HEMME APPROACH TO SOFT-TISSUE THERAPY

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injuries. Factors that contribute to soft-tissue impairments are fatigue, psychological stress, environmental factors, and somatic or visceral reflexes. Some impairments develop without apparent cause (idiopathic conditions), while others are caused by inappropriate treatment (iatrogenic disorders). Most soft-tissue impairments are caused by trauma and the most common sequel is tissue damage, spasm, edema, pain, and ultimately myofibrosis. The onset of soft-tissue impairments can be rapid or insidious. An example of rapid onset is trauma where the causes for impairment are easy to identify and sudden. Insidious onset implies the symptoms are few and the causes for impairment are gradual and subtle. An example of insidious onset is neck and shoulder pain caused by incorrect posture. The two most common complaints in soft-tissue therapy are pain and loss of movement. Characteristic signs of soft-tissue impairment are decreased range of movement (hypomobility), increased muscle tone (hypertonia), adhesions, contractures, edema, and trigger points. Signs of sympathetic hyperactivity such as perspiration, pilomotor responses, and changes in skin color or temperature are common in acute cases, and complaints of general weakness (asthenia), rapid fatigue, and depression are common in chronic cases. Symptoms reported by the patient are normally less reliable as indicators of a soft-tissue impairment than signs witnessed by the examiner. Various medical terms describe conditions with characteristics similar to those found in soft-tissue impairments. • Fibrositis: inflammation of fibrous tissue. • Myositis: inflammation of voluntary muscles. • Fibromyositis: inflammation of fibromuscular tissue. • Myofibrositis: inflammation of the perimysium. • Perimyositis: inflammation of connective tissue around a muscle. • Fascitis: inflammation of fascia. • Myofibrosis: replacement of muscle tissue by fibrous tissue. • Muscle rheumatism: muscular conditions characterized by pain, tenderness, local spasm, stiffness, myalgia, and myofibrosis. 2 <strong>HEMME</strong> Approach to Soft-Tissue Therapy
These conditions point out three characteristics common to most softtissue impairments: (1) inflammation of soft tissue, (2) replacement of muscle tissue by fibrous tissue, and (3) pain. These three factors contribute to a self-perpetuating sequence called a pain cycle. During the initial stage of an injury (acute stage, one to three days), trauma is followed by inflammation, edema, impaired circulation, spasm, ischemia, hypoxic damage, and pain. The effects of hypoxic damage are similar to those precipitated by the injury that caused stage one. By stage two (sub-acute stage, three to seven days), the victim's range of motion is limited by pain, muscle guarding, and splinting. In stage three (early chronic stage, seven days to six weeks), if limitations on range of motion continue, movements become even more restricted as proliferation of connective tissue produces scar tissue, adhesions, or contractures. During stage four (late chronic stage, longer than six weeks), small movements are sometimes enough to irritate or rupture restricted tissues and reproduce the physiologic changes characteristic of stage one. Entrapment neuropathies and myofascial trigger points develop in stage four. By stage four, disuse atrophy may or may not be present, depending on the extent of disability. Even if present, atrophy can be difficult to identify if losses in muscle mass are offset by fluid accumulation. When this occurs, the circumference of an injured part may be smaller after treatment than before treatment if therapy dissipates collected fluids to other body parts. With the advent of modern science came two different types of medicine: emergency and rehabilitation medicine. Emergency medicine seeks to preserve life and rehabilitation medicine seeks to improve the quality of life after survival. The purpose of therapy is to support the parts of the wound healing that are beneficial and to limit the parts that cause disability. Whereas acute pain can be useful because it warns the body of actual or potential tissue damage, chronic pain can be disabling. Without therapy, acute pain can generate self-perpetuating pain cycles that may continue for years. Once pain becomes chronic, the initial causes are difficult to identify or treat. Painkillers, anti-inflammatories, and muscle relaxants are rarely efficacious, and surgery without definitive laboratory evidence is more likely to aggravate than correct the problem. Unlike conservative, noninvasive forms of treatment, surgery traumatizes the body and precipitates scar tissue. 3 <strong>HEMME</strong> Approach to Soft-Tissue Therapy
Page 1 and 2: HEMME APPROACH TO SOFT-TISSUE THERA
Page 3 and 4: iii HEMME APPROACH SOFT-TISSUE ANSW
Page 5 and 6: v HEMME Approach to Soft-Tissue The
Page 7 and 8: vii TABLE OF CONTENTS Section Page
Page 9 and 10: ix Section Page NEUROMUSCULAR THERA
Page 11: 1 INTRODUCTION Soft-tissue therapy
Page 15 and 16: (D) Although pain cycles are seldom
Page 17 and 18: and protective muscle shortening ar
Page 19 and 20: Although "train, don't strain" is m
Page 21 and 22: The same trend applies to allopathi
Page 23 and 24: 13 CHAPTER SUMMARY THREE SIGNS OR S
Page 25 and 26: 15 HEMME APPROACH Soft-tissue thera
Page 27 and 28: whereas MODALITIES, MANIPULATION an
Page 29 and 30: 19 CHAPTER SUMMARY FIVE STEPS IN TH
Page 31 and 32: Since little can be done to change
Page 33 and 34: 23 MECHANISM OF INJURY F FORCE Dire
Page 35 and 36: 25 CHAPTER SUMMARY THREE WORDS THAT
Page 37 and 38: The sensitivity of the hand varies
Page 39 and 40: 29 MUSCLE TESTING Manual muscle tes
Page 41 and 42: 31 (1) Active Range-of-Motion Testi
Page 43 and 44: 33 (4) Resisted Range-of-Motion Tes
Page 45 and 46: pull of the muscle being tested, ot
Page 47 and 48: knows nothing of individual muscles
Page 49 and 50: 39 cardiac decompensation Failure o
