SOFT TISSUE MANIPULATION.pptx

This presentation is apt for Physiotherapy students with basic knowledge about STM.

1. THERAPEUTIC MASSAGE (SOFT TISSUE MANIPULATION) Submitted by – Sakshi Upadhyay MPT Sports

2. Definition Massage is therapeutic manipulation of the soft tissues of the body used to achieve normalization of those tissue. It can be defined also as an act of rubbing, kneading, or stroking the superficial parts of the body for the purpose of modifying nutrition, restoring power of movement or breaking down adhesions.

3. Why massage is used? To increase flexibility, coordination, venous return and blood flow T o decrease neuromuscular excitability and pain To stimulate circulation To facilitate healing and restore joint mobility To remove lactic acid and edema To treat bursitis, tendonitis, muscle spasm 

4.  Purpose of Massage Manipulates the body’s tissues to: – Reduce muscle spasm Promote relaxation Improve blood flow Increase venous drainage

5. Physiological Effects of Massage The physiological effects of Massage include: Mechanical Physiological Psychological

6. Mechanical Effects Techniques that stretch a muscle, elongate fascia, or mobilize soft tissue adhesions or restrictions are all mechanical techniques Mechanical effects are always accompanied by some reflex effects. Muscle – massage is done either for mechanical stretching or to relieve pain associated with trigger points. Skin massage increases skin temperature, increases sweating &  decrease resistance to electrical current. It also softens the skin. It removes dead cells present on the skin surface. It stretches & breaks down fibrous tissues.

7. PHYSIOLOGICAL Effects Depending on the amount of pressure applied & the speed of the stroke, many results can occur: Light, slow strokes that evoke systemic relaxation Fast, deep strokes that increase blood flow to the area. Different body systems are affected by massage. Physiological effects are : Muscular System Skeletal System Circulatory System Nervous System

8. Muscular System Relieves , tension, and stiffness Improves muscle tone Increases flexibility and range of motion of joints Improves the flow of nutrients to muscles and joints Reduces scar tissue Breaks down or prevents adhesions Enhances freedom of movement Prevents muscular atrophy, resulting from inactivity caused by injury, age, surgery, or illness Increases physical confidence Relieves cramps and muscle spasms Reduces pain and swelling

9. Skeletal System Improves posture/body alignment Relieve stiff joints Decreases inflammation Restores range of motion Releases joint strain Releases restrictions in the fascia Improves the circulation and nutrients of your joints

10. Circulatory System Increases blood flow (to tissues and organs), which can relieve much muscular and joint pain (especially associated with swelling) Increases the flow of oxygen and nutrients (to cells and tissues), improving and relieving congestion throughout the body Increases the number of RBC’s, especially in cases of anemia Lower blood pressure Reduces heart rate (helps develop a stronger heart) Elimination of metabolic waste

11. Nervous System Stimulates Nervous System ( boosting energy) Calms the Nervous System (relaxing) Relieves restlessness and insomnia Relieves pain due to pinched nerves Decreases chronic pain Stimulates the release of endorphins (the body's natural painkiller)

12. Psychological Effects Increases awareness of mind-body connection! Massage can help you become more aware of where you are holding tension, as well as where you have tight muscles or painful areas Massage reduces mental stress and Decreases angry feelings Promotes better sleep and sleep patterns Massage induces mental relaxation Fosters peace of mind Massage helps improve concentration Provides mental clarity Revitalizes your mind

13. Classification of Massage

14. Effleurage / Stroking It is unidirectional manipulation of soft tissues from distal to proximal in the direction of the lymph drainage. Effleurage is used more than any other massage technique. It usually initiates and ends each treatments. “Any stroke that glide over the skin is called as effleurage ” Types of Stroking: Superficial Stroking or Superficial Effleurage Deep Stroking or Deep Effleurage

15. Effect of effleurage

16. Types of effleurage Knuckling - Clench the fist in palmar flexion, gradually bring the hand from flexion to extension. Bilateral - Both hands progressing simultaneously on the either side. Single - Single hand used for the stroke

17. PETRISSAGE

18. Kneading It is circular manipulation performed so that the skin and subcutaneous tissues are moved in a circular manner on the underlying structures . It is performed with palmar aspect of the whole hand, with palm only, with all fingers, or with the pads of the thumb or fingers. Effects 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. Restores mobility between tissue interfaces.

19. Classification of Kneading Grade 1 : is sufficient to influence superficial vessels and compress superficial tissues of underlying structures. Grade 2 : effects deeper tissue drainage and will compress deep tissues of underlying structures. Grade 3 : is applied to superimposed or reinforced strokes. It may be applied as strongly as can be tolerated by the patient without producing tissue damage.

