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 suffering, 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 infection  Malignancy  Systemic localized infection  Sutures over the area  Recent fracture  Cellulitis  Febrile state  Hematoma  Acute circulatory condition  An open wound at the treatment site CONTRAINDICATIONS

 Absolute  Osteomyelitis  Advanced diabetes  Hypersensitivity 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 pain  Pain 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

 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

 Massage  The systemic and scientific manipulation of soft tissue for remedial or restorative purposes. 1 MASSAGE

 Effects  Muscle relaxation  Blood vessel dilation  Increased blood and lymphatic flow  Promotion of fluid mobilization  Stretching and breakdown of tissue adhesions MASSAGE

 Types  Effleurage  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 thickness  Three layers  Superficial  Deep  Subserous FASCIAL ANATOMY

 Third whole-body communicating network  Grapefruit metaphor FASCIAL ANATOMY Obtained from Obtained from

 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 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 sufficiently hypersensitive, gives rise to referred pain and tenderness.”1  Active  Latent  Satellite TRIGGER POINT RELEASE Obtained from

 What are we looking for?  How much pressure should we apply?  How do I determine which structures I am actually palpating? PALPATION Obtained from

 Superficial v Deep Tissues  Very light  Increasing pressure  Appropriate pressure  Epidermis  3-10grams  Dermis  10-30grams  Superficial Fascia  grams  Deep Fascia & Superficial Muscles  grams  Deep Fascia & Middle layer Muscles  grams  Deep Fascia & Deep Muscle  grams PALPATION Obtained from

 Dime Lab  Sponge Lab PALPATION

 1. Houglum, Peggy. Therapeutic Exercise for Musculoskeletal Injuries. 3 rd ed. Champaign: Human Kinetics, 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. 2 nd ed. Philadelphia: Churchill Livingstone Elsevier  4. Kinesio Taping Association International  5. Chaitow, Leon. Muscle Energy Techniques. 4 th 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 th ed. New York: Mcgraw-Hill REFERENCES