HEMME APPROACH TO SOFT-TISSUE THERAPY

More documents

Recommendations

Info

26 EVALUATION The second step in the HEMME APPROACH is EVALUATION. Whereas medical histories are based on information provided by the patient, physical evaluations are based on observations made by the examining practitioner. A similar distinction is made between symptoms and signs: symptoms are indications of illness as perceived by the patient and signs are evidence of disease or dysfunction discovered by the examiner. Even though not completely objective, physical evaluations and signs are considered more objective than medical histories and symptoms. The classical methods of physical evaluation are (1) percussion, (2) auscultation, (3) palpation, and (4) inspection. Percussion is a method of tapping sharply on the body and either listening or feeling for resonance. When resonance is detected by listening, the process is called auscultatory percussion. When resonance is detected by touch, the process is called palpation percussion. Percussion is most commonly used on the chest and back to examine the heart and lungs. Auscultation, by itself, is a method of listening for abnormal sounds such as crepitus or the clicking of a tendon. When aided by a stethoscope, the examiner can hear sounds of blood rushing through a vessel (bruits) and sounds of muscular contraction. The cracking or popping sound made when joints move is not considered diagnostic. Reasons for the sound include breaking a vacuum in the joint or releasing nitrogen gas. It normally takes about twenty minutes for the same joint to reset before it can pop again. Palpation is any form of examination done by touching or feeling with the hands or fingers. When done with skill, palpation can reveal spasms, contractures, adhesions, crepitus, and tremors or fasciculations. Palpation can also detect changes in the temperature, texture, tightness, and moisture of skin and variations in the thickness, density, symmetry, and compliance of underlying tissues. Changes in surface topography may suggest atrophy, swelling, or a pathologic growth. Palpation is frequently used in soft-tissue therapy to locate trigger points, tender points, indurated muscles, scars, or edema. During palpation patients may report pain, numbness, or itching. HEMME Approach to Soft-Tissue Therapy
The sensitivity of the hand varies from part to part. The finger pads are most sensitive to touch, the dorsum of the hand is most sensitive to changes in temperature, and the palmar aspects of the metacarpophalangeal joints are most sensitive to movement. The central palm is most sensitive in terms of stereognosis, the ability to recognize the gross shape of an object by touch. Motion palpation combines palpation with active or passive movement. Abnormalities that are imperceptible when body parts are static and relaxed are sometimes more discernible when body parts are moving. Restrictions, in particular, become more apparent if movement causes stretching that helps the examiner identify tissues that are too short or too tight. The most common restrictions are found in muscles, fascia, ligaments, joint capsules, and skin. Hypertonic scalene muscles are easier to palpate when the head is rotated to the opposite side. The muscles may feel taut when palpated and range of motion may be limited. Motion can also change the position or thickness of overlying tissues. A principle of palpation that is frequently overlooked is progressive penetration. Tissues cover the body in layers. Examiners must first penetrate the superficial layers to reach the deep layers. Active or passive movements that stretch superficial muscles such as the trapezius will make it easier to palpate deeper muscles such as the rhomboids. If the iliopsoas is hypertonic, reducing the tension on superficial tissues will make it easier to palpate the muscle. Progressive penetration requires concentration and manual dexterity. The two most common errors during palpation are too much pressure and not moving the hand slowly