Myofascial Cupping presented by David Sheehan The fascia forms the - - PowerPoint PPT Presentation

Myofascial Cupping


presented by David Sheehan “The fascia forms the largest system in the body as it is the system that touches all of the other systems.”

James L. Oschman 2009

Photography & Video

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Myofascial Cupping...

...Can change lives!

Royal Hobart Hospital - Clinical Trial

Neuropathic pain? Nociceptive pain? Dysesthesia? Increased ROM

What is Fascia?

Dense irregular connective tissue which surrounds and connects every muscle, even the tiniest myofibril, and every single organ of the body. (R Schleip, 2003) Composition Extracellular Matrix (ECM) Ground Substance Gel-like – 70% water Collagen fibres most common protein in the body (approx. 25% of all proteins) Orient themselves on lines of tension Elastin fibres protein ~ ear, skin, ligaments where elasticity required Cells Fibroblasts (manufacture collagen fibres) Macrophages (white blood cells – big eaters of bad stuff incl. cell debris in e.g. trauma) Plasma cells (white blood cells which produce antibodies; produced in bone marrow) Mast Cells (involved in wound healing and defense against pathogens) Myofibroblasts – new discoveries discussed later

What is Fascia?

Ground Substance Gel-like containing: Insoluble protein fibrils Soluble complexes of carbohydrate polymers linked to protein molecules which bind water Can dehydrate due to: Trauma Overuse Immobility Aging process – decrease in ability to bind water Dehydration can cause: Reduced Range of Motion (ROM) Pain Postural deviation Trauma

Tensegrity – the role of fascia

Tensegrity is defined as ‘tension + integrity’. Buckminster Fuller, building on the highly original sculptures of Kenneth Snelson, coined the term, to indicate that the integrity of the structure derived from the balance of tension members, not the compression struts - think soft tissue Vs. bone structure.

Tensegrity – the role of fascia

Human structure is ‘finitely closed’ ie we can keep our structure together standing, sitting etc. and not reliant on external structures eg a spider’s web is not ‘finitely closed’. Human structure is held holistically in balance by tension & compression. Musculoskeletal system serves this purpose both stationary and in movement.

Tensegrity – the role of fascia

Fascia and Tensegrity Connects the whole body and importantly… Pre-stresses the human structure Allows body to react quickly to changes in load Adapt to change with minimal effort Human structure responds to stress by: Muscular contraction (via nervous system) ECM remodelling eg trauma/collegen Fascial responses via contraction…

Tensegrity – a role of fascia

Myofibroblasts (MFBs) in ECM

Until recently, scientists viewed fascia as non-contractile and inelastic. Robert Schleip and his team in Germany confirmed ability

• f MFBs in ECM of fascia to contract.

They demonstrated that MFB’s assist fascia in pre- stressing human structure.

Fascia is able to contract in a smooth muscle-like manner and thereby influence musculoskeletal mechanics

Originally published in Liepsch D: Proceedings of the 5th World Congress of Biomechanics, Munich, Germany 2006, pp 51-54

Tensegrity on all levels

• Balancing stress and strain = health & well being
• S.A.I.D. principle (Specific Adaptation to Imposed

Demands)

• Tensegrity allows a balanced transmission of forces

throughout the body.

“If every cell has an ideal mechanical environment, then there is an ideal ‘posture’ – likely slightly different for each individual, in which each cell of the body is in its appropriate mechanical balance for

• ptimal function”

Myers, T. Anatomy Trains 2009; p59

Tensegrity on all levels

The microvacuole concept

Dr Jean-Claude Guimberteau – a pioneer in microsurgery and transplanatations Trained in hand and plastic surgery Presenter at the 1st Fascia Research Congress in Boston, USA (2007)

Observations in vivo showed via video camera:

the every-changing and maintaining purpose of fascia “Notions of different fascias ie superficialis or profundas fascia are

• bsolete” (Guimberteau, 2007)

Muscle Attitudes

presented by Dr. Jean-Claude Guimberteau, MD

Myofascial Release

Myofascial release is a form of soft tissue therapy used to treat somatic dysfunction and accompanying pain and restriction of motion. This is accomplished by relaxing contracted muscles, increasing circulation, increasing venous and lymphatic drainage, and stimulating the stretch reflex

• f muscles and overlying fascia.

