SlideShare a Scribd company logo
Myofascial Web and
Fibromyalgia
Fibromyalgia Information Foundation
2014 Annual Conference
Ginevra Liptan, MD
Fibromyalgia (FM) pain
Hyper-reactive spinal cord and brain called
“central sensitization”
Pain generated from muscle tissue
18 tender points used to
diagnose FM
Fibromyalgia muscle pain sources
-Fascia –connective tissue around muscle
-Myofascial trigger points
What is fascia?
 Connective tissue network
 Surrounds both individual and groups
of muscles
 Highly sensitive to pain
 Contracts to give muscles extra
strength
Myofascial “web”
Connective tissue that
envelopes muscles
Connective tissue that’s left after
muscle cells dissolved
Fascia in FM
 Increased tension
 Inflammation
 Prone to “ knotting up”( myofascial trigger
points)
Myofascial trigger points
 Hyper-irritable or taut band of muscle
 Painful on compression
 Refers pain
 Can occur in any muscle under strain
Myofascial trigger point
Treatments for fascia/trigger
points
 Myofascial release (MFR)
 Trigger point injections
 Self-care
Myofascial release therapy
 Manual traction and prolonged assisted
stretching
 Breaks up painful adhesions in the
connective tissue surrounding muscle
MFR is not massage
Myofascial release for FM
Castro-Sanchez et al . 2011
 20 weeks myofascial release therapy
 Compared to sham ultrasound
 Significant improvement in pain and tender
points
 Pain reduction persisted at 1 and 6 months post-
intervention
Our study- MFR vs. massage
Women between the ages of 21 and 50 with a
confirmed FM diagnosis
Randomized to myofascial release or Swedish
massage
Therapists had advanced training using the
John F. Barnes MFR approach
90 minutes weekly for 4 weeks
FIQ-R Percentage Change in
Myofascial Release SubjectsPercentagechangeinFIQ-R
Myofascial release subjects 1–8
A change of 14% or more is considered significant
FIQ-R Percentage Change in
Massage SubjectsPercentagechangeinFIQ-R
Massage subjects 1–4
A change of 14% or more is considered significant
Trigger point injections
 Injection of lidocaine
 “Dry needling”
Trigger point self-treatment
Resources
www.theracane.com
www.myofascialrelease.com
Book:
The Trigger Point Therapy Workbook:Your Self-
Treatment Guide for Pain Relief by Clair Davies
Web sites:
THE MYOFASCIAL WEB

More Related Content

What's hot

Myofascial pain syndrome and the effects of self myofascial
Myofascial pain syndrome and the effects of self myofascialMyofascial pain syndrome and the effects of self myofascial
Myofascial pain syndrome and the effects of self myofascial
Erik Nason MBA, MS, ATC, LAT, CSCS
 
Myofascial pain syndrome
Myofascial pain syndromeMyofascial pain syndrome
Myofascial pain syndrome
Asnawi Johari
 
Mayofacial release technique
Mayofacial release techniqueMayofacial release technique
Mayofacial release technique
navinderpal singh
 
Myofascial pain and dysfunction
Myofascial pain and dysfunctionMyofascial pain and dysfunction
Myofascial pain and dysfunction
jcklp1
 
MFR manual
MFR manualMFR manual
MFR manual
Aniruddh Bairwa
 
Myofascial release ue (1)
Myofascial release ue (1)Myofascial release ue (1)
Myofascial release ue (1)
Satoshi Kajiyama
 
Myofascial Pain Syndrome
Myofascial Pain SyndromeMyofascial Pain Syndrome
Myofascial Pain Syndrome
TeMz Gordonas
 
Myofascial Pain and Trigger Points By: Brooke Petho (Grand Valley State Univ...
Myofascial Pain and Trigger Points  By: Brooke Petho (Grand Valley State Univ...Myofascial Pain and Trigger Points  By: Brooke Petho (Grand Valley State Univ...
Myofascial Pain and Trigger Points By: Brooke Petho (Grand Valley State Univ...
Erik Nason MBA, MS, ATC, LAT, CSCS
 
