Index
Accessory movement Autonomic aspects of myofascial pain syndrome, component motions, 12 138–139, 144–145 defi nition and origin of term, 10 Autonomic eff ects of massage, 83 historical development, 4 Avicenna, 6 joint play motions, 12 Axial fl exion of cervical spine, 305–306, 307 types of, 12 ACR (American College of Rheumatology), 149 Back pain. See Low-back pain (LBP) Active movement analysis, 193–194 Barker, Herbert, 8 Acupuncture Biceps for fi bromyalgia, 155 biceps stretch, 300 for myofascial pain management, 146 transverse fascial stretch of, 299–300 Acute pain, 111. See also Pain Biceps stretch, 300 Aeschylus, 91 Bilateral sacral release, 222–223 Aff erent neurology of connective tissue Bilateral upper thoracic release, 283–284 free nerve endings, 93 Bindegewebsmassage, 18–20 Golgi tendon organs (GTOs), 92, 93, 99–101, 118, Bindegewebsmassage-type stroke, 205–207 120 Biomechanics hair receptors, 93, 96–97 of connective tissue, 4, 40–54 joint capsule receptors, 92, 93, 101–102, 108–109 of junctional zones, 59–63 mechanoreceptors, 92–104 of muscles, 56–58 Meissner’s corpuscles, 92–95 Biotensegrity of musculoskeletal system, 61–63 Merkel’s receptors, 93, 96 Blood fl ow, massage’s eff ects on, 80–82 muscle spindles, 92, 93, 97–101 Body posture. See Postural and structural nociceptors, 104–105 evaluation Pacinian corpuscles, 93, 95–96, 101, 118, 119, Bohm, Max, 20 120 Bone setters (17th–19th centuries), 6–8 Ruffi ni corpuscles, 50, 93, 96, 101, 119, 120 Bony clearing small-diameter muscle aff erents (III and IV), 93, of iliac crest, 217–219 102–104, 121 of tibia, 271–274 Alexander, F. Matthias, 25–27 Borthwick, E. K., 91 Alexander technique, 25–27, 201 American College of Rheumatology (ACR), 149 Cells of connective tissue, 35–37 American Physical Th erapy Association, 125 Central sensitization Anterolateral fascial elongation, 117–118, 288–289 fi bromyalgia, 153–154 Antidepressants, 155 myofascial pain syndrome, 142–144 Aponeuroses, 47 Cervical cervicothoracic myofascia, diagonal stretch Arthrokinematics, 4, 10, 11–12, 199–200 of, 308 Assessment of myofascial system. See Evaluation of Cervical laminar release, 306–308 myofascial system Cervical spine ASTYM (augmented soft tissue manipulation), 85 axial fl exion of, 305–306, 307 Augmented soft tissue manipulation (ASTYM), 85 cervical laminar release, 306–308 Autonomic approaches to myofascial manipulation, diagonal stretch of cervical cervicothoracic myo- 17–21 fascia, 308
317 318 Index
Cervical spine (continued) functions of, 33–34 elongation of paravertebral muscles, 305 general characteristics of, and defi nitions of evaluation of, 190–191 terms, 40–46 frontal facial decompression, 311–312 histology of, 34–40 manipulation of subcranial and OA myofascia, insertion of, to bone, 59–61 308–309 loose irregular connective tissue, 47–48 masseter manipulation, 309–310 pathophysiology of soft tissue repair, 69–72 retro-orbital decompression, 312–313 percentage of body weight and storage of water sternocleidomastoid (SCM) muscle play, 313–314 content by, 33 temporalis manipulation, 310–311 photomicrograph of, 37 therapeutic techniques, 305–314 plasticity of, 50 Cervicothoracic area, muscle agonist/antagonist response of, to immobilization, 73–80 groups of, 192 stress–strain curve, 41, 44–45 Chila, Anthony, 24 types of, 34 Chiropractic, 9–10, 12, 155 types of injuries to, 40 Chisel grip, 202, 203 viscoelastic model of, 41–45 Chondroitin, 38 Wolff ’s law, 45 Chronic fatigue syndrome, 151 Connective tissue massage (CTM), 18–20 Citalopram, 155 Contractility of connective tissue, 48–49 Collagen Contraction of muscles, 50–51, 131, 139–140 in basement membrane, 59 