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Chapter 4 - Non-Swedish Massage Techniques

Terms in this set (123)

What makes a technique "not Swedish"?
If it is not part of Per Ling's list of manipulations.
How did connective tissue massage develop?
-Elizabeth Dicke developed it in 1920s
-She had a neglected tooth abscess that caused general toxemia and severe occlusion of her peripheral circulation in right leg; was to be amputated
-By stroking fingertips over painful areas in back, backache diminished
-She continued to stroke over tight areas around hip, noticed paresthesia in affected limb and warmth
-Over 3 months treatment, sx subsided; went back to job as physiotherapist
How did MLD develop?
-Emil Vodder (physiotherapist) thought of it in "sudden instant of creativity" in 1920s
-had studied immune system for many years (@ time when was first recoginzed as important system)
-Palpated hard, swollen cervical lymph nodes in client; imagined nasal sinus covered w/ lymph vessels etc...
Diaphragmatic Breathing
-Key part of every massage treatment
-Easiest way for the client to achieve relaxation and to break the pain cycle
-Good as self care
how many breaths does the average person take:
-per minute
-per day
-per minute: 12 to 15 breaths
-per day: 20,000 breaths
Describe optimal breathing - relaxed inhalation
-Respiratory diaphragm contracts and descends, compressing abdominal viscera
-QL muscles stabilize lower ribs and diaphragm
-External intercostal muscles contract and lift ribs laterally (like handle of a bucket)
-Scalene muscles and SCMs contract to elevate the sternum, and first 2 ribs
-All these actions increase space in thoracic cavity and decrease air pressure w/in lungs (allows air to flow into lungs)
Describe optimal breathing - relaxed exhalation
-Passive process
-Relaxation of all the muscles of inspiration
-Diaphragm relaxes first, largest volume of air can be expired easily
-Next, relaxation of intercostals, scalenes, SCMs
What does the diaphragm do to the viscera?
Massages the viscera (as it contracts, descends and compresses organs in the abdomen)
What does the contraction of the diaphragm do to blood flow?
-Rhythmical action of diaphragm creates vacuum in thorax, facilitates return of venous blood and lymphatic fluid from legs and lower torso to heart.
What does diaphragmatic breathing do in terms of O2 and CO2
Allows for most efficient intake of oxygen and output of carbon dioxide
What are the beneficial effects of diaphragmatic breathing?
-Promotes relaxation by decreasing effects of sympathetic nervous system
-Pain modulation
How to instruct pain modulation of DB
B/c muscles relax on exhalation and tighten when the breath is held, the therapist can use the client's conscious exhalation to relax muscles, increase the effectiveness of techniques and reduce the perception of pain
-When using deeper techniques or working on painful areas, the therapist should encourage the client to "breathe into" the tissue and "breathe out" the pain.
Breathing Assessment
-Never assume client is able to breathe diamphragmatically
-SUPINE --> place hands on client's abdomen, palpate and observe motion as inhale and exhale, next put hands in ribs, palpate and observe again, then upper chest.
-SIDELYING OR PRONE (palpate lower ribs and QL instead of abdomen)
What is apical breathing?
-An inefficient breathing pattern, where the client mainly uses the upper chest, apex of the lungs, to breathe.
-The lateral ribs move slightly and the abdomen hardly moves at all
What is apical breathing seen with?
-Respiratory dysfunction like asthma
-Postural dysfunction
-When in pain or stress
Paradoxical breathing - when does it happen?
-Occurs when client's abdomen does not appear to rise when inhales (abdominal muscles do not relax which holds the viscera somewhat immobile)
-Lateral rib motion and scalene muscles must compensate for lack of visceral motion
Who is paradoxical breathing seen in?
-Clients who must maintain a certain posture (i.e. trained to breathe in this manner) such as:
*Dancers
*Figure skaters
*Gymnasts

-May also be indicative of patholgoy like pneumothoroax or paralysis of diaphragm
When should clients be educated about proper breathing?
