Lecture 5: soft tissue and myofascial release techniques Flashcards
What does “soft tissue” entail?
Living tissues of the body other than bone. – Fascia – Muscles – Organs – Nerves – Vasculature – Lymphatic
what are connective tissue layers composed of?
collagen fibers (and occasionally also elastin fibers) in an amorphous matrix of hydrated proteoglycans (PGs), which mechanically links the collagen fiber networks in these structures.
what are the 2 components of fascia?
- ECM (95%)
- cells (5%)
What is fascia?
• A complete system with blood supply,
fluid drainage & innervations
– Thus, fascia comprises the largest organ system in the body
• Composed of irregularly arranged fibrous
elements of varying density
what is the function of fascia?
Involved in tissue protection &
healing of surrounding systems
what is fascia NOT?
- Tendons
- Ligaments
- Aponeuroses
Fasica- omnipresnet
- is continuous throughout the body
- lacks a well defined border
Pannicular Fascia (aka Panniculus)
Outermost layer of fascia derived from somatic
mesenchyme & surrounds entire body with
exception of the orifices; outer layer is adipose
tissue & inner layer is membranous & adherent,
generally, to the outer portion
Axial & Appendicular Fascia (aka
investing layer)
Internal to the pannicular layer; fused to the
panniculus and surrounds all of the muscles, the
periosteum of bone & peritendon of tendons
endomysium
forms a continuous lattice connecting all the muscle fibers in the fascicle.
Meningeal Fascia
Surrounds the nervous system; includes
the dura
Visceral Fascia
Surrounds the body cavities (pleural,
pericardial & peritoneum
fascia-omnipotent
Provides for mobility and stability of the
musculoskeletal system
omnipotent contractile celss
-myofibroblasts
omnipotent healing cells
- macrophages
- mast cells
fascia- omniscient
- contains mechanoreceptors in loose fascia
- used for muscles and proprioception (balance) (relative positions of neighboring parts)
fascial layers (VAMP)
- pannicular fascia
- axial and appendicular fascia
- meningeal fascia
- visceral fascia
Viscoelastic Material
Any material that deforms according to rate of loading and deformity
Stress
is the force that
attempts to deform a connective
tissue structure.
Strain
the percentage of
deformation of a connective
tissue.
Hysteresis
energy loss in connective tissue system
-difference between loading and unloading characteristics
creep
Connective tissue under a sustained, constant load (below failure
threshold), will elongate (deform) in response to the load.
Ease
• The direction in which the connective tissue may be moved most
easily during deformational stretching.
• Palpated as a sense of tissue “looseness”, or laxity or greater degree
of mobility.
Bind
a palpable restriction of connective tissue
mobility.
Newton’s Third Law
‘When two bodies interact, the force exerted by
one is equal in magnitude and opposite in
direction to the forces exerted by the other.’`
Hooke’s Law
“The strain (deformation) placed on an elastic
body is in proportion to the stress (force) placed
upon it.”
Wolff’s Law
• “Bone will develop according to the under stresses placed upon it.” • This concept extends to fascia, too.
somatic dysfunction
Impaired or altered function of: – Skeletal, – Arthroidal, and – Myofascial structures, and their related – Vascular, – Lymphatic, – Neural elements
what does a somatic dysfunction produce?
- a restrictive barrier with a decrease in AROM and PROM
Direct techniques
Go towards & eventually
through the restrictive
barrier
indirect techniques
Go away from the
restrictive barrier!
-shifted neutral
Sherrington’s Law:
-when a muscle receives a nerve impulse to contracts, is antagonists receive simultaneously an impulse to relax
Common Compensatory pattern
- 80% of healthy people
* L/R/L/R
Uncommon Compensatory pattern
- 20% of healthy people
* R/L/R/L
Uncompensated Pattern
-L/L/L/L
-R/L/L/R
• Usually symptomatic
• Usually a trauma is involved
what are the transition zones of the spine
OA, C1, C2
C7, T1
T12, L1
L5, Sacrum
transverse restrictors
Tentorium Cerebelli
Thoracic Inlet
Thoracolumbar Diaphragm
Pelvic diaphragm
Soft Tissue Technique Defined
“A system of diagnosis and
treatment directed toward
tissues other than skeletal or
arthrodial elements.”
what must be present for somatic dysfunction?