Contractures of trigger points, 131, 140–142 biosynthesis of, 38–40 Convex/concave rule for joint mobilization, 12 critical interfi ber distance, 74 Creep and relaxation, 43–44 cross-links and, 71, 74, 75 Critical interfi ber distance, 74 in dense irregular connective tissue, 47 Cross-friction of gastrocnemius–soleus musculo- in dense regular connective tissue, 46 tendinous junction, 275–276 diagram of, 34 Cross-friction of piriformis insertion, 263–264 distribution of, 85–86 Cross-links, 71, 74, 75 in extracellular matrix, 35, 37–40 CTM (connective tissue massage), 18–20 half-life of, 45, 74 Cutaneous pain, 125 in loose irregular connective tissue, 48 Cyclobenzaprine, 155 lubrication of, 74 Cyriax, Edgar, 10 massage’s eff ects on, 83–86 Cyriax, James, 10–12, 184 response of, to immobilization, 74–75 types of, 35, 38 Dense irregular connective tissue, 47 viscoelastic model of connective tissue and, 43, 45 Dense regular connective tissue, 46–47 weave pattern of, 43 Diagnosis. See also Evaluation of myofascial system wound healing and, 71–72, 83–85 of dysfunction, 183–184 Compression, defi nition of, 40 of fi bromyalgia (FMS), 149–152, 153 Compressive testing of spine, 195 in modern times, 10–13 Connective tissue of myofascial pain syndrome, 129–132 aff erent neurology of, 92–105 of soft tissue lesion and mechanical dysfunction, biomechanics of, 40–54 127 cells of, 35–37 Diagonal stretch of cervical cervicothoracic myo- classifi cation of, 47 fascia, 308 collagen, 35, 37–40 Diaphragm release, 241–244 contractility of, 48–49 Diaphragmatic techniques, 119–120 dense irregular connective tissue, 47 Dicke, Elizabeth, 18–19 dense regular connective tissue, 46–47 Distraction, 12 diagram of, 34 Dry needling. See Physical therapy dry needling extracellular matrix, 35, 37–40 Duloxetine, 155 fascia as force transmitter, 50–54 Dupuytren disease, 50 fi brosis cycle and decreasing mobility in, 72–73, Dysfunction 77–78 criteria for somatic dysfunction, 127 Index 319
defi nition of, 183 postural and structural evaluation, 185–193 defi nition of somatic dysfunction, 183 questions for, 184 diagnosis of, 183–184 skin rolling, 196, 197 motor and mechanical dysfunction in myofascial thoracic spine, 191, 192 pain syndrome, 133–135 Exercise myofascial pain dysfunction syndrome, 128 for fi bromyalgia, 155–157 sensory dysfunction in myofascial pain syn- for low-back pain (LBP), 13 drome, 135–138 Extension exercises, 4–6 soft tissue lesion and mechanical dysfunction, Extracellular matrix, 35, 37–40 126–128 somatic dysfunction, 127, 183 Facet hypothesis, 10 Fascia as force transmitter, 50–54 Ebner, Maria, 18 Fascial contraction loop, 50, 51 Effl eurage massage techniques, 20 Fascial sheaths, 47 Elastin, 35, 37, 38 Fasciculi, 56 Electrogenic muscle tone, 112–113 FCU (fl exor carpi ulnaris), 53 Electromyograms (EMGs), 183 Feldenkrais method, 24, 27–28, 201 Elongation Fibroblastic phase of wound healing, 71–72 anterolateral fascial elongation, 288–289 Fibroblasts lateral elongation of peroneal tissue, 274–275 contractility of connective tissue, 48–49 lateral elongation of upper thoracic area, 279–281 description and functions of, 35–36 lower extremity/posterior quadrant fascial elon- during healing process, 71–73, 83–85 gation, 276–277 massage’s eff ects on, during healing process, medial–lateral fascial elongation, 209–211 83–85 of paravertebral muscles, 305 Fibrocytes, 35 in sequencing of treatment, 201 Fibromyalgia (FMS) side-bending elongation quadratus stretch, comorbidities with, 151 225–229 defi nition of, 126, 149 upper extremity and posterior quadrant fascial diagnosis of, 149–152, 153 elongation, 296–298 incidence of, 149 EMGs (electromyograms), 