At the beginning of each treatment --> client is instructed to inhale through nose (warms and filters air before entering lungs) and exhale through mouth.
Words to use to instruct breathing
"Take a slow, deep breath, then another, and another... good" (don't say "take a breath, then another, then one last breath).
Steps to showing client diaphragmatic breathing
1. While client supine, therapist places hands on abdomen and asks client to "lift up my hands with your breath" or "imagine a balloon in your stomach that you are inflating with your inhalation" (done w/ little upper chest mvmt as possible)
2. Therapist places hands on lateral parts of rib cage. Client instructed to "move my hands out with your breathing"
3. Therapist places fingertips of one hand on manubrium and ask client to "breathe into this area and lift your sternum"
How to ensure proper exhalation
Direct client to relax the diaphragm first, followed by intercostal muscles and then neck muscles (assisted by gentle touching of areas in order).
Encourage full relaxation of UT and scaslenes by thinking about brinng shoulders "down"
Effects of diaphragmatic breathing
-Increases:
*relaxation
*lymphatic flow
*efficiency of gas exchange
-Facilitates:
*stretching techniques
-Decreases:
*pain
CIs diaphragmatic breathing
-Long-term diabetes
-Kidney disease
Manual Lymph Drainage (MLD)
-Who developed it and when?
-Is this a proven technique?
-Developed by Emil Vodder in 1930s
-YES; various research studies have verified the efficacy of the technique since 30s
What does MLD do?
-Encourages lymph flow and reduces certain types of edema.
-Slow, repetitive, rhythmical nature of techniques also decreases pain perception and effects the SNS
With what type of edema are MLD techniques useful in reducing formation of scar tissue?
-With edema resulting from acute or subacute trauma
How does MLD help to reduce the formation of scar tissue?
By removal of fibrin from initial lymphatics
What does lymphatic movement depend on?
It's largely a passive system; relies primarily on surrounding skeletal muscles and the action of the diaphragm to move lymphatic fluid through its capillaries, nodes, and ducts.
What do the larger abdominal and thoracic lymphatic ducts have?
Contractile abilities and recent studies indicate that superficial lymphatic capillaries also have minor ability to contract (1995)
MLD technique
-Light, repetitive techniques to pump lymphatic fluid through superficial lympathic capillaries
-Therapist's hands soft and relaxed
-No lubricant; talcum powder may be used to facilitate drag
-Must repeat each manipulation at least 5-7 times to pump lymphatic fluid through tissue
-Strokes are unidirectional and overlapping
-Pressure applied centripetally
-Rhythmic strokes
-Start at proximal lymph nodes and work distally towards edematous site
-Thorough treatment of a single limb may take 20 minutes
How much pressure is used and why?
-20-40 mm Hg to avoid collapsing superficial lymphatic capillaries (pressure of more than 60 mm Hg will compress and temporarily collapse these vessels, temporarily preventing drainage of lymph)
-Average pressure of 30 mm Hg has greatest effect on moving lymph
Complex decongestive physiotherapy
-combination of MLD, skin hygiene, bandaging and REMEX
-Effective for treating lymphedema (study)
Effects of lymphatic drainage
-encourages lymph to flow
-Reduces:
*Pain
*Edema
*Excess fibrin
*Metabolic products in inflammatory process
What is the order of techniques when treating local edema in acute or subacute stage of injury?
-Lymphatic drainage techniques first
-THEN deeper Swedish (b/c don't want to collapse superficial lymphatic capillaries)
What is the order of techniques when treating chronic edema?
-Deeper Swedish and fascial techniques applied proximal to edematous site to release soft tissue restrictions that may inhibit lymphatic flow
-Wait a few minutes (i.e. do something at a different part of body) before lymphatic drainage techniques applied (allows capillaries to refill)
Nodal pumping
-Used to treat acute, sub-acute, and chronic edema
-Compressions applied to lymphatic nodes of most proximal part of limb that has edematous tissue (nodes are also closest to thoracic and right lymphatic ducts, which return lymph to venous system)
-In arm the most proximal nodes are axillary lymph nodes; in leg they are the inguinal lymph nodes.
