Manual therapy in the Training Room More than joint mobilization 6 modalities for your bag of “tricks” Positional Release Therapy, (PRT) Myofascial Release, (MFR) Craniosacral Therapy, (CST) Tui Na, (Chinese Massage) Shiatsu, (Japanese massage) Acupressure PRT Place the involved tissues in a position of comfort, (POC). This reduces irritability of the tender point, (TP). Ideal position is determined by the patients perception of reduced tenderness & the clinicians perception of reduced tone in the TP. Effects of PRT Normalization of muscle hyper tonicity Normalization of fascial tension Reduction of joint hypomobility Increased circulation & reduced swelling Decreased pain Increased strength Contraindications for PRT Open wounds Sutures Healing fx’s Hematoma Hypersensitivity of the skin Systemic or localized infection Malignancy Contraindications Aneurysm Acute rheumatoid arthritis Conditions that respond to PRT Patients with a distinct physical mechanism of injury, e.g. Sports injuries, motor vehicle accidents 4 Phases of Tx Phase 1: acute phase--PRT can be used immediately after injury, due to the gentleness of the tx. Phase 2: treating structural dysfunction in the acute and chronic pt. Phase 3: restoration of functional movement Phase 4: normalization of life activities General Principles of tx Anterior TP’s usually tx’d in flexion Posterior TP’s usually tx’d in extension TP’s near the midline tx’d with more flexion if anterior and more extension if posterior TP’s lateral to midline tx with sidebending and rotation Achieving the optimal position of comfort Ultimate goal of PRT Comfort zone, (CZ), is specific and different for each tx position CZ has been reached when: 1) Reduction in tenderness noted 2) Palpable softness of tissues in area of TP. Perseverance is key when trying to eliminate a TP TP & Position Remember to maintain contact with TP while moving Patient into treatment position. By maintaining contact-it is meant to be a gentle pressure on the TP, not increased pressure TP, Position and Pressure As CZ is approached increase pressure over TP periodically to monitor progress When CZ is reached contact with TP is maintained, but non additional pressure is applied POC When in POC, patient should not have pain If there is pain--then not in POC Discomfort arising after POC is achieved is part of normal release process This discomfort should subside after 1-3 minutes POC POC is maintained for 90 seconds Once a TP has been fully released the body must be returned to neutral position SLOWLY. PRT Positional Release Therapy: assessment & treatment of Musculoskeletal Dysfunction--Kerry J. D’Ambrogio & George B. Roth. Myofascial Release “Fascia is a tough connective tissue that spreads throughout the body in a 3 dimensional web from head to foot functionally without interruption.” Restrictions of the fascia can create pain or malfunction throughout the body. MFR “By requiring the therapist to respond to the subtle changes that occur in tissue tension during myofascial stretching, the therapist is able to work with the patient and not on the patient.” MFR “An athlete with fascial restrictions will not efficiently absorb the shocks of continued activity.” “ connective tissue is composed of collagen, elastin and the polysaccharide gel complex, or ground substance. These form a 3 dimensional, interdependent system of strength, support , elasticity and cushion.” MFR “ MFR along with therapeutic exercise and movement therapy improve the vertical alignment and lengthen the body,providing more space for the proper functioning of osseous structures, nerves, blood vessels and organs.” Fascia Is a slightly mobile connective tissue which is derived embryologically from mesoderm Composed of an elasto-collagenous complex The elastic component is stretchable & is the core of the complex Fascia The elasto-collagenous complex creates a 3 dimensional web, which runs from the top of the head to the tip of the toes. Fascia surrounds every organ muscle, bone and nerve as well as blood vessels. Elastocollagenous complex Relaxed Complex Elastic fibers Collagen fibers Elastocollagenous Complex Stretched complex Collagen fibers Elastic fibers Soft Tissue Mobilization J-stroking Vertical stroking Strumming Bear Claw J Stroking & Vertical Stroking Stroke in direction of the restriction ( with J stroke only) Use counter pressure with one hand Strumming Downward pressure is applied with the fingertips and then a strumming motion is applied to the muscle tissue Strumming if performed correctly is NOT a COMFORTABLE technique Bear Claw Is a form of strumming--used to clear the gluteal and hip regions. Cross Hand Releases Slowly stretch the tissue until you encounter a barrier Maintain the stretch for 90-120 seconds or until you feel a release. Do not try and force your way thru the barrier. Follow thru the barrier until all is quiet Arm Pull This technique can be utilized with patients who have upper extremity dysfunction. It can also be used to aid patients