183 management of, 155–157 End feel, 11 nonpharmacological management of, 155–157 Endomysium, 56 pathogenesis of, 152–154 Endplate (integrated) hypothesis, 147 pharmacological management of, 155 Energy crisis hypothesis, 140–141 tender points, 150–151 Epimysium, 56 treatment costs for, 149 Erector spinae Fibrosis cycle, 72–73, 77–78 “ironing” of, 216–217 Fibrositis, 149 long axis laminar release, 212–214 First rib shoulder depression technique, 282–283 muscle play of, 214–216 Flexor carpi ulnaris (FCU), 53 quadratus lateral erector spinae release, 224–225, Fluoroscopy, 12–13 226 Fluoxetine, 155 Erector spinae muscle play, 120–121 FMS. See Fibromyalgia (FMS) Evaluation of myofascial system. See also Diagnosis Forearm active movement analysis, 193–194 forearm “ironing,” 300–301 cervical spine, 190–191 muscle splay of, 301–303 compressive testing of spine, 195 transverse muscle bending of, 303 forward-head posture, 186–190 Forearm “ironing,” 300–301 history of, 184 Forward-bending laminar release, 230–232 lateral shear examination, 239–240 Forward-bending laminar release—quadruped, layer palpation, 195–197 232–235 lumbar spine, 191–193 Forward-bending laminar release—sitting, 236–237 observation of posture, 185–193 Forward-head posture, 186–190 palpatory examination, 195–197 Free nerve endings, 93 320 Index
Frontal facial decompression, 311–312 Histopathology Frozen shoulder, 50 fi brosis cycle and decreasing mobility in connec- Fuller, Buckminster, 13, 61–62 tive tissue, 72–73, 77–78 Functional imaging techniques, 154 of myofascia, 69–80 pathophysiology of soft tissue repair, 69–72 GAGs (glycosaminoglycans), 35, 38, 113–114, 116 response of myofascial tissue to immobilization, Gain adjustment of muscle spindles, 98–99 73–80 Galen, 6, 91 scar formation, 77–78 Gastrocnemius–soleus, transverse muscle play of, Historical basis for evaluation of myofascial system, 268–270 184 Gastrocnemius–soleus musculotendinous junction, Historical basis for myofascial manipulation cross-friction of, 275–276 ancient times, 3–6 Gel–sol principle, 50 bone setters (17th–19th centuries), 6–8 Ghormley, R. K., 10 chiropractic, 9–10, 12 Gluteal fascial plane manipulation, 262–263 modern trend toward mobility and diagnosis of Glycosaminoglycans (GAGs), 35, 38, 113–114, 116 pathology, 10–13 Golgi-Mazzoni receptors, 102, 108, 118 osteopathic medicine, 8–9 Golgi tendon organs (GTOs), 92, 93, 99–101, 107– Renaissance, 6 108, 118, 120 Hoff a massage, 20–21 Granulation phase of wound healing, 70–71 Hold–relax stretch of hip, 255–258 Greater trochanter rocking, 248–249, 250 Hood, Wharton, 7 Ground substance, 35, 37, 38, 74 Humpback (kyphosis), 4–6 GTOs (Golgi tendon organs), 92, 93, 99–101, 107– Hyaluronic acid, 38 108, 118, 120 Iliac crest Hair receptors, 93, 96–97 bony clearing of, 217–219 Half-chisel grip, 202, 204 release, 119, 219–221 Hamstring Iliac crest release, 119, 219–221 hamstring manipulation, 258–259 Iliotibial band (ITB) paratrochanteric manipula- longitudinal stroking, 258 tion, 253–255 proximal hamstring stretch, 259–261 Imaging techniques, 154, 183 splay technique, 258–259 Immobilization transverse muscle play of hamstrings, 267–268 fi brosis cycle and, 72–80 transverse muscle play of hamstrings and adduc- muscle tissue and, 78–80 tor magnus: posterior-to-anterior pressure, nontraumatized connective tissue and, 74–77 268 response of myofascial tissue to, 73–80 Hamstring manipulation, 258–259 traumatized connective tissue and, 77–78 Hands Ineffi cient use, 113 care and protection of, 202–205 Infl ammation, 70 chisel grip, 202, 203 Injections. See Trigger point injections half-chisel grip, 202, 204 Interstitial myofascial receptors, 