Mst techniques

PAIN ANALOG Minor ;1. MILD, 2. DISCOMFORTING, 3 TOLERABLE

Does not interfere with most activities. Able to adapt to pain psychologically and with medication or devices such as cushions.

Contraindications FASCIA Systemic Absolute

Acute Rheumatoid Arthritis- active Fever Systemic Infections-lupus, scleroderma Acute Circulatory Conditions Aneurysm Osteomyelitis Obstructive Lymphedema- removed lymph nodes Meningitis Advanced Diabetes- poor peripheral circulation Severe Connective Tissue disorders: Systemic Lupus Erythematosus, scleroderma Blood Clotting Disorders and Anticoagulant Therapy Systemic Relative Pregnancy- 1st and 3rd trimesters Malignancies Osteoporosis or advanced degenerative changes Local Relative Acute injuries Hypotonic or atonic muscle i.e. bed rest Lax joints- hypermobility needed for client health Open Wounds and Sutured Wounds Localized Infections ex. Cellulitis Hematoma Healing Fractures Hypersensitivity or Easily broken skin Spinal Cord Injuries

Cross-linking

Collagen fibres get stuck to each other via hydrogen bonds if they are held closely together. The longer the period of inactivity the more cross-linking occurs. Chemistry of cross- linking: Hydrogen in the connective tissue "soup" has a free electron (H+) and becomes strongly attracted to and attached to the available electron on carbon proteins or collagen fibers via covalent bonding (H=C). When gentle stress is placed on connective tissues with cross-linked collagen fibres, crosslinks start to break creating heat. The heat and circulation brings water, which breaks the hydrogen/carbon covalent bonds and thus tissues become more mobile.

DEEP FASCIA

Compartmentalizes the body Forms the covering of muscles and muscle groups, septae and interosseous membranes. All periosteum and synovial membranes in the body are thus, continuous with each other and form one continuous system Relatively non-elastic, tightly fitting sleeves and sheets Tough and dense in nature Blends with the periosteum and is bound down to bone Contributes to the body's contours and function

Fascia

Connective tissue that surrounds all muscles, muscle groups, bones and organs. Holds these structures in place. A continuous sheet of supportive tissue enveloping the entire body. Is strong yet mobile. It is composed of: Fluids resembling blood plasma ex. Hyaluronic acid Cells - fibroblasts, immune cells, adipose cells, pigment cells Fibers- collagen, elastic, reticular Ground substance (70% water and 30% glycoaminoglycans) - acts as a sieve for nutrients, cellular products and mobile cells. The ground substance is a gel, which is responsible for maintaining the "critical inter- fiber distance" or space between collagen fibers.

Contractility

Connective tissue will contract back to original shape in space because of the elastic fibers present within the fascia once stresses removed

Active Inhibition techniques (CMTO Approved)

Contract Relax (CR) Agonist-Contract (AC) Contract-Relax-Contract (CRC)

ASSESSING FASCIA Fascial Gliding (Strain Around the Clock)

Gently place a relaxed hand onto the clients body and imagine that your hand is the center of a clock Drag the skin in various directions until all the slack has been taken up and not to glide on the skin Engage the superficial fascia towards the direction of 12 o'clock and feel the degree of tension in the tissues Return to the center position Engage the superficial fascia towards the direction of 3 o'clock and feel the degree of tension in the tissues. Return to the center position Repeat this for the 6 o'clock and 9 o'clock positions Once you have gone around the clock determine which direction had the most resistance Two things can be gained from this information 1. This is the direction which can be used for your direct techniques 2. The direction is where the restriction may be found **Do not repeat this process too many times because then you will start treating the restriction and determining the direction of greatest resistance will become difficult**

SUPERFICIAL FASCIA

Immediately deep to the skin Superficially it is very firmly attached to the skin yet mobile Has the potential to accumulate fluids and metabolites Deeply, it is loosely attached by to deeper tissues (the Deep Fascia) but is firmly attached to superficial bone by meshing with the fibrous periosteum. ex. Spinous processes, acromion, patella, malleoli Prepared by Krystal Mayer Raymond For the Canadian College of Massage and Hydrotherapy 2 | P a g e May contain elastic tissue in abundance ex. lower abdomen Can contain an abundance of adipose cells Houses the cutaneous nerves, blood and lymphatic capillaries, sweat glands, mammary glands, some lymph nodes, and thin muscles of the face, neck (ex. platysma), scrotum and nipples.

