Myofascial release ue (1)
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satoshi kajiyama laudner presentation athletic training manual therapy kinesiology myofacial release and trigger point therapy illinois state university boston red sox orthopedic and sports enhancement center
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Myofascial release ue (1)
- 1. Myofascial Release &Myofascial Release & Trigger Point TherapyTrigger Point Therapy Modern Manual Therapy IModern Manual Therapy I KNR 494KNR 494
- 2. FasciaFascia • 3D network of connective tissue from3D network of connective tissue from head to toehead to toe • ContainsContains - Vascular structuresVascular structures - Adipose cellsAdipose cells - Sensory receptorsSensory receptors (Manheim, 2001)(Manheim, 2001) • Myofascial tissue?Myofascial tissue?
- 4. Myofascial PainMyofascial Pain • Originates in both muscle & fasciaOriginates in both muscle & fascia • SymptomsSymptoms - Deep, sharp, burning, dull, diffuse, heavy,Deep, sharp, burning, dull, diffuse, heavy, squeezingsqueezing • Needs to be treated quicklyNeeds to be treated quickly - Why?Why?
- 5. What is Myofascial ReleaseWhat is Myofascial Release (MFR)?(MFR)? • Interactive stretching technique that usesInteractive stretching technique that uses manual pressure to facilitate maximummanual pressure to facilitate maximum relaxation of tight or restricted tissuesrelaxation of tight or restricted tissues - DirectionDirection - ForceForce - DurationDuration (Manheim, 2001;(Manheim, 2001; Ferguson & Gerwin)Ferguson & Gerwin)
- 6. ““Fixes/Anchors”Fixes/Anchors” • ForearmForearm • ElbowElbow • FistFist • PalmPalm • GripGrip • Reinforced thumbsReinforced thumbs • Finger(s)Finger(s) • Knuckle(s)Knuckle(s) • External devicesExternal devices (Manheim, 2001)
- 7. Direction of StretchDirection of Stretch • HorizontalHorizontal • DiagonalDiagonal • PerpendicularPerpendicular • VerticalVertical
- 8. Why not just use a grossWhy not just use a gross stretch?stretch?
- 9. Benefits of MFR over GTBenefits of MFR over GT • Less expensiveLess expensive • Patient easePatient ease • Less invasiveLess invasive • Self-treatSelf-treat • Tightness vs. restrictionsTightness vs. restrictions • Difficult to evaluate some areas with GTDifficult to evaluate some areas with GT
- 10. General IndicationsGeneral Indications Myofascial restrictionsMyofascial restrictions • Pain has not been alleviated by otherPain has not been alleviated by other treatmentstreatments • Pain is complex, global, or specific painPain is complex, global, or specific pain • Underlying chronic condition causing tightnessUnderlying chronic condition causing tightness and restrictionsand restrictions • Complex postural asymmetriesComplex postural asymmetries • Athlete needs stretching to increaseAthlete needs stretching to increase performance and prevent injuryperformance and prevent injury (Manheim, 2001)
- 11. Precautions/ContraindicationsPrecautions/Contraindications Myofascial RestrictionsMyofascial Restrictions • InflammationInflammation • Patient uncomfortable with touchPatient uncomfortable with touch • DermatitisDermatitis • Contagious/infectious diseaseContagious/infectious disease • Fractures/open woundsFractures/open wounds • Circulatory problemsCirculatory problems • Taking blood clotting medicineTaking blood clotting medicine • OsteoporosisOsteoporosis (Manheim, 2001)
- 12. MFR Treatment StepsMFR Treatment Steps 1.1. Gross stretch of entire body areaGross stretch of entire body area 2.2. Focused stretch of muscles in sameFocused stretch of muscles in same body areabody area 3.3. Finish with gross stretch of entireFinish with gross stretch of entire musclemuscle
- 13. Focused StretchFocused Stretch • One hand, finger or bodyOne hand, finger or body weight acts as anchorweight acts as anchor • Use broad surface to applyUse broad surface to apply stretch if possible for largestretch if possible for large musclesmuscles • For smaller muscles – use 1 orFor smaller muscles – use 1 or 2 fingers2 fingers
- 14. Focused StretchFocused Stretch • 1-2 fingers of each hand1-2 fingers of each hand • 1 or both hands may move1 or both hands may move • Distance between fingers may be severalDistance between fingers may be several millimeters/inchesmillimeters/inches
- 15. Levels of MFRLevels of MFR 1.1. No stretch/pre-tensionNo stretch/pre-tension 2.2. Pre-tension (stripping)Pre-tension (stripping) 3.3. Moderate passive stretchModerate passive stretch 4.4. Active MFRActive MFR (Leahy & Mock)(Leahy & Mock)
- 16. Common MistakesCommon Mistakes • Too much pressureToo much pressure • Too long of stretchToo long of stretch • Too many applicationsToo many applications
- 17. Myofascial Trigger PointsMyofascial Trigger Points
- 18. Myofascial Trigger Points (TP)Myofascial Trigger Points (TP) • A hyperirritable spot located within aA hyperirritable spot located within a taut band of skeletal muscle or its fasciataut band of skeletal muscle or its fascia - ActiveActive - LatentLatent (Travell & Simons, 1983)(Travell & Simons, 1983)
- 20. (Marieb, 2004)
- 21. Overloading Stretch/shortening Micro/macro trauma Destruction of sarcolema & SR Release of Ca2+ Sustained muscle contraction Ischemia, hypoxia, metabolic waste Trigger point formation/activation Release of nociceptive substances Local pain, muscle guarding & REFERRED PAIN Loss of flexibility (Kostopoulos & Rizopoulos, 2001)
- 23. How can TP therapy alleviateHow can TP therapy alleviate this pathologic cycle?this pathologic cycle?