TART
Tissue texture abnormality & Asymmetry of tissues treatment goals
- Stretch and increase the elasticity of
shortened myofascial structures to return
symmetry - Improve local tissue nutrition, oxygenation,
and removal of metabolic wastes to
normalize tissue texture
Asymmetry of muscles Treatment goals
- Restore symmetry
2. Normalize tone
Restriction of
motion treatment goals
Set the fascia free to normalize ROM
Tenderness treatment goals
- Normalize neurologic activity
- Improve abnormal somato-somatic &
somato-visceral reflexes
soft tissue relative contraindications
Severe osteoporosis
Acute Injuries
soft tissue absolute contraindications
- Fracture or dislocation
- Neurologic entrapment syndromes
- Serious vascular compromise
- Local malignancy
- Local infection (e.g., cellulitis, abscess, septic arthritis, osteomyelitis)
- Bleeding disorders
soft tissue technique
forces are very gentle and of low
amplitude. The force is applied rhythmically, typically 1 or 2
seconds of stretch followed by a similar time frame releasing that
stretch
stretch (parallel traction)
Increase distance
between origin and
insertion (parallel
with muscle fibers
The taffy pull Stretch
the forces being
applied are parallel to the myofascial structures
needing treatment. This may be done by
• Separating the proximal and distal attachments of
the muscle (both hands moving in opposite
directions like a taffy pull) or by
• Anchoring one end of the muscle and pulling on the
other (one hand or structure serving as a stationary
anchor, the other one mobile)
Knead (perpendicular traction) (the bowstring)
Repetitive pushing of tissue
perpendicular to muscle fibers
Inhibition
• Push and hold perpendicular to the
fibers at the musculotendinous part
of hypertonic muscle.
• Hold until relaxation of tissue
MFR
A system of diagnosis & treatment first described
by A.T. Still and his early students, which
engages continual palpatory feedback to achieve
release of myofascial tissues
INR (integrated neuromusculoskeletal release)
A treatment system in which combined
procedures are designed to stretch & reflexively
release patterned soft tissue & joint related
restrictions
what technique helps speed the treatment process of INR
REMS
Examples of INR
• Breath holding
– The goal is to alter both intrathoracic & intraabdominal pressure using
costodiaphragmatic, shoulder girdle & lumbopelvic interactions
• Prone & supine simulated swimming & pendulum arm swing
maneuvers as direct & indirect barriers are released.
• R/L cervical rotation
• Isometric limb & neck movements against the table, chair…
• Patient evoked movement from cranial nerves (eye, tongue, jaw,
oropharynx)
indications for MFR
• Somatic dysfunction
– Almost all soft tissue or joint restrictions
• When HVLA or muscle energy is contraindicated
– Consider indirect MFR
• When counterstrain may be difficult secondary to a patient’s
inability to relax.
absolute contraindications of MFR
- Lack of Patient Consent
- Absence of Somatic Dysfunction
relative contraindications MFR
- Infection of soft tissue or bone
- Fracture, Avulsion or dislocation
- Metastatic disease
- Soft tissue injuries: Thermal, Hematoma or Open wounds
- Post-op patient with wound dehiscence
- Rheumatologic condition involving instability of cervical spine
- DVT or Anticoagulation therapy
activating forces- inherent forces
using the body’s PRM (primary respiratory
mechanism)
activating forces-Respiratory Cooperation
Refers to a physician directed,
patient performed, inhalation or exhalation or a holding of the
breath to assist with the manipulative intervention.
activating forces-Patient Cooperation
the patient is asked to move in specific
directions to aid in mobilizing specific areas of restriction
MFR treatment endpoint
• A three dimensional release is often palpated as:
– Warmth
– Softening
– Increased compliance/ROM
• The continuous application of activating forces no longer produce
change
• When finished, recheck of the tissue demonstrates symmetry