Effects of Fascial Release Technique

Increase local circulation and hydration Reduce Pain Increase fascial extensibility Improve posture

AGONIST CONTRACT PROCEDURE

Isometrically - without moving the joint "Tight muscle" is known as "Agonist" or "Target Muscle" "Opposing muscle" is known as "Antagonist" RMT: 1) Stretch the tight (agonist) muscle to the feeling of resistance (1st Barrier) Ex: Biceps 2) Ask the client to isometrically contract the opposite muscle (antagonist) (only 80% strength) against the RMT's resistance Ex: Triceps 3) Client holds contraction for 7-10 sec. 4) As the contraction is released, the tight muscle (agonist) is now relaxed and is able to be stretched and lengthened. 5) Stretch the tight (agonist) muscle to the feeling of resistance (2nd Barrier) Ex: Biceps 6) Ask the client to isometrically contract the opposite muscle (antagonist) (only 80% strength) against the RMT's resistance Ex: Triceps 7) Client holds contraction for 7-10 sec. 8) Stretch the tight (agonist) muscle to the feeling of resistance (3rd Barrier) Ex: Biceps 9) Ask the client to isometrically contract the opposite muscle (antagonist) (only 80% strength) against the RMT's resistance Ex: Triceps 10) Client holds contraction for 7-10 sec. 11) Now stay at the 3rd Barrier and stretch the tight (agonist) muscle for 30 sec. Ex: Biceps *Only go to 3rd barrier, even if muscle isn't in full range. *Client should inhale during contraction, exhale during relaxation - "Respiratory Synkinesis" *Other examples: Quads/Hamstrings, Tib. Ant/Gastrox, Forearm Flexors/Extensors, etc.

CONTRACT RELAX CONTRACT PROCEDURE

Isotonically & Isometrically RMT: (Biceps will be the Target Muscle/Agonist) 1. Passively lengthen the tight (Target) muscle to feeling of resistance (1st Barrier) Ex: Biceps 2. Get client to isotonically contract muscle (agonist) (only 80% strength) (CR) Ex: Biceps 3. Change Hand Placement. Ask the client to isometrically contract the opposite muscle (antagonist) (only 80% strength) against the RMT's resistance (AC) Ex: Triceps 4. Client holds contraction for 7-10 sec. 5. Have client relax 6. Passively lengthen the tight (Target) muscle to feeling of resistance (2nd Barrier) Ex: Biceps 7. Get client to isotonically contract muscle (agonist) (only 80% strength) (CR) Ex: Biceps 8. Change Hand Placement. Ask the client to isometrically contract the opposite muscle (antagonist) (only 80% strength) against the RMT's resistance (AC) Ex: Triceps 9. Client holds contraction for 7-10 sec. 10. Have client relax 11. Passively lengthen the tight (Target) muscle to feeling of resistance (3rd Barrier) Ex: Biceps 12. Get client to isotonically contract muscle (agonist) (only 80% strength) (CR) Ex: Biceps 13. Ask the client to isometrically contract the opposite muscle (antagonist) (only 80% strength) against the RMT's resistance (AC) Ex: Triceps 14. Now stay at the 3rd Barrier and stretch the tight (Target) muscle for 30 sec. Ex: Biceps *Only go to 3rd barrier, even if muscle isn't in full range. *Client should inhale during contraction, exhale during relaxation - "Respiratory Synkinesis

