S1B3 - Omm1: Mfr

Front 1

Who first described and used myofascial release?

Back 1

A.T. Still.

Front 2

What is MFR?

Back 2

Myofascial release is a system of dx and tx which engages continual palpatory feedback to achieve release of myofascial tissues.

Front 3

What are the subcategories of MFR?

Back 3

Balanced ligamentous tension (BLT), ligamentous articular strain (LAS), integrated neuromusculoskeletal release (INR), fascial unwinding.

Front 4

What is the basic concept of MFR?

Back 4

Contact of the myofascial structures is made, tissues are returned to normal position and function to promote a positive change in a patient’s body. Improved: circulation of fluids- arterial, venous, lymphatic; neurologic function; ability of the person to heal himself/herself

Front 5

What does MFR require?

Back 5

Palpatory skills, dx ability, application of basic OMT principles.

Front 6

What is fascia?

Back 6

Band of fibrous tissue such as lies deep to the skin or forms an investment for muscles and various organs of the body.

Front 7

What germ layer does fascia arise from?

Back 7

Mesoderm

Front 8

What are the functions of fascia?

Back 8

Packaging, protection, posture, passageways, homeostasis.

Front 9

List properties of fascia.

Back 9

Elasticity, plasticity, viscosity, strain, stress, relaxation, creep, piezoelectricity, contractility, Newton's 3rd law, Wolf's law.

Front 10

Describe a typical stress-strain curve for connective tissue.

Back 10

Toe region represents the region where little stress is required to lengthen the tissue; it probably represents straightening of wavy pattern of collagen fibers. Elastic region is that portion of the curve in which tissue returns to its original length when the stress is removed. Plastic region is that portion of the curve that results in permanent elongation when the stress is removed.

Front 11

What is creep?

Back 11

Tissue undergoes gradual elongation over time when subjected to constant stress.

Front 12

What is the piezoelectricity?

Back 12

Electric current generated in some materials in response to mechanical strain.

Front 13

What is the piezoelectric phenomenon?

Back 13

Mechanical stress produces piezoelectric effect in bones which leads to bone remodeling. The concave side {of a bone} (or side under compression) becomes electronegative. Electro-negativity signals osteoblasts to lay down bone on the concave side.

Front 14

How does fascia have contractility?

Back 14

Fibroblasts, chrondoblasts, osteobalsts have innate capacity to express the gene for alpha-smooth muscle actin. Human fibroblasts respond to acyclic strain by altering cell shape and alignment, undergoing hyperplasia… The increased secretion of IL-6 and nitric oxide may provide insight into the pathophysiology of fibrosis and tissue texture changes seen with injury and OMT.

Front 15

What was the result of the experiment with human fibroblast under repetitive motion strain, with subsequent direct OMT?

Back 15

The modeled injury (RMS) appropriately displayed enhanced apoptosis activity (consistent with pro-apoptotic BadS91 and DAPK2 signaling) and loss of intercellular integrity. Added DOMT to this group resulted in normalization in apoptotic rate and enhanced proliferative capacity, albeit in a BadS91 and DAPK2-independent fashion.

Front 16

List and describe fascial mechanorecptors.

Back 16

Front 17

What mechanoreceptors does the physician use in his body in OMT treatment and what do they do?

Back 17

Pacinian corpuscles (acceleration receptors) - uses to identify end range of motion of the patient's joints, to differentiate the restrictive barrier. Ruffini's endings (dermal stretch receptors) - use to determine skin drag. Interstitial [free nerve endings] (for light touch, temperature, nociception) - uses to identify temperature and tissue texture changes.

Front 18

How does the patient use mechanoreceptors in treatment?

Back 18

Pacinian corpuscles - sense of acceleration or deceleration causes change in muscle tension in response to differing forces being applied. Ruffini's endings - use to determine physiologic barrier and end range of motion. Intersitial - uses to identify nociceptive signals.

Front 19

Describe tightness.

Back 19

Restrictive barrier found, tethering (acute muscle spasm), bind, restriction of motion.

Front 20

Describe looseness.

Back 20

Ease of motion, neural inhibition (muscle weakness), pain, hypermobility.

Front 21

What is indirect MFR?

Back 21

Stack all myofascial tissues in the directions of ease.

Front 22

What is direct MFR?

Back 22

Stack all myofascial tissues in the directions of restriction.

Front 23

List the palpable layers.

Back 23

Skin, adipose tissue, superficial fascia, muscles, tendons/ligaments, deep fascia, bone.

Front 24

What motion does the body undergo in inhalation?

Back 24

Spinal curves flatten (decrease), extremities tend toward external rotation.

Front 25

What motion does the body undergo in exhalation?

Back 25

Spinal curves accentuated (increase), extremities tend toward internal rotation.

Front 26

What is respiratory cooperation?

Back 26

A physician directed inhalation and/or exhalation by the patient to assist the manipulative process.

