Soft Tissue Mobilization Intro

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Rhumaila Team OPD AnnexMale PT


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Revision

Body tissues

epithelial tissue connective tissue

Muscular tissue Nervous tissue

Blood

Connective tissue

Dermis Cartilage Fascia

Bone Bursae ligamenttendon scar tissue


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Function ?! Structural ? !

Defensive ?!


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Biomechanical properties of collagen fibers

Tensile strength

Biomechanical properties of Its ground substance- Maintains critical fiber distance

- Lubrication

- Viscosity / compression strength


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Visco-elastic Behavior of C.T

Load Relaxation

Creep phenomenon

Ellis :

Universal in all tissues, constant pressure or tensioncauses wasting, while intermittent tension promotesgrowth and strength, with increased capacity forresistance


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Factors that affect Biomechanical properties

Age

Pregnancy

NSAIDS

Mobilization / Immobilization


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James Cyriax


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Deep Transverse Friction

Purpose To maintain, or

improve mobilitywithin the soft

tissue structuresof ligaments,tendons, andmuscles .

To prevent

adherent scarsfrom formingduring the healingand repair processpost injury


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cont To produce traumatic hyperemia analgesia

To produce a strong, mobile, non tender scars

controlled microtrauma induced through the use ofthe tools increased the cellular activity, including

fibroblasts in the treated area.( Dian lee 1999 )


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CONTRAINDICATION

Calcification

Rheumatoid tendinous lesions

Local sepsis

Skin diseases


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Deep Transverse Friction acute injuries Gentle passive motion to move the injured structure,

that does not detach the healing fibrils during repair

Thought to be an imitation of the structures normalmobility by broadening, but not stretching the repair

Movement is thought to encourage realignment andlengthening of the repaired fibers


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Deep Transverse Friction Traumatic Hyperemia

DF results in increased blood flow to the injured area

( hyperemia )

This appears to decrease pain via acceleratedbreakdown in substance P

Substance P normally produces tissue ischemia andirritation

DF has been postulated to release histamine ..whichwould counteract the substance P reaction


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Technique*Exact localization

*No movement between finger and skin (possiblycleanse the skin with alcohol or use a thin layer of cotton-wool

between finger and skin)

*Transverse

*Sufficient amplitude: we move over-up-and againover the structure

*Sufficient depth


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Technique* Starting position lesion accessible to the finger, tendons with a

tendon sheath generally in a stretched position, just like

ligaments muscle bellies always in a shortened position

* Various grips are used according to the nature and the position ofthe lesion

* Economy of effort: an arm movement instead of small fingermovement(is so much more comfortable to the patient and to the therapist)

* A two-phase movement: active phase and relaxation Always try tokeep your own finger joints slightly flexed


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DURATION, FREQUENCYVaries with injury :

Acute : daily, gentle, 1-2 minutessubacute : every other day, deeper, 5-7 minuteschronic : 2-3/w, deep, 10-20 minute


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NORMAL EXECUTION One or more fingers are put onto the lesion, reinforced by

the one or more fingers.

A reserve of skin is taken in the opposite direction,pressure is applied and the active phase of the DF is

then a movement towards ourselves. In most cases.This is a large arm movement and not a small finger

movement, with all our finger joints slightly flexed

The relaxation phase then follows into the oppositedirection

Sometimes all fingers are used to next to each other forDF, i.e. when treating muscle belly lesions in largemuscles


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Deep Transverse FrictionMUSCLE

DF transversely across muscle fibers to broaden andprevent adhesions surround the fibers

Followed with isometric contraction in shortenedposition .. Progressing to elongated positions astolerated

Progress to active movements


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Deep Transverse FrictionTendon With Tendon Sheath

Place the tendon on stretched position to provide animmobile base for DF

DF across tendon, moving sheath on tendon Exercise or stretching is contraindicated following DF


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Deep Transverse FrictionTendon Without Sheath Place tendon on stretch

DF across tendon

No exercise or stretching following DF


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Deep Transverse FrictionLigament Place ligament on stretch

DF transversely to maintain passive mobility

Follow with gentle active movement in pain free range Do not stretch as chronic sprains usually produce

adherent ligaments to underlying bone


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DF lateral collateral ligament 21


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DF supraspinatus, tenoperiosteal junction


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DF infraspinatus


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DF long head of biceps in the bicipital groove


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DF extensor carpi radialis longus

(Tennis elbow type 1)


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DF extensor carpi radialis brevis, tenoperiosteal junction



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Df extensor carpi radialis brevis, muscle belly



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DF extensor carpi radialis brevis, body of tendon



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Documents

Soft Tissue Mobilization Intro