Patrick St. Louis MSRS LAT/ATC, CKTF, CCT

MANUAL THERAPY AND

MYOFASCIAL RELEASE

Certified and Licensed Athletic Trainer Instructor of Health and Human Performance at

Concordia University Wisconsin in our Master of Science in Athletic Training Program

Certified in Graston Technique® M1 (IASTM)Certified Faculty Instructor of Kinesio Taping Method®Certified Cupping Therapist (ICTA)Proficient in

Muscle Energy Technique Joint Mobilizations Myofascial Release Myofascial Trigger Point Therapy

Ischemic compression

PERSONAL BACKGROUND

“Beyond all doubt, the use of the human hand, as a method of reducing human suff ering, is the oldest remedy known to man.”

James Mennell

A number of manual therapies have evolved over the years

By their nature, many of these techniques are not founded on the same scientific rigor as anatomy and physiology, and much of their use is based on clinical outcomes, rather than evidence-based proof.

OVERVIEW

The decision on which manual technique to use is based on the clinician’s belief, their level of expertise, and their decision-making processes

OVERVIEW

“Manual therapy is the use of hands-on techniques to evaluate, treat and improve status of neuromusculoskeletal conditions.” Joints Soft tissue Nervous tissue

DEFINITION

There is general agreement on those criteria that are important for the correct application of a manual technique. These include: Specificity Direction and amount of force The duration, type, and irritability of symptoms Patient and clinician position

APPLICATION

Manual therapy is indicated when there is: Mild pain A non-irritable condition Intermittent musculoskeletal pain Pain that is relieved by rest, or by particular motions or

positions

INDICATIONS

Absolute Bacterial infectionMalignancySystemic localized infectionSutures over the areaRecent fractureCellulitisFebrile stateHematomaAcute circulatory conditionAn open wound at the treatment site

CONTRAINDICATIONS

AbsoluteOsteomyelitisAdvanced diabetesHypersensitivity of the skin Inappropriate end feel (spasm, empty, bony)Constant, severe pain, including pain which disturbs sleep, indicating that the condition is likely to be in the acute stage of healing

Extensive radiation of painPain unrelieved by rest

CONTRAINDICATIONS CONT.

Relative Joint effusion or inflammation Rheumatoid arthritis Presence of neurological signs Osteoporosis Hypermobility Pregnancy Dizziness

CONTRAINDICATIONS CONT.

Direct Techniques Manual therapy maneuvers that load or bind tissue and

structures. Move toward the point of limitation of tissue mobility.

Goal: Move the point of restriction closer to the normal range of

motion. Techniques

Stretching Joint Mobilizations Trigger Point Muscle Energy

TYPES OF MANUAL THERAPIES

Indirect Techniques Move the tissue away from the direction of limitation.

Goal Allows the tissue to “let go” or release its restriction and allow

more motion. Techniques

Positional release therapy Strain-Counterstrain

TYPES OF MANUAL THERAPIES

Manual technique that involves the voluntary contraction of a muscle in a precisely controlled direction, at varying levels of intensity, against a distinct counterforce.

Can be used to help mobilize joints, realign joints, strengthen weakened muscles, and to stretch adaptively shortened muscles and fascia

MUSCLE ENERGY TECHNIQUE (MET)

Obtained from http://www.humankinetics.com

Joint mobilization techniques include a broad spectrum, from the general passive motions performed in the physiologic cardinal planes at any point in the joint range, to the semi-specific and specific accessory (arthrokinematic) joint glides, or joint distractions, initiated from the open-packed position of the joint.

JOINT MOBILIZATIONS

Obtained from http://www.rpm-therapy.com

Massage The systemic and scientific manipulation of soft tissue for

remedial or restorative purposes.1

MASSAGE

Eff ects Muscle relaxation Blood vessel dilation Increased blood and lymphatic flow Promotion of fluid mobilization Stretching and breakdown of tissue adhesions

MASSAGE

Types Effl eurage

Stroking. Typically used at the beginning and end of treatment Petrissage

Compression and kneading. Soft tissue is grasped and manipulated intermittently so that there is movement between the skin’s underlying structure and muscle.

Tapotment Rhythmic tapping application or pounding/patting. Helps to

revitalize sore and tired muscles Friction

Deep pressure movement of superficial soft tissue against underlying structures.

MASSAGE

Continuous structure that surrounds and integrates tissues and structures throughout the body.1

Varies in density and thicknessThree layers

Superficial Deep Subserous

FASCIAL ANATOMY

Third whole-body communicating networkGrapefruit metaphor

FASCIAL ANATOMY

Obtained from http://www.circusconditioning.com

Obtained from http://www.anatomytrains.com

A series of techniques designed to release restrictions in the myofascial tissue that are used for the treatment of soft tissue dysfunction that has not responded to other interventions.1

MYOFASCIAL RELEASE

MYOFASCIAL RELEASE

Myofascial Restriction

Changes in force requirement

Acute or Chronic Trauma

Length imbalance of agonist/antagonist

Unbalanced forces of agonist/antagonist

Neurological readjustment

Posture changes

Coordination changes

Palpation: Normal mobility Superficial to deep Autonomic Effects

Time: 3-5 minutes

Guidelines: Avoid Bruising Relaxed Stabilization

MYOFASCIAL RELEASE TREATMENT GUIDELINES

Styles J-Stroke Oscillation Wringing Stripping Arm Pull Leg Pull Trigger Point Release Skin Rolling Grip and Rip technique Foam Rolling IASTM Cupping Therapy

MYOFASCIAL RELEASE TREATMENT GUIDELINES

“Focus of hyperirritability in a tissue that, when compressed, is locally tender and, if suffi ciently hypersensitive, gives rise to referred pain and tenderness.”1

ActiveLatentSatellite

TRIGGER POINT RELEASE

Obtained from http://www.lauraquinn.com.au

What are we looking for?How much pressure should we apply?How do I determine which structures I am actually

palpating?

PALPATION

Obtained from http://www.orchardclinic.co.uk

Superfi cial v Deep Tissues Very light Increasing pressure

Appropriate pressure Epidermis

3-10grams Dermis

10-30grams Superficial Fascia

30-100grams Deep Fascia & Superficial Muscles

80-160grams Deep Fascia & Middle layer Muscles

150-200grams Deep Fascia & Deep Muscle

250-400grams

PALPATION

Obtained from http://www.orchardclinic.co.uk

Dime LabSponge Lab

PALPATION

1. Houglum, Peggy. Therapeutic Exercise for Musculoskeletal Injuries. 3 rd ed. Champaign: Human Kinetics, 2010. Print

2. Hammer, Warren. Functional Soft-Tissue Examination and Treatment by Manual Methods. 3 rd ed. Sudbury: Jones and Bartlett Publishers

3. Myers, Thomas. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 2n d ed. Philadelphia: Churchill Livingstone Elsevier

4. Kinesio Taping Association International 5. Chaitow, Leon. Muscle Energy Techniques. 4 t h ed.

Philadelphia: Churchill Livingstone Elsevier 6. Lewit, Karel. Manipulative Therapy Musculoskeletal

Medicine. Philadelphia: Churchill Livingstone Elsevier 7. Prentice, William. Rehabilitation Techniques for Sports

Medicine and Athletic Training. 4 t h ed. New York: Mcgraw-Hill

REFERENCES