Untitled Quiz

Manual Therapy (BASPT 218)

• Manual therapy is a skilled, specific hand-on approach to diagnose and treat soft tissue and joint structures.
• The goal is to decrease pain, improve joint range and alignment, improve contractile and non-contractile tissue repair, improve extensibility and stability, and facilitate function.
• The musculoskeletal system is a chain of components: osseous, soft tissue (muscle, fascia, ligaments), and neural (central and peripheral).
• Manual therapy is a science of somatic diagnosis, not just technique
• It treats functional disturbances in the spine or extremity joints and abnormal muscle function, including shortening, weakening, and imbalance of muscles.

Types of Tissues

• Connective tissue
• Epithelial tissue
• Muscle tissue
• Nerve tissue

Connective Tissue (CT)

• Maintains the form of the body and organs, providing cohesion and support.
• Connects cells and tissues
• Has three components: cells, fibers, and extracellular matrix (ECM)

Myofascial System

• Myo (muscle) and fascia (band)
• Fascia is a three-dimensional, weblike matrix that supports all body structures (muscles, bones, nerves, organs).
• It is a continuous, innervated, and sensory organ for stability and motion.
• Fascia adapts its arrangement and density based on local and tensional demands.
• Fascia interlocks and connects muscle groups.

Elements of Fascia

• Collagen: provides strength and structural integrity
• Elastin: provides elasticity, allowing stretch and absorbing tensile force
• Ground substance: a viscous fluid that provides lubrication and distance between collagen fibers. It is made up of Glycosaminoglycans (30%) and Water (70%).

Types of Fascia

• Superficial fascia: beneath the skin, connecting it to underlying tissue
• Deep fascia: surrounds muscles, tendons, ligaments; providing support, protection, and lubrication, and plays a role in postural stabilization.
• Meningeal fascia: surrounds the nervous system and brain.
• Visceral fascia: surrounds lungs, heart and abdominal organs.

Superficial Fascia

• Thin fibrous layer beneath the skin
• Allows normal sliding action between skin and underlying tissues.
• Passageway for blood vessels and nerves
• Insulates, thermoregulation, and circulation.
• Can hold inflammatory exudates
• Damage manifests as shortening and tightness.

Deep Fascia

• Tough, tight, and compact
• Covers muscles, tendons, ligaments, and aponeuroses.
• Provides protection and lubrication
• Transfers force during muscle contraction
• Involved in postural stabilization

Healthy Fascia

• Adaptable to change and moves freely with other tissues.

Causes of Fascial Restriction

• Poor posture
• Injury/trauma to surrounding tissues
• Inflammation
• Inactivity
• Overuse

Consequences of Fascial Restriction

• Reduced flexibility
• Limited motion
• Myofascial (trigger point) pain
• Muscle weakness
• Neural symptoms (numbness, tingling)
• Postural deviations and misalignments
• Autonomic imbalance
• Recurring injuries
• Headaches
• Unbalanced load transfer

Myofascial Release (MFR)

• Skilled hand-on technique for diagnosis and treatment of myofascial tension and restrictions.
• Converts ground substance to a more fluid state, allowing fibers to slide.
• Increases extensibility of tissues, leading to improved flexibility and range of motion.
• Improves circulation & waste removal
• Reduces pain
• Improves general well-being

Indications of MFR

• Various musculoskeletal issues (facial, hip, knee, ankle, etc.)
• Systemic issues like headaches, nerve issues (nueralgia), etc.

Trigger Points (TrPs)

• Hyperirritable spot within a taut band of a skeletal muscle.
• Painful on compression, stretch, overload or contraction
• Referred pain at a location distant from the trigger point.

Difference between Trigger Point and Spasm

• Spasm is a sudden, hard contraction of the entire muscle.
• Trigger point is a small, localized area of muscle contraction.

Myofascial Syndrome (MFS)

• A general term encompassing all symptoms from trigger points.

Myofascial Pain Syndrome (MPS)

• When pain is the primary symptom of MFS.
• A complex psychological and physiological event representing chronic pain syndrome.

Signs and Symptoms of Myofascial Trigger Points

• Palpable taut bands (or nodules) in skeletal muscles.
• Hyperirritable spots within the taut bands
• Local twitch response
• Referred pain
• Pain on contraction
• Physical dysfunctions (e.g., muscle weakness, inhibition, increased motor irritability (spasm), muscle imbalance).

Trigger Point Classification

• Primary/central: Located in the center of the muscle.
• Secondary/satellite: Response to primary trigger points in nearby muscles.