- 24. Considering FibromyalgiaConsidering Fibromyalgia Trigger PointsTrigger Points • No gender biasNo gender bias • Can be sudden &Can be sudden & related to specificrelated to specific movementsmovements • Often have tautOften have taut bands and twitchbands and twitch responsesresponses FibromyalgiaFibromyalgia
- 25. General IndicationsGeneral Indications Myofascial Trigger PointsMyofascial Trigger Points • Frequently complaints ofFrequently complaints of referred painreferred pain • Autonomic &Autonomic & proprioceptive disturbancesproprioceptive disturbances • Taut bandTaut band • Tender and painful nodulesTender and painful nodules • Local twitch responseLocal twitch response • Limited ROMLimited ROM • Muscle weaknessMuscle weakness (Kostopoulos & Rizopoulos, 2001)
- 26. Precautions/ContraindicationsPrecautions/Contraindications Trigger PointsTrigger Points • InflammationInflammation • Patient uncomfortable with touchPatient uncomfortable with touch • DermatitisDermatitis • Contagious/infectious diseaseContagious/infectious disease • Fractures/open woundsFractures/open wounds • Circulatory problemsCirculatory problems • Taking blood clotting medicineTaking blood clotting medicine • OsteoporosisOsteoporosis (Manheim, 2001)
- 27. Trigger Point TherapyTrigger Point Therapy Progressive pressure technique/IschemicProgressive pressure technique/Ischemic CompressionCompression • Use pain as guideUse pain as guide - Varying pressure (light pressure/stretching,Varying pressure (light pressure/stretching, heavy pressure)heavy pressure) • 10 seconds to 2 minutes10 seconds to 2 minutes • Follow with myofascial stretchingFollow with myofascial stretching • Positive stretch signPositive stretch sign (Kostopoulos & Rizopoulos, 2001)
- 28. Trigger Point Therapy: SelfTrigger Point Therapy: Self TreatmentTreatment
- 29. Trigger Point TherapyTrigger Point Therapy Positional Release Therapy/Strain-Positional Release Therapy/Strain- CounterstrainCounterstrain • Trigger points are addressed while body isTrigger points are addressed while body is a position of comforta position of comfort (D’Ambrogio & Roth, 1997)(D’Ambrogio & Roth, 1997) Physiologic basis?Physiologic basis? Reduce muscle spindle inputReduce muscle spindle input
- 30. Trigger Point TherapyTrigger Point Therapy Ice-and-stretchIce-and-stretch • Apply ice in sweeping motionApply ice in sweeping motion • Slow continual passive stretch is applied at same time asSlow continual passive stretch is applied at same time as ice applicationice application • Can also add contraction of antagonistCan also add contraction of antagonist • Can repeat for several cyclesCan repeat for several cycles
- 31. Trigger Point TherapyTrigger Point Therapy Stripping MassageStripping Massage • Deep-stroking massage applied with minimalDeep-stroking massage applied with minimal lubrication on the fingertipslubrication on the fingertips • Increase pressure with each successive passIncrease pressure with each successive pass along musclealong muscle Both stripping and ischemic compression areBoth stripping and ischemic compression are believed to cause a reflexive hyperemia thatbelieved to cause a reflexive hyperemia that returns the site to a normal conditionreturns the site to a normal condition
- 32. Myofascial & TriggerMyofascial & Trigger Point Treatments:Point Treatments: Upper ExtremitiesUpper Extremities
