Move Better, Feel Better: A Movement-Based Approach to Soft Tissue Mobilization for the Lower Body: Summary 10
RESEARCH SUMMARIES • Improved pain thresholds following 6 sessions of IASTM in the upper trap. • IASTM can improve hamstring flexibility. • Cupping affects hemodynamic, immune regulation and metabolism and can offer pain relief. • Cupping resulted in reduced pain in patients with fibromyalgia after 18 days. • Kinesiotaping reduced pain and performance on SL hop test for patients with patellofemoral pain at 6 and 12 weeks post follow up. • KT resulted in reduced knee pain with walking in patients with OA. 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): more difficult to treat, less is more • 4 R’s of PSE: ○ Rule out red flags ○ Reassure ○ Reconceptualize ○ Recalibrate • Biopsychosocial model: ○ 40% of health outcomes is based on social and economic circumstance ○ 30% of health outcomes are associated with health behaviors and lifestyle Therapeutic Alliance Improved therapeutic alliance leads to overall improved outcomes and reduced pain for the patient. Key characteristics to 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.
INTRODUCTION Instrument assisted soft tissue mobilization (IASTM), cupping therapy, and kinesiology taping can stimulate the central nervous system, helping with pain, mobility, and performance. Passive treatments are meant to
enhance active treatments, not replace them. Concepts of Movement-Based Soft Tissue Mobilization (STM)
• Movement is the focus of the approach: ○ Restricted? Painful? Not well controlled? Important to the client? ○ Incorporate movement in your treatment • Test → treat → retest: this is the foundation of manual therapy • Regional interdependence: ○ All joints need mobility and stability ○ If one joint lacks mobility, another will make up for it to compensate ○ Always assess above and below the affected joint • Facilitated vs inhibited: ○ Some muscles are too tight (facilitated) and others are therefore inhibited due to not being in an optimal position • Hands-on treatments only have short term effects: combine treatments and encourage movement for greatest response Foundations of Movement-Based Soft Tissue Mobilization (STM) STM incorporates multiple layers including the fascia, muscle, and central nervous system (CNS). Different techniques stimulate different mechanoreceptors, which allows for increased neurosensory input to the brain. Pain relief is thought to primarily be a result from this increase in afferent stimulus to the CNS and improved proprioception. This neuro-physiological response is explained by several theories and concepts: • Gate theory : Non-noxious input suppresses pain input to the brain • Diffuse noxious inhibitory control (DNIC) : Descending modulation from CNS reduces pain, triggered by sustained nociceptive input. (Chronic pain is thought to be the failure of this system) • Cortical mapping : There are anatomically discrete areas of the brain that represent movement, position, and health: ○ Chronic pain “smudges” these maps, altering motor control
○ Increasing afferent input can improve neuroplasticity and help to “reshape” this map
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