Manual therapy in the Training Room More than joint mobilization 6 - - PowerPoint PPT Presentation

Manual therapy in the Training Room

More than joint mobilization

6 modalities for your bag of “tricks”

Positional Release Therapy, (PRT) Myofascial Release, (MFR) Craniosacral Therapy, (CST) Tui Na, (Chinese Massage) Shiatsu, (Japanese massage) Acupressure

PRT

Place the involved tissues in a position

• f comfort, (POC).

This reduces irritability of the tender

point, (TP).

Ideal position is determined by the

patients perception of reduced tenderness & the clinicians perception

• f reduced tone in the TP.

Effects of PRT

Normalization of muscle hyper tonicity Normalization of fascial tension Reduction of joint hypomobility Increased circulation & reduced swelling Decreased pain Increased strength

Contraindications for PRT

Open wounds Sutures Healing fx’s Hematoma Hypersensitivity of the skin Systemic or localized infection Malignancy

Contraindications

Aneurysm Acute rheumatoid arthritis

Conditions that respond to PRT

Patients with a distinct physical

mechanism of injury, e.g. Sports injuries, motor vehicle accidents

4 Phases of Tx

Phase 1: acute phase--PRT can be used

immediately after injury, due to the gentleness of the tx.

Phase 2: treating structural dysfunction

in the acute and chronic pt.

Phase 3: restoration of functional

movement

Phase 4: normalization of life activities

General Principles of tx

Anterior TP’s usually tx’d in flexion Posterior TP’s usually tx’d in extension TP’s near the midline tx’d with more

flexion if anterior and more extension if posterior

TP’s lateral to midline tx with

sidebending and rotation

Achieving the optimal position

• f comfort

Ultimate goal of PRT Comfort zone, (CZ), is specific and

different for each tx position

CZ has been reached when:

1) Reduction in tenderness noted 2) Palpable softness of tissues in area of TP. Perseverance is key when trying to eliminate a TP

TP & Position

Remember to maintain contact with TP

while moving Patient into treatment position.

By maintaining contact-it is meant to be

a gentle pressure on the TP, not increased pressure

TP, Position and Pressure

As CZ is approached increase pressure

• ver TP periodically to monitor progress

When CZ is reached contact with TP is

maintained, but non additional pressure is applied

POC

When in POC, patient should not have

pain

If there is pain--then not in POC Discomfort arising after POC is achieved

is part of normal release process

This discomfort should subside after 1-3

minutes

POC

POC is maintained for 90 seconds Once a TP has been fully released the

body must be returned to neutral position SLOWLY.

PRT

Positional Release Therapy: assessment

& treatment of Musculoskeletal Dysfunction--Kerry J. D’Ambrogio & George B. Roth.

Myofascial Release

“Fascia is a tough connective tissue that

spreads throughout the body in a 3 dimensional web from head to foot functionally without interruption.”

Restrictions of the fascia can create

pain or malfunction throughout the body.

MFR

“By requiring the therapist to respond

to the subtle changes that occur in tissue tension during myofascial stretching, the therapist is able to work with the patient and not on the patient.”

MFR

“An athlete with fascial restrictions will not

efficiently absorb the shocks of continued activity.”

“ connective tissue is composed of collagen,

elastin and the polysaccharide gel complex,

• r ground substance. These form a 3

dimensional, interdependent system of strength, support , elasticity and cushion.”

MFR

“ MFR along with therapeutic exercise and movement therapy improve the vertical alignment and lengthen the body,providing more space for the proper functioning of osseous structures, nerves, blood vessels and

• rgans.”

Fascia

Is a slightly mobile connective tissue

which is derived embryologically from mesoderm

Composed of an elasto-collagenous

complex

The elastic component is stretchable &

is the core of the complex

Fascia

The elasto-collagenous complex creates

a 3 dimensional web, which runs from the top of the head to the tip of the toes.

Fascia surrounds every organ muscle,

bone and nerve as well as blood vessels.