-Use palmar sfc of hand, presssure in wave-like motion from just distal to the node in a proximal direction (compresses capillaries distal to node, moving lymph proximally into duct)
Stationary circles
-Used to treat larger areas of limb b/w edema and proximal nodes
-Palmar sfc of one or both hands, including fingers, rotate or spiral into and out of tissue
Local technique
-Tissue immediately proximal to edema treated w/ ulnar borders of hand, web b/w thumb and index finger, or broad sfc of entire thumbs
-Stroke tissue in proximal direction
-Tissue distal to lesion NOT treated w/ lymphatic drainage until edema decreases
CIs lymphatic drainage
-Chronic heart failure
-Acute conditions d/t bacterial or viral infection
-Recent thrombosis
-Low-protein edema d/t kidney pathologies
-Malignancy
-Obstruction by parasites
Golgi Tendon Organs
-GTOs = proprioceptive nerve receptors / minute sensory organs located in tendons near junction w/ muscle
-Hundreds of these receptors detect "load" placed on tendons
-Part of muscle tension-monitoring system; they moderate muscle contraction through a neural loop and therefore the strength of muscle contraction
-Specifically, alpha motor neuron firing maintains muscle contraction; GTO is able to slow alpha neuronal firing, causing relaxation of muscle
What is the inhibitory effect on muscle contraction by GTO (via slowing alpha neuronal firing) referred to as?
Lengthening reaction
GTOs are also part of a ___________ reflex to prevent muscle injury or rupture through ___________ of the muscle
-protective
-relaxation
When is the protective reflex activated?
When there is excessive load or stretch placed on the tendon.
Golgi Tendon Organ Release (GTO)
-What sort of technique?
-When is it used?
-Which muscles is the technique most effective on?
-Kinesiology technique originating w/ physiotherapists
-Can be used to reduce muscle spasm and tone, esp. when on-site massage too painful
-Most effective on muscles whose tendons are long and easily palpable (like hamstrings at isch. tub., Achilles etc)
GTO release technique
-Direct compression on tendon or near tendon within muscle (greatest GTO concentration here)
-Use reinforced thumbs or fingers, hold for minimum 30 seconds or until muscle relaxes OR can bow tendon into C or S shape
-Rate slow, pressure moderate to deep (approx 2 lbs pressure on GTOs in direction away from belly)
What does GTO do?
Reduces muscle tone and spasm
CIs to GTO & O&I release & muscle approximation techniques
-Locally painful conditions
-Local acute conditions affecting tendon to be treated
-Hypotonic or atonic muscles
-Tissue fragility
-Pathologies of connective tissue
-Skin lesions including healing
Origin and Insertion Technique
-A variation of GTO release
-Used when tendon to be treated is short (e.g. medial attachment of infraspinatus muscle)
-Used to reduce spasm and tone in muscle when direct work on muscle belly uncomfortable
-As w/ GTO release, stimulation of GTOs in musculotendinous junction reduces mm tone by inhibiting alpha neuron firing
How to do origin and insertion technique
-Thoroughly treat origin (attachment) of muscle using either reinforced finger or thumb kneading
-Cross-fibre and then with-fibre strokes (like little plus sign) are made on same location
-Then move several centimeters along origin to repeat technique, continuing to make plus signs along entire origin
-Treat insertion in same manner
-Rate is slow and pressure is moderate to deep
Effects of O&I technique
-Reduce muscle tone and spasm
Muscle spindles
-Proprioceptive nerve receptors / minute sensory organs
-Located in muscle belly
-Monitor muscle length and help control muscle movements by detecting amount of stretch placed on muscle
-Protect muscle from being overstretched
-Set different levels of tone in muscle in response to activity or stress by increasing gain or frequency of gamma efferent nerve firing
Speculation re: GTOs and muscle spindles
-Speculated that each muscle has a resting length that is remembered by the amount of contraction of the spindle cells and the amount of relaxation of the GTOs
Muscle approximation
-Kinesiology technique originating with physiotherapists
-Uses the reflex effect of muscle spindles to reduce tone or spasm in muscle
-Approximating, or bringing ends of mm closer together, lessens the stretch on the muscle spindles
-Decreases gamma firing, reduces muscle tone and spasm
Muscle approximation technique - how to
-Therapist either:
*compresses origin and insertion (attachments) into bony structures below, then approximates
OR
*using pincer grasp on muscle attachments, and bring ends towards each other
-2 lbs of pressure applied from each end towards muscle belly
Effects of muscle approximation
Reduces muscle tone and spasm
Myofascial Trigger Point (TrP) techniques
-Treated by a variety of techniques including:
*Skin rolling
*Repetitive muscle stripping (Swedish techn.)
