD Department of Family and Preventive Medicine 2013 Voluntary faculty at SDSU DPT program 2013 National Arab American Medical Association NAAMA 2012 Physical Therapy for all 2012 Presentation Objective Upon completion of this presentation, the participant will be able to: Discuss the rational for DSTM outcome Discuss the rational for using passive vs. dynamic technique Discuss / interpret findings of skin mobility testing Discuss the rationale for Active Muscle Pump ( AMP) Perform 2 Dynamic Soft Tissue Mobilization Dynamics of an injury Trauma Inflammation Chemical response V asodilation Pain threshold Local permeability Tonic Reflexogenic Effect 2

3 Dynamics of an injury Flow velocity Neural input Local edema Muscle Atrophy Nerve Atrophy Nutrients Metabolic drainage Fatigue Proprioception Coordination Tissue Repair/Healing Instability Scar/adhesion/ contractures Literature Review Many Authors have found inconclusive evidence regarding the effect of soft tissue techniques on various topics. Massage and Strength No significant difference between isometric and dynamic peak torque between massage and control group up to 96 hours post exercise. 3

4 Massage and Lactic Acid Lactic acid production enhanced during bicycle ergometer exercise between 50-60% Max VO2 Lactic acid removal most effective between % Max VO2. Massage and DOMS Sports massage reduces DOMS and CK when given 2 hours after eccentric exercise. L. Smith, PhD 94 No significant difference between myofascial technique and muscle energy technique for PEMS of elbow flexors. D. Molea Petrissage does not attenuate DOMS. It may augment CPK release. D.L.Carr 93 Eccentric exercise induces DOMS that peaks in intensity hours post exercise. Cryotherapy alone is not effective in preventing DOMS. Yeckzen et al, 84 Massage and Circulation No significant differences in subjects O 2 consumption with massage. No significant differences in HR, stroke volume, cardiac output, or AV O 2 differences during massage. Boone 95 No clinical significance of one minute back rub on mixed venous O2 saturation and HR in critically ill patients. T. Tyler, 90 Six minute slow-stroke back massage (SSBM) in 32 healthy women showed decreased muscle tension and increased skin temperature; no change in HR or BP. Longworth, 82 Three minute SSBM in 18 elderly nursing home residents; Significantly decreased HR and BP, and increased skin temperature. C. Fekhoury, 87 Blood flow maintained homeostasis during contraction level below 10% MVC. This based on metabolic and mechanical criteria. Sjogaard et al, 88 4

5 Massage and Circulation Metabolic Criteria During a sustained 4-8% MVC, there is no lactate accumulation during a one hour period and no postexercise hyperemia. Muscle temperature remained constant after initial increase of 1-2 C. Mechanical Criteria No mechanical hindrance to blood flow occurs during low contraction levels since mean arterial blood pressure is well above intramuscular pressure. Massage and Blood Fluidity Blood viscosity, hematocrit, and plasma viscosity declines after both acute and longterm treatment. The changes in blood rheology seem to be caused mainly by hemodilution! Massage and Pain Inhibition Pain is an emotional disturbance. B. Wyke 78 The nociceptive receptor system: A receptor system that is histologically identifiable in most tissues whose activation may evoke the experience of pain. Longworth, 82 The plexus system is normally inactive. When there is sufficient mechanical or chemical stimulus, it becomes activated. Stimulation of the disc and facet joint capsule produced contractions in the multifidus fascicles. A. Indahl, 95 5

6 Active Muscle Pump (AMP) The involved muscle is placed on a slight tension. The patient is asked to concentrically contract the muscle. The resistance should be minimal in magnitude. The operator guides the movement in a pain free range from an elongated position into a shortened position. Added external pressure could be applied to the muscle parallel to the muscle fibers during the elongation phase followed by releasing the compression as the therapist feels tension developing in the muscle belly during the active contraction. Passive Muscle Pump (PMP) A technique where we passively apply a compression force to the muscle's belly parallel to its fiber direction. Starting from a shortened position, passively move the joint to elongate the muscle(s) treated while applying pressure. The effect is superficial compared to the active approach. CERVICAL SPINE SCREENING Patient Position: Seated T h e r a p i s t P o s i t i o n : Standing behind patient Technique: Neck ROM Limitation Assessment Instruct your patient to turn their neck to the right- check ROM Repeat with both shoulders shrugged- Notice changes in ROM 6

7 Patient Position: Seated ROTATION Therapist Position: Standing behind patient Technique: Neck ROM Limitation Assessment Instruct your patient to turn their neck to the right- check ROM Repeat with both shoulders shrugged- Notice changes in ROM Patient Position: Seated SIDE BEND Therapist Position: Standing behind patient Technique: Neck side bending Limitation Assessment Instruct your patient to bring their ear to right shoulder - check ROM Repeat with both shoulders shrugged- Notice changes in ROM EXTENSION Patient Position: Seated Therapist Position: Standing to the side of patient Technique: N e c k e x t e n s i o n Limitation Assessment Instruct your patient to look up - check ROM Repeat with both shoulders shrugged or after placing the platysma on slack- Notice changes in ROM, fulcrum of motion and symptoms 7

8 3/17/16 TRAPEZIUS- MIDDLE FIBERS Patient Position: Sidelying Therapist Position: Standing facing patient placing patients hand on your shoulder, both of your hands on the medial scapular boarder. Technique: Protract the scapula elongating the middle traps by leaning back, followed by applying pressure on the middle traps. Instruct the patients to bring the shoulder blade backward (squeeze your shoulder blade) TRAPEZIUS- UPPER FIBERS Patient Position: Side lying Therapist Position: Standing behind patient Technique: Supporting the patients Glenohumeral joint with the caudal hand applying an elongation moment; using the cranial hand lumbrical grip, apply pressure on the trapezius muscle; Instruct the patient to shrug the shoulder (AMP), release pressure over the traps Reverse technique PMP. SHOULDER CLOCK ASSESSMENT Patient Position: Sidelying Therapist Position: Standing behind patient Technique: Move the shoulder in a cicular motion corresponding with the clock landmark. Assess for restriction into the direction or away from the intended movement. (i.e. Correlate 9 o clock with 3 o clock) 8

9 SUBSCAPULARIS Patient Position: Sidelying Therapist Position: Standing facing patient, place a pillow between you and your patient Technique: Gently squeeze the scapulae into the rib cage to influence the subscapularis. The subscapularis is divided into three parts, medial, middle and lateral fibers. To influence each part the therapist must bring that muscle in contact with the ribs. Medial fibers= scapulae in an adducted position Middle fibers= scapulae in mid section in contact with the ribs Lateral fibers= scapulae is protracted and tilted causing a flare of the medial scapular border. Apply compression pressure into the ribs with cranial/ caudal direction Patient Position: Sidelying Therapist Position: Standing facing patient with both of your hands on the medial scapular boarder. Technique: Protract the scapulae elongating the Rhomboids by leaning back, followed by applying pressure on rhomboids. Instruct the patients to bring the shoulder blade backward (squeeze your shoulder blade). After shortening step, muscles relaxed and slowly mobilize your fingers deep into medial scapule RHOMBOID SUPRASPINATUS Patient Position: Sidelying Therapist Position: Standing facing patient, place patients arm on therapist s shoulder with therapist support hand at the GHJ. With the other hand/thumb apply pressure on the supraspinatus. Technique: A M P, P M P, Thumbing 9

10 3/17/16 Thank you Q&A Wishing you all the best Contact info: Yousef Ghandour PT, MOMT,FAAOMPT