STM & MFR

Question 1

glycoaminoglycans (GAG’s) of the ground substance functions as what?

Answer 1

• Lubricant & buffer
• helps determine cohesiveness, viscosity & rigidity of the tissues

Question 2

How many times is the J-Stroke performed?

in what direction?

Answer 2

2-3 times

in the direction of the restriction

Question 3

 Ground substance mobility decreases with:

Answer 3

1. age
2. immobility
3. muscle atrophy/trauma (“dehydration”)

Question 4

Causes of Soft Tissue Restrictions:

Answer 4

1. intermolecular cross-linking
2. scar tissue adhesions
3. ground substance dehydration
4. lymphatic stasis & interstitial swelling
5. neuro-reflexive/muscle guarding

Question 5

What is fascia composed of?

Answer 5

irregular sheaths of collagen & elastin fiber

Question 6

STM indications:

Answer 6

1. decrease soft tissue mobility
2. adaptive shortening
3. soft tissue injury (not acute)
4. scar release
5. pain

Question 7

Soft tissue restrictions are defined via…

Answer 7

• depth & direction (using face of clock, quadrants).
• Look for:
  
  • decreased excursion
  • hard end-feel
  • tissue feeling crunchy, leathery, lumpy or gristly feeling
•  Soft tissue layer concept (“peeling
  layers of an onion”):
  
  • Superficial layers are evaluated & treated before the deeper layers; allows the therapist to exert the least amount of force to treat the deeper restrictions.

Question 8

during TFM cascading technique, assisting hand providing STRETCH or TENSION is place where?

Answer 8

assisting hand is in BEHIND of treating hand

(treatting hand is moving in the direction of the restriction)

Question 9

True or false:

Ground substance consistency influences collagen fiber formation.

Answer 9

True

Question 10

Which STM technique assesses skin’s ability to lift from the underlying structures?

Answer 10

Skin rolling:

Restricted areas will feel painful & skin will be difficult to lift from underlying tissues.

Question 11

increased resistance to movement in fascia occurs due to what?

Answer 11

1. Reduction in GAG’s within the ground substance occurs with immobilization.
2. Dehydration leads to a decrease in lubrication & critical fiber distance.

Question 12

Manual therapy documentation

Answer 12

• Patient position: prone, supine or sitting; make sure to mention that proper draping was used.
• Type of manual therapy: be specific on type of massage, STM or MFR.
• Treatment location(s): be specific
• Duration (min): if more than 1 body part was treated, specify duration for each body part.
• Patient’s response to treatment: ie. decrease pain decrease tightness, increase ROM etc.

Question 13

Cascade of STM Treatment Techniques

Answer 13

1. Position yourself so that the technique can be applied toward the restriction. (DIRECT technique).
2. First, put tissues around the restriction on slack (”passive tissue shortening”).
3. If not successful after 10 seconds, put the tissues around the restriction on stretch to create tension/traction (”passive tissue lengthening”).
4. Unlocking Spiral: Use if the restriction is NOT responding to the sustained pressure & assisting hand techniques.

Question 14

a band or sheet of connective tissue, primarily collagen, basement membrane of the
dermis to the periosteum, that attaches, stabilizes, encloses, and separates muscles and other internal organs:

Answer 14

fascia

Question 15

STM contraindications:

Answer 15

1. malignancy
2. aneurysm
3. acute RA
4. fracture
5. localized infections
6. inflammatory skin conditions
7. ostemyelitis (infection of bone)
8. sites of hemorrhage
9. obstructive edema
10. advance osteoporosis
11. hypermobile joint segment

An aneurysm is an excessive localized enlargement of an artery caused by weakness in the arterial wall.

Question 16

How does STM affect tissues?

Answer 16

1. Some elongation occurs via removal of the inherent crimp within the fiber & its visco-elastic properties.
2. Breaking of covalent bonds & fibers occurs when greater force is placed in the tissue.

Question 17

A whole body evaluation & treatment
approach that looks for fascial strain(s) in the body that can create pain & malfunctions throughout out the body that do NOT always follow a dermatomal pattern.

Answer 17

Myofascial Release (MFR)

Question 18

Dysfunctional tissue that needs to be treated feels…

Answer 18

• hard end feel
• feels hard, hot or tender
• feels crunchy, leathery, lumpy or gristly

Question 19

RED flags:

Answer 19

• Fever > 100/chills/night sweats
• Unexplained wt loss >10 lbs within 3 mos
• Malaise & loss of appetite
• Rest/night pain (not relieved with rest or awakens pt at night)
• Saddle anesthesia/changes in bowel &
  bladder function

Question 20

MFR techniques:

Answer 20

1. Sub-occipital release: headaches &
   upper cervical pain. 5 min.
2. Cross hand release: 5 min.
3. Lumbosacral decompression: 5 min
4. Myofascial stretching: 5 min in each fascial barrier

Question 21

STM techniques:

Answer 21

1. Skin gliding
2. Finger sliding
3. Skin rolling
4. Bony contours

Question 22

Patient preparation to STM:

Answer 22

• explain purpose of treatment
• patient position (comfortable & access to body part)
• patient instruction (to breath & imagine tissue “melting like butter” to try to soften or relax the area)
• use specific force (precise depth, angle & direction) directly on the restriction at their end range.