Fascial Manipulation
Fascial Manipulation Fascial Manipulation
Fascial Manipulation
Adam Glowacz MCSP
 
Myofascial Pain Syndrome
Myofascial Pain SyndromeMyofascial Pain Syndrome
Myofascial Pain Syndrome
mcorreamd
 
Trigger Point Manual
Trigger Point ManualTrigger Point Manual
Trigger Point Manual
Jonathan Kuttner
 
Referral pain and phantom pain
Referral pain and phantom painReferral pain and phantom pain
Referral pain and phantom pain
Arthi Rajasankar
 
Myofacial pain
Myofacial painMyofacial pain
Myofacial pain
Indian dental academy
 
Muscle pain mechanism
Muscle pain mechanismMuscle pain mechanism
Muscle pain mechanism
aditya romadhon
 
Trigger point injection
Trigger point injectionTrigger point injection
Trigger point injection
Interventional pain and spine Centre
 
Myofascial Release and MET Presentation Slides
Myofascial Release and MET Presentation SlidesMyofascial Release and MET Presentation Slides
Myofascial Release and MET Presentation Slides
Katie Emmett 🌐 Myofascial Decompression Therapy
 
Referred Pain (Physiology Seminar)
Referred Pain (Physiology Seminar)Referred Pain (Physiology Seminar)
Referred Pain (Physiology Seminar)
KemUnited
 
Positional release technique
Positional release techniquePositional release technique
Positional release technique
Radhika Chintamani
 
Myofacial pain dysfunction syndrome anindya
Myofacial pain dysfunction syndrome anindyaMyofacial pain dysfunction syndrome anindya
Myofacial pain dysfunction syndrome anindya
Dr. Anindya Chakrabarty
 
Neurodynamics III
Neurodynamics IIINeurodynamics III
Neurodynamics III
Radhika Chintamani
 

What's hot (20)

Myofascial pain syndrome and the effects of self myofascial
Myofascial pain syndrome and the effects of self myofascialMyofascial pain syndrome and the effects of self myofascial
Myofascial pain syndrome and the effects of self myofascial
 
Myofascial pain syndrome
Myofascial pain syndromeMyofascial pain syndrome
Myofascial pain syndrome
 
Mayofacial release technique
Mayofacial release techniqueMayofacial release technique
Mayofacial release technique
 
Myofascial pain and dysfunction
Myofascial pain and dysfunctionMyofascial pain and dysfunction
Myofascial pain and dysfunction
 
MFR manual
MFR manualMFR manual
MFR manual
 
Myofascial release ue (1)
Myofascial release ue (1)Myofascial release ue (1)
Myofascial release ue (1)
 
Myofascial Pain Syndrome
Myofascial Pain SyndromeMyofascial Pain Syndrome
Myofascial Pain Syndrome
 
Myofascial Pain and Trigger Points By: Brooke Petho (Grand Valley State Univ...
Myofascial Pain and Trigger Points  By: Brooke Petho (Grand Valley State Univ...Myofascial Pain and Trigger Points  By: Brooke Petho (Grand Valley State Univ...
Myofascial Pain and Trigger Points By: Brooke Petho (Grand Valley State Univ...
 
Fascial Manipulation
Fascial Manipulation Fascial Manipulation
Fascial Manipulation
 
Myofascial Pain Syndrome
Myofascial Pain SyndromeMyofascial Pain Syndrome
Myofascial Pain Syndrome
 
Trigger Point Manual
Trigger Point ManualTrigger Point Manual
Trigger Point Manual
 
Referral pain and phantom pain
Referral pain and phantom painReferral pain and phantom pain
Referral pain and phantom pain
 
Myofacial pain
Myofacial painMyofacial pain
Myofacial pain
 
Muscle pain mechanism
Muscle pain mechanismMuscle pain mechanism
Muscle pain mechanism
 
Trigger point injection
Trigger point injectionTrigger point injection
Trigger point injection
 
Myofascial Release and MET Presentation Slides
Myofascial Release and MET Presentation SlidesMyofascial Release and MET Presentation Slides
Myofascial Release and MET Presentation Slides
 