*Ischemic compression
*Intermittent cold distraction and stretch
*Percussion and stretch
*Post-isometric relaxation
Ischemic Compression
-TrP release technique
-Static compression applied by therapist's thums, fingertips, or olecranon
-w/in pain tolerance
-time held varies from 7 seconds to one minute
-reactive hyperemia may help flush metabolites
Intermittent cold distraction and stretch
-Brief application of cold to skin over muscle w/ TrP
-Followed by slow, careful stretch of affected muscle to just before onset of pain
Percussion and stretch
-Slow tapping of TrP using a reflex hammer, followed by pain-free stretch
Post-treatment of TrP - what to do?
HEAT followed by pain-free stretch or full AROM
The Pressure Point Technique
-Compression then release of painful tissue creates temporary ischemia followed by reactive hyperemia (thought to flush out metabolites that cause nerve irritation and pain)
-Once pain cycle broken, hypertonicity and spasm diminish
-Gradual application of tolerable, static pressure to painful tissue using fingers, reinforced thumbs, knuckles, or elbow
-Pressure maintained until symptoms decrease or muscle relaxes
-Rate is slow and pressure variable
-No need for lubricant
Effects of pressure point technique
-Relax muscles
-Treat sinus congestion
What is compression over frontal or maxillary sinuses used for?
To encourage drainage when treating sinusitis.
Which types of therapy systems use pressure point techniques?
Eastern therapy systems like:
-Acupressure
-Shiatsu
-Reflexology
Based on locations, NOT on musculoskeletal system but rather on meridian system or lines of energy that flow through the body; pressure applied to normalize the energy flow
CIs pressure point technique
-Acute conditions
-Hypotonic or atonic muscles
-Painful conditions like tissue "lumps" such as lipomas, cysts, ganglions
Cross-fibre frictions - who discovered them, how they are preformed
-First described by James Cyriax, MD
-Intended to disrupt and break down existing and forming adhesions in muscles, tendons, ligaments using compression and motion
-Therapist's fingers or thumb do not slide over skin; instead, superficial tissues are moved over the deeper ones
-Though most modern authors credit Cyriax w. discovering the technique, Cyriax notes it was a rediscovery of old technique for tendinitis, described by Hooker in 1849
When are cross-fibre frictions used?
-In subacute and chronic stages of healing to break down adhesions which prevent normal motion
-The adhesions may be w/in muscle fibres and between structures such as ligaments and tendons
What is the point of breaking down adhesions?
-Helps to form a smaller, more mobile scar
-Over series of treatments, collagen fibres of the developing scar tissue are thought to be realigned by repeated frictions, similar to repeatedly rolling fingertips over a pile of toothpicks lying in a random, haphazard manner
Late subacute v.s. chronic stage re: XFF
-In late subacute stage, collagen fibres are weak and break down more easily
-In chronic stage, deeper more vigorous frictions required to break down collagen fibres
When should XFF be used?