Diffuse Trigger Points

• Develop along lines of altered stress and strain patterns.
• May involve entire quadrant of the body.
• Secondary to multiple central trigger points.

Active and Latent Trigger Points

• Active: pain at rest and motion/pressure. Stimulated by increased muscle activity.
• Inactive/ latent: no pain at rest, but pain with pressure. Potentially due being less stimulated.

Theories of Trigger Point Pathophysiology:

• Motor endplate theory
• Energy crisis theory
• Increased Metabolism: Needs more energy.
• Localized Ischemia (inadequate blood flow leading to tissue damage)
• Calcium Imbalance (can't enter myosin/actin)
• Inflammation: (a response to repair)

Causes of Trigger Points (cont.)

• Acute Myofascial pain (trauma, strain)
• Postural Stress (awkward positions)
• Vitamin and mineral insufficiencies
• Metabolic disorders
• Psychological Factors (stress, anxiety, depression)
• Ageing
• Chronic infections
• Lack of sleep
• Weight gain
• Congenital malformation

Benefits of Strain and Counterstrain (SCS)

• Neurological changes
• Proprioceptive theory: Restoring appropriate motor control (muscle function).
• Altered fibroblast responses: Reducing inflammation

Traditional Chinese Medicine

• Acupuncture
• Dry needling
• Acupressure
• Reflexology
• Cupping

Fundamentals of Acupuncture

• Meridian system: 12 major meridians to circulate Qi (life force) through the body which links organs.
• Yin and Yang theory: Interrelated (and opposing) forces that are essential for balance. Yin (receiving) and Yang (expressing).

Manual Lymphatic Drainage (MLD)

• Gentle, manual technique that enhances lymph circulation to reduce edema and related problems

Lymphedema

• Accumulation of excess lymph fluid in the tissues.
• May result from primary (developmental) lymphatic abnormalities, or secondary (secondary) to infections, injuries, surgeries, or other conditions.

Kinesio Taping

• Method using flexible therapeutic tape to improve muscle function, joint function, pain reduction, etc
• The tape supports to improve circulation, reduce pain and re-educate muscles/joints.

Scar Tissue Release Therapy

• Gentle techniques and manipulations can decrease scar tissue's impact.
• Aims to loosen collagen fiber linkages, improve function and reduce pain.

Precautions for Immature Scar Tissue

• Handle very gently.
• Avoid techniques for which there is an increase in tissue redness or pain.
• Massage not to be performed on any open wounds.

Contraindications for Treatments

• Acupuncture: Life-threatening diseases, Epilepsy, Psychosis, (etc.)
• MLD: Acute infections, active untreated malignancies, acute deep vein thrombosis, cardiac insufficiency, renal failure, etc.
• Kinesio Taping: Open wounds, unhealed scars, infections, cancer, etc.
• SCS: Systemic localized infection, open wounds, acute nerve root compression, etc.

Techniques in Manual Therapy, Acupuncture and Other methods

• Ischemic compression (IC): part of integrated neuromuscular inhibition technique (INIT)
• Strain-counter strain (SCS): Part of integrated neuromuscular inhibition technique (INIT)
• Muscle energy technique (MET): part of integrated neuromuscular inhibition technique (INIT)
• Massage Techniques: Various types, like transverse, deep touch, J stroking, and others
• Spray and stretch technique: Utilizing cold sprays to reduce muscle tension
• Dry needling: Acupuncture points with needles to modulate pain/discomfort
• Kinesio-Tape: Application of elastic tape for various purposes
• Electrostimulation acupuncture: Acupuncture with electrical stimulation
• Acupressure: Applying pressure to specific acupuncture points
• Cupping: Creating suction with cups to improve blood flow and alleviate pain
• Electrophysical agents: such as LASER, ultrasound, etc.
• Laser acupuncture: Using laser therapy coupled with acupuncture
• Cryostretch: Applying cold to reduce pain/spasm
• Injections: Injections using saline, anesthetics, steroids, for treatment
• Exercise: Stretching, Strengthening, and exercises for posture correction
• Psychotherapy: Mental health support
• Hydrotherapy: Water-based therapies
• Functional assessment: Identifying dysfunction, to inform/guide other treatments
• Myofascial Release: Address fascia stiffness
• Manual Lymphatic Drainage (MLD): Improving lymphatic flow and treating edema.
• Scar tissue release: Addressing scar-related pain/restrictions.