Soft Tissue and Myofascial Release Techniques

Question 1

Fascial Anatomy

Answer 1

Generally speaking, these connective tissue layers are
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.

EMC 95%, Cells: 5%

Question 2

Fascia

Answer 2

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
• Fn: Involved in tissue protection &
healing of surrounding systems

Question 3

Fascia is not:

Answer 3

Tendons
• Ligaments
• Aponeuroses

Question 4

Continuity of Fascia

Answer 4

Perimysium (fascia), peritendium, periosteum

Question 5

Pannicular Fascia (aka Panniculus)

Answer 5

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)
• Meningeal Fascia
• Visceral Fascia

Question 6

Axial & Appendicular Fascia (aka

investing layer)

Answer 6

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

Question 7

Meningeal Fascia

Answer 7

Surrounds the nervous system; includes

the dura

Question 8

Visceral Fascia

Answer 8

Surrounds the body cavities (pleural,

pericardial & peritoneum

Question 9

Viscoelastic Material

Answer 9

Any material that deforms according to rate of loading and deformity

Question 10

Stress

Answer 10

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

Question 11

Strain

Answer 11

is the percentage of
deformation of a connective
tissue.

During cyclic loading of tendon, the stress-strain
curve gradually shifts to the right

Question 12

Hysteresis

Answer 12

The difference between the loading
and unloading characteristics
represents energy that is lost in the
connective tissue system; this
energy loss

Stretching connective tissue into its’
plastic deformational range will
bring about a lengthening of the
tissue.

Question 13

Creep

Answer 13

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

Question 14

Ease

Answer 14

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 15

Wolff’s Law

Answer 15

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

Question 16

Somatic Dysfunction

Answer 16

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

Question 17

Sherrington

’s Law:

Answer 17

When a muscle receives a nerve impulse to contract, its antagonists receive an impulse to relax.

Question 18

Common Compensatory

• 80% of healthy people

Answer 18

L/R/L/R

Question 19

Uncommon Compensatory

Answer 19

20% of healthy people

• R/L/R/L

Question 20

Uncompensated Pattern

Answer 20

Usually symptomatic

• Usually a trauma is involved

Question 21

Transition Zones of the

Spine

Answer 21

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

Question 22

Transverse

Restrictors

Answer 22

Tentorium Cerebelli
Thoracic Inlet
Thoracolumbar Diaphragm
Pelvic diaphragm

Question 23

Tissue texture abnormality & Asymmetry of tissues

Answer 23

Tx Goal: Stretch and increase the elasticity of shortened myofascial structures to return
symmetry – Tx Goal: Improve local tissue nutrition, oxygenation, and removal of metabolic wastes to normalize tissue texture

Question 24

Asymmetry of muscles – Hypertonic muscles – Muscle spasm

Answer 24

Tx Goal: return symmetry & normalize tone

Question 25

Restricted motion of soft tissue – Myofascial restrictions

Answer 25

Tx Goal: set the fascia free

Question 26

Tenderness – Abnormal neurologic activity

Answer 26

Tx Goal: Normalize neurologic activity (pain, guarding & proprioception) & Improve abnormal somato-somatic and somato-visceral reflexes

Question 27

ST Indications

Answer 27

Diagnostically to identify areas of restricted motion, tissue texture changes, and sensitivity • Feedback about tissue response to OMT • Improve local and systemic immune response • Provide a general state of relaxation • Enhance circulation to local myofascial structures • Provide a general state of tonic stimulation

Question 28

Individual techniques may be contraindicated in specific | situations such as:

Answer 28

Severe osteoporosis – prone pressure techniques may be contraindicated in the thoracocostal region, but lateral recumbent techniques could be easily applied. Acute Injuries – Direct techniques that stretch acutely injured muscles, tendons, ligaments, or joint capsules may do additional damage to these structures, or increase the amount of pain the patient experiences and are therefore contraindicated.

Question 29

Contraindicated for use in the local region of any of the | following conditions:

Answer 29

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

Question 30

Principles of ST Technique

Answer 30

Patient comfort • Physician comfort: to minimize energy expenditure • Initially, the applied 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 • As the soft tissues are palpated responding to the technique, the applied forces can be increased to increase the amplitude of the technique. The rate of application typically remains the same

Question 31

Principles of ST Technique

Answer 31

The applied forces should be comfortable for the patient. Some patients experience some discomfort, but it is recognized by the patient as a good discomfort Do not allow your hands to create friction by sliding across or rubbing the skin. The physician’s hand should carry the skin and subcutaneous tissues in applying the activating force. • The technique is continued until the desired effect is achieved. This typically means that the amplitude of excursion of the soft tissues has reached a maximum and has plateaued at that level. F

Question 32

Stretch (parallel | traction)

Answer 32

Increase distance between origin and insertion (parallel with muscle fibers

Question 33

In this type of soft tissue technique, the forces being applied are parallel to the myofascial structures needing treatment. This may be done by

Answer 33

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) The taffy pull = Stretch

Question 34

Knead (perpendicular traction)

Answer 34

Repetitive pushing of tissue perpendicular to muscle fibers The bowstring = Kneading

Question 35

Inhibition

Answer 35

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

Question 36

Myofascial Release

Answer 36

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 37

Integrated Neuromusulskeletal Release

Answer 37

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

Question 38

REMs speed up the treatment price

Answer 38

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 39

Indications of MFR

Answer 39

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 40

Contraindications of MFR

Answer 40

Absolute: Lack of Patient Consent Absence of Somatic Dysfunction ``` Absence of Somatic Dysfunction Relative: 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 41

Inherent Forces

Answer 41

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

Question 42

Respiratory Cooperation

Answer 42

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

Question 43

Patient Cooperation:

Answer 43

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

Question 44

MFR Treatment Endpoint

Answer 44

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