(E DiGiovanna, S Schiowitz, D Dowling, 2005)

Myofascial Release

Gel-to-sol model Myofascial treatments influenced by Ida Rolf (IP Rolf, 1977) Stated that ground substance can be influenced by the application of energy (heat or mechanical pressure) resulting in its aggregate form from a more dense (gel) to a more fluid (sol) state. How long does this affect last?

Myofascial Release

Beneficial responses to the Autonomic Nervous System – comments from Dr Robert Schleip deep sustained mechanical pressure produces parasympathetic reflex responses:

causing local vasodilation decreased EMG [Electromyography] activity lower muscle tonus and a more quiet emotional state

Myofascial Release

Beneficial responses to the Autonomic Nervous System Mechanoreceptors also influence local fluid dynamics

During myofascial release Interstitial receptors activate and trigger autonomic nervous system responses which:

change the local pressure in fascial arterioles and capillaries (Schleip, R, 2003). can cause extrusion of plasma from blood vessels altering the viscosity of the ECM.

Ruffini endings are also stimulated which lowers sympathetic activity

Myofascial Release

Beneficial responses to the Autonomic Nervous System

Tissue Manipulations Stimulation of mecanorecept

• rs

Interstitual and Ruffini receptors Autonomic Nervous System Local Fluid Dynamics Palpable Tissue Response

Myofascial Release

Beneficial responses to the Central Nervous System Stimulation of intrafascial mechanoreceptors leads to an altered proprioceptive input to the central nervous system, which results in a changed tonus regulation

• f motor units (Schleip, R, 2003)

Myofascial Release - CNS Loop

Tissue Manipulations Stimulation of mecanorecept

• rs

Central Nervous System Tonus change

• f local

muscles Palpable Tissue Response

Myofascial Cupping & its benefits

Hybrid

Is a form of Myofascial Release Creates a compression pressure with rim Creates a negative (tensional) pressure which:

Passively stretches tissue resulting in increased ROM Increases blood supply/heat to area treated Increases fluid movement which assists in recovery ie decreased edema Increases nutrient-rich blood supply to injured area Breaks down fascial adhesions Increases overall hydration of the fascia resulting in an increased Critical Fibre Distance (CFD)

Creates a response from the CNS

Reduced local muscle unit firing (reduced local Muscle Tonus)

Creates a response from the ANS

lowers sympathetic activity Assists in re-hydration of Ground Substance Reduced global muscle unit firing (reduced global Muscle Tonus)

Bibliography

Anderssen, G.B.J.; Lucente, T.; Davis, A.M., et al. (1999). Comparison of osteopathic spinal manipulation with standard care for patients with low back pain. New England Journal of Medicine , 1426-1431. Berg, F. v., & Cabri, J. (1999). Angewandte Physiologie - Das Bindegewebe des Bewegungsapparates verstehen und beeinflussen. Stuttgart: Georg Thieme Verlag. DiGiovanna, E., Schiowitz, S., & Dowling, D. (2005). Myofascial (Soft Tissue) Techniques. In L. W. Wilkins, An Osteopathic Approach to Diagnosis and Treatment. Philadelphia: Lippincott Williams & Wilkins. Folkow, B. (1962). Cardiovascular reactions during abdominal surgery. Annuls of Surgery , 156, 905-913. Gellhorn, E. (1967). Principles of Autonomic-Somatic Integration: Physiological basis and Psychological and CLinical implications. Minneapolis, MN: University of Minesota. Guimberteau, J. (2007). Human subcutaneous sliding system. The basic stone: The microvacuolar concept. Fascia Research articles book (p. 237). Elsevier. Guimberteau, J.-C., Delage, J.-P ., & Wong, J. (2010). The role and mechanical behavior of the connective tissue in tendon sliding. Chirurgie de la Main , 29 (3), 155-166.