-Late subacute and chronic stage
(even though Cyriax advocated use in acute stage)
What technique is used in acute and early subacute stage that helps remove excess fibrin that leads to adhesions?
-lymphatic drainage
What, apart from breaking down adhesions, do cross fibre frictions accomplish?
-may cause minor tissue damage and inflammation causing release of histamine and bradykinin --> effect on local circulation and on nerve receptors for pain --> local vasodilation likely accelerates tissue repair
-Nociceptive chemicals = pain; thought that the painful stimuli close the "pain gate" --> the additional discomfort modulates and reduces perception of peripheral pain
-Pain blocking chemicals like endorphins may be released --> temporary local analgesia during application of technique
Assessment for adhesions
-assess specific structure involved and site of adhesion; don't just treat painful area (may be referred pain)
-Palpation, testing used on tendons, muscles, ligaments
Assessment for adhesion within a muscle
-AROM and PROM used to assess for pain in mm's range
-RROM to pinpoint adhesion --> as contract mm, stress placed on it, painfully pulling on adhesion site where XFF need to be applied
-palpation used to confirm adhesion site
Assessment for adhesions within a tendon
-located with RROM and palpation
Assessment for adhesions within a joint capsule
-located with passive stretching and palpation
Cross-fibre friction technique
-Specific consent needed b/c can be painful and deep
-Communication re: pain levels throughout technique
-Preparatory techniques like lymphatic drainage, effleurage, petrissage and fascial or connective tissue techniques used to prepare tissue beforehand
-Tissue containing adhesions placed in accessible position (e.g. supraspinatus tendon made accessible by internally rotating, extending, and adducting humerus to bring tendon out form acromion)
-Tissue to be treated placed under appropriate tension:
*tendon or mm w/out synovial sheath = place in relaxed, shortened position
*tendon w/ synovial sheath = place tendon in maximum stretch so tecnique can develop a maximum force b/w tendon and sheath (believed that frictions smooth out roughened sfc of tendon)
*ligament = appropriate tension achieved using shortened position so ligament free as possible to move over adjacent tissue
-Technique applied over a number of minutes
-Adhesion is often most tender spot reported by client, sometimes different texture to surrounding tissue
-Use reinforced fingers or thumbs to compress superficial tissue over ahdesion
-Finger goes back and forth at right angle to fibres of tissue, and sweep is like a pencil eraser across a single letter
-Rate = 2-3 cycles per second
-Remove oil or lotion from skin to avoid sliding (otherwise blister will form)
What happens after 1-2 minutes of cross fibre frictions?
-Analgesic effect occurs, feels less tender
-Tenderness not subsided or feels more tender? Stop technique.
-Less tender? Increase pressure to new tolerance and continue technique
Duration cross-fibre frictions
-Depending on tolerance, maybe apply initially w/ less pressure, shorter periods, over several sessions, gradually increasing length
-Recommended duration varies by author (5, 15, 20 minutes)
-Recommends on stage of healing --> subacute 1-2 minutes; chronic longer
-BUT longer applications may cause bruising, may be poorly tolerated by client and therapist
-RATTRAY CLINICAL EXPERIENCE: 2-4 minutes for chronic adhesion = reasonable
Post cross-fibre frictions actions
-Repetitive effleurage to increase local circulation through injury site, decrease remaining pain perception
-Mobilize or stretch treated tissue in pain free ROM (w/ muscles and tendons, normalizes tissue length once adhesions that reduce range are removed; w/ ligaments, mobilizing the ligaments over surrounding structures restores range and improves proprioception) --> muscles/tendons = pain-free passive stretch or full PROM or AROM; ligaments = PROM including distraction and over pressure (ligamentous stress) used
-Next, apply ice to control inflammatory response
-Re-assess post-treatment --> after first session should be improvement, pain reduced w/ RROM w/ muscle and tendon injuries; AROM and PROM w/ ligament injuries
What client can expect after cross-fibre frictions?
