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Soft Tissue Treatment of Musculoskeletal Disorders - Thomas E. Hyde

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Soft Tissue Treatment of Musculoskeletal Disorders Utilizing Functional and Kinetic Treatment with Rehab, Provocation and Motion (FAKTR-PM) by Thomas E. Hyde, DC, DACBSP, CSTI, ICSSD, FRCCSS (Hon).

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Soft Tissue Treatment of Musculoskeletal Disorders - Thomas E. Hyde

  1. 1. SOFT TISSUE TREATMENT OF MUSCULOSKELETAL DISORDERSUtilizing Functional and Kinetic Treatment with Rehab, Provocation and Motion (FAKTR-PM)<br />National University of Health Sciences<br />Thomas E. Hyde, DC, DACBSP, CSTI, ICSSD, FRCCSS (Hon)<br />
  2. 2. How about an adjustment?<br />
  3. 3. Don’t be afraid to jump into the unknown….<br />
  4. 4. El Misti 08/05Summit being treated by Greg Doerr, DC at 19,223 feet<br />
  5. 5. Objectives of this lecture<br /><ul><li>Teach you something new to consider using in your practice
  6. 6. Not to teach you to be an expert by the end of the lecture
  7. 7. Stimulate you to learn more
  8. 8. To provide you options to better treat your patients</li></li></ul><li>Objectives of this lecture<br /><ul><li>Teach you something new to consider using in your practice
  9. 9. Not to teach you to be an expert by the end of the lecture
  10. 10. Stimulate you to learn more
  11. 11. To provide you options to better treat your patients</li></li></ul><li>Before Treatment Begins<br />1. Take a complete history<br />2. Perform a complete examination<br />3. Make your best clinical decision regarding whether you feel your diagnosis for this patient would be best served by you treating them with whatever technique/s you employ<br />4. If not, refer to someone you feel would be more likely to help them<br />
  12. 12. Soft Tissue Techniques<br /><ul><li>Nimmo
  13. 13. Cyriax
  14. 14. Mattes (AIS)
  15. 15. Buttler Never Flossing</li></ul>Myofascial Release Tech<br /> Active Release Tech ®<br /><ul><li>Postisolation Relaxation
  16. 16. Proprioceptive Neurolmuscular Facilitation (PNF)
  17. 17. Stretching/gliding/pulling/pushing/compression
  18. 18. Stecco</li></ul>GuaSha<br />Graston Technique®<br />Sound Assisted Soft Tissue Technique<br />ASTYM<br />Rolfing<br />Massage<br />Strain Counterstrain<br />Pin and Stretch<br />Mulligan<br />Functional Position Patterns by Gary Gray<br />Muscle Energy Technique<br />
  19. 19. Which Technique would you chose for these folks?<br />
  20. 20.
  21. 21. Lowe continues to state that when traumatized and inflamed, a fascial lesion heals by spider-webbing together with irregularly arranged collagen.<br />Lowe<br />
  22. 22. Where fascia has been intermittently stressed, fibroblasts produce more linearly arranged collagen to reinforce the loaded myofascia.<br />Chamberlain, GJ. “Cyriax’sfrictionmassage: a review.” JOSPT, 1082; 4: p 20<br />
  23. 23. Muscle and fascia can’t be separated in that they function and dysfunction together. Where there is a tight muscle, there is usually tight fascia. Fascial-release techniques, then become important.<br />John Lowe, Ma, DC<br />
  24. 24. Nimmo – lumbar spine<br />
  25. 25. Nimmo - gluteals<br />
  26. 26. Nimmo Anyone????<br />
  27. 27. RaceTrack<br />
  28. 28. Acu-Force <br />Another instrument assisted from of soft tissue treatment.<br />There are 4 instruments used in an attempt to break up fascial restriction.<br />There are a small and large star, an S-shaped instrument and a 7 pound larger I-shaped instrument<br />
  29. 29. Acu-Force – forearm flexors<br />
  30. 30. AcuForce<br />
  31. 31. Acu-Force – trapezius/thoracic<br />
  32. 32. Acu-Force – lumbar spine<br />
  33. 33. I always feel better after my Acu-Force treatment.<br />
  34. 34. Death Valley<br />
  35. 35. Cyriax<br />Felt moving across the fibers at a right angle would not injure the normal healing tissue but would prevent the formation of or break down abnormal scar tissue.<br />Hammer<br />
  36. 36. Cyriax<br />Stated TF moved the involved tissue while longitudinal friction affected the transportation of blood and lymph.<br />Hammer<br />
  37. 37. Cyriax<br />In the acute phase, only necessary to use a light force<br />In the chronic stages a deep, stronger friction is necessary.<br />Hammer<br />
  38. 38. Cyriax<br />Friction creates anesthesia<br />Usually within 3 minutes of friction, anesthesia begins<br />
  39. 39. Cyriax – Shoulder - Knee<br />
  40. 40. CyriaxElbow<br />
  41. 41.
