The document discusses soft tissue treatment techniques for musculoskeletal disorders, focusing on functional and kinetic approaches (FAKTR-PM) that incorporate rehabilitation, provocation, and motion. It outlines various treatment methods, emphasizing the importance of complete history and examination, and selecting appropriate techniques to address fascial lesions and related issues. The document also highlights the role of fibroblasts in tissue healing and the effectiveness of different soft tissue modalities in improving patient outcomes.

1. SOFT TISSUE TREATMENT OF MUSCULOSKELETAL DISORDERSUtilizing Functional and Kinetic Treatment with Rehab, Provocation and Motion (FAKTR-PM)National University of Health SciencesThomas E. Hyde, DC, DACBSP, CSTI, ICSSD, FRCCSS (Hon)

2. How about an adjustment?

3. Don’t be afraid to jump into the unknown….

4. El Misti 08/05Summit being treated by Greg Doerr, DC at 19,223 feet

5. Objectives of this lectureTeach you something new to consider using in your practice

6. Not to teach you to be an expert by the end of the lecture

7. Stimulate you to learn more

8. To provide you options to better treat your patientsObjectives of this lectureTeach you something new to consider using in your practice

9. Not to teach you to be an expert by the end of the lecture

10. Stimulate you to learn more

11. To provide you options to better treat your patientsBefore Treatment Begins1. Take a complete history2. Perform a complete examination3. 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 employ4. If not, refer to someone you feel would be more likely to help them

12. Soft Tissue TechniquesNimmo

13. Cyriax

14. Mattes (AIS)

15. Buttler Never FlossingMyofascial Release Tech Active Release Tech ®Postisolation Relaxation

16. Proprioceptive Neurolmuscular Facilitation (PNF)

17. Stretching/gliding/pulling/pushing/compression

18. SteccoGuaShaGraston Technique®Sound Assisted Soft Tissue TechniqueASTYMRolfingMassageStrain CounterstrainPin and StretchMulliganFunctional Position Patterns by Gary GrayMuscle Energy Technique

19. Which Technique would you chose for these folks?

21. Lowe continues to state that when traumatized and inflamed, a fascial lesion heals by spider-webbing together with irregularly arranged collagen.Lowe

22. Where fascia has been intermittently stressed, fibroblasts produce more linearly arranged collagen to reinforce the loaded myofascia.Chamberlain, GJ. “Cyriax’sfrictionmassage: a review.” JOSPT, 1082; 4: p 20

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.John Lowe, Ma, DC

24. Nimmo – lumbar spine

25. Nimmo - gluteals

26. Nimmo Anyone????

27. RaceTrack

28. Acu-Force Another instrument assisted from of soft tissue treatment.There are 4 instruments used in an attempt to break up fascial restriction.There are a small and large star, an S-shaped instrument and a 7 pound larger I-shaped instrument

29. Acu-Force – forearm flexors

30. AcuForce

31. Acu-Force – trapezius/thoracic

32. Acu-Force – lumbar spine

33. I always feel better after my Acu-Force treatment.

34. Death Valley

35. CyriaxFelt 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.Hammer

36. CyriaxStated TF moved the involved tissue while longitudinal friction affected the transportation of blood and lymph.Hammer

37. CyriaxIn the acute phase, only necessary to use a light forceIn the chronic stages a deep, stronger friction is necessary.Hammer

38. CyriaxFriction creates anesthesiaUsually within 3 minutes of friction, anesthesia begins

39. Cyriax – Shoulder - Knee

40. CyriaxElbow

42. Cyriax can repair any damaged tissue

43. Denmark

44. Major Goals in the Promotion of Healing1. Enhance proliferative invasion of vascular elements and fibroblasts followed by:2. Collagen deposition and3. Ultimate maturation.Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med 22 (2003):

45. Healing of TendinosisIncreased collagen alone is not enough to heal a degenerated tendinosisEqually important is the correct orientation of the collagen fibers.

46. Healing of TendinosisNecessity of post treatment stretching & strengthening to provide the forces necessary for adaptive remodeling of new collagen in the affected areas.Exercise creates collagen alignment and stimulates collagen cross-linkage formation thereby improving tensile strength.