-local hyperemia
-local tenderness day after 1st or 2nd treatments
-Not uncommon, not an indication of worsening symptoms
Frequency of Cross-fibre frictions
-Number of sessions varies from 6-12 performed every other day
-Another source says 6-10 sessions over 2-3 weeks
-Most overuse syndromes respond in 2 weeks to 2 months
What do cross-fibre frictions do to adhesions?
Break them down in subacute and chronic stages
Contraindications cross-fibre frictions
-Do not use over peripheral nerves
-RA
-Acute injury
-Infective arthritis
-Structures too deep to be reached
-If using anti-inflammatories, anticoagulants, high-dose long-term steroid medication
-Peripheral vascular disease
-Fragility of skin or soft tissue
Fascia
-Connective tissue / fascia surrounds all muscles, muscle groups, bones, organs, holding them in place
-Continuous sheet of support tissue that envelopes the entire body
-Strong yet mobile
-Generally oriented in longitudinal direction except for layers covering opening of pelvis (pelvic diaphragm), thoracic diaphragm, junction of thorax and cervical regions (thoracic inlet or outlet)
Three categories of fascia
-Superficial - just below skin, composed of loosely knit connective tissue combined with fat, vascular structures, nerve receptors. Mobile and has potential for accumulation of tissue fluids and metabolites
-Deeper - denser, tougher, tighter. Compartmentalizes the body and surrounds the muscles and viscera, contributing to body's contours and function
-Subserous - loose areolar tissue that covers the viscera, supports the organs and provides lubrication so they may slide against each other
Fascial Assessment
-Fascial shortening, adhesions, or restrictions d/t inflammation, trauma, surgery, pathology, postural imbalances create abnormal tension patterns
-Sx that appear unrelated may be transmitted from one body part to another through fascial imbalances
-Assessment required to locate restrictions prior to treatment
-Assessment methods include:
*Slow skin rolling
*Fascial glide
*Positional testing
Slow skin rolling
-Resistance in superficial fascia noted
-Areas of thickened, tender, hyperirritable skin (panniculosis) indicate fascial restrictions and sometimes TrPs
Fascial glide
-Therapist's hand contacts skin, move or glide it over deeper structures (ant., post., sup., inf., lat., or med.)
-Lighter pressure for more superficial fascia; deeper for deeper fascia
-Note area and direction of greatest restriction
Positional testing
-limb or body part is passively moved through its range until a barrier to motion encountered
-Barrier may be subtle or obvious and occurs before ligamentous or joint capsule barrier (i.e. before capsular end feel)
-Fascia involved influences quality and direction of restriction of motion
What are the two main categories of fascial / connective tissue techniques?
Direct and indirect techniques
Direct fasical techniques
-Take the fasica towards the restriction or adhesion (engages teh soft tissue barrier)
-Tissue carefully taken beyond barrier, which breaks down bonds b/w connective tissue fibres
-E.g. "rope burn" (skin wringing)
-IMPORTANT TO GET CONSENT AND WORK W/IN PAIN TOLERANCE
Direct fascial techniques concepts
1. appropriate level of fascia reached by applying pressure to tissue (varies according to depth)
2. stretch placed on fascia to be treated, taking elastic slack out of tissue
3. tissue engaged by holding the stretch
4. stretch is held long enough to break bonds b/w individual --> burning sensation perceived by client, several minutes may be required to achieve release
5. Successful release indicated by hyperemia, a palpable release of heat, decrease of pain, or other sx and a softening or lengthening of tissue
LITTLE OR NO LUBRICANT USED, RELY ON DRAG FOR EFFECT
PRESSURE MODERATE TO DEEP
SPEED IS SLOW
Skin rolling
-Thumbs placed on skin next to each other
-Fingers grasp skin, forming a line
-"walk" over skin
-Rates is slow, perform in long sweeps
-If oil used, it is a petrissage technique
Cross-hands fascial stretch
-Therapist's forearms parallel to each other, elbows at 90 degrees flexion
-Palms contact client's skin, hands positioned so fingers pointing away from each other; heels of hands a few inches apart
-Slack taken out of tissue moving heels of hands away from each other, but they should not slide at all
-Hold until tissue release
Fascial spreading
