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Myofascial Release (MFR) Flashcards

1
Q

Where do we look for the cause of disease and the place we consult for remedies?

A

Fascia

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2
Q

DO fact for 1918

A

Spanish Flu Epidemic where osteopaths used OMT to mount an immune response with techniques of spine/rib mobilization and lymphatic drainage

DO death rate = 0.2-10%
MD death rate = 12-25%

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3
Q

Fascia is what?

A

Fibrous band or sheet of connective tissue that lies deep to the skin and invests all structures of the body

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4
Q

Fascia is the connective tissue that what?

A

Unites all aspects of the body

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5
Q

Fascia is a unitary body system with what?

A

A function that can be described as supportive, protective and healing that is comprised of irregular connective tissue that can have varying densities

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6
Q

What are the 4 general layers of fascia?

A
  1. Pannicular Fascia
  2. Axial and Appendicular Fascia
  3. Meningeal Fascia
  4. Visceral Fascia
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7
Q

5 things about Pannicular Fascia

A

 The outermost layer
 Superficial layer derived from mesenchyme
 Surrounds the entire body except orifices (oral, aboral, orbits, nasal passages)
 Composed of loose and dense irregular connective tissue and a variable amount of adipose
 Platysma and associated facial muscles are embedded in this layer

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8
Q

5 things about Axial and Appendicular Fascia

A

 Internal to the pannicular layer (deep fascia)
 Derived from mesenchyme
 Hypaxial – surrounds hypaxial muscles and attaches to the transverse processes
 Epaxial fascia – surrounds epaxial muscles and attaches to the transverse processes

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9
Q

How does the upper extremity pass in regards to pannicular fascia?

A

Internal to pannicular fascia and external to axial fascia

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10
Q

4 things with Meningeal Fascia

A

 Surrounds the nervous system
 Involves dura and leptomeninges
 Derives from primitive meninx
 Terminates with the development of the epineurium that surrounds the peripheral nerves

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11
Q

4 things with Visceral Fascia

A

 Derived from splanchnic tissue and surrounds the body cavities
 Can be traced from cranial base into the pelvic cavity
 Covers the somatic body wall (ectoderm)
 Covers the visceral organs (endoderm)

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12
Q

What are the 4 components to fascia?

A

 Fibroblasts
 Myofibroblasts
 Macrophages
 Mast Cells

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13
Q

Fibroblasts do what?

A

Prepare and secrete collagen, elastin, and other proteoglycans

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14
Q

Do fibroblasts increase when needed for repair?

A

Yes

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15
Q

What are fibroblasts in conjunction with macrophages called? What do they do?

A

Histiocytes, they comprise the reconstructive component of reconstruction

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16
Q

What are myofibroblasts?

A

Differentiated fibroblasts that share many cellular and biochemical similarities with smooth muscle cells

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17
Q

Do myofibroblasts express gap junctions? If so, what is facilitated?

A

Yes; cell to cell communication is facilitated and potential syncytial behavior - such as coordinated contraction of large sheets of myofibroblasts

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18
Q

Fascia has the capacity for what?

A

Myofascial-mediated contraction that is propagated and reinforced cell to cell

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19
Q

What do activated macrophages release?

A

TGF-β1

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20
Q

What does TGF-β1 promote?

A

Proliferation and differentiation of collagen-producing cells such as fibroblasts and myofibroblasts

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21
Q

What are macrophages processes predisposed to?

A

Increased fibrosis and scar or adhesion formation

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22
Q

Mast cells are what?

A

Granule-laden cells capable of phagocytosis and the production of pro-inflamatory cytokines

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23
Q

Connective tissue mast cells have been identified as carrying what?

A

Prefabricated stores of TNF-α, a potent proinflammatory compound that stimulates fibroblasts and results in fibrosis

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24
Q

Mast cell have been reported in increased numbers where?

A

In tissue undergoing fibrosis, but their role in tissue healing is not yet clarified