Front 27

List indications for MFR?

Back 27

Acute painful situations, hospitalized pts, chronic disease states, peds pt, geriatric pts, anytime you wish to use OMT.

Front 28

List contraindications for MFR?

Back 28

Fractures, physicians inability, inability to position pt, inability of pt to respond to tx.

Front 29

What are the steps of MFR technique?

Back 29

Front 30

In performing direct MFR, what should you note about the tension?

Back 30

There should be increased tension under your hands and less distally.

Front 31

In performing indirect MFR, what should you note about the tension?

Back 31

There should be decreased tension under your hands and more distally.

Front 32

How is diagnosis made for MFR?

Back 32

Visual inspeciton, TTA assessment, assess somatic dysfunction of area.

Front 33

What are the indications for MFR on the knee?

Back 33

Knee pain, ankle somatic dysfunction, late post-operative, patellofemoral syndrome, postural imbalance, knee swelling, etc.

Front 34

Describe the MFR technique for the knee.

Back 34

Patient supine. Stand beside affected knee. Place cephalad hand on the distal thigh, superior to the patella. Place caudad hand on the proximal tibia, inferior to the patella. Make firm and full contact with hands. Palpate for fascial layers. Evaluate rotatory motion – internal/external rotation of tibia/femur. Maintain rotatory tension. Evaluate abduction/adduction motion (induce valgus/varus). Hold the tissues at the restrictive barrier. Evaluate compression and traction. Hold in the position of tightness (restrictive barrier). Ask patient to breath in an out. Notice which breath cycle tightens the tissues (respiratory cooperation). Then ask patient to hold breath in the cycle which tightened the barrier further, until air hunger. Hold the tissues firmly in all planes until release is appreciated. Release and retest the TTA and motion in the knee joint looking for improvement in range and quality.

Front 35

What are the indications for MFR on the ankle?

Back 35

Ankle or foot pain, grade 1 ankle sprain (grades 2-3 when cleared orthopedically), plantar fasciitis, postural imbalance, etc.

Front 36

Describe the MFR technique for the ankle.

Back 36

The patient is supine. Stand at side of affected ankle . Place cephalad hand so that thumb is around the distal tibia and on lateral ankle ligaments, fingers grasping tibia. Place caudad hand so that web of thumb and fingers is on the hind foot (just distal to other hand). Palpate for fascial layer(s). Evaluate rotatory motion. Next evaluate inversion/ eversion motion . Next evaluate compression and distraction. Ask patient to breath in an out. Notice which breath cycle increases the ease in the tissues. Then ask patient to hold breath in the cycle which loosened the tissues further, until air hunger. Hold the tissues firmly in all planes until release is appreciated. Release and retest the TTA and motion in the ankle joint looking for improvement in range and quality.

Front 37

What are the indications for MFR on the scapulothoracic joint?

Back 37

Shoulder restrictions in motion, pain, cervical pain, postural imbalances, thoracic outlet syndrome, etc.

Front 38

Describe the MFR technique for the scapulothoracic.

Back 38

Partner is prone with arm hanging over table (or lateral recumbent). Stand on the side of the affected shoulder. Using caudad hand, place the thumbs on the lateral border and fingers along the medial border of the scapula, so angle of scapula is in palm. With cephalad hand, place fingers at medial border and thumb at lateral border. Motion test in the following 3 planes, assessing for ease and restriction: superior/inferior (red); lateral/medial (blue); clockwise/counterclockwise (yellow). Ask patient to breath in an out. Ask patient to hold breath in the cycle which tightened the barrier further, until air hunger, for direct technique. Hold tissues until release is palpated and patient takes a breath. Release tissues and reassess.

Front 39

What are the indications for MFR on the wirst, forearm, and elbow?

Back 39

Forearm/wrist/elbow pain, lateral and epicondylitis, carpal tunnely syndrome, etc.

Front 40

Describe the MFR technique for the wirst, forearm, and elbow.

Back 40

Partner is standing, seated, or supine. Grasp the thenar eminence with four fingers. The index and long fingers contact the area of the transverse carpal ligament. The grasping thumb contacts the extensor surface of the hand and wrist pointing proximally along the long axis of the forearm. The other hand grasps the patient’s forearm at the elbow (radial head). Palpate superficial and deep myofascial structures to determine which layer to work in. Next turn the wrist in pronation and supination until a restrictive (tight) barrier is noted at either side of the elbow or within the mechanics of the wrist and hand (Diagnosis= pronation or supination). Assess fascial motion of the wrist (Diagnosis= flexion/extension/abduction/adduction). Add compression or traction, whichever tightens the barrier (Diagnosis= compression or traction). Ask patient to breath in an out. Notice which breath cycle tightens the tissues. Then ask patient to hold breath in the cycle which tightened the barrier further, until air hunger. Hold the tissues firmly for a few seconds until release is appreciated. Release and retest the motion of the forearm looking for improvement in range and quality.