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50 Cards in this Set
- Front
- Back
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Soft Tissue Release
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Myofascial unwinding
Myofacial manipulation Active Release Technique Myofascial Massage Soft Tissue Manipulation Superficial and rhythmic |
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Other soft tissue techniques (not soft tissue release)
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Counterstrain
Direct Fascial Release Cranial Osteopathy Facilitated Positional Release Muscle Energy Techniques Visceral Manipulation Still Techniques |
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Acute MyoFascial Injury
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Severe Sharp Pain
Warmth Erythema Bogginess Increased Hypertonicity |
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Chronic Myofascial Injury
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Fibrous Tissue
Less reversible, More permanent Muscle Shortening and Inhibition Decrease Stretch Restricted Movement Dull, aching, burning Ropy, dry skin under tension |
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Pain relief, Rehab,& Performance Enhancement
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Massage
Stretching Deep Friction Massage Strain-counterstrain Myofascial release Muscle energy Facilitated Positional Release Unwinding Indirect functional techniques |
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Sports Injuries
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Cervical spine Football
1st Rib Skiing Ankle Soccer Elbow, wrist Golf Iliotibial Friction Syndrome Cycling Heel and Foot Running Back B-Ball Rotator Cuff Baseball ScapulaDysfunction Wrestling |
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Soft Tissue Goals
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Muscle relaxation
Flexibility Circulation of body fluids Mobilization |
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Tenderpoints
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Points of hypersensitivity (sharp pain)
Beneath the skin Smaller than a finger tip Sensitive and tense to palpation Often located remote to the patient’s complaint Once the patient is positioned in a direction of ease, the point “relaxes” |
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Direct Techniques
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Moves body tissue and/or joints closer to the restrictive barrier
Tethering & Tightness Isometric Resistance |
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Indirect Techniques
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Move Tissue Away From Barrier
Laxity and Looseness Isokinetic Resistance |
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Direct MassageTechniques
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Traction or Stretching
Kneading Inhibition Effleurage Petrissage Tapotement Vibration Skin Rolling |
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Myofascial Release (principles)
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Deeply Directed, Alternating Rhythmic
Pressure On Pressure Off |
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Counter Strain
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Developed by Lawrence Jones, D.O. Family Practice!!
Passive Indirect Technique Moving Away from the Restrictive Barrier |
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Counterstrain (how to)
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Identify the tender point.
Positioning of athlete to a point of maximum comfort. Maintain the position for ninety seconds. Slow passive return to a neutral position. Reevaluation of the tender point |
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Position of Ease
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Hyper-shorten the muscle PASSIVELY
Keep in mind that this does not always move the body towards the tenderpoint! Hold in position for 90 seconds S-L-O-W-L-Y return to neutral This is a slow stretch back to neutral. The slow return allows the muscle to get back to it’s original length without reinitiating the stretch response |
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Muscle Energy Concept
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“A form of OMT in which the patient’s muscles are actively used on request, from a precisely controlled position, in a specific direction and against a distinctly executed counterforce.” -Goodridge
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Muscle Energy Technique
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Mobilize joints in which movement is restricted
Stretch tight muscles and fascia Improve local circulation Balance neuromuscular relationships to alter muscle tone Isometric Counterforce 3-5 seconds |
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Muscle Energy Goals
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Strengthen the weaker side of an asymmetry
Decrease hypertonicity Lengthen muscle fibers Reduce the restraint of movement Alter related respiratory and circulatory function |
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Postisometric Relaxation
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“immediately following (an isometric) contraction, the neuromuscular apparatus is in a refractory state during which passive stretching may be performed without encountering strong myotatic reflex opposition. All the operator needs to do is resist the contraction and then take up the slack in the fascias during the relaxed refractory period.” -Mitchell, Jr.
Increased tension on the Golgi organ proprioceptors in the tendons – inhibits active muscle’s contraction |
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Reciprocal Inhibition
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Used when antagonistic muscles are contracted
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Muscle Energy Technique Contraindications
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Painful muscle or muscle group
Patient with low vitality who could further be compromised by adding active muscular exertion Examples: Post-surgical patient Patient on monitor in intensive care unit who is having a Myocardial infarction |
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Muscle Energy Technique Direct technique – Based on accurate diagnosis
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Take the dysfunction into the barrier in three or more planes (Reverse the Diagnosis)
Have the patient return to neutral (move toward the freedom of motion) with a small amount of force for 3-5 seconds. Physician resists with an equal and opposite force. Re-engage the barrier (Take up the slack) Repeat 3-5 times Engage the barrier (Take up the slack) Recheck |
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Facilitated Positional Release
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“counter-strain” with compression”
Good for regional diagnosis Large, superficial muscles Also good for individual articulations Small, deep muscles |
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FPR so how does it work?
