Move Better, Feel Better: A Movement Based Approach to Soft Tissue Mobilization for the Upper Body: Summary 33
Indications/Contraindications for Manual Techniques Indications Contraindications
Precautions
• Movement dysfunction • Musculoskeletal pain • Peripheral neuropathic pain • Muscle inhibition • Hyper-/hypotonicity • Tendinopathies • Edema reduction
• Open wound • Skin infection • Unhealed fracture • DVT/thrombophlebitis • Uncontrolled hypertension • Inflammatory conditions due to infection • Hematoma/myositis ossificans • Osteomyelitis • Decreased sensation in affected area • Pregnancy (first trimester over abdomen)
• Pregnancy (second and third trimesters)
• Anticoagulants • Varicose veins • Cancer • Autoimmune disorders • Chronic heart failure • Hematoma • Rheumatoid arthritis
IASTM
Proposed Benefits: • Pain relief/improved mobility • Neurophysiologic response (gate theory, DNIC or CMP, neuroplasticity) • Mechanical mechanisms (mechano-transduction, gliding of tissues, fluid dynamics) Application: • Can use tools made of different materials (plastic, metal) and different shapes: ○ Concave edge—more gentle; convex tool—more aggressive ○ The more vertical the tool, the more aggressive • Scan the tissue first to assess for texture (bumpy, gritty) • Start treatment in direction of least resistance/pain (proximal to distal, distal to proximal) • Start with tissue on slack and then can add stretch to increase intensity for reducing tone
Pros
Cons
• Patients report relief
• No strong research • Might not be better than placebo • Not a standalone treatment
and improved mobility
• Can be an effective adjunct treatment to exercise
Research: • Reduced pain
• Increased fibroblast proliferation in tendons • Improved collagen formation and orientation in ligaments • Reduced size/improved tissue quality for chronic tears • Physiological changes via: ○ Increased blood flow ○ Reduced tissue viscosity ○ Myofascial release ○ Interruption of pain receptors ○ Improvement of flexibility
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