enough. Only rarely should palpation cause pain. Although palpation is probably the best and sometimes the only way to identify soft-tissue impairments, it is also the method of evaluation medical doctors seem to use least. As allopathic physicians become more reliant on instrumentation, palpation is losing ground. This could explain why so many soft-tissue impairments are diagnosed as psychogenic and not organic. Inspection refers to examining the patient with the eyes. Observation of posture may show defects in symmetry or alignment, whereas observation of movement may identify defects in flexibility or coordination. Inspection can also detect atrophy, enlargements, lesions, and changes in coloration. Even though inspection is a valuable source of information, examiners should remember that bodies are not symmetric and deviations in alignment 27 HEMME 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 and 32: Since little can be done to change
Page 33 and 34: 23 MECHANISM OF INJURY F FORCE Dire
Page 35: 25 CHAPTER SUMMARY THREE WORDS THAT
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
Page 83 and 84: HEMME Approach to Soft-Tissue Thera
Page 85 and 86: 75 TRIGGER POINT THERAPY Trigger po
Page 87 and 88:
cause spontaneous contraction of th
Page 89 and 90:
• Third, trigger point therapy re
Page 91 and 92:
pressure that normally causes pain
Page 93 and 94:
83 TRIGGER POINT THERAPY VS. CROSS-
Page 95 and 96:
The immediate goal of neuromuscular
Page 97 and 98:
Facilitation techniques can reverse
Page 99 and 100:
89 FOUR WAYS TO INHIBIT A MUSCL
Page 101 and 102:
In situations where muscles are sho
Page 103 and 104:
antagonist, (2) relax the antagonis
Page 105 and 106:
stretch. The technique of stretchin
Page 107 and 108:
97 FACILITATORS Activation of Stre
Page 109 and 110:
concentration of muscle spindle cel
Page 111 and 112:
101 CONNECTIVE TISSUE THERAPY Of al
Page 113 and 114:
103 substance that limits tissue mo
Page 115 and 116:
105 Range-of-motion stretching and
Page 117 and 118:
107 the skin away from the patient'
Page 119 and 120:
109 STRETCHING Unlike the stretchin
Page 121 and 122:
111 Although measurements can be ta
Page 123 and 124:
113 The recommendations for regular
Page 125 and 126:
115 Whenever heat is used to facili
Page 127 and 128:
117 stretching be done slowly becau
Page 129 and 130:
119 CHAPTER SUMMARY THREE HEMME LAW
Page 131 and 132:
121 FOUR TYPES OF FORCE USED IN SOF
Page 133 and 134:
123 FOUR GOALS OF CONNECTIVE TISSUE
Page 135 and 136:
125 overstressed. Even though an ea
Page 137 and 138:
127 great enough to overcome extern
Page 139 and 140:
129 The most recent theories now su
Page 141 and 142:
131 Complete positive transfer is n
Page 143 and 144:
133 OBJECTIVES SATISFIED OR NOT SAT
Page 145 and 146:
135 SELECTED BIBLIOGRAPHY Alter, Mi
Page 147 and 148:
137 Clemente, Carmine D. 1981. Anat
Page 149 and 150:
139 Fryette, Harrison H. 1954. Prin
Page 151 and 152:
Kendall, Florence Peterson, Elizabe
Page 153 and 154:
143 Licht, Sidney, ed. 1965. Therap
Page 155 and 156:
145 Noback, Charles R., and Robert
Page 157 and 158:
Shriber, William J. 1975. A manual
Page 159 and 160:
149 GLOSSARY acute Short duration,
Page 161 and 162:
151 cocontraction Mutual contractio
Page 163 and 164:
153 exteroceptor A sense organ rece
Page 165 and 166:
155 hypomobility Decreased mobility
Page 167 and 168:
157 myofascial Involving muscles an
Page 169 and 170:
159 rebound tenderness Pain or disc
Page 171 and 172:
161 synergist A muscle functioning
Page 173 and 174:
163 6. What does the first letter o
Page 175 and 176:
165 16. Which structures are least
Page 177 and 178:
167 26. What is another name for st
Page 179 and 180:
169 36. Which concept explains why
Page 181 and 182:
171 46. Which word defines loss of
Page 183 and 184:
173 Hilton's law 43, 64, 74 Hooke's
Page 185 and 186:
I QUICK REFERENCE GUIDE FOR NEUROMU
Page 187 and 188:
III RECIPROCAL INHIBITION (RI) Prac
show all

HEMME APPROACH TO SOFT-TISSUE THERAPY

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?