  42. 42. Cyriax can repair any damaged tissue<br />
  43. 43. Denmark<br />
  44. 44. Major Goals in the Promotion of Healing<br />1. Enhance proliferative invasion of vascular elements and fibroblasts followed by:<br />2. Collagen deposition and<br />3. Ultimate maturation.<br />Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med 22 (2003):<br />
  45. 45. Healing of Tendinosis<br />Increased collagen alone is not enough to heal a degenerated tendinosis<br />Equally important is the correct orientation of the collagen fibers.<br />
  46. 46. Healing of Tendinosis<br />Necessity of post treatment stretching & strengthening to provide the forces necessary for adaptive remodeling of new collagen in the affected areas.<br />Exercise creates collagen alignment and stimulates collagen cross-linkage formation thereby improving tensile strength.<br />
  47. 47.
  48. 48.
  49. 49. Superficial Posterior Spinal Fascial Lamina<br />Barker PJ, Briggs CA. Attachments of the Posterior Layer of Lumbar Fascia. Spine 24 (17):1757-64.<br />
  50. 50. DeepPosteriorSpinalLamina<br />SERRATUS POSTERIOR INFERIOR<br />FUSION OF SUPERFICIAL & DEEP LAMINAE<br />GLUTEUSMEDIUS<br />SACROTUBEROUSLIGAMENT<br />Barker PJ, Briggs CA. Attachments of the Posterior Layer of Lumbar Fascia. Spine 24 (17):1757-64.<br />
  51. 51. Lighthouse Tasmania<br />
  52. 52. New Research with IASTM<br />During the Fascial Conference at Harvard in 2007, research emphasized that ALL types of soft tissue mechanical loading including exercise, injury, manual muscle treatments such as fascial release, stretching techniques, and IASTM act by affecting the fibroblasts.<br />The fibroblasts are located within the ECM where repair, regeneration and maintenance of soft tissue takes place.<br />Hammer W. April 2008<br />
  53. 53. Hammer continued<br />Use of light manual fascial methods stimulation of fibroblasts can respond with anti-inflammatory cytokines, growth factors and vasoactive compounds that underlie positive clinical outcomes. <br />Standley showed how injury strains fibroblasts and fascia in negative ways while manual muscle treatment strains fibroblasts in curative ways.<br />Hammer W. April 2008<br />
  54. 54. Thomas <br />Meyers<br />Anatomy <br />Trains<br />
  55. 55. Superficial<br />Back<br />Line<br />Fascia<br />Removed <br />From <br />Cadaver<br />
  56. 56. Superficial<br />Back<br />Line<br />
  57. 57. Superficial<br />Front Line<br />
  58. 58. Lateral<br />Line<br />
  59. 59. Spiral<br />Line<br />
  60. 60. Arm<br />Line<br />
  61. 61. Front<br />And<br />Back<br />Functional<br />Lines<br />
  62. 62. Deep<br />Front<br />Line<br />
  63. 63. Thinking Outside the Box<br />What size and shape is your box?<br />Are you willing to change that shape or size?<br />What will you do differently tomorrow, next week, next year and each year thereafter?<br />
  64. 64. Is your box open or closed?<br />
  65. 65.
  66. 66.
