Unit1 Extrinsics PP 22.pptx

Advanced Extrinsic Techniques Created by: Dale Gran WC(Hon) RMT Manipulative Therapist 1 Objectives • Upon completion of this PowerPoint, students should have an understanding of the following: i. Wellington College Scale for Tissue Dysfunction, Types of Muscular Dysfunction ii. The definition o...

Advanced Extrinsic Techniques Created by: Dale Gran WC(Hon) RMT Manipulative Therapist 1 Objectives • Upon completion of this PowerPoint, students should have an understanding of the following: i. Wellington College Scale for Tissue Dysfunction, Types of Muscular Dysfunction ii. The definition of and ability to differentiate hypertonicity, adhesion, contracture and hypotonicity. iii. The Extrinsic Technique options for above noted tissue dysfunctions iv. Application (mechanical applicator), Mechanical and Neurophysiological Effects of each Extrinsic Technique That’s using your Body 3 Tissue Texture Abnormalities Scale utilizes palpation of thenar eminence of one hand while other hand is creating tension differences. The Scale is as follows: (0-Hypotonicity is anything < 1) 0-Hypotonicity 1-Normal Tone 2-Exaggerated Tone 3-Hypertonicity 4-Contraction 5-Contracture 4 Tissue Texture Abnormality Chart Conditions Cause Indicators Intervention Hypertonicit y - abnormal shortening due to increased neural communication. -Absence of ATP -ROM -Palpation >4 over length of fiber GCF; LCF; Stripping; Strain Counter/ Strain; Isometric; ; Reciprocal Inhibition Adhesion -Reduced lymph flow -ROM; -Palpation 3-4 localized -Conforms to tissue Stripping, LCF, GCF Contracture -due to structural -ROM -Palpation at the < 5 -Absence of conformity to tissues LCF/ DTF -ROM, -Palpation at < 5 -Absence of conformity to tissues -Chronic DTF, Thermal Agents /anatomical changes to a muscle. -Actual damage to tissue (cell damage) Scar Tissue -Post healing to damage tissues Hypotonicity a) Decreased neural -ROM activity -Palpation >1 b) Nerve impingement -Flaccidity c) Antagonist -Fatigue a/b) IMFS, Exercise a/b) Isotonic c) Isometric 5 Tissue Texture Abnormalities/ Extrinsic Choices 6 0-Hypotonicity Tapeotment ; IMFS, Adapted LCF, Adapted Stripping 1-Normal Tone General Techniques 2-Elevated Tone Goading ; GCF ; Petrissage 3-Hypertonicity LCF ; Stripping ; I.C ; Strain/Counterstrain 4-Contraction Any besides Tapeotment ; IMFS 5-Contracture LCF ; Stripping Differentiating Hypertonicity vs Contracture Definition of a contracture An abnormal shortening in muscle length due to structural/anatomical changes of the muscle tissue Definition of a hypertonicity An abnormal shortening of muscle tissue due to a pathological neural communication Contracture Hypertonicity Damage to muscle cell No structural damage Doesn’t follow fibre direction Follows fiber direction Smaller Area Larger Area Tender on Palpation Less tender GOADING: (Inhibitory) General Information • target muscle groups • desensitizes tissue-allow deeper techniques • acute stage • hyper stimulation analgesia Application: • palmar portion of hand, 2-5 metacarpals/proximal phalanges • transversely to muscle fiber - targeting muscle belly • a constant mild passive stretch • Back/forth as far as skin and subcutaneous tissue permits • one pass per second • increase stretch as tissue allows 8 Effects of Goading Mechanical: • local thermal changes • unlikely to separate muscle fibers Neurophysiological: • floods spinal cord with A fiber (mechanoreceptors) stimulus • release of glycine • decreasing the stimulus of C fibers (nociceptors) • blocking pain to muscle • occurs in substantia gelatinosa, analgesic effect • Mechanical – Minimal • Neurophysiological – Primary Application is best suited for treatment of Hypertonicity: useful as warm-up technique/desensitize. 9 GCF: (Inhibitory) General Information • single muscle • performed in one direction • apply in one spot until a change • not painful, may cause mild burning Application: • thenar eminence and palmar aspect of abducted thumb • increasing stretch as tissue allows • transversely to muscle fiber - targeting muscle belly • applied unidirectional in one spot until a change, move and repeated 10 Effects of GCF Mechanical: • Repetitiveness- creates local thermal changes • manually mobilizes muscle fibers • transverse stretch to fibers • disrupt adhesions Neurophysiological: • same as Goading • Mechanical – Minimal effect • Neurophysiological – Primary effect Application is best suited for treatment of Hypertonicity: useful in any situation as a warm-up technique/desensitize. 11 LCF: (Inhibitory/Stimulatory) General Information • any situation - very effective technique • hypertonicity or contracture Application: • depending size of area- thumb pad or finger pads • palpate to where tightness ends • tip of thumb into section of tightness • apply transverse to muscle fibers, approximately 1/8 of an inch. • smaller the application-deeper/more specific access to tissue • Slow/steady pressure • follow-up with ice– if intent to break cross bridging 12 Why apply at End of Tightness Effects of LCF Stimulatory: • Intent - increase tone • neuromuscular weakness, nerve impingement any where along the nerve’s pathway MUST BE RULED OUT FIRST • pressure and/or speed increased to surpass elongation capacity of muscle spindle • Plucking of fibers. Mechanical: • disruption of adhesions/collagen fibers. Microtrauma to cells causes release of histamine which results in vasodilation. • reflexively fills area with blood • passive stretch - anchors fibers increased effect on muscle. 