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Theory involves the gamma loop
Sudden decrease in load (treatment) Unloads the muscle spindles (who’s job it is to sense muscle tension) Ia fiber discharges cease Motor neurons are no longer stimulated Muscle “relaxes” |
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FPR – steps in treatment
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Physician modifies the patient’s sagital posture (moves to neutral)
Facilitating force is applied Large superficial muscles are shortened. Somatic dysfunction is positioned to freedom |
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Pro's and cons of counterstrain
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PROs
Gentle Able to fine-tune CONs SLOW |
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pros and cons of FPR
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PROs
Gentle FAST CONs Can be difficult to fine tune |
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Counterstrain patients
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Can’t tolerate direct
Fear motion acute trauma |
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FPR patients
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Can’t tolerate direct
Won’t sit still kids! |
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Indications
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Soft Tissue Techniques
prelude to all techniques few contraindications |
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Still Technique - steps
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Position of ease (away from barrier)
Exaggerate position of ease Choose a body part to use as a lever for articulation (neck, extremity, etc) Apply vectored force parallel to the lever The lever is used to move the dysfunctional segment through its barrier and then back to the position of ease while the parallel force is maintained Reassess |
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Proprioceptors
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Perceive position sense
Mean “sense of self” Send this information about the muscle to the CNS to respond to muscle stretching Needed to control body movement |
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Main proprioceptors
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Muscle spindles- muscle acceleration and length
Golgi tendon organ- muscle tension Joint receptors- joint angle |
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Muscle spindles
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Found in the muscle belly
Encapsulated by connective tissue Sensitive to muscle length because they are in parallel with the contractile fibers |
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intrafusal muscle fibers
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Nuclear chain fibers- nuclei lengthwise; responsible for the static component of the stretch reflex; lasts as long as the muscle is being stretched
Nuclear bag fibers- nuclei in the center; responsible for the dynamic component; lasts for only a moment in response to the initial sudden increase in muscle length found in muscle spindles |
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Muscle spindles (components)
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Both sensory and motor components
Type Ia and type II sensory fibers Innervated by gamma motor neurons |
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Muscle contraction performed by
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extrafusal muscle fibers
These are activated by alpha motor neurons |
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Gamma Efferent Nerve-
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Keeps muscle spindle sensitive to any stretch
When the muscle contracts, the gamma MN will be activated in order to maintain the sensitivity of the muscle spindle (alpha-gamma co-activation) |
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Stretch reflex
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AKA myotactic reflex
Controls muscle length by causing muscle contraction Muscle spindle stretched Ia sensory nerve (dorsal root) Stimulates the alpha motor neuron (anterior horn motor neuron) (monosynaptically) Contracts the muscle Antagonist muscles relax (polysynaptic inhibition) |
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Stretch Reflex action
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Reflex contraction of a muscle when an attached tendon is pulled
When muscle is stretched, it contracts & maintains increased tone helps maintain equilibrium & posture stabilize joints by balancing tension in extensors & flexors smoothing muscle actions |
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LENGTHENING REFLEX
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: In the lengthening reflex excessive tension inhibits (lengthens) the muscle associated with the Golgi tendon organ.
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What happens when you stretch your muscles and hold
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The muscle spindle gets accustomed to the new length (habituates) and signals less
stretch receptors can be trained to allow greater lengthening of the muscles Allows the stretched muscle to relax (lengthening reaction) easier to stretch, or lengthen, a muscle when it is not contracting |
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Joint Receptors
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Joints contain receptors that detect the joint angle.
Firing is proportional to joint angle Some joint receptors increase firing in flexion Other joint receptors increase firing in extension |
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Joint receptors appear to trigger visceral efferents that modulate:
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Secretion of synovial fluid
Production of glycosaminoglycans and possibly other joint macromolecules Increased blood and lymph flow to/from joint |
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Flexor (Withdrawal) Reflex (polysynaptic and ipsilateral
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Elicited by pain receptors
Type c Flexors/extensor wiring is reciprocal: Ipsilateral flexors contract Ipsilateral extensors relax Polysynaptic reflex arc Can override voluntarily Spinal cord controls sequence and duration of contraction/relaxation Withdraws from pain |
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Crossed Extensor Reflex (polysynaptic and contralateral)
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Triggered with flexor (withdrawal) reflex
Contralateral extensors contract flexors relax Maintains balance. |
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Causes of Movement Limitation
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Pain induced flexor-crossed extensor reflex
Increased ipsilateral flexion (withdrawal) Increased contralateral extension Change in muscle spindle gain Increased gain on ipsilaeral side Change in Golgi Tendon Organ Gain Increased gain on ipsilateral side Pain-induced guarding Connective tissue formation with chronic limitation Reinforced by inhibition of blood and lymph flow and resultant further stimulation of pain fibers |
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High Velocity Low Amplitude (HVLA)
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With muscle relaxed, stretch to normal physiological limits of the associated joint, through restrictive barrier.
Low force required with proper positioning. Reset muscle spindles, exploits lengthening reflex. Contraindicated with certain arthritic or vascular diseases, osteopena, fracture, bony metastasis, etc. |
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Muscle Energy
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Manipulator exerts an equal and opposite force to an active force exerted by the patient.
Repeated isometric contractions with passive range of motion through the restrictive barrier. Effects include: Reciprocal inhibition of overactive muscle Use of Golgi tendon reflex to reduce tension of overactive muscle |
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PNF (proprioceptive neuromuscular facilitation) stretching
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Used by physical therapists
Ex. Hold Relax (Contract-Relax) Therapist has patient fire the tight muscle isometrically against the therapist's hand for roughly 20 seconds The patient relaxes and the therapist lengthens the tight muscle and applies a stretch at the newly found end range Uses the Golgi-tendon organ |
