Neural kineticxer workshop poland 2014


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Instrumental TenseActive Release of Median Nerve. Poland 2014. The professor David Lopez PT, DC teach how to release the median nerve and increases the affected circulation to recover the neural mobility and function using the KineticXer approach. The presentation expose the most common points where the median nerve suffer entrapment and during the workshop those techniques to produce the release according the anatomy and pathological attachments. In addition teach the traces to increaseand normalize the nerve irrigation affected by the compression and chronic dysfunction.

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Neural kineticxer workshop poland 2014

  1. 1. International Workshop “Kineticxer ® instrumental Neural Release” XX edition of International Disabled People’s Day. International Scientifique Symposium 20-23 March 2014. Zgorzelec, Poland. Prof. David López Sánchez Kinesiologyst; Chiropractor D.C. Director of Chiropractic Program Central University of Chile Director of Manual Therapy Diplomats Saint Thomas University, Chile
  2. 2. What is KineticXer?  KineticXer is an instrumental Tense Active Release Concept to diagnostic and treat or mobilize soft tissues.  KineticXer apply ergonomically designed stainlesss steel devices to act over fascias, nerve, muscles and over different conditions.  Similar to other concepts as crochetagem, Graston, Gua Sha, etc. for the treatment of soft tissues, KineticXer evoluted to diagnostic and treat neural tissues, limphtatic drainage and soft tissues repair in chronic lesions.  With a variety of new applications KineticXer improves the existent methods
  3. 3.
  4. 4. KineticXer: Different Applications
  5. 5. Diagnosis • The Instrument TenseActive Release Concepts (ITARC) use stainless steel instruments, which are thought to be able to detect and treat soft tissue lesions, by using a variety of gliding multidirectional stroke techniques over the involved soft tissue structure. (W. Hammer. Journal of Bodywork and Movement Therapies, Volume 12, Issue 3, Pages 246-256).
  6. 6. Diagnosis • Carey-Loghmani (2003) likens the stainless steel when contacting fibrotic tissue, the instrument reverberate, sending more precise information to the clinician. • Much as a stethoscope amplifies what the human ear can hear, this function hepls the clinician to detect and treat soft tissue dysfunctions.
  7. 7. KineticXer Technique • Today several instrumental to soft tissue mobilization techniques employs the use of stainless or plastics instruments, with the rationale that this technique increases blood flow and tissue healing to the area as well as breaking up soft tissue restrictions. (Carey-Loghmani, 2003:12) Crochetagem, Graston Technique, Diacutaneous Fibrolisis , eg. • These ITAR instruments are designed able to penetrate the soft tissues to a greater degree than the clinicians digital pressure.
  8. 8. Muscle Action Fascial Tension TenseActive Changes in fascia perfomance MotoActive Changes in muscle perfomance Passive muscle stiffness may be influenced by active contractility of intramuscular connective tissue. Robert Schleip *, Ian L. Naylor, Daniel Ursu, Werner Melzer, Adjo Zorn, Hans-Joachim Wilke, Frank Lehmann-Horn, Werner Klingler
  9. 9. Tense Active Action of Fascias The Fascia produces tension in the mechanical tissues related the muscles and nerve movemente Williams PE, Goldspink G. Connective tissue changes in immobilised muscle. J Anat 1984;184(2):343–50.
  10. 10. Absolute Contraindications for ITARC Techniques • Open Wound- Unhealed Suture Site/Sutures • Unhealed Fractures • Thrombophlebitis • Uncontrolled Hypertension • Kidney Dysfunction • Patient Intolerance/Non-compliance/Hypersensitivity • Hematoma • Osteomyelitis • Myositis Ossificans • Anti-Coagulant Medications • Cancer Varicose Veins • Burn Scars • Relative Contraindications for ITAR: • Acute Inflammatory Conditions (e.g. Synovitis) • Inflammatory Condition Secondary to Infection • Rheumatoid Arthritis Pregnancy (consider inherent ligament laxity) • Osteoporosis
  11. 11. Some Effects And Desirable Applications • To produce va correct muscle fiber alignement • To induce a controlled injury repair proccess (inflamatory reaction and granutation-fibrin clot- fibroblast profiferation- tissue remodeling) • To induce the repair process in chronic lesions • To increase blood flow • To break up soft tissue restrictions due to adhesions and fibroblasts • To promote the soft tissue fibrosis • To increase the mechanical tissue response to load (stiffness) • Kineticxer is reasonably able to act specifically over and treat soft tissue lesions, by using a variety of multidirectional stroke techniques over the involved soft tissue structure
  12. 12. Technique • Palpation and soft tissue evaluation: To detect tissue restricctions. • Instrumental tissue assessment: serve to detect fibrous corpuscles and fibrous adhesions.
  13. 13. Median Nerve: 1.-Cervical Radiculopathy. 2.- Thoracic Outlet Syndrom 3.-Síndrome del pronador redondo y síndrome del túnel carpiano. More Frequent Entrapments of Median Nerve (doble Crush) Osterman AL: The double crush syndrome. Orthop Clin North Am 2011;19:147-55
  14. 14. Thoracic Outlet Syndrome • Generalized Symptoms: Pain in the upper extremity, paraesthesia, numbness, weakness, skin discolorations, swelling, Raynaud’s Phenomenon.