20. Picking up Compressing the tissues against the underlying structures, then 'picked up', lifted, squeezed and released. The manipulation can be single-handed in a C-shape , double-handed in alternate C-shapes and V-shapes or double-handed in a V-shape .

21. Wringing Compressing the tissues against underlying structures, then one hand pulls towards the you while the other hand pushes away. Effects P articularly good for separating superficial and deep adherent tissues. There are only two grades for wringing: Grade 1 is usually applied to finger strokes only. Grade 2 uses the whole hand

22. ROLLING The fingers pull the tissue towards the thumbs and then the thumbs squeeze and lift to push the tissue away. Types : skin rolling and muscle rolling Effects Mobilizes scar tissue. When performed slowly, it has a stretch effect on the tissues being manipulated.

23. Shaking Muscle or more superficial tissue can be shaken from side to side Tips or whole hand are used Effects Produces a feeling of stimulation. Increases tissue mobility. Assists in breaking down tissue adhesions. Stimulates lymphatic and venous flow. Helps prepare soft tissues for stretch and exercise.

24. FRICTION It is a localized manipulation applied at the injury point aiming to give a stretching across the fibers to separate them and restore mobility. Effects Restore tissue mobility. Stimulate local circulation. Aid the resolution of inflammation. Reduce pain as a counter-irritant effect. Stretch fibrous tissue.

25. Types of Friction Circular : Friction is applied in circular manner by the fingers. Rest of hand should be out of the contact. This manipulation can be used over ligaments and myofascial junctions. Transverse : Friction is applied horizontally by the thumb or fingers. This manipulation can be used over tendon, ligament, myofascial junctions and muscles Classification of Friction Grade 1 does not apply to this technique as it is aimed at deeper structures. Grade 2 is sufficient to affect deep tissue and cause compression. Grade 3 applies to reinforced and most transverse fric­tions and may produce pain before causing numbing.

26. PERCUSSION/TAPOTEMENT

27. Hacking Hold the hands so that the palms are parallel. Strike the part with a series of soft, but brisk blows, using the lateral borders of the middle, ring and little finger. Use both hand alternatively and strike rapidly with pronation and supination at forearm. Effects Stimulates local circulation. Stimulates muscle tone. Gives a generalized feeling of stimulation. Provokes muscle and tendon reflexes. Light strokes affect superficial tissue. Deeper strokes aid the evacuation of secretion from the lungs.

28. Classification of Hacking Grade 1 uses only the medial borders of the fingers. Grade 2 uses the medial borders of hands and fingers. Grade 3 uses the medial borders of hands and fingers more deeply and slowly.

29. Clapping (Cupping) It performed with your palms facing downwards, forming a hollow curve. Strike the part with the palmar surface of the hand. The striking sound should be hollow like a horse trotting. Use both hand alternatively and strike rapidly. Effects The exception of provoking a tendon or muscle reflex

30. Classification of Clapping Grade 1 clapping is very superficial and is often called skin clapping. This is performed at a fairly fast pace with minimal contact. Grade 2 clapping is deeper, slower and firmer. Grade 3 clapping is very firm and may involve elbow as well wrist action.

31. Beating Involves the use of lightly clenched fists to hit the area Classifications of beating Grade 1 beating is performed at a fast rate, with fairly light contact. Grade 2 is slower, with firmer contact. Grade 3 is very deep and the rate can be varied as required.

32. Pounding The hands are held in lightly clasped with the thumbs resting against the first fingers Classifications of beating Grade 1 of this stroke applies to a fast rate with light contact. Grade 2 is used at a slower rate with firmer contact Grade 3 is deeper, with varying rates.

33. Tapping Tapping is done the tips or pads of the fingers. It is used on very small areas such as the face. Classifications of beating Grade 1 of this stroke applies to a fast rate with light contact. Grade 2 is used at a slower rate with firmer contact Grade 3 is deeper, with varying rates.

34. Vibration A fine tremulous movement, made by the hand or fingers placed firmly against a part, will cause the part to vibrate. Tips of the finger or whole hand is used for vibration. Vibration involves a movement in which the tissues are pressed and released using an up and down motion. Effects Stimulates muscle tone. Stimulates the local circulation. Provides a feeling of well-being.

35. Indications Increase blood flow Facilitate healing Increase range of motion Remove edema Alleviate muscle cramps Stretch scar tissue/adhesions Decrease pain

36. Contraindications Acute inflammatory conditions Severe varicose veins Open wounds Skin infections Failed or incomplete fracture healing Thrombophlebitis , Thrombosis Pregnant women Immediately after surgery