Soft Tissue Techniques

Therese Obioha OMS V Sarah Watson OMSV

21 June 2013

Overview of Lab

Review of Screen, Scan, Segmental

Definition

Overview of Soft Tissue Techniques

Types of Soft Tissue Treatments

Practice Time

Use of Soft Tissue Treatment 2

Review of Screen, Scan, Segmental Definition

1. Screen◦ Is there a problem?◦ Look, listen, feel

2. Scan◦ Where is the problem?◦ One tissue scan + one confirmatory

motion scan Tiebreaker scan if needed

3. Segmental Definition◦ What is the problem?◦ Naming the dysfunction (in ease)

4. Diagnosis Treatment3

Screen...

Scan...

Segmental Definition...

Find Somatic Dysfunction on Your Partner

•Write down areas and remember the areas for later 5

Screen—Palpation

Axial Spine: Comparing Above with Below

Ask the question, “Is there a difference in tissue resistance?”

Screen—Gross Regional Motion

Cervical rotation Apply a slight

rotary force to the left/right

Cervical sidebending Tell patient to let

the head fall to the left/right

Screen—Gross Regional Motion

Thoracic rotation Apply a slight rotary

force to the left/right

Feel for that initial resistance to motion.

Thoracic sidebending Apply a slight

downward force using your body weight as leverage

Screen-Gross Regional Motion

Lumbar lordosis Patient *actively*

flexes (bends over) Lordosis should

flatten out Lumbar rotation

A notable prominence of left or right paraspinal tissues is abnormal

This test can be combined with the previous one.

Overview of Soft Tissue Treatments10

Overview of Soft Tissue Treatments: Causes of Dysfunction?

Irritation (somatic

dysfunction)

Psychogenic factors

overuse

trauma Infectious agents

Inactivity

Visceral Disease

11- Adapted from Dr. Eland

Soft Tissue – Circle of Irritation

Irritation

Pain

Increased muscle tension

Inflammation

Fibrous reaction

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- Adapted from Dr. Eland

Overview of Soft Tissue Techniques

When to use soft tissue techniques:

1. Relax Tight Muscles

2. Stretch the fascia around tight muscles

3. Increase circulation to the fascia and muscles

4. Improve local tissue nutrition, oxygenation, and removal of waste via lymphatics 13

Overview of Soft Tissue Techniques

Defined as: Direct treatments that address the

muscular and fascial structures of the body and the

associated neural and

vascular elements.

Direct method technique: A technique engaging the restrictive barrier

and then carrying the dysfunctional segment into the restrictive barrier

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Overview of Soft Tissue Techniques

Defined as:

Direct treatments that address the muscular and fascial structures of the

body and the associated neural and vascular elements.

Direct method technique:A technique to engage the restrictive barrier

(of a muscle or group of muscles)…and then focused on carrying the

dysfunctional segment TOWARDS the restrictive barrier

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Overview of Soft Tissue Techniques

When to use soft tissue techniques (cont.)

5. Identify areas of somatic dysfunction

6. Improve local and systemic immune response

7. Provide a general state of relaxation for the patient

(from Foundations of Osteopathic Medicine, pg. 819) 16

Overview of Soft Tissue Techniques A Side Note!

Tissue Response and Treatment While you are doing these

techniques, you will feel changes in the tissues with your hands

Ex. Relaxation of muscles Increased temperature of tissue

(due to increased blood flow) A pulsation under your fingers

Related to Circulation and other natural body rhythms. 17

Types of Soft Tissue Treatment18

Types of Soft Tissue Treatment:

Lateral stretching

Linear stretching

Deep pressure (Inhibition)

Others:◦ Tapotement, Effleurage, Petrissage

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Types of Soft Tissue Treatments

Kneading (Lateral Stretching)o Force applied perpendicular to the long

axis of the muscle

o The rhythmic lateral stretching the muscle and fascia

o The origin and insertion are held stationary

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Force

Types of Soft Tissue Treatments

Inhibition

o Steady pressure applied to muscle to increase relaxation via intrinsic muscular reflexes

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Force

Types of Soft Tissue Treatments

Traction ( Linear Stretching)

o A linear force to draw structures apart

o The origin and insertion the muscle are pulled away from each

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Types of Soft Tissue Treatments

