Connective Tissue Soft Tissue Approaches in the Treatment of - - PDF document

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Kat Kate P Peck ATC, ATC, CMT

CMT

1113 Washi 1113 Washingt gton Stre Street Newton wton, MA MA 0214 02146 (508) 508) 245-29 245-2922

Journ Journey to y to Healt Health

Myofascial Release and Soft Tissue Approaches in the Treatment of Athletic Injuries

Kate Peck ATC, LAT, CMT

• 1. Everything is connected!
• 2. Look at the bigger picture!
• 3. What role does the fascia

play in injuries?

• 4. What injuries/conditions can be helped

by myofascial release?

• 5. What role do ‘myofascial chains’ have on

the treatment of injuries?

• 6. Feel for the “snag”!
• 7. Treating the “snag”.
• 1. Everything is connected!

Connective Tissue

Types of Connective Tissue

• Blood
• Lymph
• Bone
• Cartilage
• Tendons
• Ligaments
• Joint capsules
• Fascia
• Nerve sheaths
• Blood vessels

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Components of Connective Tissue

• Cells
• Fibers
• Ground Substance

Components of Connective Tissue

• Cells

– Fibroblasts – Mast cells – Macrophages – Plasma cells

Components of Connective Tissue

• Fibers
• Collagen
• tough
• very little ability to stretch
• fibers unwind but do not stretch
• provide the tensile strength & resiliency
• Elastin

Components of Connective Tissue

• Fibers
• Collagen fibers
• Elastin fibers
• give fascia its extensibility
• may stretch to 150% of resting length without

tearing

Components of Connective Tissue

• Ground substance

– Intercellular fluid in all connective tissue – Made up of:

• Water
• GAGs – Hydrophilic glycoaminoglycans – keep the ground

substance fluid, preventing adhesions

• Hyaluronic acid – keeps ground substance viscous (jelly-like)

– The proportion of these 3 components determines the consistency of the ground substance, more gelatinous

• r more liquid.

Components of Connective Tissue

• Ground substance
• In fascia it has the consistency of egg whites
• It is how the fascia is nourished
• provides lubrication so fibers slide over one another
• keeps the spatial relationship between the fibers to

keep them from adhering to one another.

• disperses shock

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Why are we talking about all the different kinds of connective tissue?

• To understand the

concept that the tissue is continuous from the periosteum of the bone to the tendon, to the muscle belly, back to tendon and back to periosteum.

Why are we talking about all the different kinds of connective tissue?

• And that the tissue is

continuous from the periosteum of the bone to the ligament & joint capsule, and back to periosteum.

Why are we talking about all the different kinds of connective tissue?

• Therefore, there is a

“fascial net” made up

• f all the different

kinds of connective tissue that connects us from head to toe and from superficial to deep.

• 2. Look at the bigger picture!
• When we evaluate injuries with this

concept of a “fascial net”, we need to evaluate the body as an interconnected whole.

• An injury in one area of the body can be

the result of a “snag” in the fascial net somewhere else in the body.

• The problem may not be where the pain is!
• 3. What role does the fascia

play in injuries?

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What is Fascia?

• It surrounds every

tissue and organ in the body including muscle, bone, nerves, arteries & veins.

Three Layers of Fascia

• Superficial
• Deep
• Deepest

Three Layers of Fascia

• Superficial

– lies directly under the skin. – is highly elastic & flexible. – The majority of pain sensors are found here.

• Deep
• Deepest

Superficial Fascia

• Strolling Under The Skin

Three Layers of Fascia

• Superficial
• Deep - also called the Investing fascia.

– surrounds and supports all of the organs of the body – surrounds muscle group (ie. quadriceps) – surrounds each muscle (epimysium) – surrounds the fascicles within each muscle (perimysium) – surrounds each muscle fiber (endomysium)

• Deepest

Deep Fascia

• Muscle Attitudes video

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Three Layers of Fascia

• Superficial
• Deep

– makes up fascial structures such as retinaculum, aponeuroses, ITB, lumbodorsal fascia, palmar fascia, planter fascia, etc. – has more collagen fibers and less ground substance so is dense. – fiber orientation is multidirectional so can respond to multidirectional stresses.

• Deepest

Three Layers of Fascia

• Superficial
• Deep
• Deepest

– forms the dural membrane that surrounds the brain & spinal cord. – It is continuous with the fascia of the body. – we work with this in craniosacral therapy.

• Restrictions in the fascia can

effect every other tissue and

• rgan in the body.
• Including

nerves arteries and veins

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• Releasing the restrictions in

the fascia can improve the function of every other tissue and organ in the body.

Fascial Dysfunction Fascial Dysfunction

• Common causes:

– Trauma (sudden or cumulative) – Postural misalignment – Patterns of repetitive overuse, underuse, or misuse – Illness/disease – Immobilization – Aging

A word about immobilization . . .