Elastocollagenous complex

Relaxed Complex

Collagen fibers Elastic fibers

Elastocollagenous Complex

Collagen fibers Elastic fibers Stretched complex

Soft Tissue Mobilization

J-stroking Vertical stroking Strumming Bear Claw

J Stroking & Vertical Stroking

Stroke in direction of the restriction

( with J stroke only)

Use counter pressure with one hand

Strumming

Downward pressure is applied with the

fingertips and then a strumming motion is applied to the muscle tissue

Strumming if performed correctly is

NOT a COMFORTABLE technique

Bear Claw

Is a form of strumming--used to clear

the gluteal and hip regions.

Cross Hand Releases

Slowly stretch the tissue until you

encounter a barrier

Maintain the stretch for 90-120 seconds

• r until you feel a release.

Do not try and force your way thru the

barrier.

Follow thru the barrier until all is quiet

Arm Pull

This technique can be utilized with

patients who have upper extremity dysfunction.

It can also be used to aid patients with

cervical, thoracic and lumbar dysfunction

Anterior Thoracic Release

2nd person maintains longitudinal

traction thru the U.E.’s and follows the release 3 dimensionally.

Patient is in supine position.

Interscapular Release

Patient is in the prone lying position Assistants maintain longitudinal traction

thru the U.E.’s

Leg Pull

Leg pull can be utilized with patients

with lower quadrant dysfunction, including lumbar and thoracic dysfunction

Lateral Thoracolumbar Release

3 person technique- Pt. is sidelying-1

person and the top leg, 1 person on the top arm and 1 person on the chest.

Anterior thoracic Release

One assistant maintains traction thru

both U.E.’s.

One person on the anterior chest

Interscapular Release

3 person release- Pt. is in prone

position--1 person on arm abducted to 90 degrees--1 person on scapula and 1 person on the opposite arm

Cervical Release

Patient in supine position with the head

• ff of the table

Drop head into slight extension and

apply gentle traction

Continue with head traction and apply

caudad pressure to the chest

Maintain traction and apply caudad

pressure top each shoulder.

MFR

Myofascial Release the search for

excellence: John Barnes

The Myofascial Release Manual: Carol

Manheim & Diane Lavett

Craniosacral Therapy

• Based on the belief that the cranial

bones move in relation to each other throughout life.

William Sutherland, an osteopath,

became fascinated with the design of the cranial bones.

Basic Concepts of CST

Craniosacral system is a semi-closed

hydraulic system

Boundaries formed by the meningeal

membranes, ie the dura mater.

CSF intake via the choroid plexus CSF returns to the venous system via

the arachnoid villae.

“Listening Stations”

Heels Dorsum's of the feet Anterior thighs ASIS Ribs Shoulders Cranial vault-3 holds

Techniques for headache & Concussion

Occipital release Frontal release Sphenoid release TMJ release

Release for Posterior of Temporalis

Sit at head of table Arrange tips of fingers 2-4 over the tip

• f the ear,(ask pt. to clench teeth

briefly and if I right place you will feel mov’t)

Apply medial pressure with cephalad

traction

Temporalis cont’d

Apply moderate amount of medial

pressure and without sliding pull fingertips superiorly

Maintain medial pressure and traction

until you feel release

Masseter Release

Sit at head of table Place thumbs over the masseter fibers

and apply medial pressure until you get a release.

CST

CranioSacral Therapy: John E. Upledger

& Jon D. Vredevoogd

CranioSacral Therapy ll: Beyond the

Dura: John E. Upledger

Tui Na: Chinese Massage

Chinese massage and theory are

inseparable.

Yin-yang theory: at the core of

traditional Chinese medicine.

Yin and Yang are interdependent The balance between Yin and Yang is

not a fixed state

Techniques to use in the Training Room

Gun Fa--Rolling Yi Zhi chan Tui Fa- one finger

meditation

Rou Fa --kneading Mo Fa -- round rubbing Na Fa -- grasping Cuo Fa-- rub rolling

Techniques cont’d

Ca Fa --scrubbing with palm or edge of

hand

An Fa -- pressing with thumb or heel of

palm

Ya Fa --suppressing with the elbow Tui Fa --pushing with thumb, heel of

hand or both palms

Techniques cont’d

Ma Fa --wiping Ji Fa -- chopping using the edge of the

hand, back of the hand or tips of the fingers

Zhenb Fa --vibrating with 1 finger, 2

fingers or the palm

Dou Fa -- shaking

Techniques cont’d

Yao Fa --rotating Ban Shen Fa --pulling/stretching An Rou Fa -- revolving Pia Fa --knocking using cupped palm or