Referred Pain (Physiology Seminar)
Referred Pain (Physiology Seminar)Referred Pain (Physiology Seminar)
Referred Pain (Physiology Seminar)
 
Positional release technique
Positional release techniquePositional release technique
Positional release technique
 
Myofacial pain dysfunction syndrome anindya
Myofacial pain dysfunction syndrome anindyaMyofacial pain dysfunction syndrome anindya
Myofacial pain dysfunction syndrome anindya
 
Neurodynamics III
Neurodynamics IIINeurodynamics III
Neurodynamics III
 

Viewers also liked

Positional Release Therapy
Positional Release TherapyPositional Release Therapy
Positional Release Therapy
janine020
 
Elettroporazione tecnophor
Elettroporazione tecnophorElettroporazione tecnophor
Elettroporazione tecnophor
JOLIMENT- official Abamav dealer
 
HA Cryogel article in white 2014
HA Cryogel article in white 2014HA Cryogel article in white 2014
HA Cryogel article in white 2014
Noelle Aghajanian-Tenaglia
 
Self Passive Mobility Corrections Presentation
Self Passive Mobility Corrections PresentationSelf Passive Mobility Corrections Presentation
Self Passive Mobility Corrections Presentation
Cade Jones
 
Booklet instylan eng
Booklet instylan engBooklet instylan eng
Booklet instylan eng
Oleksii Denysov
 
DIACO Medical devices catalogue 2016
DIACO Medical devices catalogue 2016DIACO Medical devices catalogue 2016
DIACO Medical devices catalogue 2016
Oleksii Denysov
 
Skin and fascial medicos notes.com
Skin and fascial medicos notes.comSkin and fascial medicos notes.com
Skin and fascial medicos notes.com
MedicosNotes
 
Spinal Osteopathic Manipulative Therapy (OMTh) Revisited by Manual Therapist...
Spinal Osteopathic Manipulative Therapy (OMTh) Revisited  by Manual Therapist...Spinal Osteopathic Manipulative Therapy (OMTh) Revisited  by Manual Therapist...
Spinal Osteopathic Manipulative Therapy (OMTh) Revisited by Manual Therapist...
www.dolordeespalda.cl www.icup.cl
 
Tensegrity
TensegrityTensegrity
Tensegrity
Mahindra Venkat
 
Vaginal absorption
Vaginal absorption Vaginal absorption
Vaginal absorption
Laith Alasadi
 
1% Hyaluronic Acid ppt
1% Hyaluronic Acid ppt1% Hyaluronic Acid ppt
1% Hyaluronic Acid ppt
Kumar Organic Products Ltd
 
Blaschkoid dermatitis
Blaschkoid dermatitisBlaschkoid dermatitis
Blaschkoid dermatitis
Dr. Aseem Sharma
 
Welcome to Gua Sha/Soft Tissue Mobilization
Welcome to Gua Sha/Soft Tissue MobilizationWelcome to Gua Sha/Soft Tissue Mobilization
Welcome to Gua Sha/Soft Tissue Mobilization
William Burton LMT CMCE
 

Viewers also liked (13)

Positional Release Therapy
Positional Release TherapyPositional Release Therapy
Positional Release Therapy
 
Elettroporazione tecnophor
Elettroporazione tecnophorElettroporazione tecnophor
Elettroporazione tecnophor
 
HA Cryogel article in white 2014
HA Cryogel article in white 2014HA Cryogel article in white 2014
HA Cryogel article in white 2014
 
Self Passive Mobility Corrections Presentation
Self Passive Mobility Corrections PresentationSelf Passive Mobility Corrections Presentation
Self Passive Mobility Corrections Presentation
 
Booklet instylan eng
Booklet instylan engBooklet instylan eng
Booklet instylan eng
 
DIACO Medical devices catalogue 2016
DIACO Medical devices catalogue 2016DIACO Medical devices catalogue 2016
DIACO Medical devices catalogue 2016
 
Skin and fascial medicos notes.com
Skin and fascial medicos notes.comSkin and fascial medicos notes.com
Skin and fascial medicos notes.com
 
Spinal Osteopathic Manipulative Therapy (OMTh) Revisited by Manual Therapist...
Spinal Osteopathic Manipulative Therapy (OMTh) Revisited  by Manual Therapist...Spinal Osteopathic Manipulative Therapy (OMTh) Revisited  by Manual Therapist...
Spinal Osteopathic Manipulative Therapy (OMTh) Revisited by Manual Therapist...
 