  15. 15. 15 Neurogenic Symptoms of TOS: Pain, paraesthesia, weakness, coldness of the arm after prolonged hyperabduction: – For exampe in Hair dressing, painting… {this pain is similar to claudication pain}  C8-T1 “Ulnar nerve”: (more common) • Back of neck, medial side of arm to ring & little finger  C5-7: Lateral neck, shoulder tip, outside upper arm back of thumb & index finger {Compression of C8-T1 (ulnar nerve) is more common.} {Although cervical rib is congenital, Symptoms rarely develop before adulthood because a person suddenly gets taller in puberty and then symptoms appear.}
  16. 16. Causes of TOS  Elongated C7 TVP  Cervical Rib (or fibrous band)  Trauma, exostosis  Posture induced (Forward head/rounded shoulders)  Pancoast Tumor  Scalene Muscles (spastic, flaccid, or anomalous)  Costoclavicular area  Subcoracoid area (Pec minor/Coracoid Pr.)
  17. 17. Cervical Ribs  A congenital overdevelopment, bony or fibrous, of the C7 costal process. Can be unilateral or bilateral  Usually asymptomatic.  Occurs in 1% of the population and only 10% of those are symptomatic.  Pain and paresthesias in the medial forearm and hand, usually relieved by changing position. Can have weakness and difficulty with fine motor control.
  18. 18. Interscalene Triangle • Anterior Scalene • Middle Scalene • T1 Rib • Subclavian Artery • Brachial Plexus • Subclavian Vein passes anterior
  19. 19. Foraminal Space Median Nerve: Entrapment Zones
  20. 20. Escalene Muscles Median Nerve: Entrapment Zones
  21. 21. Subescapular muscle 1. Axilar Nerve 2. Subescapular Muscle Median Nerve: Entrapment Zones
  22. 22. Minor Pectoralis Median Nerve: Entrapment Zones
  23. 23. Subescapular, Pectoral mayor y menor: posición ITARC: Liberación TensoActiva • Colocar el hombro de lanzar en la pared o la puerta de la creación de un ángulo recto Desde esta posición, haga que el paciente mueva suavemente su cuerpo hacia adelante hasta que sienta un estiramiento suave. • Sobre la piel desnuda aplicar tranversal y longitudinalmente el kineticer® ; mientras se elonga el pectoral menor y mayor. En la misma posición, con mayor elevación de hombros y extensión de codo, contra resistencia es posible trabajar el subescapular
  24. 24. Pectoral-Deltoid Fascia Median Nerve: Entrapment Zones
  25. 25. Strüthers Ligament Median Nerve: Entrapment Zones
  26. 26. Lacertus Fibrosus Median Nerve: Entrapment Zones
  27. 27. Teres Pronator Median Nerve: Entrapment Zones
  28. 28. Median Nerve: Pronator Teres Entrapment • Entrapment at the level of the elbow or the proximal forearm gives rise to the pronator teres syndrome. Causes • A fibrous band at the site at which the nerve passes between the heads of the pronator teres muscle • Hypertrophy of the pronator teres muscle • The aponeurotic bridge of the flexor digitorum superficialis muscle (superficialis arch) • Thickening of the bicipital aponeurosis
  29. 29. Median Nerve: Pronator Teres Entrapment Anatomy
  30. 30. • (a) Axial T1-weighted SE MR image at a middle level in the forearm shows normal volume and normal signal intensity of the proximal forearm muscles 1pronator teres, 2 flexor carpi radialis, 3 palmaris longus, 4 flexor digitorum superficialis, 5 flexor pollicis longus, 6a radial part of the flexor digitorum profundus, 6b ulnar part of the flexor digitorum profundus) and normal signal intensity of the radius (R) and ulna (U). • (b) Corresponding T2-weighted fat-suppressed fast SE MR image demonstrates increased signal intensity indicative of edema in all of the muscles that are innervated by the median nerve.
  31. 31. Clinical Symptoms • Pain and burning of the skin supplied by median nerve branches • Loss of thumb opposition, with loss of flexion of the three radial fingers on prolonged compression • Painful pronation Thenar tenderness and characteristic distribution of pain on compression of the pronator teres • Muscle and thenar atrophy • Weakness of the flexor pollicis • Longus and abductor pollicis brevis muscles
  32. 32. Jean-Pierre Barral, Alain Croiber, Manipulaciones de los Nervios Periféricos, Osteopatía, The Barral Institute, editorial Elsevier- Masson, 2009 Palmaris Longus Median Nerve: Entrapment Zones
  33. 33. Jean-Pierre Barral, Alain Croiber, Manipulaciones de los Nervios Periféricos, Osteopatía, The Barral Institute, editorial Elsevier-Masson, 2009 Ligamento Transverso del Carpo Median Nerve: Entrapment Zones
  34. 34. l. Axial T1-weighted images of the median nerve MR s: scaphoid bone, c: capitate bone, h: hamate bone, t: triquetrum bone, p: pisiform bone, fcr: tendon of flexor carpi radialis muscle, fpl: tendon of flexor pollicis longus, fdp: tendons of flexor digitorum profundus muscle, fds: tendons of flexor digitorum superficialis muscle, mn: median nerve, fr: flexor retinaculum. Normal anatomic localization of the median nerve in the carpal tunnel
  35. 35. Neural structure traces  Use KineticXer Manthis ®.  The pressures over the nerve not much of 40 mmHG. Follows the instructcions of the teacher.  The trace under the tension not much of 20 mm HG.  A nerve is safe elongated between 6-8% without manifest functional changes.  Start the release from the central points to peripheric points.
  36. 36. Set of Techniques for today Treatment: Scalene Group Treatment: Deltoid Fascia & Pectoral Fascia Treatment: Subescapular Muscle Treatment: Teres Pronator Treatment: Radialis Longus Treatment: Carpal Tunnel entrapment PD: “Please Follows strictly the instructions of Prof. David Lopez” Median Nerve exclusively