Lecture 5: soft tissue and myofascial release techniques

Question 1

What does “soft tissue” entail?

Answer 1

Living tissues of the body other than
bone.
– Fascia
– Muscles
– Organs
– Nerves
– Vasculature
– Lymphatic

Question 2

what are connective tissue layers composed of?

Answer 2

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.

Question 3

what are the 2 components of fascia?

Answer 3

• ECM (95%)

- cells (5%)

Question 4

What is fascia?

Answer 4

• 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

Question 5

what is the function of fascia?

Answer 5

Involved in tissue protection &

healing of surrounding systems

Question 6

what is fascia NOT?

Answer 6

• Tendons
• Ligaments
• Aponeuroses

Question 7

Fasica- omnipresnet

Answer 7

• is continuous throughout the body

- lacks a well defined border

Question 8

Pannicular Fascia (aka Panniculus)

Answer 8

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

Question 9

Axial & Appendicular Fascia (aka

investing layer)

Answer 9

Internal to the pannicular layer; fused to the
panniculus and surrounds all of the muscles, the
periosteum of bone & peritendon of tendons

Question 10

endomysium

Answer 10

forms a continuous lattice connecting all the muscle fibers in the fascicle.

Question 11

Meningeal Fascia

Answer 11

Surrounds the nervous system; includes

the dura

Question 12

Visceral Fascia

Answer 12

Surrounds the body cavities (pleural,

pericardial & peritoneum

Question 13

fascia-omnipotent

Answer 13

Provides for mobility and stability of the

musculoskeletal system

Question 14

omnipotent contractile celss

Answer 14

-myofibroblasts

Question 15

omnipotent healing cells

Answer 15

• macrophages

- mast cells

Question 16

fascia- omniscient

Answer 16

• contains mechanoreceptors in loose fascia

- used for muscles and proprioception (balance) (relative positions of neighboring parts)

Question 17

fascial layers (VAMP)

Answer 17

• pannicular fascia
• axial and appendicular fascia
• meningeal fascia
• visceral fascia

Question 18

Viscoelastic Material

Answer 18

Any material that deforms according to rate of loading and deformity

Question 19

Stress

Answer 19

is the force that
attempts to deform a connective
tissue structure.

Question 20

Strain

Answer 20

the percentage of
deformation of a connective
tissue.

Question 21

Hysteresis

Answer 21

energy loss in connective tissue system

-difference between loading and unloading characteristics

Question 22

creep

Answer 22

Connective tissue under a sustained, constant load (below failure
threshold), will elongate (deform) in response to the load.

Question 23

Ease

Answer 23

• 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.

Question 24

Bind

Answer 24

a palpable restriction of connective tissue

mobility.

Question 25

Newton’s Third Law

Answer 25

‘When two bodies interact, the force exerted by one is equal in magnitude and opposite in direction to the forces exerted by the other.’`

Question 26

Hooke’s Law

Answer 26

“The strain (deformation) placed on an elastic body is in proportion to the stress (force) placed upon it.”

Question 27

Wolff’s Law

Answer 27

``` • “Bone will develop according to the under stresses placed upon it.” • This concept extends to fascia, too. ```

Question 28

somatic dysfunction

Answer 28

``` Impaired or altered function of: – Skeletal, – Arthroidal, and – Myofascial structures, and their related – Vascular, – Lymphatic, – Neural elements ```

Question 29

what does a somatic dysfunction produce?

Answer 29

- a restrictive barrier with a decrease in AROM and PROM

Question 30

Direct techniques

Answer 30

Go towards & eventually through the restrictive barrier

Question 31

indirect techniques

Answer 31

Go away from the restrictive barrier! -shifted neutral

Question 32

Sherrington’s Law:

Answer 32

-when a muscle receives a nerve impulse to contracts, is antagonists receive simultaneously an impulse to relax

Question 33

Common Compensatory pattern

Answer 33

* 80% of healthy people | * L/R/L/R

Question 34

Uncommon Compensatory pattern

Answer 34

* 20% of healthy people | * R/L/R/L

Question 35

Uncompensated Pattern

Answer 35

-L/L/L/L -R/L/L/R • Usually symptomatic • Usually a trauma is involved

Question 36

what are the transition zones of the spine

Answer 36

OA, C1, C2 C7, T1 T12, L1 L5, Sacrum

Question 37

transverse restrictors

Answer 37

Tentorium Cerebelli Thoracic Inlet Thoracolumbar Diaphragm Pelvic diaphragm

Question 38

Soft Tissue Technique Defined

Answer 38

“A system of diagnosis and treatment directed toward tissues other than skeletal or arthrodial elements.”

Question 39

what must be present for somatic dysfunction?

Answer 39

TART

Question 40

Tissue texture abnormality & Asymmetry of tissues treatment goals

Answer 40

1. Stretch and increase the elasticity of shortened myofascial structures to return symmetry 2. Improve local tissue nutrition, oxygenation, and removal of metabolic wastes to normalize tissue texture

Question 41

Asymmetry of muscles Treatment goals

Answer 41

1. Restore symmetry | 2. Normalize tone

Question 42

Restriction of | motion treatment goals

Answer 42

Set the fascia free to normalize ROM

Question 43

Tenderness treatment goals

Answer 43

1. Normalize neurologic activity 2. Improve abnormal somato-somatic & somato-visceral reflexes

Question 44

soft tissue relative contraindications

Answer 44

Severe osteoporosis | Acute Injuries

Question 45

soft tissue absolute contraindications

Answer 45

* Fracture or dislocation * Neurologic entrapment syndromes * Serious vascular compromise * Local malignancy * Local infection (e.g., cellulitis, abscess, septic arthritis, osteomyelitis) * Bleeding disorders

Question 46

soft tissue technique

Answer 46

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

Question 47

stretch (parallel traction)

Answer 47

Increase distance between origin and insertion (parallel with muscle fibers

Question 48

The taffy pull Stretch

Answer 48

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)

Question 49

Knead (perpendicular traction) (the bowstring)

Answer 49

Repetitive pushing of tissue | perpendicular to muscle fibers

Question 50

Inhibition

Answer 50

• Push and hold perpendicular to the fibers at the musculotendinous part of hypertonic muscle. • Hold until relaxation of tissue

Question 51

MFR

Answer 51

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

Question 52

INR (integrated neuromusculoskeletal release)

Answer 52

A treatment system in which combined procedures are designed to stretch & reflexively release patterned soft tissue & joint related restrictions

Question 53

what technique helps speed the treatment process of INR

Answer 53

REMS

Question 54

Examples of INR

Answer 54

• 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)

Question 55

indications for MFR

Answer 55

• 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.

Question 56

absolute contraindications of MFR

Answer 56

- Lack of Patient Consent | - Absence of Somatic Dysfunction

Question 57

relative contraindications MFR

Answer 57

- 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

Question 58

activating forces- inherent forces

Answer 58

using the body’s PRM (primary respiratory | mechanism)

Question 59

activating forces-Respiratory Cooperation

Answer 59

Refers to a physician directed, patient performed, inhalation or exhalation or a holding of the breath to assist with the manipulative intervention.

Question 60

activating forces-Patient Cooperation

Answer 60

the patient is asked to move in specific | directions to aid in mobilizing specific areas of restriction

Question 61

MFR treatment endpoint

Answer 61

• 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