50 lubricant for, 205 Intrafascial circulation loop, 50, 51 octopus grip, 202, 203 Involuntary guarding, 113 power grip, 204 “Ironing” washing of, 204–205 of erector spinae muscle group, 216–217 Hippocrates, 4–6, 9 forearm “ironing,” 300–301 Hips Ischial tuberosity cross-friction, 261 hip fl exion, external rotation, adduction, 256– ITB. See Iliotibial band (ITB) paratrochanteric 258 manipulation hip fl exion/adduction, 255–256 hold–relax stretch of, 255–258 Joint, defi nition of, 199 Histology Joint capsule receptors, 92, 93, 101–102, 108–109 of connective tissue, 34–40 Joint capsules of junctional zones, 58–59 as dense irregular connective tissue, 47 of muscles, 54–56 insertion of, to bone, 59–61 Index 321
Joint manipulation versus soft tissue manipulation, forward-bending laminar release, 230–232 199–200 forward-bending laminar release—quadruped, Joint mobilization, convex/concave rule for, 12 232–235 Joint pain, 11 forward-bending laminar release—sitting, 236–237 Junctional zones iliac crest release, 219–221 biomechanics of, 59–63 iliacus release, 246–248 biotensegrity of musculoskeletal system, 61–63 “ironing” of erector spinae muscle group, 216–217 connective tissue insertion to bone, 59–61 L3 deep soft tissue manipulation, 229–230 histology of, 58–59 lateral sacral release, 221–222 musculotendinous junctions, 58–59 lateral shear correction, 239–241 long axis distraction of superfi cial connective tis- Kabat, Herman, 25 sue, 207–209 Kaltenborn, Freddy, 12 long axis laminar release, 212–214 Knott, Margaret, 25 longitudinal posterior hip release, 232 Kyphosis (humpback), 4–6 lumbar myofascial roll, 237–239 medial–lateral fascial elongation, 209–211 L3 deep soft tissue manipulation, 229–230 medial–lateral pull-away, 223–224 Lange, M., 128 muscle play of erector spinae, 214–216 Lateral elongation psoas release, 244–246 of peroneal tissue, 274–275 quadratus lateral erector spinae release, 224–225, of upper thoracic area, 279–281 226 Lateral fascial distraction of tibia, 274 side-bending elongation quadratus stretch, Lateral sacral release, 221–222 225–229 Lateral shear correction, 239–241 therapeutic techniques, 205–248 Lateral shear examination, 239–240 tissue rolling, 196, 197, 211–212 Layer palpation, 195–197 Lumbar/lumbopelvic area, muscle agonist/ Layered syndrome, 189, 190, 191 antagonist groups of, 192 LBP. See Low-back pain (LBP) Lumbopelvic area, muscle agonist/antagonist “Legs carry trunk” model, 52 groups of, 192 Ligaments Lumbopelvic/lower quarter area as dense regular connective tissue, 46–47 bony clearing of tibia, 271–274 function of, 47 cross-friction of gastrocnemius–soleus musculo- insertion of, to bone, 59–61 tendinous junction, 275–276 Long axis distraction of superfi cial connective tis- cross-friction of piriformis insertion, 263–264 sue, 207–209 gluteal fascial plane manipulation, 262–263 Long axis laminar release, 212–214 greater trochanter rocking, 248–249, 250 Longitudinal posterior hip release, 232 hamstring manipulation, 258–259 Loose irregular connective tissue, 47–48 hold–relax stretch of hip, 255–258 Low-back pain (LBP) iliotibial band (ITB) paratrochanteric manipula- causes of, 10 tion, 253–255 exercise for, 13 ischial tuberosity cross-friction, 261 fi brotic process and decreasing mobility in con- lateral elongation of peroneal tissue, 274–275 nective tissue, 73 lateral fascial distraction of tibia, 274 incidence of, 13 lower extremity/posterior quadrant fascial elon- Lower crossed syndrome, 188–189 gation, 276–277 Lower extremity/posterior quadrant fascial elonga- piriformis release in prone, 264–266 tion, 276–277 plantar fascia manipulation, 278–279 Lubricant for hands, 205 proximal hamstring stretch, 259–261 Lumbar myofascial roll, 237–239 therapeutic techniques, 248–279 Lumbar spine transverse muscle play of gastrocnemius–soleus, bilateral sacral release, 222–223 268–270 bindegewebsmassage-type stroke, 205–207 transverse muscle play of hamstrings, 267–268 bony clearing of iliac crest, 217–219 transverse muscle play of hamstrings and adduc- diaphragm release, 241–244 tor magnus: posterior-to-anterior pressure, 268 evaluation of, 191–193 transverse muscle play of quadriceps, 249–252 322 Index
