Antibiotics:

https://www.drugs.com/article/antibiotics.html

 

Inflammatory process

Werner p. 15

HERP L.

H= heat

E = edema

R = redness

P = pain

L = loss of function

Purpose of inflammation:

• To protect the body from pathogenic invasion

• To limit the range of contamination

• To prepare damaged tissue for healing

Possible outcomes of an inflammatory response

• Complete resolution with no significant tissue changes

• Accumulation of scar tissue

• Chronic inflammation, possibly including the formation of cysts and abscesses

Vascular activity during inflammation:

• The vascular component of inflammation comes into play when tissue is damaged

• Vasoconstriction occurs during the first moments

• This ends within moments after a minor injury

• May last several minutes after a more serious injury

Vasodilation is the next step in vascular activity

• Damaged cells release a host of chemicals

• Some increase the permeability of blood vessel walls

• Some reinforce capillary dilation

• Some attract platelets

• Some slow blood flow away from the area

Vasodilation is short-lived with minor injuries; it may last for several days with more severe injuries.

After injury, many types of cells are recruited to manage tissue damage and contamination risk

• Endothelial cells

• Release chemicals that activate platelets

• Platelets

• Release several chemicals that interact with plasma proteins

• White blood cells

• Several types of WBCs participate in the inflammatory process

• Fibroblasts

• Produce collagen and other components of extracellular matrix

Chemical activity during inflammation:

All cells involved in inflammation are coordinated by chemical messages that tell them what to do

• Some increase pain sensation and the permeability of capillaries

• Some release histamine and serotonin

• Some activate platelets

• Some form other inflammatory chemicals

The healing process:

When tissues are injured, the body automatically repairs the damage with regeneration and with fibrosis

• Regeneration: the process of replacing destroyed cells

• Fibrosis:  the production of fibrous connective tissue

​

The tissue repair process requires additional resources from the body

• Adequate rest

• Hydration

• Nutritional protein

• Vitamins

Massage can facilitate the healing process

• Restores movement

• Creates functional scar tissue

• Increases the circulation of blood and lymph

 

NMT (neuromuscular therapy):

What are the goals of NMT?

• Identify and isolate tissue irregularities

• Reduce ischemia

• Normalize reflex activity

• Eliminate trigger points

• Restore normal ROM

• Release adhesions and fascial binding

• Eliminate perpetuating factors

• Sport injuries

• Repetitive strain injuries

• Car accident victims

Contraindications:

• Large bruises

• Phlebitis (expansion of blood vessels)

• Varicose veins

• Open wounds

• Skin infections

Laws of NMT (refer to handout “definitions and laws of NMT”).

 

Physiology of muscle contraction

• Fascicles (bundles of muscle fibers)

• sacromere

• Myofilaments (actin and myosin)

• ATP

• Calcium

Energy crisis hypothesis

Gate control theory (hyperstimulation helps to relieve pain) example:  cryoderm, icy hot, flexol

 

Clinical characteristics of trigger points:

• Myofascial pain is referred from trigger points in specific patterns characteristic of each muscle.

• Trigger points are activated directly by acute overload, overwork fatigue, direct trauma, and by chilling

• Trigger points are activated indirectly by other trigger points, visceral disease, arthritic joints, and by emotional distress.

• Active trigger points vary in irritability from hour to hour and day to day.

 

Clinical characteristics of trigger points:

• Trigger point irritability may be increased from latent to active by many factors (sustained shortening, chilling, fatigue or a viral illness)

• The signs and symptoms of trigger point activity long outlast the event that caused the activation of said trigger point.

• Trigger points often cause phenomena other than pain.

• Myofascial trigger points cause stiffness and weakness in affected muscle.

Findings on examination:

• When active trigger points are present, passive or active stretching increases pain

• The stretch range of motion is restricted

• Pain is increased when the affected muscle is strongly contracted against fixed resistance

• The maximum contractile force of an affected muscle is weakened

• Deep tenderness and dysesthesia are referred by active TP’s to the zone of reference…

Findings:

• Muscles in the vicinity of an active trigger point feel tense to palpation

• The trigger point is found in a palpable band as a spot of exquisite tenderness.