  67. 67. FAKTR-PM<br />Developed by:<br />Greg Doerr, DC, CCSP, CKTP<br />Tom Hyde. DC, DACBSP, CKTP, FCCSS (Hon)<br />Contributions by:<br /> Vince DeBono, DC, CCSP, CSCS (KT Tape)<br /> Warren Hammer, DC, MS<br /> Dick Vincent, DC<br /> Shawn Burger, PT<br /> Mike Cicero, PT<br /> Mike Schneider, DC, PhD<br /> Phil Page, ATC, PT, PhD, CSCS<br /> Andre Labbe, PT<br /> Ed Feinberg, DC, CCSP<br /> Ted Forcum, DC, DACBSP<br /> Kay Pearce<br /> Donna Strachan<br />
  68. 68. Functional and Kinetic Treatment with Rehab, Provocation and Motion-FAKTR-PM<br />F - Functional and<br />K - Kinetic<br />T - Treatment with<br />R - Rehab<br />P - Provocation and<br />M - Motion<br />
  69. 69. Functional<br />What activity causes a reproduction of the patient’s pain, loss or ROM, tightness, loss of function<br />Is this with motion, without motion, active, passive, with resistance, without resistance<br />What activity can you patient NOT do<br />
  70. 70. Kinetic<br />Once the patient has been treated in the position of provocation with functional assessment, they are brought back to a non-pain producing position, then asked to assume the position of pain once more with functional testing. Many times, the pain will move up or down the kinetic chain – you now chase that pain.<br />
  71. 71. Treatment<br />Treatment is rendered in the position of provocation and with the function mechanism in play<br />Treatment can be performed utilizing many different soft tissue modalities<br />
  72. 72. Rehabilitation (Rehab)<br />This entails the use of many types of low tech rehab devices such as the Swiss Ball, Both Sides Up (BOSU), balance pads and boards, tubing, Therabands, and more<br />
  73. 73. Provocation<br />The patient is asked to assume the position of provocation, that is the position that will reproduce their pain<br />If the complaint is low back pain, you must determine if the pain is seated, standing, leaning, bending, etc<br />This applies to any area of the body where pain is secondary to musculoskeletal disorders<br />
  74. 74. Motion<br />What motion, if any, will reproduce the patient’s pain<br />Consider treating the patient in motion such as low back pain brought on by getting up from a seated position for example<br />
  75. 75. Myofascial treatment has always worked for me.<br />
  76. 76. Arundel Castle<br />
  77. 77. GuaSha<br />GuaSha involves palpation and cutaneous stimulation where the skin is pressured, in strokes, by a round-edged instrument; that results in the appearance of small red petechiae called 'sha', that will fade in 2 to 3 days.<br />http://www.guasha.com/<br />
  78. 78. GuaSha<br />Raising Sha removes blood stagnation considered pathogenic, promoting normal circulation and metabolic processes.The patient experiences immediate relief from pain, stiffness, fever, chill, cough, nausea, and so on. GuaSha is valuable in the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and many other acute or chronic disorders.<br />
  79. 79. GuaSha<br />
  80. 80. Demonstration ShoulderActive Supraspinatus<br />
  81. 81. Isometric Supraspinatus<br />
  82. 82. Active Resisted Biceps<br />
  83. 83. Active Resisted Subscap<br />
  84. 84. Active Resisted Serratus<br />
  85. 85. Active Resisted Scapular Stabilizers<br />
  86. 86. Active Resisted Scapular Stabilizers<br />
  87. 87.
  88. 88.
  89. 89.
  90. 90.
  91. 91. Shoulder w/Motion + Proprio<br />
  92. 92.
  93. 93. Knee Demonstration<br />
  94. 94.
  95. 95. Active Resisted Quad<br />
  96. 96. Quad, Patellar Tendon with Ball Squat<br />
  97. 97.
  98. 98.
  99. 99. QUAD JUMPERS<br />
  100. 100. Ankle Demonstration<br />
  101. 101.
  102. 102. Ankle Propiroception<br />
  103. 103. ANTERIOR SHIN SPLINTS<br />
  104. 104. Cervical Spine Demonstration<br />
  105. 105. Cervical Flexion/Extension GT<br />
  106. 106. Active Resisted CS Lateral Flexion<br />
  107. 107. Active Resisted CS Flexion/Extension<br />
  108. 108. Active Resisted CS with Rotation<br />
  109. 109. Active Resisted Upper Trap/LevatorScap<br />
  110. 110.
  111. 111.
  112. 112. CERVICAL SPRAIN/STRAIN<br />Correction Strip<br />
  113. 113. Lumbar spine demonstration<br />
  114. 114.
  115. 115.
  116. 116.
  117. 117.
  118. 118.
  119. 119.
  120. 120.
  121. 121. Questions and Answers<br />
  122. 122.
  123. 123. Every patient is different, and that’s why there is no cook book for care.<br />
  124. 124. Helpful Websites<br />www.spine-health.com<br />www.thera-bandacademy.com<br />www.grastontechnique.com<br />www.faktr-pm.com<br />http://www.stretchingusa.com/<br />http://www.spidertech.com<br />
  125. 125. Thank You<br />Thyde444@bellsouth.net<br />

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