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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)
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)
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 â use 1 orFor smaller muscles â 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
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)
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)
22.
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)
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
(DâAmbrogio & Roth, 1997)(DâAmbrogio & 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
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
89. Teres MinorTeres Minor
⢠Additional stretchAdditional stretch
- Place patientâs arm in internal rotationPlace patientâs arm in internal rotation