Thoracic II Indirect I Flashcards
Treating injury w/ counter strain
. Counters strain by reintroducing position of original strain which is position of shortened tissues and relative ease
Neurophysiology of normal and shortened muscles
. Muscle spindles report changes in overall muscle length and rate of change of stretch
. Stretching muscle inc. firing of spindles
. Hyper-shortened muscles produce little/no firing
Counterstrain application
. Acute or chronic somatic dysfunction
. Somatic dysfunctions w/ neural component (hypershortened muscle)
. Can be primary treatment of in conjunction w/ other approaches
. Any area of body can be treated but patient must relax
. Good for patient’s w/ painful musculoskeletal conditions
Facilitated position release
. Indirect myofascial releases developed by Stanley Schiowitz
. Positional, uses facilitating force to activate inherent forces
. Good for somatic dysfunction or abnormal muscle tension
. Activating force held for 3-5 sec.
. Used for articular or myofascial restrictions
Physiologic basis for FPR
. Similar to counterstrain
. Muscle spindles report stretch, inc. firing of gamma afferents in stretched muscle
. Restoration of hyper-shortened muscle dec. firing
. Compressive force causes neural feedback to rapidly normalize
FPR general procedure
. Put joint in loose pack position . Flatten spine . Add facilitated force . Position into freedom of motion or shortening of muscle . Hold 3-5 sec. then release
Indications to complete FPR
. Somatic dysfunction w/ neural component
. Any area of body
. Acute or chronic
. Need for gentle technique
. Primary treatment or combined w/ others
. Useful for pain from disc herniation
Cellular components of fascia
- Fibroblasts
- Fat cells
- Fixed macrophages
- Mast cells
- Plasma cells
- Leukocytes
Components of ECM
- Collagen (tensile strength)
- Proteoglycans/Mucopolysaccharides (glycosaminoglycans)
- Mucin
- Reticulin
- Elastin
- Fibers: Elastic and Reticular
Superficial fascia
. Loose fibrous envelope beneath skin containing fat, cutaneous vessels, and nerves
. Related to dermis
Subserous fascia
Covers, supports, and lubricates organs
. Comprises the loose CT underlying endothelial, vascular, and glandular surfaces
Deep fascia
. Strong fibrous CT that compartmentalizes body into cavities
. Inner and outer layers can envelop structure
. Specialized around joints to form/strengthen ligaments
Fascial functions
. Super fascial planes follow fiber direction of muscles they span and cover multiple joints
. Allows individual structures to communicate while not disturbing their individual functions
. Limits and directs planes of motion
. Provides anatomic support and stability while acting as location where metabolic/physiologic functions occur
T/F Fascia is not affected by internal forces
F, affected by both external and internal forces
Fascial sheet qualities
. Move w/ respiration and inherent movement assoc. w/ cranial rhythmic impulse (CRI), circulation, lymph flow, and muscular pumps
. Some sheets have multidirectional fibers (trap)
. SOme have complex, non-linear motion
. Some have no motion (scar tissue)
. Had 3D areas of tightness and looseness
Unique physiologic properties of fascia
. Plasticity: quality of being formed and retaining shape
. Elasticity: recoverable deformation
. Viscosity: rate of deformation under load
Horizontal diaphragms of fascia
a. Abdominal diaphragm
b. Pelvic diaphragm
c. Thoracic inlet
d. Tentorium cerebelli
e. Lesser diaphragms
f. Palmar fascia
g. Plantar fascia
Longitudinal cables of fascia
. Dural sleeve from occiput to S2
. Ant. Longitudinal ligament to S2
. Psoas major to lower extremity
. Rectus abdominus, quadratus lumborum, internal/external abdominal oblique
. Trachea, esophagus, pericardium inserting to central tendon of diaphragm
Still technique
. Starts indirect then becomes direct
. Gentle, precise localization
. Utilized location of all planes of motion to balance point/position of ease
. Uses final activating force through affected tissue
. Vector force from part of body that can be used as lever for techniques
. As coupled vector force and tissue motion takes tissue past its restriction a palpable release occurs
When to use Still technique
. Any type of dysfunction . Quick and efficient . Retreat w/o complications . Gentle . Treat in seated and supine positions
Indirect balancing
. Indirect treatment where restrictive barrier is disengaged, tissue moves away from it until tension is equal in all planes
. Release via inherent forces
. Good for articular restrictions
Balance point
. New neutral
. Floating sensation (loss of tension)
. Same amount of tension in all planes
Mechanics of treating w/ indirect balancing
- Finding a point of neutral tension.
- The new neutral point.
- Stacking components.
- Include translatory movements.
- Include exhalation/inhalation.
- Include cranial motion.
Clinical usefulness of indirect balancing
. Older patients
. When HVLA or DIrect techniques were contraindicated
. Acute injuries
. Achieving general relaxation
Strain reflexes cause
. Impaired metabolism
. Impaired circulation
. Altered proprioception
. Maintenance of nociceptive sensitivity in involved tissues
T/F Never remove monitoring finger i counterstrain and indirect balancing
T, wait until it is time to completely reassess after patient pain is less than 3/10
How many treatment points can you treat per visit?
6
How many days do you wait until patient can repeat counterstrain treatment?
3 days
WHen to NOT use counterstrain
. Fracture directly affected by positioning
. Ligamentous tear directly affected by positioning
. Severely ill patient until they have been stabilized
. Patient refuses treatment
Counterstrain relative contraindications
. Patient can’t voluntarily relax
. Patient develops neurologic symptoms during treatment
. Patients w/ vascular disease, spinal disease, rheumatologic or other condition where positioning leads to vascular compromise or joint instability
Force effects in CT
. Plastic or elastic deformation . Viscosity . Creep . Stress . Strain
Physical properties of muscle
. Irritability . Contractility . Relaxation . Dispensability . Elasticity
Exercise caution w/ using MFR for
. Open wounds . Fractures . DVT . Abscess . Soft tissue/ bony infection . Aortic aneursym . Severely ill patient
Facilitating forces
Compression (most common)
Torsion
Traction
