Optical Measurements of the Skin Surface to Infer Bilateral Distinctions in Myofascial Tissue Stiffness.

About half the U.S. adult population suffers from chronic neuromusculoskeletal pain. While its evaluation and treatment are widely addressed by therapies using soft tissue manipulation (STM), their efficacy is based upon clinician judgment. Robust biomarkers are needed to quantify the effects of STM on patient outcomes. Among noninvasive methods to quantify the mechanics of myofascial tissue, most are limited to small (<10 mm2), localized regions of interest. In contrast, we develop an approach to optically simultaneously measure a larger (~100 cm2) field of deformation at the skin surface. Biomarkers based on skin lateral mobility are derived to infer distinctions in myofascial tissue stiffness. In specific, three cameras track ink speckles whose fields of deformation and stretch are resolved with digital image correlation. Their ability to differentiate bilateral distinctions of the cervicothoracic region is evaluated with four participants, as a licensed clinician performs STM. The results indicate that the optically derived surface biomarkers can differentiate bilateral differences in skin mobility, with trend directions within a participant similar to measurements with an instrumented force probe. These findings preliminarily suggest skin surface measurements are capable of inferring underlying myofascial tissue stiffness, although further confirmation will require a larger, more diverse group of participants.

Quantifiable Soft Tissue Manipulation (QSTM™) - A novel modality to improve clinical manual therapy with objective metrics.

Soft Tissue Manipulation (STM), a form of mechanotherapy, offers a clinical modality to examine and treat Neuromusculoskeletal (NMS) pain disorders and dysfunction. The, current STM practice is mostly subjective and reliant on anecdotal patient feedback and lacks quantification with objective metrics. This paper proposes Quantifiable Soft Tissue Manipulation (QSTM™), a sensor based computerized technological advancement in Soft tissue examination and treatment enabling new standard of practice in manual therapy. This novel medical device technology aims to produce optimum STM prescriptions using ergonomic, portable, handheld medical tools with specially contoured tips designed to palpate and assess tissue anomalies of specific musculoskeletal conditions. QSTM™ captures three-dimensional forces and motion of the mechatronic handheld tools to quantify STM treatment parameters, such as (resultant force, force application angle, rate, direction, and treatment time). Clinical practice using QSTM™ facilitates real-time visual feedback of treatment metrics and subsequent treatment documentation for comparison and analysis on a Windows based computer software (Q-Ware©). Pre-clinical testing using the QSTM™ medical device system clearly identifies inconsistencies among practitioners and distinguishes STM practice variabilities. Thus, QSTM™ is an apt tool for soft tissue treatment assessment, analysis, and individualized prescriptions for targeted STM dosing and commercialization.

Treatment of a patient with post-natal chronic calf pain utilizing instrument-assisted soft tissue mobilization: a case study.

Musculoskeletal pain is commonly reported by pre- and postnatal women, with the most common complaint being low back pain. However, lower leg pain is also frequently reported by women particularly in the third trimester. The purpose of the case study is to illustrate how instrument-assisted soft tissue mobilization (ISTM) can be used to treat a patient with a 2-year history of chronic calf pain. The subject was a 35-year-old female who developed calf pain during the last trimester of her pregnancy following severe lower leg edema. The calf pain was present for the 2 years following delivery and was described as a dull ache, typically aggravated by direct pressure on the calf, prolonged standing, and stairs. An X-ray, magnetic resonance imaging (MRI) with contrast, and ultrasound Doppler study prior to referral ruled out tumors, vascular, lymphatic, or skeletal bone abnormalities. However, her MRI did show a dense superficial venous tissue asymmetry in the same location of her symptoms. Impairments were minimal; the only asymmetrical objective findings were calf length, strength, and soft tissue restrictions detected on palpation. After nine treatments incorporating an ISTM approach, soft tissue mobility, pain, calf strength, and lower extremity functional scale score all improved and her symptoms were abolished.