Manual Therapy Techniques For Treating M

Manual Therapy Techniques For Treating Myofascial Pain : 

Manual Therapy Techniques For Treating Myofascial Pain

Case Scenario : 

Case Scenario Patient presenting with muscle pain describes a feeling of muscle tightness Traditionally tightness treated with stretching

Case Scenario : 

Case Scenario Stretching may not be the most appropriate treatment choice Soft tissue mobilization techniques may be used to treat myofascial pain in general and active myofascial trigger points in specific

Manual Therapy Techniques For Treating Myofascial Pain : 

Manual Therapy Techniques For Treating Myofascial Pain Myofascial Pain Syndrome Myofascial Trigger Points Manual Therapy Techniques Strain/ Counterstrain Positional Release Soft Tissue Mobilization Self Myofascial Release

Myofascial Pain Syndrome : 

Myofascial Pain Syndrome Characterized by the presence of discreet, hypersensitive nodules known as trigger points.

Trigger Points : 

Trigger Points Palpable within muscles as cord-like bands within a sharply circumscribed area of extreme tenderness Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points

Myofascial Trigger Point : 

Myofascial Trigger Point Hyperirritable locus within a taut band of skeletal muscle or a hard, tender "lump“ located in the muscle and/or fascia Note the bunching up of the muscle fibers in the trigger point knot, and the stretching and elongation of the muscle fibers to either side of the trigger point

Myofascial Trigger Point : 

Myofascial Trigger Point Characterized by intense contractile activity in the absence of nerve excitation (Like a muscle with a cramp, but in a small circumscribed area).

What Causes Trigger Points To Develop? : 

What Causes Trigger Points To Develop? Predisposing Factors Plus Precipitating Factors Plus Perpetuating Factors

Predisposing Factors : 

Predisposing Factors Lack of exercise Poor diet Smoking Poor Sleeping Poor Posture Joint hypermobility Growing older Genetic?

Precipitating Factors : 

Precipitating Factors Excessive Exercise Acute Overload on Muscle Direct Injury to Muscle Chilling of Muscle Chronic Overload and Muscle Fatigue Immobilization Stress/Tension Nerve Root Compression

Perpetuating Factors : 

Perpetuating Factors Mechanical/ Postural Nutritional Metabolic (hyperthyroidism) Psychological (depression)

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Overstretching Overshortening Overloading Microtrauma Destruction of Sarcolemma & Sarcoplasic Reticulum Release of Calcium Thru Presynaptic Membrane Sustained Muscle Contraction Ischemia, Hypoxia, Accumulation of Metabolic Waste Trigger Point Activation Release of Noxiceptive Substances Local Tenderness And Pain Muscle Guarding Loss of ROM Referred Pain Pattern Failure of Calcium Re-uptake Pump Macrotrauma

Myofascial Trigger Point : 

Myofascial Trigger Point May be as small as a pinpoint or as big as a thumb Not an inflammed area of muscle Exquisitely tender to pressure Classified as being latent or active depending on their clinical characteristics

Latent Trigger Points : 

Latent Trigger Points Does not cause spontaneous pain, but may restrict movement or cause muscle weakness Patient presenting with muscle restrictions or weakness becomes aware of pain originating from a latent trigger point only when pressure is applied directly over the point

Active Trigger Points : 

Active Trigger Points Causes pain at rest Palpation elicits pain Directly over the trigger point Remote Area Pain described as spreading or radiating Pain pattern often similar to the patient's pain complaint

Referred Pain : 

Referred Pain Important characteristic of an active trigger point Differentiates an active trigger point from a latent trigger point Associated with pain at site of palpation only

Identifying Active Trigger Points : 

Identifying Active Trigger Points Most often occur in muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency

Identifying Active Trigger Points : 

Identifying Active Trigger Points Contracting the muscle against fixed resistance significantly increases pain

Identifying Active Trigger Points : 

Identifying Active Trigger Points Firm pressure applied over the point usually elicits a "jump sign" Patient winces or withdraws from the stimulus

Identifying Active Trigger Points : 

Identifying Active Trigger Points Fasciculations, called the local twitch response may be observed when firm pressure is applied over the point

Managing Active Trigger Points : 

Managing Active Trigger Points Various modalities, have been recommended to inactivate trigger points Spray and Stretch technique Ultrasound Electrical stimulation Injection Manual Therapy Techniques

Strain/Counterstrain : 

Strain/Counterstrain Approach to decreasing muscle tension and guarding that may be used to normalize muscle function Passive technique that places body part in a position of greatest comfort relieving pain

Strain/Counterstrain Technique : 

Strain/Counterstrain Technique Monitors tension and level of pain elicited by tender point Move patient into position of comfort by shortening muscle Position of comfort -- tender point is no longer tense or tender

Strain/Counterstrain Technique : 

Strain/Counterstrain Technique Maintain for minimum of ninety seconds Tension in the tender point and in the corresponding joint or muscle is reduced or cleared Slowly return to a neutral position Tender point remains pain free with normal tension

Strain/Counterstrain Technique : 

Strain/Counterstrain Technique Explained by stretch reflex Muscle is stretched Impulses from muscle spindles create a reflex contraction With strain/counterstrain muscle is placed in a position of relaxation Muscle spindle activity reduced allowing for decreased tension and pain

Positional Release Technique : 

Positional Release Technique Once located tender point is maintained with palpating finger at subthreshold pressure Part placed in position of comfort Specific position is adjusted throughout the ninety-second treatment period

Iliopsoas Positional Release Technique : 

Iliopsoas Positional Release Technique

Hamstrings Positional Release Technique : 

Hamstrings Positional Release Technique

Quadratus Lumborum Positional Release Technique : 

Quadratus Lumborum Positional Release Technique

Upper Trapezius Positional Release Technique : 

Upper Trapezius Positional Release Technique

Slide 33: 

Deep tissue technique used for breaking down scar tissue/adhesions and restoring function and movement Developed to correct soft tissue problems in muscle, tendon, and fascia caused by formation of fibrotic adhesions or myofascial trigger points Result of acute injury, repetitive or overuse injuries, or tension injuries Soft Tissue Mobilization

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When soft tissue or nerve is damaged tissues heal with fibrotic adhesions or formation of scar tissue Scar tissue is weaker, less elastic, less pliable and more pain sensitive than healthy tissue Fibrotic adhesions disrupt normal muscle function that can create myofascial trigger points which leads to pain and dysfunction Soft Tissue Mobilization

Slide 35: 

Locate adhesions in the muscle, tendon, or fascia that are causing the problem Trap affected muscle by applying pressure or tension with the thumb or finger over these lesions in the direction of the fibers Soft Tissue Mobilization

Slide 36: 

Ask patient to actively move body part taking the affected muscle from a shortened position to an elongated position Clinician continues to apply tension to the lesion Repeat 3-5 times per treatment session Soft Tissue Mobilization

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By breaking up adhesions patients' condition will improve by softening and stretching scar tissue Results in increased range of motion, increased strength, and improved circulation which optimizes healing Soft Tissue Mobilization

Slide 38: 

Treatments are painful This is temporary and subsides almost immediately after the treatment Soft Tissue Mobilization

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Biceps Soft Tissue Mobilization

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Supraspinatus Soft Tissue Mobilization

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Pectoralis Minor Soft Tissue Mobilization

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Iliopsoas Soft Tissue Mobilization

Slide 43: 

Piriformis Soft Tissue Mobilization

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Questions

Slide 45: 

Self-Myofascial Release

Questions : 

Questions

Questions : 

Questions