Macrophages, 35, 36 fi bromyalgia, 126, 149–157 Magnetic resonance imaging (MRI), 154, 183 myofascial pain syndrome, 126, 128–149 Maitland, G. D., 12 physical therapists and treatment of patients with Manipulation, 12. See also Myofascial manipulation chronic pain, 125 Manual medicine. See Historical basis for myofas- soft tissue lesion and mechanical dysfunction, cial manipulation; Myofascial manipulation; 126–128 Th erapeutic techniques Muscle play Mapp, Sarah, 7 of erector spinae, 214–216 Massage. See Myofascial manipulation; Th erapeutic pectoralis major muscle play/pectoralis minor techniques; and specifi c types of massage, such manipulation, 285–286 as Hoff a massage transverse muscle play of gastrocnemius–soleus, Masseter manipulation, 309–310 268–270 Mast cells, 35, 36 transverse muscle play of hamstrings, 267–268 Maturation or remodeling phase of wound healing, transverse muscle play of hamstrings and adduc- 72 tor magnus: posterior-to-anterior pressure, 268 Mechanical approaches to myofascial manipulation, transverse muscle play of quadriceps, 249–252 21–25 Muscle spasms, 111, 113, 115–116, 131 Mechanoreceptors, 92–104 Muscle spindles, 92, 93, 97–101 Medial–lateral fascial elongation, 209–211 Muscle splay Medial–lateral pull-away, 223–224 of forearm, 301–303 Medications. See Pharmacological management of hamstring, 258–259 Meissner’s corpuscles, 92–95 Muscle stretch refl ex (MSR), 106–107 Mennell, James, 10 Muscle tone Mennell, John, 11 electrogenic muscle tone, 112–113 Merkel’s receptors, 93, 96 muscular contraction compared with, 111–112 Metabolism, massage’s eff ects on, 82–83 thixotropy, 114–117 Middle Ages, 6 viscoelastic muscle tone, 113–114 Milnacipran, 155 Muscles Mobility philosophy, 4, 10–13 biomechanics of, 56–58 Mobilization, defi nition of, 12 cellular and histological organization of skeletal Modifi ed convergence projection theory, 143 muscle, 55–56 Motor and mechanical dysfunction, myofascial pain classifi cation of muscle fi ber types, 57–58 syndrome, 133–135 contraction of, 50–51, 131, 139–140 Movement diagram of architectural hierarchy of muscle tis- basics of motor control, 105–106 sue, 56 description of movement approaches to myofas- histology of, 54–56 cial manipulation, 25–28 mechanism of growth in skeletal muscle, 54–55 Golgi tendon organs (GTOs), 107–108 normal muscle contraction, 139–140 historical development of movement reeduca- response of, to immobilization, 78–80 tion, 4 sarcomeres of, 54–56, 59, 140, 147 joint receptors, 108–109 Musculotendinous junctions, 58–59 muscle stretch refl ex (MSR), 106–107 Myofascia receptor infl uence on, 105–117 connective tissue histology and biomechanics, skin receptors and position sense, 109–110 33–54 Movement reeducation, 4, 201 histopathology of, 69–80 MRI, 154, 183 junctional zones histology and biomechanics, MSR (muscle stretch refl ex), 106–107 58–63 Muscle aff erents (small-diameter), 93, 102–104, 121 muscle histology and biomechanics, 54–58 Muscle agonist/antagonist groups response of, to immobilization, 73–80 of cervicothoracic area, 192 Myofascial assessment. See Evaluation of myofascial of lumbar/lumbopelvic area, 192 system of lumbopelvic area, 192 Myofascial manipulation. See also Th erapeutic tech- Muscle pain syndromes niques; and specifi c therapeutic techniques cutaneous pain compared with, 125 autonomic approaches, 17–21 diff erent terms for, 128 fascia as force transmitter, 50–54 Index 323