Tensegrity
TensegrityTensegrity
Tensegrity
 
Vaginal absorption
Vaginal absorption Vaginal absorption
Vaginal absorption
 
1% Hyaluronic Acid ppt
1% Hyaluronic Acid ppt1% Hyaluronic Acid ppt
1% Hyaluronic Acid ppt
 
Blaschkoid dermatitis
Blaschkoid dermatitisBlaschkoid dermatitis
Blaschkoid dermatitis
 
Welcome to Gua Sha/Soft Tissue Mobilization
Welcome to Gua Sha/Soft Tissue MobilizationWelcome to Gua Sha/Soft Tissue Mobilization
Welcome to Gua Sha/Soft Tissue Mobilization
 

Recently uploaded

Psychedelic Retreat Portugal - Escape to Lighthouse Retreats for an unforgett...
Psychedelic Retreat Portugal - Escape to Lighthouse Retreats for an unforgett...Psychedelic Retreat Portugal - Escape to Lighthouse Retreats for an unforgett...
Psychedelic Retreat Portugal - Escape to Lighthouse Retreats for an unforgett...
Lighthouse Retreat
 
The crucial role of mathematics in ai development.pptx
The crucial role of mathematics in ai development.pptxThe crucial role of mathematics in ai development.pptx
The crucial role of mathematics in ai development.pptx
priyabhojwani1200
 
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 FaridkotFaridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
varun0kumar00
 
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTNURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
blessyjannu21
 
Daughter's of Dr Ranjit Jagtap (Poulami & Aditi)
Daughter's of Dr Ranjit Jagtap (Poulami & Aditi)Daughter's of Dr Ranjit Jagtap (Poulami & Aditi)
Daughter's of Dr Ranjit Jagtap (Poulami & Aditi)
Aditi Jagtap Pune
 
一比一原版(USF毕业证)旧金山大学毕业证如何办理
一比一原版(USF毕业证)旧金山大学毕业证如何办理一比一原版(USF毕业证)旧金山大学毕业证如何办理
一比一原版(USF毕业证)旧金山大学毕业证如何办理
40fortunate
 
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa AjmanSatisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...
rightmanforbloodline
 
Sectional dentures for microstomia patients.pptx
Sectional dentures for microstomia patients.pptxSectional dentures for microstomia patients.pptx
Sectional dentures for microstomia patients.pptx
SatvikaPrasad
 
Electrocardiogram_20240614_173859_0000.pdf
Electrocardiogram_20240614_173859_0000.pdfElectrocardiogram_20240614_173859_0000.pdf
Electrocardiogram_20240614_173859_0000.pdf
Elackkiya Balamurugan
 
Test bank clinical nursing skills a concept based approach 4e pearson educati...
Test bank clinical nursing skills a concept based approach 4e pearson educati...Test bank clinical nursing skills a concept based approach 4e pearson educati...
Test bank clinical nursing skills a concept based approach 4e pearson educati...
rightmanforbloodline
 
nurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdfnurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdf
Carolyn Harker
 
Data-Driven Dispensing- Rise of AI in Pharmacies.pdf
Data-Driven Dispensing- Rise of AI in Pharmacies.pdfData-Driven Dispensing- Rise of AI in Pharmacies.pdf
Data-Driven Dispensing- Rise of AI in Pharmacies.pdf
Jasper Colin
 
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
Vedanta A
 
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa AjmanFriendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa AjmanDiscover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
National Rural Health Mission(NRHM).pptx
National Rural Health Mission(NRHM).pptxNational Rural Health Mission(NRHM).pptx
National Rural Health Mission(NRHM).pptx
Jyoti Chand
 