fist

Che Fa -- squeezing/tweaking Nian Fa -- holding /twisting

Applying techniques

Sciatica Strained lumbar muscles Tennis elbow

Tui Na

Chinese Massage Manual: The Healing

Art of Tui Na: Sarah Pritchard

Shiatsu

“Practitioner uses pressure with his/her

thumbs, fingers, palm, elbow, knees and feet to induce deep relaxation and a feeling of well being.”

First practitioners of Shiatsu in Japan

were blind, because it was thought that their sense of touch was more heightened.

Styles of Shiatsu

Namikoshi--first of the “Shiatsu” styles.

A very western approach, which does not rely on the meridian system

Tsubo therapy--concentrates on the

therapeutic effect of tsubo’s, (pressure points)

Zen Shiatsu--utilizes meridian functions

and Oriental theory.

Yin & Yang

Yin & yang consume and support one

another

Yin & Yang transform into each other All diseases are due to imbalance of Yin

& yang.

All diseases can be defined as either Yin

• r Yang

5 Element Theory

Wood: controls earth and is controlled by

Metal

Fire: controls metal and is controlled by

Water

Earth: controls water and is controlled by

Wood

Metal: controls Wood and is controlled by Fire Water: controls Fire and is controlled by Earth

5 Element Theory

Metal: Lung Meridian,(Yin), Large

Intestine, (Yang). Lung meridian is responsible for intake of air,(Ki).

Large Intestine meridian is responsible

for Elimination

5 Element Theory

Earth: Stomach,(yang) &

Spleen/Pancreas,(Yin) meridians. Stomach meridian is responsible for Intake of nourishment.

Spleen/pancreas is responsible for

Digestion and Transformation.

5 Element Theory

Fire: Heart, Yin & Small Intestine, Yang. Heart meridian is responsible for being

the emotional and spiritual center.

Small Intestine meridian is responsible

for Assimilation

5 Element Theory

Water: Bladder,(Yang) & Kidneys, (Yin) Bladder meridian is responsible for

purification.

Kidney meridian is responsible for

Impetus.

5 Element Theory

Fire: heart Govenor, (Yin) & Triple

Heater, ( Yang)

Heart Govenor is repsonsible for

Circulation

Triple heater is responsible for

protection

5 Element Theory

Wood: Gall Bladder, (Yang) & Liver,

(Yin)

Gall Bladder is responsible for Decision

making and Distribution

Liver is responsible for Control and

planning, detoxification

Characteristics of Shiatsu

Dx & therapy are combined Uses only the hands and fingers-no

mechanical devices or medicines

No side effects No age limits Shiatsu is a health barometer Tx’s the whole body

Aim of Shiatsu

Applies manual and digital pressure to

the skin with the goal of preventing and curing dysfunction by stimulating the body’s natural powers of healing.

Yin

Water

Below

Moon

Inside

Dark

Slow

Heavy

Matter

Descending

Rest

Damp

Contraction

Cold

Yang

Fire

Above

Sun

Outside

Bright

Fast

Light

Energy

Ascending

Activity

Dry

Expansion

Hot

Kyo & Jitsu

Kyo: too little energy Jitsu: to much energy

Kyo

Kyo: feels unresponsive: it may feel

soft, like Jello, a sinking feeling, nothing there to hold you out

Too little Ki To tonify Kyo,(put more energy into it),

you use a long slow holding pressure at medium to light depth

Jitsu

Jitsu: feels hard or unresponsive--

bounding or bouncy--not letting you in, holding out, stuck or stagnant.