Question 23

Which STM technique assesses soft tissue restriction along the bony contours (iliac crest, scapula, patella etc).

Answer 23

Bony Contours Assessment

Question 24

One of the functions of fascia is shock absortion and transmition of mechanical forces. “Because we are not meant to be acontainer of energy, we are a conductor of energy.”

Answer 24

Dr. Quijano

Question 25

Functions of fascia:

Answer 25

1. Separates muscles and structures to allow independent function while joining them as a functional unit 2. Shock absorption & transmission of mechanical force. 3. Exchange of metabolites between fibrous elements, the circulatory & lymphatic systems. 4. Stores energy in adipose tissue. 5. Protect against the spread of infection. 6. Allows for muscle play (normal muscle mobility in relation to surrounding structures).

Question 26

What is the pt going to experience durinf the application of the STM J-stroke technique?

Answer 26

Patient might experience a burning/pulling sensation from the treatment.

Question 27

How many times is the STM vertical stroke technique performed? in what direction? in what position?

Answer 27

2-3 times in the direction of the restriction position the area in stretch

Question 28

What does a myofascial release feel like?

Answer 28

* burning/ripping sensation, pulsation tingling or heat * Symptoms often intensify as the release occurs, then decrease/dissapear when it is complete

Question 29

Which STM technique is used to determine **precise location & direction** of restriction?

Answer 29

Finger gliding

Question 30

What STM techniques must be followed if there is no change after 10 seconds?

Answer 30

Cascading

Question 31

**Elements** of connective tissue:

Answer 31

1. Elastin fibers 2. Reticulin fibers 3. Fibroblast: "fiber producing" 4. **Collagen fibers:** in fascia, tendons, ligaments & joint capsules. High tensile 5. **Ground substance:**"fluid element" vicous gel made of H2O and carbohydrate. * composed mainly of glycoaminoglycans (GAG’s), proteoglycans & tropocollagen

Question 32

STM techniques that is performed 3-5x that can be use to **trace/clear** borders of iliac crest, medial border of scapula, spinous process, ischial tuberosity etc.

Answer 32

Bony contour

Question 33

How do we know what to treat in STM?

Answer 33

* Normal tissues = springy end feel * Dysfunctional tissues: * hard end feel * feels hard, hot or tender * feels crunchy, leathery, lumpy or gristly

Question 34

What is the **ground substance composed** of?

Answer 34

* "fluid element" vicous gel made of H2O and carbohydrate: * composed mainly of glycoaminoglycans (GAG’s), proteoglycans & tropocollagen

Question 35

What is **Intermolecular Cross-linking**?

Answer 35

1. Reduction in GAG’s within the ground substance occurs with **immobilization**. 2. Dehydration leads to a decrease in lubrication & critical fiber distance. 3. **End result:** increased resistance to movement

Question 36

Which STM technique is used to initially determine the general regions of restrictions (quadrant) and assess skin’s extrinsic mobility to slide in relation to underlying structures?

Answer 36

**Skin gliding**

Question 37

What do you assess during STM **sking gliding** technique?

Answer 37

quality of extensibility & end feel.

Question 38

Other STM techniques:

Answer 38

* Vertical stroke * Transverse stroking (90 degrees) * Scar release: use two hands (2-3 min) in the direction of greatest restriction * Bony contour:

Question 39

Breaks up cross-links in the fascia & increase tissue mobility.

Answer 39

STM, J stroke technique *Performed 2-3x in the direction of restriction with a torque at the end of the motion using 2 or 3 fingers, knuckle or elbow with counter-pressure from heel of other hand.*

Question 40

Of the four types of tissue, which one is **fascia**? 1. Connective 2. Epithelial 3. Muscle 4. Nervous

Answer 40

**connective tissue**

Question 41

Which layer of fascia is **thicker** and **stronger**?

Answer 41

**deep layers** superficial layers: thinner & more delicate

Question 42

during TFM cascading technique, the assisting hand providing SLACK is placed where?

Answer 42

assisting hand is IN FRONT the treating hand (treatting hand is moving in the direction of the restriction)

Question 43

What do you tell the pt prior to myofascial release?

Answer 43

1. purpose of treatment 2. sensations they may feel: **burning /ripping sensation, pulsation, tingling or heat** 3. Drink 5-8 glasses of water

Question 44

used to break up cross-restrictions of the collagen of the fascia

Answer 44

Soft Tissue mobilization

Question 45

Where do you want to be in the stress/strain curve during STM?

Answer 45

**Plasticity** region

Question 46

How many times do you perform STM tranverse stroking technique? what is the position of the therapist's hands?

Answer 46

Up to 10 times MCP flexes in 90 degrees

Question 47

How long do you apply STM scar release? what is the position of the hands?

Answer 47

2-5 minutes Use 2 hands: bottom hand is for direction & top hand applies the force.