future considerations, 13–14 Pacinian corpuscles, 93, 95–96, 101, 118, 119, 120 historical basis for, 3–10 Paget, Sir James, 7 mechanical approaches, 21–25 Pain. See also Low-back pain (LBP); Muscle pain modern theories and systems of, 17–28 syndromes modern trend toward mobility and diagnosis of acute pain, 111 pathology, 10–13 cutaneous pain, 125 movement approaches to, 25–28 nociception and nociceptors, 104–105, 111 physiology of, 80–86 pain–spasm–pain cycle, 111, 113, 115–116 Myofascial pain dysfunction syndrome, 128 polymodal pain, 111 Myofascial pain syndrome. See also Evaluation of referred pain, 136–138, 253 myofascial system Widespread Pain Index (WPI), 152 autonomic aspects, 144–145 Pain–spasm–pain cycle, 111, 113, 115–116 autonomic dysfunction, 138–139 Palmar stretch, 303–304 clinical characteristics of, 132–139 Palmer, David Daniel, 9 defi nition of, 126, 128–129 Palpatory examination, 195–197 diagnosis of, 129–132 Paravertebral muscles, elongation of, 305 management of, 145–149 Paré, Ambroise, 6 motor and mechanical dysfunction, 133–135 Paris, Stanley, 12 normal muscle contraction, 139–140 Paroxetine, 155 pathogenesis of, 139–145 Pathophysiology of soft tissue repair, 69–72 peripheral and central sensitization, 142–144 Peckman, John, 24 physical therapy for, 145–147 Pectoralis major muscle play/pectoralis minor ma- referred pain, 136–138, 253 nipulation, 285–286 sensory dysfunction, 135–138 Periosteum, 47 taut bands and, 73, 131, 132 Peripheral neuropathy, 128 trigger point contractures, 140–142 Peripheral sensitization, 142–144 Myofascial release, 24–25 Peroneal tissue, lateral elongation of, 274–275 Myofascial trigger point release (infraspinatur) fl at Petrissage massage techniques, 21 palpation, 292–294 Pharmacological management, of fi bromyalgia Myofascial trigger point release (upper trapezius) (FMS), 155 pincer palpation, 294 Physical therapy Myofascial trigger points. See Trigger points for chronic pain, 125 Myofi broblasts, 35, 36, 48–49, 72–73 diagnosis and, 183–184 Myofi laments, 54–56, 59 dry needling, 145–146 Myogelosis, 128 for myofascial pain syndrome, 145–147 Myotendinous junction trigger point injections, 147–148 biomechanics of, 59–63 trigger point release, 146–147 biotensegrity of musculoskeletal system, 61–63 Physical therapy dry needling, 145–146 connective tissue insertion to bone, 59–61 Physiology of myofascial manipulation histology of, 58–59 blood fl ow and temperature, 80–82 collagen distribution, 85–86 Neural mechanisms, 4 fi broblastic activity/collagen synthesis during Nociception and nociceptors, 104–105, 111, 125. See healing process, 83–85 also Muscle pain syndromes; Pain metabolism, 82–83 Nonthrust articulation, 12 refl exive (autonomic) eff ects, 83 Nontraumatized connective tissue, response of, to Piezoelectric eff ect, 50 immobilization, 74–77 Piriformis Nuclear bag fi bers, 97 cross-friction of piriformis insertion, 263–264 Nuclear bag spindles, 97 piriformis release in prone, 264–266 Nuclear chain fi bers, 97–98 Plantar fascia manipulation, 278–279 Plasma cells, 35 OA myofascia, manipulation of, 308–309 Plasticity, of connective tissue, 50 Octopus grip, 202, 203 PNF (proprioceptive neuromuscular facilitation), 25 Opioids, 155 Polymodal pain, 111. See also Pain Osteopathic medicine, 8–9, 155 Position sense, 109–110 324 Index