Too much Ki To sedate Jitsu use fast, strong and

deep techniques

Diagnosis: East & West

Oriental

Western

Abstract

Concrete/specific

Subjective

Objective

Artistic

Technical/scientific

Right brain

Left brain

Oriental med:

Western med: science Philosophy & art

Diagnosis: East & West

Oriental concerned

Western more with spiritual develop. materialistic & how well one concerned;phys Understands symptoms emphasized

Diagnosis: East & West

Oriental dx very

Western very precise imprecise;very concerned with what’s general wrong

Holistic;concerned Symptomatic; focused

With whole person on specific organs, not Not with specific whole person complaint

Diagnosis: East & West

Based on human

Based on to human machines & lab Communication tests touching

Diagnosis: East & West

Medicine is general, Medicine is precise

Lifestyle oriented drug & surgery

• riented

Patient heals

• Dr. & medicine heal

Himself;healer only patient Guides

Healer more passive Dr. more paternal,

aggrerssive

Diagnosis: East & West

Healer & Pt.

• Dr. gives med’s, Pt.

Involved in not seen as giving relationship in anything-Dr. is giver which both receive, and Pt. is receiver. Healer grateful to Pt.-giver is receiver And receiver is giver

Pressure

Pressure should be deep, but not

uncomfortable to the patient.

Listen to the patients feedback--they

are ALWAYS RIGHT.

Too much pressure and your patient

will tighten up

Too little pressure and tx will be

ineffective.

Low back pain

One thumb works BL25,(located

between the 4th & 5th lumbar vert.), while the other finds trigger points along the top of the illiac crest.

Low back pain

One hand on the sacrum for support,

while the the thumb of the other hand works the piriformis m. working a line from the sacrum to the top of the femur.

The piriformis originates along the edge

• f the SI jt.

Low back pain

Feel around for trigger points in the

lumbar area, while applying elbow pressure to GB30 in the gluts.

Low back pain

Points along the Bladder meridian in the

posterior calf and thigh can be used to help alleviate low back pain.

Shiatsu

The Complete book of Shiatsu Therapy:

Toru Namikoshi

Zen Shiatsu: Shizuto Masunaga with

Wataru Ohashi

Tao Shiatsu: Ryokyu Endo Shiatsu: Elaine Liechti Reading the body: Ohashi

Acupressure

Predates acupuncture Theoretical background rests on 2000-

4000 year old tradition of Chinese medicine.

Acupressure

Can use customized menu’s for tx. Use of certain acupressure points in

combination at the same time, I.e. Left hand on one point and the Right hand

• n another at the same time.

Athletes and Acupressure

Muscular relaxation point: GB 34 In the depression in front of and below

the prox. head of the fibula

Helps relieve muscle soreness anywhere

in the body

Particularly useful after practice or

contest

Athletes and Acupressure

ST 36: particularly useful before a

practice or contest.

Wit leg straight, 3 body inches down from

inferior pole of patella and 1 finger width

• ut from the midline of tibia,(in Ant tib

muscle)

Apply firm pressure angling the pressure

toward the tibia-for more stim-press and let up several times

Athletes and Acupressure

To calm nerves: H7 Located below the little finger in the

wrist crease, (press under the tendon of the FCU muscle

K1: on the plantar surface of the foot -

• n he flexor digitorum brevis muscle,

(between 2nd and 3rd toes)

Revival point--renewed energy

Athletes and Acupressure

To relieve muscle cramps:LV3 In the notch of the metatarsals

between the the first and 2nd toes, (interosseous dorsalis muscle)

Special Headache Release

LH on GB 20 (at base of occiput,

between external occipital ridge & mastoid process)

RH on GB 39 (3 cun above the lateral

malleolus, back border of fibula)

RH on GB 34 (in front & slightly below

proximal head of fibula)

Address both L. & R. sides

Muscle Relaxation Release

Treat both sides: sit R. LH: base of sternum RH GB 34(ant. & just distal to prox.

head of fibula) left side

RH LV 3(1.5-2 cun above web between

first & 2nd toes; L. side

ST 36(3 cun below patella in depression

between tib and fib; L. side

Muscle Relaxation cont’d

RH on GB 34 right side RH on LV 3 right side RH on St 36 right side

Aupressurre

A Complete guide to Acupressure: Iona

Marsaa Teeguarden

Basic Acupressure: Aminah Raheem