Soft Tissue Midterm 1

8/7/2019 Soft Tissue Midterm 1

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Soft Tissue

Midterm Exam


2/45

What are the layers of subcutaneous fascia?

Superficial

Deep

What are the 2 types of fascia? Subcutaneous

Subserous

Fascia is derived from which embryological origin?

Mesoderm Which layer of fascia connects muscles, skin, and

skeletal structures?

Subcutaneous fascia


3/45

Where would you find sub serous fascia?

Lining body cavities

Which fascia lines the thorax?

Pleura

Which fascia lines the abdomen?

Peritoneum

Pleura and peritoneum is separated by__________?

The diaphragm


4/45

What are the functions of fascia?

Stabilizes and maintains posture

Limits muscle or group of muscles w/I givenarea

Prevents muscles form tearing and breaking

Serves as an extensive water storage system Assists in venous/ lymphatic flow


5/45

Which layer of fascia is able to store water?

Deep fascia

What happens when the deep facia becomesdehydrated?

Deplete smoothhydrated matrix

Creates adherence to tissues as if partially glued

Creates tension, fatigueischemia

Leads to build up of metabolic toxins


6/45

Which soft tissue techniques may be used forhypertonic muscles?

PIR

PFS SELF STRETCH

What does PIR stand for?

Post isometric relaxation (gentle)

What is PFS stand for?

Post facilitation stretch (more aggressive)

What does PNF mean?

Proprioceptive Neuromuscular Facilitation


7/45

PNF comes from which occupation?

PT

Muscle Energy Technique (MET) comes from which occupation?

Osteopathy

What is PNF?

Any therapeutic maneuver that uses proprioceptive , cutaneous and or

auditory input to facilitate or inhibit movement

What is the neurophysiological basis of PNF?

Primarily based on stretch reflex involving 2 types of receptors1. Muscle Spindle (MS)

2. Golgi Tendon Organ (GTO)


8/45

What five things can cause muscle weakness?

Concerned with quality of musclesspringiness

Normal, healthy muscle = smooth springyquality with normal length

Shortened muscle due to spasm = harder

springy quality Shortened muscle due to contracture = little

or no spring


9/45

What are the 2 inhibitory neurological phenomena?

Reciprocal inhibition

The simultaneous relaxation of one muscle and the

contraction of its antagonist Autogenic inhibition

The reflex inhibition of a motor unit when excessivetension, as monitored by the Golgi tendon organs, is

applied to the muscle fibers that it triggers. Thisprotective response prevents the muscles form exerting

more force than the tendons can tolerate.


10/45

In upper crossed syndrome, which muscles are prone totightness?

PLUS

Pectoralis Major

Levator Scapular Upper Traps

SCM

In upper crossed syndrome, which muscles are prone to

weakness? Deep Neck Flexors

Mid and Lower Traps

Rhomboids


11/45

In lower crossed syndrome, which muscles are proneto tightness?

Hip Flexors

Erector Spinae

Hamstrings

In lower crossed syndrome, which muscles are proneto weakness?

Gluteus minimus

Gluteus medius Gluteus Maximus

Abdominals


12/45

In layer syndrome, which upper body muscles aretight?

LUCE

Levator spinae

Upper Traps

Cervical Erector Spinae

In layer syndrome, which upper body muscles areweak?

Rhomboids Mid and Lower Traps

Serratus Anterior


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What muscles are tight in the thoracic area inlayer syndrome?

Thoracic Erector Spinae

Which muscles are weak in the lower body inlayer syndrome?

Thoracic Erector Spinae

Hamstrings

Which lower body muscle gets weak in layersyndrome?

Lumbar Erector Spinae


14/45

Which type of muscles are prone to tightness?

Postural muscles

Which muscles are postural muscles?

HAT PER QTIP

Hamstrings

Adductors

Triceps surae (Gastrocs and Soleus)

Pectoralis major

Erector spinae

Rector femoris

Quadratus Lumborum Tensor Fascia Lata

Iliopsoas

Piriformis


15/45

What is the neurophysiological basis of PNF?

Primarily based on stretch reflex involving 2

types of receptors 1. Muscle Spindle (MS)

2. Golgi Tendon Organ (GTO)


16/45

What are some relative contraindications to

stretching and muscle relaxation?

K

nown or suspected osteoporosis Prolonged immobilization of tissue

Joint pain or muscle soreness lasting greater

th

an 24h

ours Be mindful of pathology and stages ofhealing


17/45

What are absolute contraindications tostretching and muscle relaxation?

Acute (inflammatory) phase ofhealing

Patient is unable to relax Presence of primary muscle disease or

inflammatory arthropathy

Pain before resistance of movement during

PROM Recent fractures

Abnormal joint end feels


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What are some Indications for Stretching & MuscleRelaxation?