Page 51 and 52: 41 PAIN Pain is often defined as th
Page 53 and 54: cases of soft-tissue pain and disab
Page 55 and 56: The distribution of pain within a s
Page 57 and 58: 47 CHAPTER SUMMARY FOUR CLASSICAL M
Page 59 and 60: 49 ALTERNATIVES The HEMME APPROACH
Page 61 and 62: First, separate the problem into pa
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53 MODALITIES Modalities are used i
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changes in temperatures. This expla
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The term hunting reaction implies t
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Contraindications specifically for
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61 CHAPTER SUMMARY FOUR INDICATIONS
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63 MANIPULATION Soft-tissue therapy
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65 B. Reciprocal Inhibition: when t
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experience another cycle: (1) pain
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69 Table of Figures Figure 1: Belly
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HEMME Approach to Soft-Tissue Thera
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HEMME Approach to Soft-Tissue Thera
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75 TRIGGER POINT THERAPY Trigger po
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cause spontaneous contraction of th
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• Third, trigger point therapy re
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pressure that normally causes pain
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83 TRIGGER POINT THERAPY VS. CROSS-
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The immediate goal of neuromuscular
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Facilitation techniques can reverse
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89 FOUR WAYS TO INHIBIT A MUSCL
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In situations where muscles are sho
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antagonist, (2) relax the antagonis
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stretch. The technique of stretchin
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97 FACILITATORS Activation of Stre
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concentration of muscle spindle cel
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101 CONNECTIVE TISSUE THERAPY Of al
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103 substance that limits tissue mo
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105 Range-of-motion stretching and
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107 the skin away from the patient'
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109 STRETCHING Unlike the stretchin
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111 Although measurements can be ta
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113 The recommendations for regular
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115 Whenever heat is used to facili
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117 stretching be done slowly becau
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119 CHAPTER SUMMARY THREE HEMME LAW
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121 FOUR TYPES OF FORCE USED IN SOF
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123 FOUR GOALS OF CONNECTIVE TISSUE
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125 overstressed. Even though an ea
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127 great enough to overcome extern
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129 The most recent theories now su
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131 Complete positive transfer is n
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133 OBJECTIVES SATISFIED OR NOT SAT
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135 SELECTED BIBLIOGRAPHY Alter, Mi
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137 Clemente, Carmine D. 1981. Anat
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139 Fryette, Harrison H. 1954. Prin
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Kendall, Florence Peterson, Elizabe
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143 Licht, Sidney, ed. 1965. Therap
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145 Noback, Charles R., and Robert
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Shriber, William J. 1975. A manual
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149 GLOSSARY acute Short duration,
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151 cocontraction Mutual contractio
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153 exteroceptor A sense organ rece
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155 hypomobility Decreased mobility
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157 myofascial Involving muscles an
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159 rebound tenderness Pain or disc
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161 synergist A muscle functioning
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163 6. What does the first letter o
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165 16. Which structures are least
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167 26. What is another name for st
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169 36. Which concept explains why
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171 46. Which word defines loss of
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173 Hilton's law 43, 64, 74 Hooke's
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I QUICK REFERENCE GUIDE FOR NEUROMU
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III RECIPROCAL INHIBITION (RI) Prac
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HEMME APPROACH TO SOFT-TISSUE THERAPY

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