Thursday Thoughts: Petechiae, a Normal Response? | Modern Manual Therapy Blog

Thursday Thoughts: Petechiae, a Normal Response?


There are schools of thought out there that think that discoloration is either a normal response to tissue work, or that it even leads you to more dysfunctional areas.

Heck, I used to even tell my students that if you did not bruise someone within the first week of clinical, you're not being aggressive enough. So the above picture, not only is that a normal response, but it's not needed. AT ALL. It has nothing to do with the amount of adhesions in the fascia, well maybe it does, but that's not proven. It also has nothing to do with how thin your instrument is. In my clinical opinion, if you see either petechiae, or excessive discoloration you are
  • using excessive force
  • not enough lubricant
  • the tissue has too much tone
The last part is the most likely scenario. Remember, you should be looking at ortho patients as neuro patients as there are neurological cases or disease processes, but you cannot take the nervous system out of the musculoskeletal system. Tissue that has high tone resists pressure and scraping, thus superficial blood vessel tend to get damaged and petechiae is the result. As soon as I see this, I use techniques like
  • much slower strokes
  • PNF
  • positional inhibition - passively slacking the tissue to reduce tone
  • combine with breathing techniques to reduce tone
After inhibition, I try techniques like IASTM again if it is even necessary. I will be shooting a lot of my positional inhibition techniques for UQ in an upcoming course I am teaching and will be featuring them on The OMPT Channel!

Remember, just because you got results causing pain, discoloration, or bruising.... does not mean the positive outcome was a result of the excessive force

The patient's nervous system eventually came to the conclusion that the repetitive nature of your stimulus was none threatening.

Keeping it Eclectic....

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