with cervical, thoracic and lumbar dysfunction Anterior Thoracic Release 2nd person maintains longitudinal traction thru the U.E.’s and follows the release 3 dimensionally. Patient is in supine position. Interscapular Release Patient is in the prone lying position Assistants maintain longitudinal traction thru the U.E.’s Leg Pull Leg pull can be utilized with patients with lower quadrant dysfunction, including lumbar and thoracic dysfunction Lateral Thoracolumbar Release 3 person technique- Pt. is sidelying-1 person and the top leg, 1 person on the top arm and 1 person on the chest. Anterior thoracic Release One assistant maintains traction thru both U.E.’s. One person on the anterior chest Interscapular Release 3 person release- Pt. is in prone position--1 person on arm abducted to 90 degrees--1 person on scapula and 1 person on the opposite arm Cervical Release Patient in supine position with the head off of the table Drop head into slight extension and apply gentle traction Continue with head traction and apply caudad pressure to the chest Maintain traction and apply caudad pressure top each shoulder. MFR Myofascial Release the search for excellence: John Barnes The Myofascial Release Manual: Carol Manheim & Diane Lavett Craniosacral Therapy Based on the belief that the cranial bones move in relation to each other throughout life. William Sutherland, an osteopath, became fascinated with the design of the cranial bones. Basic Concepts of CST Craniosacral system is a semi-closed hydraulic system Boundaries formed by the meningeal membranes, ie the dura mater. CSF intake via the choroid plexus CSF returns to the venous system via the arachnoid villae. “Listening Stations” Heels Dorsum's of the feet Anterior thighs ASIS Ribs Shoulders Cranial vault-3 holds Techniques for headache & Concussion Occipital release Frontal release Sphenoid release TMJ release Release for Posterior of Temporalis Sit at head of table Arrange tips of fingers 2-4 over the tip of the ear,(ask pt. to clench teeth briefly and if I right place you will feel mov’t) Apply medial pressure with cephalad traction Temporalis cont’d Apply moderate amount of medial pressure and without sliding pull fingertips superiorly Maintain medial pressure and traction until you feel release Masseter Release Sit at head of table Place thumbs over the masseter fibers and apply medial pressure until you get a release. CST CranioSacral Therapy: John E. Upledger & Jon D. Vredevoogd CranioSacral Therapy ll: Beyond the Dura: John E. Upledger Tui Na: Chinese Massage Chinese massage and theory are inseparable. Yin-yang theory: at the core of traditional Chinese medicine. Yin and Yang are interdependent The balance between Yin and Yang is not a fixed state Techniques to use in the Training Room Gun Fa--Rolling Yi Zhi chan Tui Fa- one finger meditation Rou Fa --kneading Mo Fa -- round rubbing Na Fa -- grasping Cuo Fa-- rub rolling Techniques cont’d Ca Fa --scrubbing with palm or edge of hand An Fa -- pressing with thumb or heel of palm Ya Fa --suppressing with the elbow Tui Fa --pushing with thumb, heel of hand or both palms Techniques cont’d Ma Fa --wiping Ji Fa -- chopping using the edge of the hand, back of the hand or tips of the fingers Zhenb Fa --vibrating with 1 finger, 2 fingers or the palm Dou Fa -- shaking Techniques cont’d Yao Fa --rotating Ban Shen Fa --pulling/stretching An Rou Fa -- revolving Pia Fa --knocking using cupped palm or fist Che Fa -- squeezing/tweaking Nian Fa -- holding /twisting Applying techniques Sciatica Strained lumbar muscles Tennis elbow Tui Na Chinese Massage Manual: The Healing Art of Tui Na: Sarah Pritchard Shiatsu “Practitioner uses pressure with his/her thumbs, fingers, palm, elbow, knees and feet to induce deep relaxation and a feeling of well being.” First practitioners of Shiatsu in Japan were blind, because it was thought that their sense of touch was more heightened. Styles of Shiatsu Namikoshi--first of the “Shiatsu” styles. A very western approach, which does not rely on the meridian system Tsubo therapy--concentrates on the therapeutic effect of tsubo’s, (pressure points) Zen Shiatsu--utilizes meridian functions and Oriental theory. Yin & Yang Yin & yang consume and support one another Yin & Yang transform into each other All diseases are due to imbalance of Yin & yang. All diseases can be defined as either Yin or Yang 5 Element Theory Wood: controls earth and is controlled by Metal Fire: controls metal and is controlled by Water Earth: controls water and is controlled by Wood Metal: controls Wood and is controlled by Fire Water: controls Fire and is controlled by Earth 5 Element Theory Metal: Lung Meridian,(Yin), Large Intestine, (Yang). Lung meridian is responsible for intake of air,(Ki). Large Intestine meridian is responsible for Elimination 5 Element Theory Earth: Stomach,(yang) & Spleen/Pancreas,(Yin) meridians. Stomach meridian is responsible for Intake of nourishment. Spleen/pancreas is responsible for Digestion and Transformation.