Effleurage

o Light pressure to the skin to compress the underlying subcutaneous tissues

o This helps to move fluid along lymphatic channels

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Types of Soft Tissue Treatments

Petrissage

o Deep kneading or squeezing action to remove swelling; more pressure than effleurage.

o This helps to break up adhesive bands from the skin to the deeper tissues

o Important to know WHERE you are directing this fluid

o Anatomy of lymph nodes and lymphatic flow24

Types of Soft Tissue Treatments

Tapotment

o Striking the belly of a muscle with the hypothenar edge of the open hand in rapid succession

o Increased blood flow

o Breaks up fatty nodules25

Types of Soft Tissue Treatments

Deep Friction

o The application deep strokes of the thumb, knuckles, or elbow to small paraspinal muscles

o Helps to break up fibrotic changes in small paraspinal muscles

o Can also help to increase local circulation through release of local chemical mediators

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Summary of Treatment Types

Most Commonly Used Kneading, Inhibition, Traction

To remove swelling Effleurage/Petrissage

To Increase Circulation Tapotement, Deep Friction

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Time to Practice!28

Paraspinal Muscle DysfunctionA. Kneading

1. Pt prone2. Physician stands opposite

of tight muscle3. Doc places heel of one

hand along erector spinae muscles and reinforces with heel of other hand

4. Force is applied anteriorly and laterally to scoop muscle laterally

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Paraspinal Muscle Treatment

A. Inhibition1. Pt prone2. Physician stands

opposite of tight muscle

3. Doctor places pad of thumb over tight muscles and reinforces with the heel of the other hand

4. Continued force is applied until relaxation of muscle is achieved

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Suboccipital Muscle DysfunctionA. Kneading and

stretching1. Pt supine2. Physician contacts

medial aspect of suboccipital muscles with pads of fingers of both hands

3. Fingers are drawn superiorly (stretching) and laterally (kneading)

4. Use enough force to feel the muscles relax, but not to cause discomfort

5. Force is slowly relaxed, fingers repositioned, and kneading and stretching repeated

6. Recheck

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Cervical Paraspinal Muscle Dysfunction

A. Bilateral stretch1. Pt supine2. Physician’s forearms

crossed under patient’s neck and hands are placed on anterior aspect of patient’s shoulders

3. Physician lifts pt’s head until the muscular restrictive barrier met

4. Force slowly relaxed5. Stretching may be

repeated6. Recheck

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Lumbar Paraspinal Muscle Dysfunction

A. Kneading and stretching1. Pt is prone2. Physician places heel of one hand

along the medial aspect of the erector spinae muscles

3. The other hand cups the ASIS on the side of the tight muscles and lifts to provide a stretch

4. Anterior and lateral force is applied through the hand on the erector spinae

5. A rhythm is developed between the two hands

B. Inhibition

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Upper Extremity Lymphatic CongestionA. Effleurage

1. Pt supine2. Physician lifts patient’s

arm vertically and grasps patient’s fingertip with one hand

3. Physician applies enough pressure to compress skin against the deep fascia and strokes the lateral side of finger from distal to proximal

4. Physician then applies enough pressure around the arm to compress skin against the deep fascia and strokes the arm from distal to proximal at various points on the circumference until the entire arm has been treated

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Conclusion – Student Response

Types of soft tissue treatments

When to use soft tissue

Why would we use soft tissue treatments

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(Some examples of) Clinical Application of Soft Tissue

Techniques

1. Ankle Sprain2. Low Back Pain3. Overuse

1. Acute2. Chronic

4. Tension Headache5. Other?

Next Lab!

Putting all the pieces together

OMM Applications for Headaches Dx, Tx, and Follow-Up Care…

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Resources

DiGiovanna E, Shiowitz S, Dowling D. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. 2005: Philadelphia, PA. Lippincott Williams & Wilkins: 80-83

Ward, et al. Foundations of Osteopathic Medicine. 2nd ed. :glossary

Kimberly PE. Outline of Osteopathic Manipulative Procedure: The Kimberly Manual. Millenium ed. 2000; Marceline, MO. Walsworth Publishing Co: 37-59

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