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
5sj7jxf7
 
Hyderabad Call Girls 7023059433 High Profile Escorts Service Hyderabad
Hyderabad Call Girls 7023059433 High Profile Escorts Service HyderabadHyderabad Call Girls 7023059433 High Profile Escorts Service Hyderabad
Hyderabad Call Girls 7023059433 High Profile Escorts Service Hyderabad
garge6804
 
The Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-TechThe Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-Tech
Gokul Rangarajan
 

Recently uploaded (20)

Psychedelic Retreat Portugal - Escape to Lighthouse Retreats for an unforgett...
Psychedelic Retreat Portugal - Escape to Lighthouse Retreats for an unforgett...Psychedelic Retreat Portugal - Escape to Lighthouse Retreats for an unforgett...
Psychedelic Retreat Portugal - Escape to Lighthouse Retreats for an unforgett...
 
The crucial role of mathematics in ai development.pptx
The crucial role of mathematics in ai development.pptxThe crucial role of mathematics in ai development.pptx
The crucial role of mathematics in ai development.pptx
 
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 FaridkotFaridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
 
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTNURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPT
 
Daughter's of Dr Ranjit Jagtap (Poulami & Aditi)
Daughter's of Dr Ranjit Jagtap (Poulami & Aditi)Daughter's of Dr Ranjit Jagtap (Poulami & Aditi)
Daughter's of Dr Ranjit Jagtap (Poulami & Aditi)
 
一比一原版(USF毕业证)旧金山大学毕业证如何办理
一比一原版(USF毕业证)旧金山大学毕业证如何办理一比一原版(USF毕业证)旧金山大学毕业证如何办理
一比一原版(USF毕业证)旧金山大学毕业证如何办理
 
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa AjmanSatisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
Satisfying Spa Massage Experience at Just 99 AED - Malayali Kerala Spa Ajman
 
Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...Solution manual for managerial accounting 18th edition by ray garrison eric n...
Solution manual for managerial accounting 18th edition by ray garrison eric n...
 
Sectional dentures for microstomia patients.pptx
Sectional dentures for microstomia patients.pptxSectional dentures for microstomia patients.pptx
Sectional dentures for microstomia patients.pptx
 
Electrocardiogram_20240614_173859_0000.pdf
Electrocardiogram_20240614_173859_0000.pdfElectrocardiogram_20240614_173859_0000.pdf
Electrocardiogram_20240614_173859_0000.pdf
 
Test bank clinical nursing skills a concept based approach 4e pearson educati...
Test bank clinical nursing skills a concept based approach 4e pearson educati...Test bank clinical nursing skills a concept based approach 4e pearson educati...
Test bank clinical nursing skills a concept based approach 4e pearson educati...
 
nurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdfnurs fpx 4050 assessment 4 final care coordination plan.pdf
nurs fpx 4050 assessment 4 final care coordination plan.pdf
 
Data-Driven Dispensing- Rise of AI in Pharmacies.pdf
Data-Driven Dispensing- Rise of AI in Pharmacies.pdfData-Driven Dispensing- Rise of AI in Pharmacies.pdf
Data-Driven Dispensing- Rise of AI in Pharmacies.pdf
 
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
 
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa AjmanFriendly Massage in Ajman - Malayali Kerala Spa Ajman
Friendly Massage in Ajman - Malayali Kerala Spa Ajman
 
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa AjmanDiscover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
 
National Rural Health Mission(NRHM).pptx
National Rural Health Mission(NRHM).pptxNational Rural Health Mission(NRHM).pptx
National Rural Health Mission(NRHM).pptx
 
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
1比1制作(uofm毕业证书)美国密歇根大学毕业证学位证书原版一模一样
 
Hyderabad Call Girls 7023059433 High Profile Escorts Service Hyderabad
Hyderabad Call Girls 7023059433 High Profile Escorts Service HyderabadHyderabad Call Girls 7023059433 High Profile Escorts Service Hyderabad
Hyderabad Call Girls 7023059433 High Profile Escorts Service Hyderabad
 
The Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-TechThe Ultimate Guide in Setting Up Market Research System in Health-Tech
The Ultimate Guide in Setting Up Market Research System in Health-Tech
 

THE MYOFASCIAL WEB