patrick st. louis msrs lat/atc, cktf, cct manual therapy and myofascial release
TRANSCRIPT
Patrick St. Louis MSRS LAT/ATC, CKTF, CCT
MANUAL THERAPY AND
MYOFASCIAL RELEASE
Certified and Licensed Athletic Trainer Instructor of Health and Human Performance at
Concordia University Wisconsin in our Master of Science in Athletic Training Program
Certified in Graston Technique® M1 (IASTM)Certified Faculty Instructor of Kinesio Taping Method®Certified Cupping Therapist (ICTA)Proficient in
Muscle Energy Technique Joint Mobilizations Myofascial Release Myofascial Trigger Point Therapy
Ischemic compression
PERSONAL BACKGROUND
“Beyond all doubt, the use of the human hand, as a method of reducing human suff ering, is the oldest remedy known to man.”
James Mennell
A number of manual therapies have evolved over the years
By their nature, many of these techniques are not founded on the same scientific rigor as anatomy and physiology, and much of their use is based on clinical outcomes, rather than evidence-based proof.
OVERVIEW
The decision on which manual technique to use is based on the clinician’s belief, their level of expertise, and their decision-making processes
OVERVIEW
“Manual therapy is the use of hands-on techniques to evaluate, treat and improve status of neuromusculoskeletal conditions.” Joints Soft tissue Nervous tissue
DEFINITION
There is general agreement on those criteria that are important for the correct application of a manual technique. These include: Specificity Direction and amount of force The duration, type, and irritability of symptoms Patient and clinician position
APPLICATION
Manual therapy is indicated when there is: Mild pain A non-irritable condition Intermittent musculoskeletal pain Pain that is relieved by rest, or by particular motions or
positions
INDICATIONS
Absolute Bacterial infectionMalignancySystemic localized infectionSutures over the areaRecent fractureCellulitisFebrile stateHematomaAcute circulatory conditionAn open wound at the treatment site
CONTRAINDICATIONS
AbsoluteOsteomyelitisAdvanced diabetesHypersensitivity of the skin Inappropriate end feel (spasm, empty, bony)Constant, severe pain, including pain which disturbs sleep, indicating that the condition is likely to be in the acute stage of healing
Extensive radiation of painPain unrelieved by rest
CONTRAINDICATIONS CONT.
Relative Joint effusion or inflammation Rheumatoid arthritis Presence of neurological signs Osteoporosis Hypermobility Pregnancy Dizziness
CONTRAINDICATIONS CONT.
Direct Techniques Manual therapy maneuvers that load or bind tissue and
structures. Move toward the point of limitation of tissue mobility.
Goal: Move the point of restriction closer to the normal range of
motion. Techniques
Stretching Joint Mobilizations Trigger Point Muscle Energy
TYPES OF MANUAL THERAPIES
Indirect Techniques Move the tissue away from the direction of limitation.
Goal Allows the tissue to “let go” or release its restriction and allow
more motion. Techniques
Positional release therapy Strain-Counterstrain
TYPES OF MANUAL THERAPIES
Manual technique that involves the voluntary contraction of a muscle in a precisely controlled direction, at varying levels of intensity, against a distinct counterforce.
Can be used to help mobilize joints, realign joints, strengthen weakened muscles, and to stretch adaptively shortened muscles and fascia
MUSCLE ENERGY TECHNIQUE (MET)
Obtained from http://www.humankinetics.com
Joint mobilization techniques include a broad spectrum, from the general passive motions performed in the physiologic cardinal planes at any point in the joint range, to the semi-specific and specific accessory (arthrokinematic) joint glides, or joint distractions, initiated from the open-packed position of the joint.
JOINT MOBILIZATIONS
Obtained from http://www.rpm-therapy.com
Massage The systemic and scientific manipulation of soft tissue for
remedial or restorative purposes.1
MASSAGE
Eff ects Muscle relaxation Blood vessel dilation Increased blood and lymphatic flow Promotion of fluid mobilization Stretching and breakdown of tissue adhesions
MASSAGE
Types Effl eurage
Stroking. Typically used at the beginning and end of treatment Petrissage
Compression and kneading. Soft tissue is grasped and manipulated intermittently so that there is movement between the skin’s underlying structure and muscle.
Tapotment Rhythmic tapping application or pounding/patting. Helps to
revitalize sore and tired muscles Friction
Deep pressure movement of superficial soft tissue against underlying structures.
MASSAGE
Continuous structure that surrounds and integrates tissues and structures throughout the body.1
Varies in density and thicknessThree layers
Superficial Deep Subserous
FASCIAL ANATOMY
Third whole-body communicating networkGrapefruit metaphor
FASCIAL ANATOMY
Obtained from http://www.circusconditioning.com
Obtained from http://www.anatomytrains.com
A series of techniques designed to release restrictions in the myofascial tissue that are used for the treatment of soft tissue dysfunction that has not responded to other interventions.1
MYOFASCIAL RELEASE
MYOFASCIAL RELEASE
Myofascial Restriction
Changes in force requirement
Acute or Chronic Trauma
Length imbalance of agonist/antagonist
Unbalanced forces of agonist/antagonist
Neurological readjustment
Posture changes
Coordination changes
Palpation: Normal mobility Superficial to deep Autonomic Effects
Time: 3-5 minutes
Guidelines: Avoid Bruising Relaxed Stabilization
MYOFASCIAL RELEASE TREATMENT GUIDELINES
Styles J-Stroke Oscillation Wringing Stripping Arm Pull Leg Pull Trigger Point Release Skin Rolling Grip and Rip technique Foam Rolling IASTM Cupping Therapy
MYOFASCIAL RELEASE TREATMENT GUIDELINES
“Focus of hyperirritability in a tissue that, when compressed, is locally tender and, if suffi ciently hypersensitive, gives rise to referred pain and tenderness.”1
ActiveLatentSatellite
TRIGGER POINT RELEASE
Obtained from http://www.lauraquinn.com.au
What are we looking for?How much pressure should we apply?How do I determine which structures I am actually
palpating?
PALPATION
Obtained from http://www.orchardclinic.co.uk
Superfi cial v Deep Tissues Very light Increasing pressure
Appropriate pressure Epidermis
3-10grams Dermis
10-30grams Superficial Fascia
30-100grams Deep Fascia & Superficial Muscles
80-160grams Deep Fascia & Middle layer Muscles
150-200grams Deep Fascia & Deep Muscle
250-400grams
PALPATION
Obtained from http://www.orchardclinic.co.uk
Dime LabSponge Lab
PALPATION
1. Houglum, Peggy. Therapeutic Exercise for Musculoskeletal Injuries. 3 rd ed. Champaign: Human Kinetics, 2010. Print
2. Hammer, Warren. Functional Soft-Tissue Examination and Treatment by Manual Methods. 3 rd ed. Sudbury: Jones and Bartlett Publishers
3. Myers, Thomas. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 2n d ed. Philadelphia: Churchill Livingstone Elsevier
4. Kinesio Taping Association International 5. Chaitow, Leon. Muscle Energy Techniques. 4 t h ed.
Philadelphia: Churchill Livingstone Elsevier 6. Lewit, Karel. Manipulative Therapy Musculoskeletal
Medicine. Philadelphia: Churchill Livingstone Elsevier 7. Prentice, William. Rehabilitation Techniques for Sports
Medicine and Athletic Training. 4 t h ed. New York: Mcgraw-Hill
REFERENCES