- 33. Gross Stretch of Upper QuarterGross Stretch of Upper Quarter Arm PullArm Pull • SupineSupine • Stretch parallel to floorStretch parallel to floor • Hold for release and repeatHold for release and repeat CautionCaution • ATC must be relaxedATC must be relaxed • Elbow flex contractureElbow flex contracture • Hypermobile elbowHypermobile elbow
- 34. Gross Stretch of Upper QuarterGross Stretch of Upper Quarter Bilateral Arm PullBilateral Arm Pull • Supine/proneSupine/prone • Stretch parallel to floorStretch parallel to floor • Hold for release andHold for release and repeatrepeat
- 35. Posterior Cervical: TPPosterior Cervical: TP SuboccipitalsSuboccipitals Splenius capitusSplenius capitus
- 36. Posterior CervicalPosterior Cervical Make sure you know pathologies associated with muscles
- 39. Scalenes: TPScalenes: TP Pathology Combine with joint mobilization Intercostals
- 40. Upper Trapezius: TPUpper Trapezius: TP
- 42. Upper Trapezius (Active MFR)Upper Trapezius (Active MFR) (Johnson, 2009)
- 44. Subacromial Impingement:Subacromial Impingement: Forward HeadForward Head • Causes:Causes: - Stretch of levator scapulaeStretch of levator scapulae • Decreases scapular:Decreases scapular: - Posterior tiltPosterior tilt - Upward rotationUpward rotation (Ludewig et al, 1996)(Ludewig et al, 1996)
- 45. Levator Scapulae: TPLevator Scapulae: TP X
- 46. Levator Scapulae (Active MFR)Levator Scapulae (Active MFR) (Johnson, 2009)
- 48. Subacromial Impingement:Subacromial Impingement: Rounded ShouldersRounded Shoulders • Causes:Causes: - Tight serratus anterior &Tight serratus anterior & pectoralis minor & majorpectoralis minor & major (Kendall, 2005)(Kendall, 2005) • Increases scapular:Increases scapular: - ProtractionProtraction
- 49. Pectoralis Major: TPPectoralis Major: TP
- 51. Pectoralis Major: ReleasePectoralis Major: Release
- 52. Pectoralis Major: Traction ReleasePectoralis Major: Traction Release
- 55. Scapular ReleaseScapular Release • Translate scapula toward spineTranslate scapula toward spine - SuperiorlySuperiorly - InferiorlyInferiorly
- 56. Scapular Release with PectoralScapular Release with Pectoral StretchStretch
- 57. Scapular ReleaseScapular Release • Side lyingSide lying • Push scapula superiorlyPush scapula superiorly • Pull humerus inferiorlyPull humerus inferiorly Pathology?Pathology?
- 58. Anterior Capsule ReleaseAnterior Capsule Release Effective for adhesive capsulitisEffective for adhesive capsulitis
- 59. Pectoralis Minor: TPPectoralis Minor: TP
- 64. DeltoidsDeltoids
- 65. Latissimus Dorsi: TPLatissimus Dorsi: TP
- 67. Latissimus DorsiLatissimus Dorsi Prayer position
- 68. Middle/Lower Trapezius: TPMiddle/Lower Trapezius: TP
- 74. Teres Major: TPTeres Major: TP
- 76. Serratus Anterior: TPSerratus Anterior: TP
- 77. Serratus AnteriorSerratus Anterior Side lying with arm behind back
- 79. Focused Stretch: SubscapularisFocused Stretch: Subscapularis
- 84. GIRDGIRD
- 87. Infraspinatus (Passive MFR)Infraspinatus (Passive MFR)
- 88. Teres Minor: TPTeres Minor: TP
- 89. Teres MinorTeres Minor • Additional stretchAdditional stretch - Place patient’s arm in internal rotationPlace patient’s arm in internal rotation
- 90. Teres Minor (Passive MFR)Teres Minor (Passive MFR)
- 91. Posterior Capsule (Passive MFR)Posterior Capsule (Passive MFR)
- 92. Biceps Brachii: TPBiceps Brachii: TP
- 97. Extensor Carpi RadialisExtensor Carpi Radialis (Longus & Brevis): TP(Longus & Brevis): TP
- 98. Pronator Teres: TPPronator Teres: TP
- 99. Carpal Tunnel SyndromeCarpal Tunnel Syndrome
- 100. Flexor Carpi Ulnaris: TPFlexor Carpi Ulnaris: TP