Reduce pain & its associated increase in muscle tone

Correct postural faults

Correct ms imbalances to improve proper movementpatterns

Regain normal ROM of soft tissues

Maintain/increase flexibility prior & after

strengthening exercises Prevent or minimize risk of musculotendinous injuries

related to specific physical activities and sports


19/45

What are the 6 grading of muscle strength?

5: (Normal) contraction against considerable resistance

4: (Good) contraction against moderate resistance

3: (Fair) contraction against gravity; no resistance 2: (Poor) contraction only when gravity is eliminated

1: (Trace) slight contraction, no movement (twitch)

0: No evidence of contraction


20/45

What are the grades of tenderness rating of soft tissue?

GRADE DEFINITION0 No tendernessI Tenderness to palpation WITHOUT grimace or flinch

II Tenderness WITH grimace &/or flinch to palpation

III Tenderness withWITHDRAWAL (+ "Jump Sign")IV Withdrawal (+ "Jump Sign") to nonnoxious stimuli

(ie. superficial palpation, pin prick, gentlepercussion)


21/45

What is joint end feel?

The quality of movement perceived by the practitionerat the very end of the available range of motion.

What is the quality of normal muscle end feel?

Smooth, springy quality with normal length

What is the quality of muscle end feel whenshortened due to spasm?

Harder spring quality

What is the quality of muscle end feel whenshortened due to contracture?

Little or no spring


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What are the six types of joint end feel?

1. Bone-to-bone (elbow extension)

2. Soft tissue (knee flexion) 3. Spasm (muscle guarding)

4. Capsular (knee rotation)

5. Springy block (loose body in joint) 6. Empty Feeling


23/45

What is myofascial pain syndrome?

a general term to describe a regional pain syndrome of anysoft tissue origin

what is the cause of myofascial pain syndrome?

The sensory, motor and autonomic symptoms caused bymyofascial trigger points.

What is a myofascial trigger point?

Cluster of electrically active loci each of which is associatedwith a contraction knot and a dysfunctional motor endplatein skeletal muscle

What is tenderness?

Pain upon palpation


24/45

The MFTrP is __________ painful oncompression?

ALWAYS

What are some direct stimuli causes of triggerpoints?

Acute overload

Overwork fatigue (Repetitive Stress Injury, Poor

Posture)Radiculopathy

Gross trauma


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What are the symptoms of triggers points?

Latent TrP = no spontaneous pain

Active TrP = clinical complaint of myotomal pain (dull, diffuse, achy,referred)

Sometimes complains of numbness or paresth

esia rath

er th

an pain Increased muscle tension and shortening

Spasm of other muscles

Weakness of involved muscle (from reflex motor inhibition withoutatrophy of the affected muscle)

Loss of coordination by involved muscle

Decreased work load tolerance

Distorted weight perception of lifted objects


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What are the symptoms of triggers points?

Sleep disturbances

Involved limb may feel cold compared to other side (reflexvasoconstriction)

Abnormal sweatingPersistent lacrimation

Persistent coryza

Excessive salivation

Pilomotor activitiesImbalance

Dizziness

Tinnitus


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What are some signs of trigger points?

Palpable tenderness (tender nodule upon palpation)

Restricted stretch range of motion (shortened upon

muscle length test) Taut band fiber with LTR

Characteristic referred pain, tenderness and/ordysesthesia (hypesthesia, numbness, paresthesia)

Painful contraction (emphasized when contraction inshortened position)

Weakness upon muscle strength test


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What are some indirect stimuli causes of trigger

points?

Other TrPs

Abnormal (Paradoxical) Breathing

Joint dysfunction

Emotional Stress

Nutritional deficiency (esp. H2O soluble vitamins)

Heart, gallbladder and other visceral disease


29/45

What are the associated joint fixations

for the given muscle trigger points:

TrP- SCM, Suboccipitals

Craniocervical Junction

TrP - Shoulder Girdle Muscles

Cervicothoracic Junction

TrP- Pectoralis, Rhomboids

Midthoracic Spine

TrP Subscapularis

Upper Ribs


30/45


for the given muscle trigger points?