-Fingertips or thumbs of both hands may be used (hold fingertips of one hand together for support)
-Place fingertips on skin, move apart to take up slack
Cutting technique
-Fingers held together for support, placed on skin
-Terminal phalanges slightly flexed, tissue engaged by pulling towards therapist
-Fingertips, esp. middle fingertip, pulled through tissue towards therapist in cutting mostion
-Muscles may be outlined using progressively deeper strokes to client's tolerance; then fascia covering muscle loosened using oblique strokes
Fascial torquing
-Tissue raised b/w fingertips and thumbs of both hands to take up slack, pulled further off underlying sfc. and twisted to engage it
S-Bowing Fascial technique
-Thumbs placed on skill parallel to and pointing towards each other, so when thumbs moved towards each other fascia distorts into S-shape (if applied on tendon = s-bowing GTO release)
C-bowing fascial technique
-Thumbs placed on skin next to each other... C-shape made
-If applied to tendon = C-bowing GTO release
J-stroke
-deepest, most destructive direct fascial technique
-used selectively after more superficial fascial techniques
-applied in organized manner in lines or rows
-therapist makes fist, places it on tissue w/ proximal phalanges contacting tissue
-Appropriate depth reached
-The proximal interphalangeal joint of the index finger performs the technique, which is essentially drawing the knuckles towards the therapist to take up the slack, engaging the tissue, then making a small, J-shaped pull through the tissue
-The other fingers provide distraction of pressure distributed over wider area than just knuckle of index finger, making it more tolerable
Effects of direct fascial techniques
-Increase excursion and flexibility of fascia by moving it towards, then beyond, the restriction
CIs direct fascial techniques
-Acute injury
-Hypotonic or atonic muscles
-Fragile skin
-Skin lesions
-Recent incisions
-Painful conditions
-Anticoagulant medication use
Connective Tissue Massage
-Developed by Elizabeth Dicke, German physiotherapist (bindegewebsmassage) in 1929
-Involves techniques like skin rolling and connective tissue cutting
-Restrictions assessed w/ skin rolling, treated w/ repeated skin rolling
-Moderate to deep connective tissue cutting used to assess and treat restrictions
-ANS appears to be affected (CT changes on sfc of body correspond to internal organ pathologies, possibly)
-Similar principles/techniques since incorporated into other soft tissue manipulation systems, incl. neuromuscular technique (Stanley Lief, Latvian-born osteophath)
Neuromuscular Therapy (NMT) - history, what it is NOT to be confused with
-Paul St. John (American massage therapist) developed St. John method of NMT and popularized it in 1978
-Combined elements of Raymond nimmo's "receptor tonus" system and Dicke's connective tissue techniques to create a system that treats regions of the body
-should not be confused w/ neuromuscular therapy as defined by Schneider, Dvorak et al., which is a form of manual medicine that improves mobility and stretches muscles using post-isometric relaxation, agonist and antagonist contraction, joint play and neuromuscular reflex mechanisms
What is neuromuscular therapy?
-A system of evaluation and treatment for structural imbalances that cause pain
-Thorough knowledge of functional anatomy required
-Complete postural assessment before treatment begins to determine muscles and fascia to be addressed
-System incorporates fascial techniques like skin rolling and connective tissue cutting and PROM, POP, and stretching to lengthen shortened muscles
-REMEX to stretch and strengthen affected tissues included
-Rate, pressure, and direction vary
-Minimal lubricant to facilitate drag
Effects of neuromuscular therapy
-Reduces:
*pain
*hypertonicity
*postural dysfunctions
-Lengthens and strengthens tissues
Indirect fascial techniques
-Thought to unhook connective tissue
-Similar to releasing two bungee cords, hooked together (first need to push them together, exaggerating elastic tension of cords, before they can be disengaged)
-Therapist moves tissue in "direction of ease" (direction fascia moves most easily) --> opposite direction of restriction
-Slack of fascia taken up, held in this position as tissue attempts to return to original position
-As tissue stops resisting further slack will develop, repeat taking up slack...