An orthopedic surgeon wrote that normally when...one

• pens a thigh to remove fascia for surgical procedure,
• ne will be struck by the smooth surfaces of contact

between the fascia and the underlying muscle and that these surfaces fairly glisten and are not adherent....On the other hand, when one opens a thigh that has been at rest, either in a cast or in a splint, or as a result of rest in bed, one finds that the fascial surfaces, as well as the surface of the underlying muscle, is dull and does not glide; often times many small adhesions have formed between the muscle and fascia.

• Ralph K. Gormley, 'The Abuse of Rest in Bed in

Orthopedic Surgery', J.A.M.A., August 19, 1944

Fascial Dysfunction

• Results in:

– Formation of adhesions – Dehydration / thickening of the ground substance – resulting in fibers being closer together, so more likely to form adhesions.

Myofascial Release (MFR)

Myofascial release:

– Breaks up adhesions – Changes the viscosity of (liquifies) the ground substance.

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Myofascial Release (MFR)

• Indications:

– Area of muscle feels tight & restricted. – Muscle group or compartment feels tight & restricted. – Skin is “stuck down”. – History of an old injury and still has decreased ROM and/or pain. – Restricted ROM without specific injury. – Decreased power or strength

Myofascial Release (MFR)

• Indications:

– Painful movement. – Cast is removed. – After surgery. – Visible scars in the area of complaint or the myofascial chain. – Palpable thick, adhered, and/or fibrous tissue. – Series of overuse injuries in one fascial chain.

Myofascial Release (MFR)

• General Contraindications:

– Malignancy – Aneurysm – Acute rheumatoid arthritis – Systemic infection – fever, cellulitis

Myofascial Release (MFR)

• Cautions:

– Lymphedema – need specific training – Advanced osteoporosis – Advanced diabetes – Hemophilia or anticoagulant therapy

Myofascial Release (MFR)

• Local Contraindications:

– Open wounds or burns – Sutures – Hematoma – Localized infection – Suspected or healing fracture – Tumor

• 4. What injuries/conditions can

be helped by myofascial release?

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• After the acute phase of any injury

– Splinting/holding – Compensatory patterns

• Itis’s

– Tendinitis/Tendinosis – Bursitis – Fasciitis

• Pain

– Neck pain – Back pain – Joint pain

• 5. What role do ‘myofascial

chains’ have on the treatment of injuries? Myofascial Chains

• The anatomic connective tissue links

among muscles, bones, and fascial membranes that go from head to toe.

Superficial Back Line

• Plays a major role in

maintaining posture & creating extension in the body.

• Conditions involving the

SBL:

– Plantar fasciitis, achilles’ tendonitis, chronic hamstring tightness & hamstring tendonitis, chronic low back strain, chronic neck strain & headaches.

Superficial Front Line

• Functions to balance the

SBL & maintain the general flexion tension of the body.

• Conditions involving the

SFL:

– Tibial stress syndrome, patellar tendonitis, pubic symphysitis, head forward posture & headaches.

Lateral Line

• Functions to create a lateral

bend in the body – lateral flexion of the spine, abduction

• f the hip, eversion of the foot.
• Important in treating left side-

right side imbalances.

• Conditions involving the LL:

– IT band syndrome & headaches.

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• 6. Feel for the “snag”!

(the root of the problem)

Feeling Your Own Fascia

• Pull on the fascia of your shoulder.
• How far down the arm does it effect? (It

should go all the way down to your hand. If not, you have restrictions)

• Notice that the more times you do it, the

farther down the arm it effects. That is because you are already effecting the fascia

Feeling Your Own Fascia

• Feel your own fascia on your extensor

forearm.

• Flex & extend your wrist.
• Make contact (engage the tissue) with

your other hand & with gentle pressure toward your elbow, feel the effect on your ability to flex your wrist. (This is how a fascial restriction can effect ROM.)

Feeling Your Own Fascia

• Pinch the skin over your elbow.
• Flex & extend your elbow.
• Feel the effect on your ability to flex your
• elbow. (Again, this is how a fascial

restriction can effect ROM.)

Evaluation of the Superficial Fascia

• Superficial Translation
• Skin Rolling
• 7. Treating the “snag”.

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Myofascial Release (MFR)

• The ability of the fascia to “release”

depends on:

– The amount of force – The speed at which the force is applied – The amount of time the force is applied

Myofascial Release (MFR)

• In MFR we slowly apply a low load force,
• ver a long period of time to effect change.

Treating the Superficial Fascia

• Superficial Translation
• Cross-hand Technique
• Skin Rolling

Evaluating & Treating the Deep Fascia

• Deep Translation
• Deep Cross-hand Technique
• Traction Releases

Treating the Deep Fascia

Walt Fritz Techniques*

• Lumbar MFR Lift
• Thigh MFR Rotation
• Cervical Lift

* for more Walt Fritz techniqes, google Walt Fritz videos

Kat Kate P Peck ATC, ATC, CMT

CMT

1113 Washi 1113 Washingt gton Stre Street Newton wton, MA MA 0214 02146 (508) 508) 245-29 245-2922

Journ Journey to y to Healt Health