Positional theory, 4–10 RSD (refl ex sympathetic dystrophy), 19–20 Positioning of patient and therapist, 201–202 Ruffi ni corpuscles, 50, 93, 96, 101, 119, 120 Positron emission tomography, 154 Postural and structural evaluation Sacrum cervical spine, 190–191 bilateral sacral release, 222–223 forward-head posture, 186–190 lateral sacral release, 221–222 lumbar spine, 191–193 Sarcomeres, 54–56, 59, 140, 147 observation of posture, 185–193 Scapular framing, 289–292 thoracic spine, 191, 192 Scapular manipulation, 294–296 Postural instruction, 201 Scar formation, 77–78 Power grip, 204 SCM. See Sternocleidomastoid (SCM) muscle play Pregabalin, 155 Seated pectoral anterior fascial stretch, 286–287 Primary endings of muscle spindles, 98 Secondary endings of muscle spindles, 98 Proprioceptive neuromuscular facilitation (PNF), Sensory dysfunction and myofascial pain syn- 25 drome, 135–138 Proteoglycans, 35 Sequencing of treatment, 200–201 Proximal hamstring stretch, 259–261 Sharpey’s fi bers, 59, 61 Psoas release, 244–246 Shearing, defi nition of, 40 Sherrington’s law of reciprocal inhibition, 189 Quadratus lateral erector spinae release, 224–225, Side-bending elongation quadratus stretch, 225–229 226 Single photon emission computed tomography, 154 Quadriceps, transverse muscle play of, 249–252 Skeletal muscles. See Muscles Skin receptors, 109–110 Receptive fi eld, 94–95 Skin rolling, 196, 197 Receptor infl uence on movement Small-diameter muscle aff erents (III and IV), 93, basics of motor control, 105–106 102–104, 121 Golgi tendon organs (GTOs), 107–108 Snelson, Kenneth, 62 joint receptors, 108–109 Soft tissue lesion and mechanical dysfunction, muscle stretch refl ex (MSR), 106–107 126–128 nociception, 111 Soft tissue manipulation versus joint manipulation, skin receptors and position sense, 109–110 199–200 Reciprocal inhibition, Sherrington’s law of, 189 Soft tissue repair, pathophysiology of, 69–72 Referred pain, 136–138, 253 Somatic dysfunction, 127, 183 Refl ex sympathetic dystrophy (RSD), 19–20 Spasms, 111, 113, 115–116, 131 Refl exive approaches to myofascial manipulation, “Spine engine” model, 52 17–21 Splay technique Refl exive eff ects of massage, 83 forearm, 301–303 Remodeling or maturation phase of wound healing, hamstring, 258–259 72 Sternocleidomastoid (SCM) muscle play, 313–314 Renaissance, 6 Still, Andrew Taylor, 8 Repositioning Still, Charles, 9 Galen’s technique of, 6 Strain Hippocratic method of, 4–6 defi nition of, 40 osteopathy and repositioning of subluxation, 9–10 stress–strain curve, 41, 44–45 Reticulin, 35, 37, 38 Stress–strain curve, 41, 44–45 Reticuloendothelial system, 37 Structural Integration (Rolfi ng), 21–23 Retinacular stretch, 304 Subcranial myofascia, manipulation of, 308–309 Retro-orbital decompression, 312–313 Subluxation theory, 9–10, 12 Ribs Subsarcolemma, 59 fi rst rib shoulder depression technique, 282–283 Subscapularis, 287–288 unilateral posterior/anterior articulation of fi rst rib, 281–282 Tapotement massage techniques, 21 Rolf, Ida, 21–22, 50 Taut bands, 73, 131, 132 Rolfi ng (Structural Integration), 21–23 Temperature, massage’s eff ects on, 80–82 Index 325
Temporalis manipulation, 310–311 unilateral posterior/anterior articulation of fi rst Tendons rib, 281–282 as dense regular connective tissue, 46 upper extremity and posterior quadrant fascial function of, 46 elongation, 296–298 insertion of, to bone, 59–61 Th rust manipulation, 12 Tensegrity Tibia of architectural structures, 13, 61–62 bony clearing of, 271–274 biotensegrity of musculoskeletal system, 61–63 lateral fascial distraction of, 274 Tension, defi nition of, 40 Tissue rolling, 196, 197, 211–212 Th erapeutic techniques Traction and manual pressure, 4–5 care and protection