14 Effects of LCF (Cont) Neurophysiological: • passive stretch effects GT’s causing inhibition of muscle • contact in belly of muscle creates direct pressure to muscle spindle taking pressure off flower spray receptor, resulting in further decrease in muscle’s tone BOTH OF THESE OCCUR AT THE SAME TIME *** Determining factor as to whether there is primarily a mechanical or neurophysiological effect, depends on whether technique is being applied to a contracture, a hypertonicity or a hypotonicity.***. Application of this technique is appropriate in any/all situations. 15 STRIPPING: (Inhibitory/Stimulatory/Palpatory) General Information • constant speed/pressure • relies on understanding of muscle’s fiber direction • altered for different intent/effects • adequate pressure-bulging ahead of contact Application: • thumb pad-many other contacts may be used • applied towards dysfunctional joint  few instances where this may not be possible – client cannot get in a position – body mechanics of therapist are compromised – bunching up of tissue being treated 16 Effects of Stripping Palpation: • search out dysfunction in muscle tissue • wider/uses a lighter pressure Stimulatory: • applied to increase muscle tone • neuromuscular weakness, nerve impingement any where along nerve’s pathway MUST BE RULED OUT FIRST • pressure and/or speed of stroke is increased to surpass elongation capacity of muscle spindle. 17 Effects of Stripping (Cont) Mechanical: • creates heat • separates muscle fiber/disrupts intramuscular adhesion • deep flushing of vascular structures/lymph resulting in reflexive hyperemia • localized passive stretch to area Neurophysiological: • contact in belly of muscle-pressure to muscle spindle resulting in a further decrease in muscle’s tone -muscle spindle adaptation • lesser extent, passive stretch applied to muscle will effect GTO’s causing inhibition of muscle spindle • Mechanical – Slightly Less • Neurophysiological - Primary Application is best suited for a Hypertonicity. 18 ISCHEMIC COMPRESSION: (Inhibitory) General Information • comfort zone of client • localized area of hypertonicity, 1 inches or less and not to exceed 90 seconds in length • passive stretch after technique will be beneficial • if during application of technique no change occurs in tissue, may be dealing with contracture 19 ISCHEMIC COMPRESSION: (Cont) Application: • thumb pad/braced finger pad-stereognostic sense • pressure applied to center of hypertonicity • applied slowly until a resistance in tissue is felt • Apply/ease off pressure slowly • areas of approximately 1 inches or less, NOT exceed 90 seconds • 1 inches or less due to size of biomechanical applicator • a passive stretch to tissue after helps allow interstitial fluids to flow through area 20 Effects of Ischemic Compression Mechanical: • may stretch muscle fibers transversely to their normal line of pull Neurophysiological: • hypertonicity - alteration in neural patterning as well as maintained actin/myosin coupling due to the ischemic area in tissue • pressure applied will cause a re-routing of neural pathways • alternate muscle fibers take over giving affected muscle fibers chance to rest • pressure when let-off creates reflexive hyperemia bringing added blood and oxygen • Mechanical- Very Minimal • Neurophysiological - Primary • Application is used ONLY in the case of a Hypertonicity.21 STRAIN/COUNTERSTRAIN: (Inhibitory) General Information • either a portion of a muscle/entire muscle • no lotion • hypertonicity larger than 1 inches • approximation of contact points occurs ONLY AS TISSUE ALLOWS Application: • specific portion of muscle - find ends of hypertonicity-place a contact at each end • approximate contacts only as far as tissue allows. • hold until tissue decreases tone, then further approximation of contact points is applied- this is NOT sliding over the skin • repeat until no further approximation or up to a maximum of 90 seconds • entire muscle - contact made at both ends of muscle 22 Effects of Strain/Counterstrain Mechanical: • a passive stretch to ends of muscle • reflexive hyperemia Neurophysiological: • passive stretch to ends of muscle- tension on GTO’s • inside of contact points direct pressure to muscle spindle results in a further decrease in muscle’s tone • Mechanical – Very Minimal • Neurophysiological - Primary Application is used ONLY in the case of a Hypertonicity. 23 IFMS: (Stimulatory) General Information • applied to either a hypotonic area or two to three areas in muscle belly • neuromuscular weakness, nerve impingement any where along nerve’s pathway MUST BE RULED OUT FIRST • care must be taken in monitoring the stretch or pressure applied so as not to cause autogenic inhibition to muscle 24 IFMS: (Cont) Application: • 2nd to 4th digit tips, brace fingers with opposite handcontact into muscle belly at a right angle • size of muscle dictates whether fingers are placed longitudinally or transversely to fiber direction • slack is taken up by direct pressure into muscle before technique is applied • three short bursts • original slack is not let off • speed is most important - faster application, better result • intent is to stimulate stretch reflex which is monitored by rate and speed of tension applied 25 Effects of IFMS Mechanical: • stretches muscle tissue at right angle Neurophysiological: • force and speed will reflexively create myotatic stretch reflex • Mechanical – Very Minimal • Neurophysiological - Primarily Application is best suited for a Hypotonicity. 26 Heavy Metal: It’s more than “Just Music”