Soft Tissue Myofacial Release Flashcards
What does “soft tissue” entail?
fascia, muscles, organs, nerves, vasculature, lymphatic
fascia
a complete system with blood supply, fluid drainage, and innervations composed of irregularly arranged fibrous elements of varying desity
function of fascia
tissue protection and healing
omnipresent
continuous throughout the body
pannicular fascia
outermost layer of fascia derived from somatic mesenchyme and surrounds entire body with exception of orifices; outer layer is adipose tissue and inner layer is membranous and adherent to the outer portion
axial and appendicular fascia
internal to the pannicular layer; fused to the panniculus and surrounds all of the muscles, the periosteum of bone, and peritendon of tendons
meningeal fascia
surrounds the nervous system; includes the dura
visceral fascia
surrounds the body cavities (pleural, pericardial, and peritoneum)
omnipotent
provides mobility and stability of the musculoskeletal system
omniscient
mechanoreceptors, stretch receptors, liquid crystal like properties
viscoelastic material
material that deforms according to rate of loading and deformity
stress
force that attempts to deform a connective tissue structure
strain
percentage of deformation of a connective tissue
hysteresis
energy lost between the loading and unloading characteristic in the connective tissue system
creep
connective tissue under a sustained, constant load (below failure threshold) will elongate 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 on it – extends to fascia
direct technique
towards and through the restrictive barrier
indirect technique
away from the restrictive barrier
Sherrington’s law
when a muscle receives a nerve impulse to contract, its atagonists receive, simultaneously, an impulse to relax
common compensatory
left, right, left, right
80% healthy people
uncommon compensatory
right, left, right, left
20% healthy people
uncompensated pattern
usually symptomatic, trauma caused
transverse restrictors
tentorium cerebelli, thoracic inlet, thoracolumbar diaphragm, pelvic diaphragm
soft tissue technique
a system of diagnosis and treatment directed toward tissues other than skeletal or arthroidal elements
treatment goal of ST techniques related to tissue texture abnormality
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
treatment goal of ST techniques related to asymmetry of muscles
return to symmetry and normalize tone
treatment goal of ST techniques related to restricted motion of soft tissue
set the fascia free
treatment goal of ST techniques related to tenderness
normalize neurologic activity and improve abnormal somato-somatic and somato-visceral reflexes
ST indications
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
ST relative contraindications
severe osteoporosis - prone techniques
acute injury - direct techniques
ST absolute contraindications
fracture or dislocation neurologic entrapment syndromes serious vascular compromise local malignancy local infection bleeding disorders
principles of ST technique
patient comfort
physician comfort: minimize energy expenditure
initially apply forces gently with low amplitude
apply forces rhythmically for 1-2 seconds of stretch followed by a similar time frame releasing the stretch
increase amplitude, not rate
comfortable for pt
carry skin and subcutaneous tissues
until tissue creep
parallel
increase distance between origin and insertion with muscle fibers
knead
repetitive pushing of tissue perpendicular to muscle fibers
inhibition
push and hold perpendicular to the fibers at the musculotendinous part of hypertonic muscle
MFR
a system of diagnosis and treatment first described by AT 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 and reflexively release patterned soft tissue and joint related restrictions
REMs
speed up treatment process
example of REMs
breath holding
prone and supine simulated swimming and pendulum arm swing maneuvers as direct and indirect barriers are release
R/L cervical rotation
isometric limb and neck movements
patient evoked movement from cranial nerves
indications of MFR
somatic dysfunction
HVLA or muscle energy contraindication
counterstrain difficulty secondary to a patient’s inability to relax
absolute contraindications of MFR
lack of patient consent
absence of somatic dysfunction
relative contraindications of MFR
infection of soft tissue or bone fracture, avulsion, dislocation metastatic disease soft tissue injury post-op pt with wound dehiscence rheumatologic condition involving instability of c-spine DVT or anticoagulation therapy
inherent forces
using the body’s PRM
respiratory cooperation
physician directed patient performed inhalation or exhalation or holding of the breath to assist with manipulative intervention
patient cooperation
patient asked to move in specific directions to aid in mobilizing specific areas of restriction
activating forces
inherent forces, respiratory cooperation, patient cooperation
MFR treatment endpoint
3D release palpated as warmth, softening, increased compliance/ROM
continuous application of activating forces no longer produce change
symmetrical
