HEMME APPROACH TO SOFT-TISSUE THERAPY

The end-feel for most joints is either hard like elbow extension or soft like
elbow flexion. End-feels that are soft when they should be hard or hard when
they should be soft indicate joint dysfunction. If the problem appears to be
joint dysfunction, palpate the joint for signs of heat, swelling, or pain. Normal
joints are never swollen and normal ligaments are not painful when palpated.
The next possibility to investigate is spasm or contracture. Spasms can
result from calcium deprivation (carpopedal spasm), sewing or writing
(occupational spasm), spasmodic contraction of muscles (intentional spasm),
disease (myopathic spasm), or trauma (charley horse). Contractures, on the
other hand, are caused by tissue fibrosis (ischemic contracture), sleeping in or
maintaining a position that allows the muscles to shorten (functional
contracture), or the effects of heat or chemicals (physiological contracture).
Both spasm and contracture restrict joint movement by increasing resistance to
passive stretch.
The initial end-feel for spasm or contracture is more like stretching a
spring than either hard or soft: the greater the stretch, the greater the
resistance. If properly applied, slow and steady tension will cause a decrease
in resistance. The key points are (1) apply moderate force directly against the
resistance and (2) use slow and steady pressure. Unlike pathologic joints that
normally become more painful with stretching, muscles in a state of spasm or
contracture often become less painful as tissues approach their normal length.
(3) Active-Assisted Range-of-Motion Testing
If the patient's passive ROM is normal, the next step is active-assisted
range-of-motion testing. If a full range of motion is possible with assistance
from the examiner, the implication is muscular weakness. Having the patient
move as far as possible in one direction and then using manual assistance to
complete the range of motion will help to identify which muscles or muscle
groups are weak. The normal approach at this point is using facilitation
techniques or therapeutic exercise to strengthen weak muscles. Facilitation
techniques such as methods for activating spindle cells and repeated
contraction are part of neuromuscular therapy. Therapeutic exercises to
strengthen weak muscles are called progressive resistance exercises.
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HEMME Approach to Soft-Tissue Therapy