HEMME APPROACH TO SOFT-TISSUE THERAPY

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condition and not the patient. The personality or circumstances surrounding the patient should not be allowed to bias the investigation. After reviewing the patient's medical history, the examiner should ask questions requiring more than a "yes or no" answer. Questions concerning (1) the problem or chief complaint and (2) the quality of past or present treatment will give the examiner a good place to start. Open-ended questions about pain, loss of motion, and changes in lifestyle will further define the problem. Almost every patient can provide at least some information that is helpful enough to be recorded as part of the patient's permanent medical history. Open-ended Questions for Medical History • What is the nature of the problem? • Are you under a doctor's care? • Has this problem been treated before? • Do you have any other medical problems? • Are you taking any medication? • What type of treatments do you think might help? • How does the problem affect your life? The acronym PDQ summarizes the first three questions above: P-Problem D-Doctor's care Q-Quality of past treatment Interviews should normally proceed from general to specific. After asking open-ended questions about the patient's condition, the interviewer should continue with questions that are more specific, such as questions concerning the mechanism of injury. By this point, most practitioners will have formed at least one or two preliminary theories concerning the patient's condition. Even if the patient's information is not complete, any information provided will make it easier to reconstruct the mechanism of injury. The acronym FIRST can be used to assess the mechanism of injury. 22 <strong>HEMME</strong> Approach to Soft-Tissue Therapy
23 MECHANISM OF INJURY F FORCE Direction of force I INTENSITY Magnitude of force R REGIONS Body parts affected by the force S SEVERITY Degrees of injury or loss of function T TIME Frequency and duration of force Reconstructing an automobile accident may be helpful. If the patient's vehicle struck a fixed object while moving forward, the neck was probably flexed during the impact and then extended during the rebound. High rates of acceleration increase the force of impact and potential for injury. If the patient saw the accident coming and braced for impact, then wrist, elbow, and shoulder injuries can be expected. The quality of pain and changes in mobility and lifestyle will indicate severity, whereas time since the onset of injury may indicate chronicity and possibly severity. Seemingly small and insignificant injuries sometimes become more severe with time. The time elapsed since an injury occurred is also important for another reason: injuries of long-standing duration are normally more difficult to treat than injuries of short duration. As a rule, when a body part loses mobility, fibrotic changes and atrophy increase with time. Another line of questioning involves pain. • Where do you feel the pain? • When did the pain first occur? • When do you feel the pain? • How does the pain feel (sharp, dull, aching, etc.)? • What makes the pain feel better or worse? • How does the pain affect your life? <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 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: Since little can be done to change
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
Page 67 and 68: The term hunting reaction implies t
Page 69 and 70: Contraindications specifically for
Page 71 and 72: 61 CHAPTER SUMMARY FOUR INDICATIONS
Page 73 and 74: 63 MANIPULATION Soft-tissue therapy
Page 75 and 76: 65 B. Reciprocal Inhibition: when t
Page 77 and 78: experience another cycle: (1) pain
Page 79 and 80: 69 Table of Figures Figure 1: Belly
Page 81 and 82: 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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