• Digital pressure of a trigger point usually elicits a “jump sign”.

• Snapping palpation usually elicits a local twitch response

• Moderate, sustained pressure on a sufficiently irritable trigger point causes or intensifies pain in the reference zone.

Positional release:

• Position of greatest ease.  Muscle spindles and Golgi tendon organs.

• SCS was developed accidentally by Dr. Lawrence Jones

• Prior to his death he mapped over 180 tender points and developed specific positions for each tender point

• Over 300 tender points have been mapped

Tender point:

• Small zones of tense, tender, edematous muscle and fascial tissue about a centmeter in diameter

• 4 times more tender than normal tissue

• 18 mapped tender points were used to diagnose fibromyalgia.A patient had to have 11 out of 18 to be considered fibromyalgia.

Local tenderness, singular, local pain (no referral).

Trigger point:

• Local tenderness, taut band, local twitch response

• Singular or occasionally multiple

• Refer pain

Muscle spindle.  Pain receptor.  Sensory neuron, Integration center, motor neuron, effector muscle

Pain-spasm cycle (pain-tension-decrease of circulation and the cycle repeats itself)

*After positional release – slowly stretch the muscle to its barrier, hold for 5 seconds, waiting for tendon reflex to relax further.

Muscle stripping

Friction:

• Muscle identification

• Assessment

• Fibrotic tissues and adhesions

Circular, cross fiber friction (XFF), longitudinal

Proprioceptive neuromuscular facilitation

• Muscle spindle – if stimulated muscle contracts

• Golgi tendon organ – if stimulated muscle relaxes

• Utilizes specialized receptors in the nervous system

• Post isometric relaxation

• Reciprocal inhibition

Clinical progression:

• Initial contact

• General warming

• Twisting compression

• Specific warming

• Decongestion

• Specific treatment

• Muscle stripping

• Friction variations

• Trigger point therapy (NMT)

• Positional release

• Myofascial therapy

• Muscular lengthening

• Gliding techniques – slow application

• Stripping

• Forearm

• Stretching

• Passive

• Proprioceptive neuromuscular facilitation / muscle energy technique

• Contract and relax

• Reciprocal inhibition

 

Skin

Effects of the integumentary system: p.366

Superficial warming

Sensory receptors kick in

Sebum from sebacious gland – creates sebum for lubrication

• Understand the layered structure of the skin

• Basic function of the skin and integumentary system

• Identify the appendages of the skin such as hair nails, sudoriferous and sebaceous glands

• The nerve supply of the skin and dematomal patterns

• Effects of massage on the skin

 

Functions:

Protect the skin

Protection against infection, dehydration, regulates body temperature, collection of sensory information

Vitamin D synthesis – molecules that convert under the UV rays of sunlight

 

Skin exists in three layers which are made of different tissues:

1. Epidermis – stratified squamous epithelium (epi means superficial)

2. Dermis -fibrous connective tissue

3. Subcutaneous layer – areolar (watery glue) and adipose (adds padding, fat) tissues.

 

Massage on the skin (benefits):

• Effective in reducing scar tissue after burns

• Decrease systems of eczema and other skin conditions

• Helpful in preventing bedsores (decubitus ulcer)

• Reduce stress which may exacerbate dermatological conditions

• Increase skin temp

• Contribute to overall health of skin tissue

 

Treatment plans:

Healing time:  (j.a.i.l.w.e.e.d)

• Age

• Diet

• Lifestyle

• Working out

• Job

• Ergonomics

• Emotional health (mind and stress) and health in general

• Old injury (20 years)

 

Goals:

Decrease pain, increase ROM

 

Short term goals:

• 2 weeks

• Decrease pressure from 8 to 6

• Increase range of motion

• Visual postural changes

Long term goals:

• 2 months

• Self-care

• Little to no pain (ADL – activities of daily living)

• Changing compensation patterns