of hands, 202–205 Trager, Milton, 23–24 cervical spine, 305–314 Trager/Tragering, 23–24 joint versus soft tissue manipulation, 199–200 Tramadol, 155 lumbar spine, 205–248 Transverse fascial stretch of biceps, 299–300 lumbopelvic/lower quarter area, 248–279 Transverse muscle bending of forearm, 303 positioning of patient and therapist, 201–202 Transverse muscle play of gastrocnemius–soleus, sequencing of treatment, 200–201 268–270 thoracic/upper thoracic spine and upper extrem- Transverse muscle play of hamstrings, 267–268 ity, 279–304 Transverse muscle play of hamstrings and adductor use of ground to facilitate weight shift ing, 202 magnus: posterior-to-anterior pressure, 268 use of lever arms as force multiplier, 202 Transverse muscle play of quadriceps, 249–252 use of therapist’s body weight, 202 Traumatized connective tissue, response of, to im- Th ixotropy mobilization, 77–78 clinical implications of, 115–116 Travell, Janet, 128 defi nition of, 50, 114–115 Treatment. See Th erapeutic techniques erector spinae muscle play and, 121 Tricyclic antidepressants, 155 mechanisms of, in muscle, 115 Trigger point injections, 147–148 neurophysiological implications of, 116–117 Trigger point release, 146–147 Th oracic rotational laminar release, 298–299 Trigger points Th oracic spine, evaluation of, 191, 192 autonomic aspects, 144–145 Th oracic/upper thoracic spine and upper extremity autonomic dysfunction, 138–139 anterolateral fascial elongation, 288–289 clinical characteristics of myofascial pain, biceps stretch, 300 132–139 bilateral upper thoracic release, 283–284 contractures of, 140–142 fi rst rib shoulder depression technique, 282–283 diagnosis of myofascial pain syndrome, 129–132 forearm “ironing,” 300–301 energy crisis hypothesis of, 140–141 lateral elongation of upper thoracic area, 279–281 management of myofascial pain, 145–149 muscle splay of forearm, 301–303 motor and mechanical dysfunction, 133–135 myofascial trigger point release (infraspinatur) myofascial pain syndrome defi ned, 128–129 fl at palpation, 292–294 myofascial trigger point release (infraspinatur) myofascial trigger point release (upper trapezius) fl at palpation, 292–294 pincer palpation, 294 myofascial trigger point release (upper trapezius) palmar stretch, 303–304 pincer palpation, 294 pectoralis major muscle play/pectoralis minor pathogenesis of, 139–149 manipulation, 285–286 peripheral and central sensitization, 142–144 retinacular stretch, 304 physical therapy dry needling, 145–146 scapular framing, 289–292 referred pain patterns of, 136–138 scapular manipulation, 294–296 sensory dysfunction, 135–138 seated pectoral anterior fascial stretch, 286–287 trigger point injections, 147–148 subscapularis, 287–288 trigger point release, 146–147 therapeutic techniques, 279–304 Trochanter rocking, 248–249, 250 thoracic rotational laminar release, 298–299 transverse fascial stretch of biceps, 299–300 Unilateral posterior/anterior articulation of fi rst rib, transverse muscle bending of forearm, 303 281–282 326 Index
Upper crossed syndrome, 188, 189 Widespread Pain Index (WPI), 152 Upper extremity and posterior quadrant fascial Wolff ’s law, 45 elongation, 296–298 Wounds. See also Histopathology U.S. Food and Drug Administration, 155 defi nition of, 69 favorable healing conditions, 70 Vata-Pacini corpuscles, 119 fi broblastic phase of, 71–72 Viscoelastic model of connective tissue, 41–45 granulation phase of, 70–71 Viscoelastic muscle tone, 113–114 healing phases of, 69–72 Voss, Dorothy, 25 infl ammation of, 70 maturation or remodeling phase of, 72 Ward, Robert, 24 scar formation, 77–78 Washing of hands, 204–205 WPI. See Widespread Pain Index (WPI)