Bibliography

Jones, T.A. (2004). Rolfing. Physical and Medical Rehabilitation Clinics of North America , 15 (4), 799-809. Klingler, W., Schlegel, C., & Schleip, R. (2007). The role of fascia in resting muscle tone and heat induced

• relaxation. 1st International Fascia Research Congress (p. 86). Chicago: Elsevier.

Koizumi, K., & Brooks, C. (1972). The integration of autonomic system reactions: a discussion of autonomic reflexes, their control and their association with somatic reactions. Ergebnisse der Physiologie , 1-68. Langevin, H., & Huijing, P . (2009). Communicating About Fascia: History, Pitfalls, and Recommendations. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice , 2 (4), 3-8. LeMoon, K. (2007). Connective tissue contractility is the central mediating factor in myofascial pain syndrome: a fasciagenic pain model. 1st International Fascia Research Congress (p. 84). Amsterdam: Elsevier. Lin, Y., & Yu, B. (2009). Anatomical discovery of Meridians and Collaterals. 2nd International Fascia Research Congress (p. 98). Amsterdam: Elsevier.

Bibliography

Marshall,R; Paula,L; McFadyn, A.K., et al. (2009). Evaluating the effectiveness of Myofascial Release to reduce pain in people with Chronic Fatigue Syndrome (CFS): A Pilot Study. 2nd International Fascia Research Congress (p. 305). Amsterdam: Elsevier. Meltzer,K.R; Cao,T.V.; Schad, J, et al. (2010). In vitro modeling of repetitive motion injury and myofascial release. Journal of Bodywork and Movement Therapies , 14 (2). Naylor,I; Zorn, A; Schleip,R; et al. (2007). The contractility of rat myofibroblasts - a review of the evidence for 'receptors', puative agonists and potential anti-contractile drugs. 1st International Fascia Research Congress (p. 81). Chicago: Elsevier. Panjabi, M. (2007). Reply to the Letter to the Editor. Eur Spine J , 16:1736. Panjabi, M. (2006). A hypothesis of chronic back pain: ligament subfailure lead to muscle control dysfunction. Eur Spine J , 15:668-676. Remvig, L. (2007). General joint hypermobility and tissue stiffness; a review. 1st International Fascia Research Congress (p. 83). Amsterdam: Elsevier. Rolf, I.P . (1977). Rolfing: The integration of Human Structures. Santa monica: Dennis Landman. Schleip, R. (2003, April). Fascial plasticity - a new neurobiological explanation: Part 2. Journal

• f Bodywork and Movement Therapies , 104-116.

Schleip, R. (2003, January). Fascial plasticity - a new neurobiological explanation: Part 1. Journal of Bodywork and Movement Therapies , 11-19.

Bibliography

Schleip, R., Klingler, W., & Lehmann-Horn, F. (2004). Active contraction of the thoracolumbar fascia - indications of a new factor in low back pain research with implications for manual therapy. 5th Interdisciplinary World Congress on Low Back and Pelvic Pain, (pp. 1-4). Melbourne. Schleip, R., Klingler, W., & Lehmann-Horn, F. (2010). Biomechanical properties of fascial tissues and their role as pain generators. Journal of Musculoskeletal Pain , Draft Review

• nly.

Schleip, R., Vleeming, A., Lehmann-Horn, F., & Klingler, W. (2007). Letter to the Editor concerning: A hypothesis of chronic back pain: ligament subfailure lead to muscle control

• dysfunction. Eur Spine J , 16:1733-1735.

Schleip, R., Zorn, A., & Lehmann-Horn, F. (2007). Active fascial contractility: an in vitro mechanographic investigation. 1st International Fascia Research Congress (p. 82). Amsterdam: Elsevier. Standley, P .R.; Meltzer, K. (2009). In vitro modeling of repetitive motion strain and manual medicine treatments: Potential roles for pro- and anti-inflammatory cytokines. 2nd International Fascia Research Congress (pp. 254-256). Amsterdam: Elsevier. Vagedes,J; Marc, C; Beutinger,D; Schwaemmle,M; et al. (2009). Myofascial Release in combination with Trigger Point Therapy and Deep Breathing Training improves Low Back

• Pain. 2nd International Fascia Research Congress (pp. 248-249). Amsterdam: Elsevier.