HEMME APPROACH TO SOFT-TISSUE THERAPY

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tissues are stretched beyond their limit, the injuries caused by tearing reactivate or reinforce chronic pain cycles. As a result, pain cycles are a sequence of injury followed by healing, on one hand, and injury followed by re-injury on the other. Failure to understand this principle can lead to inappropriate therapy if acute cases are treated as chronic cases. Heat, for instance, is normally used in chronic cases but not acute cases. If preexisting scar tissue is torn and subcutaneous bleeding is present, heating modalities would only intensify the inflammatory reaction. This principle can also explain why proximal causes for pain and disability in chronic cases are sometimes mistakenly diagnosed as psychogenic and not physical. Muscular imbalance perpetuates pain cycles. This factor relates to muscular imbalance and the fact that most muscles or muscle groups work in pairs. If a muscle goes into spasm for any reason, opposing movements that are forceful enough to cause stretching may also cause tearing. The inflammation caused by tearing exacerbates the existing spasm, increases hypoxic damage, and irritates surrounding tissue. If the sarcoplasmic reticulum surrounding a muscle fiber tears, the release of calcium ions causes a strong attraction between actin and myosin filaments that results in contraction. While metabolic demands are increasing because of contraction, circulation is decreasing because of muscle shortening and the release of histamines and serotonin from injured cells. Muscle shortening reduces circulation by compressing blood vessels and causing ischemia. Sensitizing agents such as serotonin reduce circulation by causing vasoconstriction. Because of localized ischemia, adenosine triphosphate (ATP) becomes depleted, which makes it even more difficult for the actin and myosin filaments to separate. On the positive side, sustained muscle contractions caused by depletion of ATP may help to protect an injured body part from movement by making it rigid. Splinting is the fixation of a body part to avoid pain caused by movement, and guarding is the stiffening of a body part to avoid pain or further injury caused by movement. The fixation or stiffening of a body part is normally caused by reflex spasm. The short-term benefits of reflex spasm 6 <strong>HEMME</strong> Approach to Soft-Tissue Therapy
and protective muscle shortening are stabilization of an injured part and protection against usage. In a primitive environment, protective spasm may help to encourage survival by minimizing hemorrhage, stabilizing potentially dangerous bone fragments, and forcing the victim to rest the injured part. On the negative side, involuntary contractions that are strong enough to protect a muscle from movement by making it rigid will also limit the muscle's range of motion. If the muscle remains shortened for extended periods of time, contractures may form that make the muscle highly resistant to active or passive stretch and cause a permanent decrease in mobility. If agonist muscles shorten and weaken because of spasm or contracture, antagonistic muscles have a tendency to weaken because of inactivity and lengthen because of tension. Weakness and shortness of the agonist combined with weakness and lengthening of the antagonist militate against movement. Until the agonist is lengthened and strengthened and the antagonist is shortened and strengthened, the balance needed for normal movement cannot be achieved and the pain cycle is likely to continue. As to which is more important, lengthening or strengthening, it appears clinically that lengthening a muscle by stretching should always precede strengthening a muscle by exercise. Besides spasm and contracture, possible reasons for muscle shortness include central mechanism involvement, muscle memory, and proprioceptive feedback from muscle spindle cells. Regardless of cause, exercising a shortened muscle is likely to have very little effect on restoring function or reducing pain. Except for minor and self-limiting injuries, manipulation and stretching are needed to normalize tissue length before exercise. Even though modalities can be used effectively in combination with exercise, total reliance on modalities and exercise to the exclusion of soft-tissue manipulation is both dangerous and counterproductive. Reflexogenic activity perpetuates pain cycles. Reflexogenic changes occur because of a neural pathway between a joint and the muscles that move the joint. It is difficult to say which comes first, pathologic conditions in a joint that cause muscle splinting or pathologic conditions in surrounding muscles that irritate the joint. Irrespective of which 7 <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 and 12: 1 INTRODUCTION Soft-tissue therapy
Page 13 and 14: These conditions point out three ch
Page 15: (D) Although pain cycles are seldom
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
Page 63 and 64: 53 MODALITIES Modalities are used i
Page 65 and 66: 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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