Soft Tissue and Myofascial Release Techniques

Question 1

Fascial Anatomy

Answer 1

CT layers composed of collagen fibers (occasionally also Elastin fibers) in an amorphous matrix of hydrated proteoglycans. Mechanically links collage fiber networks in these structures

Question 2

Fascia

Answer 2

Involved in tissue protection and healing of surrounding systems

Compsed of irregularly arranged fibrous elements of varying density

A complete system with blood supply, fluid drainage, and innervations

Question 3

Pannicular Fascia

Answer 3

1st Fascial Layer (Panniculus)

Outermost layer of fascia derived from somatic mesenchyme and surrounds entire body with exception of the orifices; outer layer is adipose tissue and inner layer is membranous and adherent, generally, to the outer portion

Question 4

Axial and Appendicular Fascia

Answer 4

2nd Fascial layer (Investing layer)

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

Question 5

Meningeal Fascia

Answer 5

3rd fascial layer

Surrounds the nervous system, includes the dura

Question 6

Visceral Fascia

Answer 6

Surround the body cavities (pleural, pericardial, and peritoneum)

Question 7

Viscoelastic Material

Answer 7

Any material that deforms according to rate of loading and deformity

Question 8

Stress

Answer 8

The force that attempts to deform a connective tissue structure

Question 9

Strain

Answer 9

The percentage of deformation of a connective tissue

Question 10

Hysteresiss

Answer 10

The energy that is lost in the connective tissue system due to differences in loading and unloading characteristics

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

Question 11

Creep

Answer 11

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

Question 12

Ease

Answer 12

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 13

Bind

Answer 13

A palpable restriction of connective tissue mobility

Question 14

Hooke’s Law

Answer 14

The strain (deformation) placed on an elastic body is proportional to the stress (force) placed upon it

Question 15

Wolff’s Law

Answer 15

“Bone will develop according to the stresses placed upon it”

Question 16

Direct Techniques

Answer 16

Go towards and eventually thru the restrictive barrier

Question 17

Indirect Techniques

Answer 17

Go away from the restrictive barrier

Question 18

Soft Tissue Indications

Answer 18

Diagnostically to identify areas of restricted motion, TTA, and sensitivity—> TART

Used to: 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 19

Soft Tissue Relative Contraindications

Answer 19

Severe osteoporosis and acute injuries

Question 20

Soft Tissue Absolute Contraindications

Answer 20

Fracture or dislocation 
Neurologic entrapment syndromes
Serious vascular compromise 
Local malignancy
Local infection 
Bleeding disorders

Question 21

Principles of Soft Tissue Techniques

Answer 21

Patient Comfort

Physician Comfort

Forces are very gentle and of low amplitude

As tissue responds to technique, increase in amplitude may be applied

Question 22

Stretch

Answer 22

(Parallel traction)

Increase distance between origin and insertion, parallel with muscle fibers

Question 23

Knead

Answer 23

(Perpendicular Traction)

Repetitive pushing of tissue perpendicular to muscle fibers

Bowstring

Question 24

Inhibition

Answer 24

Push and hold perpendicular to the fibers at the musculotendinous part of hypertonic muscle

Hold until relaxation of tissue

Question 25

Integrated Neuromusculoskeletal Release (INR)

Answer 25

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

Question 26

REM

Answer 26

Speed the treatment process of INR

Breath holding

Prone and supine simulated swimming and pendulum arm swing

isometric limb and neck movements against the table
Patient evoked movement from cranial nerves

Question 27

Indications for MFR

Answer 27

Somatic dysfunction

When HVLA or MET is contraindicated

When counterstrain may be difficult secondary to a patients inability to relax

Question 28

Absolute Contraindications of MFR

Answer 28

Lack of consent

Absence of somatic dysfunction

Question 29

Relative Contraindication of MFR

Answer 29

Infection of st or bone 
Fracture, avulsion or dislocation
Metastatic disease 
st injuries
post-op patient
RH condition involving c-spine
DVT or anticoagulation therapy

Question 30

Inherent Forces

Answer 30

Activating Force

Using the body’s primary respiratory mechanism (PRM)

Question 31

Respiratory Cooperation

Answer 31

Activating Force

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

Question 32

Patient Cooperation

Answer 32

Activating Force

The patient is asked to move in a specific direction to aid in mobilizing specific areas of restriction

Question 33

Sherrington’s Law

Answer 33

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

Question 34

Common Compensatory Pattern

Answer 34

80% of healthy people

L/R/L/R

Question 35

Uncommon Compensatory Pattern

Answer 35

20% of healthy people

R/L/R/L

Question 36

Uncompensated Patterns

Answer 36

Usually symptomatic and trauma involved

Question 37

Transverse Restrictors

Answer 37

Tentorium Cerebelli
Thoracic Inlet
Thoracolumbar Diaphragm
Pelvic Diaphragm

Question 38

Desired effect of ST

Answer 38

The amplitude of excursion of the soft tissues has reached a maximum and has plateaued at that level