-No lubricant used
CIs indirect fascial techniques
-Acute inflammation
-Undiagnosed lumps
-Recent head trauma
-Neurosurgery
Visceral manipulation - who developed it and what is the theory?
-Developed by French osteopaths Jean-Pierre Barral and Pierre Mercier
-Theory = among internal organs, or viscera, there is a relationship b/w structure and function that is similar to relationships of components of musculoskeletal system
Visceral manipulation - what does it consist of?
-Consists of assessment for visceral motion
-Direct and indirect fascial techniques to treat dysfunctions found and restore normal visceral motion
-Techniques of recoil and release by positioning and direct and indirect fascial techniques used
-No lubricant used
-pressure varies
What should healthy viscera be able to do?
-Slide over each other as the person breathes or moves
What do restrictions between fascia covering various internal organs create?
-Dysfunction, in same manner that occurs in musculoskeletal system
-e.g. scarring and adhesions following thoracic surgery create tensions and fascial restrictions that affect the mvmt of the thorax, lungs, heart; over time visceral restrictions of motion affect fascia that runs from thorax through c-spine, restricting neck mvmt; eventually if body cannot adequately compensate for the restrictions, a structural problem such as scoliosis, or head-forward may arise
What types of motion do healthy viscera have?
-Move passively in response to excursion of diaphragm, termed visceral mobility (e.g. kidney moves 3 cms w. each normal breath, cumulatively 600 m per day)
-Also each visceral component has an inherent, characteristic motion around a particular axis, termed motility --> independent of motion imparted by outside sources like diaphragm (e.g. motility of kidney in one subject was measured revealing inherent kidney motion of 3 cm in vertical and lateral direction, with breath held)
Mobility v.s. motility - healthy v.s. dysfunctional
In healthy viscera, axes of mobility and motility are generally the same, while in dysfunctional viscera, axes are often different.
Craniosacral therapy - who discovered it
-Based on the research and clinical work of American osteophath William Sutherland --> first noticed subtle cranial rhythms in the 1940s
-Later work by John Upledger, DO, gave plausible explanation, made it popular
Craniosacral theory
-Cranial bones have subtle, identifiable and patterned motions that are allowed by cranial sutures
-This motion is a result of fluctuations in production and flow of CSF, contained w/in meninges, bathes brain and spinal cord
-Semi-closed hydraulic system
-CSF fluctuations have effect on meninges and through them cranial bones
-Attachments of meninges covering spinal cord to sacrum influence mvmt of sacrum
-b/c fascia throughout body connected, craniosacral rhythm is palpable in CT throughout the body as well as cranial bones and sacrum
What does CST rhythm consist of?
Two movements called flexion and extension
-Flexion (expansion) = active --> subtle, palpable increase in width of skull and body at same time as anterio-poserior dimensions decrease & limbs move into external rotation
-Extension (relaxation) = passive --> opposite; narrowing of head and body, anterior-posterior dimension increase and limbs move into internal rotation
What is the rate of rhythm of flexion and extension?
12 cycles per minute
What is the craniosacral rhythm used for?
-To assess for dysfunctions of the craniosacral system as well as treat dysfunctions
What can dysfunctions in craniosacral rhythm arise from?
-Fixations of any component of craniosacral system d/t physical or emotional trauma
-Fixations increase pressure w/in semi-hydraulic craniosacral system
Effects of craniosacral therapy
-Reduce chronic pain
-Visceral dysfunction
-HA
-TMD
CIs CST
-Brainstem tumor
-Recent aneurism
-Cranial fracture
-Concussion
THIS SET IS OFTEN IN FOLDERS WITH...