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25
Mast cells appear to be capable of what?
Activating fibroblasts and enhancing the fibrosis occurring in and about an inflammatory event
26
Superficial fascial planes follow what?
Fiber direction of the muscles that they span and may cover multiple joints
27
Fascia allows what?
Individual structures to communicate while not disturbing their individual functions
28
Fascia limits and directs what?
Planes of motion
29
Fascia provides what?
Anatomic support and stability while acting as the location where metabolic and physiologic functions occur
30
What are the 4 P's of fascia and their function?
 Packaging - fascia envelops all muscle and all nerves either perforate it or are encompassed by it  Protection – as an encasement or a tether, fascia protects underlying structures  Posture – because of the fascia’s reactivity to forces, its configuration changes and precedes changes in other structures such as the muscles  Passageways – the process of circulation, both vascular and lymphatic, are maintained and regulated through fascial influence
31
When can all of the functions be altered and/or reduced in the fascia?
When change does occur in the structure of fascia, with reorganization, directionality, and thickening
32
Sudden stretching of fascia may be accompanied by what? Can regional structures contract in response to these stimuli?
A sensation of burning pain and irritation of membranous components and may result in sharp or stabbing sensations; Yes
33
What are the 5 physical properties of muscle/fascia?
1. Irritability 2. Contractility 3. Relaxation 4. Distensibility 5. Elasticity
34
Irritability
Ability of the muscle fiber to react to stimulation
35
Contractility
Ability to actively create tension between its origin and insertion
36
Relaxation
Ability to reduce tension between its origin and insertion
37
Distensibility
Ability of the associated connective tissue to be stretched or deformed by an outside force, and if the force does not exceed the tensile strength of the connective tissue, the muscle will not be injured
38
Elasticity
Ability of the connective tissue to return to its original resting shape when forces are removed
39
7 force effects in connective tissue
1. Plastic deformation 2. Elastic deformation 3. Viscosity 4. Stress 5. Strain 6. Creep 7. Hysteresis or stress-strain
40
Plastic Deformation
A stressed, formed, or molded tissue preserves its new shape
41
Elastic Deformation
A stressed, formed, or molded tissue recovers its original shape
42
Viscosity
Capability of a solid to continually yield under stress with a measurable rate of deformation
43
Stress
The effect of a force normalized over an area
44
Strain
A change in shape as a result of stress
45
Creep
The continued deformation of a viscoelastic material under constant load over time
46
Hysteresis or Stress-Strain
A connective tissue response to loading and unloading where the restoration of the final length of the tissue occurs at a rate and to an extent less than during deformation (loading) representing energy loss in the connective tissue
47
Homeostasis is both what?
A state of equilibrium AND the process by which this equilibrium is maintained
48
Is homeostasis dynamic?
Yes
49
What is the challenge of homeostasis?
Recognize [that] all events, internal and external communicate needs for adaptation throughout the organism and direct [the] responses both internal an external
50
Anterior fascial planes are related to what?
Sphenoid
51
Posterior fascial planes are related to what?
Occiput
52
What are Horizontal Diaphragms?
Musculo-fibrous partitions acting as tension and counter-tension sheets connected to vertical fascial structures and anchored to skeletal structures
53
All diaphragms are connected by what?
Fascial planes and, via rhythmic motion, are physiologically linked to lymphatic and venous flow
54
What are the 4 major diaphragms?
 Tentorium Cerebelli  Thoracic Inlet  Abdominal Diaphragm  Pelvic Diaphragm
55
Define Myofascial Release
System of diagnosis and treatment, first described by AT Still, which engages continual palpatory feedback to achieve release of myofascial tissues
56
Can MFR be direct or indirect?
Yes
57
Direct MFR
A restrictive barrier is identified in the myofascial tissues, is engaged with a loaded, constant, directional force until the tissue releases and motion is restored
58
Indirect MFR
The tissue position of ease is identified and engaged with directed pressure guiding the tissues along this line of least resistance until free movement of all tissues is achieved
59
What is the inherent activating force in MFR?
The rhythmic activity in all tissues that works to improve the hydrodynamic and bioenergetic factors around restricted tissues and articulations
60
4 steps with Respiratory Assist force
 One phase of the respiratory cycle or the other can enhance the position of the arear being treated  Breath holding for the maximum time that a patient can tolerate causes “air hunger” and triggers a generalized relaxation of the myofascial tissues  Coughing/sniffing on command produces a respiratory impulse to assist in the release of restrictions  While using a direct or indirect position, a full cycle (usually deep) is used as a fascial and/or articulatory activating force
61
Patient Cooperation
The patient is asked to move in specific directions to aid in mobilizing an area of restriction
62
Physician-Guided Force
After engaging the barrier or point of ease, the physician sequentially guides the tissues through various positions following a shifting pattern of easy motion until the path of dysfunction is retraced and released
63
What are the 4 activating forces in MFR?
1. Inherent 2. Respiratory 3. Patient Cooperation 4. Physician-Guided Force
64
7 indications for MFR
 Used as part of the screening exam to quickly Identify regions of potential motion restriction and tissue texture changes  Reduce muscle and fascial tension  Increase regional/intersegmental range of motion  Reduce tight-loose asymmetry to improve tissue consistency  Increase circulation to the specific region being treated  Increase venous and lymphatic drainage/flow to help increase immune function  Potentiate the effects of other osteopathic techniques
65
What are 6 RELATIVE contraindications?
1. Acute sprain/strain 2. Fracture dislocation 3. Neurologic/vascular compromise 4. Osteoporosis/osteopenia 5. Malignancy 6. Infection
66
Are there any absolute contraindications for MFR?
NO
67
What are 2 complications to MFR?
1. Overly aggressive interventions are counterproductive | 2. Patients commonly experience a temporary worsening of discomfort following the first treatment or two
68
What is the famous saying?
FIND IT, FIX IT, LEAVE IT ALONE!!!!!
69
Go look at slide 29
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OPP Exam 2 (9 decks)

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