Post on 08-Apr-2018
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Soft Tissue
Midterm Exam
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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
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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
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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
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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
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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
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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)
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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
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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.
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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
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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
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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
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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
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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)
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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
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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
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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
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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)
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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
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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
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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
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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
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What are the associated joint fixations
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
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What are the associated joint fixations
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
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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:
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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:
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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:
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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:
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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
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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:
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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:
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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:
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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
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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
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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
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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.
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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