How important is the contact? VERY IMPORTANT
As I was teaching this past weekend I made a mental note to put out a reminder as to how to take a proper tissue contact to avoid the dreaded skin burn/skin wedgie that "other" practitioners mistake for actual tissue tension.
I don't have to go over why shortening a muscle, taking a contact, lengthening the muscle, and repeating is NOT congruent with the currently literature regarding altering connective tissue states. I believe we have emphasized this quite a bit. Another reason why this is a problem is regarding taking a contact. If we take a contact while the tissue is short, we are much more likely to create the unwanted skin wedge which will ultimately restrict the range we are treating, cause unnecessary pain to the patient (for no beneficial reason), and will confuse us into thinking tissue tension is present….when it really isn't (the last point being of ultimate importance while performing tissue tension technique to assess for tension.
STEP 1: Identify a line of tension using Tissue Tension Technique (tension = force countering the direction of passive movement WITHIN the normal ROM of the articulation)
STEP 2: Back off ONLY 10-15 degrees - no more! If you shorten the tissue you risk losing the exact line path
STEP 3: Draw skin in the opposite direction that you will be applying tension (approximately a cm worth is usually sufficient)
STEP 4: Compress to the level of the tissue you want to treat….NO MORE/NO LESS. In other words, apply perpendicular force to the level of the 'lesion'
STEP 5: Apply pre-tension AT THE LEVEL OF THE LESION - switch from a perpendicular force (90 degree) to a 45degree force in the direction you will be treating. You can think of it as returning to the original position you were in prior to removing skin slack (step 3)
STEP 6: Move the articulation. If you palpated actual tissue tension, the force coming up into your finger will begin IMMEDIATELY. Ramp you counter force at the same rate and amount that you are feeling…overcome it by 5-10 percent
…then work within the tension SLOWLY. If you want to alter your angle of drive, do so while maintaining the tension. If you want a break, switch from an external input (your finger) to an internal input (a low level PAILs along the line of tension…then re-establish your contact and continue).