49. Superficial Posterior Spinal Fascial LaminaBarker PJ, Briggs CA. Attachments of the Posterior Layer of Lumbar Fascia. Spine 24 (17):1757-64.

50. DeepPosteriorSpinalLaminaSERRATUS POSTERIOR INFERIORFUSION OF SUPERFICIAL & DEEP LAMINAEGLUTEUSMEDIUSSACROTUBEROUSLIGAMENTBarker PJ, Briggs CA. Attachments of the Posterior Layer of Lumbar Fascia. Spine 24 (17):1757-64.

51. Lighthouse Tasmania

52. New Research with IASTMDuring 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.The fibroblasts are located within the ECM where repair, regeneration and maintenance of soft tissue takes place.Hammer W. April 2008

53. Hammer continuedUse of light manual fascial methods stimulation of fibroblasts can respond with anti-inflammatory cytokines, growth factors and vasoactive compounds that underlie positive clinical outcomes. Standley showed how injury strains fibroblasts and fascia in negative ways while manual muscle treatment strains fibroblasts in curative ways.Hammer W. April 2008

54. Thomas MeyersAnatomy Trains

55. SuperficialBackLineFasciaRemoved From Cadaver

56. SuperficialBackLine

57. SuperficialFront Line

58. LateralLine

59. SpiralLine

60. ArmLine

61. FrontAndBackFunctionalLines

62. DeepFrontLine

63. Thinking Outside the BoxWhat size and shape is your box?Are you willing to change that shape or size?What will you do differently tomorrow, next week, next year and each year thereafter?

64. Is your box open or closed?

67. FAKTR-PMDeveloped by:Greg Doerr, DC, CCSP, CKTPTom Hyde. DC, DACBSP, CKTP, FCCSS (Hon)Contributions by: Vince DeBono, DC, CCSP, CSCS (KT Tape) Warren Hammer, DC, MS Dick Vincent, DC Shawn Burger, PT Mike Cicero, PT Mike Schneider, DC, PhD Phil Page, ATC, PT, PhD, CSCS Andre Labbe, PT Ed Feinberg, DC, CCSP Ted Forcum, DC, DACBSP Kay Pearce Donna Strachan

68. Functional and Kinetic Treatment with Rehab, Provocation and Motion-FAKTR-PMF - Functional andK - KineticT - Treatment withR - RehabP - Provocation andM - Motion

69. FunctionalWhat activity causes a reproduction of the patient’s pain, loss or ROM, tightness, loss of functionIs this with motion, without motion, active, passive, with resistance, without resistanceWhat activity can you patient NOT do

70. KineticOnce 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.

71. TreatmentTreatment is rendered in the position of provocation and with the function mechanism in playTreatment can be performed utilizing many different soft tissue modalities

72. Rehabilitation (Rehab)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

73. ProvocationThe patient is asked to assume the position of provocation, that is the position that will reproduce their painIf the complaint is low back pain, you must determine if the pain is seated, standing, leaning, bending, etcThis applies to any area of the body where pain is secondary to musculoskeletal disorders

74. MotionWhat motion, if any, will reproduce the patient’s painConsider treating the patient in motion such as low back pain brought on by getting up from a seated position for example

75. Myofascial treatment has always worked for me.

76. Arundel Castle

77. GuaShaGuaSha 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.http://www.guasha.com/

78. GuaShaRaising 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.

79. GuaSha

80. Demonstration ShoulderActive Supraspinatus

81. Isometric Supraspinatus

82. Active Resisted Biceps

83. Active Resisted Subscap

84. Active Resisted Serratus

85. Active Resisted Scapular Stabilizers

86. Active Resisted Scapular Stabilizers

91. Shoulder w/Motion + Proprio

93. Knee Demonstration

95. Active Resisted Quad

96. Quad, Patellar Tendon with Ball Squat

99. QUAD JUMPERS

100. Ankle Demonstration

102. Ankle Propiroception

103. ANTERIOR SHIN SPLINTS

104. Cervical Spine Demonstration

105. Cervical Flexion/Extension GT

106. Active Resisted CS Lateral Flexion

107. Active Resisted CS Flexion/Extension

108. Active Resisted CS with Rotation

109. Active Resisted Upper Trap/LevatorScap

112. CERVICAL SPRAIN/STRAINCorrection Strip

113. Lumbar spine demonstration