TrP - Psoas, Quadratus Lumborum,ThoracolumbarErector Spinae,Latissimus Dorsi

Thoracolumbar Junction

TrP -Rectus Femoris

L3-4

TrP Piriformis

L4-5 TrP - Iliacus

L5-S1


31/45


for the given muscle trigger points? TrP -Rectus Femoris

L3-4

TrP Piriformis

L4-5

TrP - Iliacus L5-S1

TrP - Biceps Femoris*

Tibiofibular Joint*

TrP - Plantar Muscles

Tarsometatarsal Joints TrP - Biceps Brachii, Triceps, Supinator,Finger Extensors

Elbow & Midcervical Spine


32/45

TrP that causes a clinical pain complaint

Active

TrP in one ms. that occurs concurrently with aTrP in another ms. One may have induced the

other or bothmay stem from the same

mechanical or neurological origin

Associated:


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TrP at musculotendinous junction and/or atosseous attachment of the muscle thatidentifies TrP at musculotendinous junction

and/or at osseous attachment of the musclethat identifies

Attachment:

TrP closely associated with

dysfunctionalendplates & located near center of ms. belly

Central:


34/45

TrP responsible for activating one or more satelliteTrPs. Clinically, a key TrP is identified when inactivationof that TrP also inactivates the satellite TrP

K

ey:

TrP that is clinically quiescent with respect tospontaneous pain. It is painful only when palpated.May have all the other clinical characteristics of anactive TrP and always has a taut band that increases ms

tension and restricts ROM

Latent:


35/45

Central TrP that was apparently activated directly by acute or chronicoverload or repetitive overuse of the ms in which it occurs and was notactivated as a result of TrP activity in another muscle

Primary:

A central TrP that was induced neurogenically or mechanically by the

activity of a key TrP. May develop in the zone of reference of the keyTrP, in an overloaded synergist that is substituting for key ms, in anantagonist countering increased tension of the key

ms, or in a ms linked apparently only neurogenically to the key TrP.

Satellite:


36/45

Transient contraction of a group of tense

muscle fibers (taut band) that traverse a TrP.

Contraction is in response to stimulation

(usually by snapping palpation or needling) of

the same TrP, or sometimes of a nearby TrP

Local Twitch Response:


37/45

Soleplate ending where a terminal branch ofthe axon of a motor neuron makes synapticcontact with a striated muscle fiber

Motor Endplate:

Simultaneous expansion of the chest and

contraction of abdominal muscles that pullsthe abdomen inward during inhalation

Paradoxical Respiration


38/45

Vasoconstriction (blanching), coldness, sweating,pilomotor response, ptosis, and/or hypersecretion thatoccur in a region separate from the TrP causing thesephenomena. The phenomena usually appear in thesame general area to which that TrP refers pain

Referred Autonomic Phenomena:

Region where some, but not all, patients experiencereferred pain beyond the essential pain zone, due togreater hyperirritability of a TrP

Spillover Pain Zone:


39/45

Group of tense muscle fibers extending from aTrP to the muscle attachment. The tension of thefibers is caused by contraction knots that arelocated in the region of the TrP

Taut Band:

Specific region of the body at a distance from aTrP, where phenomena (sensory, motor, and/orautonomic) caused by the TrP are observed

Zone of Reference:


40/45

The region of referred pain that is present in

nearly every patient when the TrP is active

Essential Pain Zone:

General pain response of the patient, who

winces, may cry out, and may withdraw in

response to pressure applied on a TrP

Jump Sign:


41/45

What important steps are important to PIR

procedure in general?

1. Patient Positioning

2. Engaging the Barrier

3. Isometric Contraction

4. Synkinesis (Breath

ing & Eye Movement) 5. Feel the Release and Lengthen the Muscle


42/45

Describe the PIR procedure, step by step?

1. Isolate target muscle

2. Lightly lengthen to barrier

3. Patient contract (isometric) withminimal force (10% of

max) 4. Breath-in and hold

5. Hold contraction and breathe for 8 to 10 sec

6. Instruct Pt to breathe out and relax (let it go)

7.W

AIT until you feel relaxation 8. Take up slack (new end range)

9. Start procedure again at this new end range

10. Repeat 3 to 5 times or until no further gain


43/45

Describe the general procedures for PFS?

1. Position Pt so that target muscle at 50% length

2. Aggressively contract (isometric) for 7 to 10

sec (maximum strength) 3. Pt instructed to suddenly and completely relax

4. WAIT for latency (1-2 sec)

5. Quickly and aggressively stretch muscle 6. After stretch, return muscle to new midpoint

and repeat 3 to 5 times


44/45

Trigger Point Pressure Release

1. Apply slowly increasing, nonpainful

pressure over a TrP until a barrier of tissue

resistance is encountered.

2. Maintain contact until the barrier releases.

3. Increase pressure to reach new barrier to

eliminate the TrP tension and tenderness.


45/45

Spray & Release (Spray & Stretch)

1. Vapocoolant (can be substituted with ice) is sprayedover skin where the TrP is located in the direction ofthe muscle fibers with repeated parallel sweeps

2. After first sweep, pressure is applied to take up theslack in the muscle and is continued as additionalsweeps of spray are applied

3. Sweeps of spray are extended to cover the referredpain pattern of that muscle

4. Steps 1, 2 and 3 may be repeated 2 or 3 times untilthe skin becomes cold to the touch or when the ROMreaches maximum

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Soft Tissue Midterm 1