Move Better, Feel Better: A Movement Based Approach to Soft Tissue Mobilization for the Upper Body: Summary 38
THE SCIENCE Pain science education (PSE) Pain is not just about tissue damage. It is very complex and different for everyone. • Nociception is neither sufficient nor necessary for pain (phantom limb pain) • Peripheral sensitivity : An enhanced sensitivity to local stimulus via decreased activation threshold of the nociceptors • Central sensitivity : Altered CNS processing of nociceptive signals (increased responsiveness from the brain)—typically more difficult to treat; think “less is more” • 4 R’s of PSE: ○ Rule out red flags ○ Reassure ○ Reconceptualize ○ Recalibrate Biopsychosocial Model: • 40% of health outcomes based on social and economic circumstance • 30% of health outcomes associated with health behaviors and lifestyle
Therapeutic Alliance: Improved therapeutic alliance leads to overall improved outcomes and reduced pain for the patient. Key characteristics of good therapeutic alliance include trust, care, and respect. This requires the clinician to have good verbal/ nonverbal communication skills and the ability to collaborate with the patient. This is further enhanced by the actions of the clinician. Both spending time listening to the patient’s needs and concerns and providing hands-on care have been associated with improved therapeutic alliance.
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
• Pregnancy (second and third trimesters)
• Anticoagulants • Varicose veins • Cancer • Autoimmune disorders • Chronic heart failure • Hematoma • Rheumatoid arthritis
• Uncontrolled hypertension • Inflammatory conditions due to infection • Hematoma/myositis ossificans • Osteomyelitis • Decreased sensation in affected area • Pregnancy (first trimester over abdomen)
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