CMTP General Protocol

• 1: Superficial - Deep - Superficial
• 2: General - Specific - General
• 3: Proximal - Distal - Proximal
• 4: Peripheral - Central - Peripheral
• 5: Treat the antagonist

• a: check in on contraindications
• b: any changes in condition since last visit
• c: trigger point communication
• d: explain treatment goals and techniques
• e: permission to begin

Hold until parasympathetic breathing is perceived (slow, deep breaths)

• A: opening communications
• B: resting position
• C: stroking and initial dry warming
• D: myofascial techniques
• E: joint mobilization
• F: lymphatic work
• G: clearing
• H: deeper warming (apply lotion)
• I: treat area of dysfunction
• J: passive stretching
• K: referral zone
• L: cross-fiber friction
• M: superficial/ general closure
• N: hydrotherapy
• O: closing concerns/ comments

Softens tissue of hypertonic structures and allows for deeper work wilthout creating kick-back response. Tissue shows hyperemia (warms, reddens) and is softer when palpated.

Isolates and/or decreases guarding

When indicated, removes metabolic waste secondary to edema and inflammation

Term used to describe a cross-fiber friction that is applied to nonropy tendon attachments to trigger Golgi Tendon Organ (GTO) response

• Muscle stripping (4-6 inches per second)
• Cross-fiber palpation
• Pincer grasp

• a: isolate TP
• b: activate tissue - 4 directional fiber application (plus sign)
• c: treating rate - 1 inch per 3 seconds, start stroke before TP and end stroke after it
• d: get initial pain number from client (PS 1-10)
• e: Continue stripping for 8 - 12 seconds
• f: Ask about referred pain
• g: Get pain scale number again - if pain has lowered, continue slow muscle stripping until only pressure is felt locally and referral pain is gone but if pain number remains constant or is worse, then slowly stop muscle stripping, smooth out and leave area to return later