CONTRACT RELAX PROCEDURE

Isotonically - moves through the ROM of the joint RMT: 1) Passively lengthen the tight muscle to feeling of resistance (1st Barrier) 2) Get client to isotonically contract muscle (only 80% strength) 3) Resist contraction for 7-10 sec. 4) Have client relax 5) Passively lengthen the tight muscle to feeling of resistance (2nd Barrier) 6) Get client to isotonically contract muscle (only 80% strength) 7) Resist contraction for 7-10 sec. 8) Have client relax 9) Passively lengthen the tight muscle to feeling of resistance (3rd Barrier) 10) Get client to isotonically contract muscle (only 80% strength) 11) Resist contraction for 7-10 sec. 12) Have client relax 13) Hold & Stretch this barrier for 30 sec *Only go to 3rd barrier, even if muscle isn't in full range. *Client should inhale during contraction, exhale during relaxation - "Respiratory Synkinesis"

SUBSEROUS FASCIA

Loose areolar tissue surrounding viscera Covers viscera Supports organs and lubricates them Outer layer is fibrous and is continuous with the fibrous layer of synovial joints.

Positional testing OF FASCIA

Observe the changes in body alignment from position to position ex. does the arm remain slightly bent when lying in supine How does moving a body part from one position to another affect the rest of the body How is the movement limited or altered by the pull of fascial adhesions ex. does the arm stay in the coronal plane with abduction or is it pulled anterior by scapular/pectoral fascial adhesions

Fascial Skin rolling

Pick-up the skin and subcutaneous tissue with the fingers and thumbs and slowly walk with the fingers to pull more tissue into the fold. Walk repeatedly over adhered tissues until they have softened, pain is reduced, or the client's limit to the technique has been reached

INDICATIONS FOR FASCIA

Reduce fascial restrictions during late sub-acute and chronic stages of healing Restore mobility between fascial layers Improve posture, gait and coordinated movements Improve muscular efficiency (strength?) Reduce pain Balance opposing tissues Compression syndromes

J-stroke

Similar to cutting but the knuckle is only dragged for a short period and then flicked in the circular movement to create a "J" movement. This is considered an aggressive technique

Anchor & Spread

Similar to cutting but with a larger contact surface like the heel of the hand (if pushing) or pads of all four fingers (if pulling)

Function of Fascia

Supports body structures - suspension Protective and strong - protection Absorbs shock and compression Provides shape to body - separation Acts like a sponge to hold water in the ground substance

Direct Fascial Techniques

Techniques that take fascia towards the restriction to engage the soft tissue barrier. The tissue is held at the barrier in order to stretch or break the connective tissue bonds, realign collagen fibers and allow rehydration of the ground substance. The benefits of direct fascial technique will accumulate incrementally when you free the fascial layers in an orderly succession from superficial to deep

Autogenic Inhibition (aka - Post Contraction Inhibition)

The Golgi Tendon Organ (GTO) is a proprioceptor located at the musculotendinous junction of a muscle The GTO is sensitive to tension in the muscle and is stimulated by passive stretch or active contraction The GTO is a protective mechanism for when tension in the muscle increases to minimize the risk of overstretch injuries

Indirect Fascial Techniques

Thought to 'unhook' the connective tissue like releasing two bungee cords. First engage the fascia and push it together into ease before the fascia becomes disengaged. Use very light pressure or moderately heavy pressure. Once a release is felt and a sense of movement in the tissue occurs, the slack is taken up again. This is repeated for several cycles with a slow rate and no lubrication on the skin. Increases excursion of tissue and flexibility.

Skin Rolling

Used as an assessment and also as a treatment of restrictions Fingertips are very light with pressure as to not pinch the skin Lift and roll the superficial fascia over the deep underlying tissues in a wave-like motion.

Reciprocal Inhibition

When a muscle is contracted (Target Muscle/Agonist), its opposite (Antagonist) muscle is reflexively inhibited Example: Elbow Flexion - Biceps is the Target Muscle (Agonist) and the opposite would be Elbow Extension - Triceps (Antagonist). To stretch the Biceps, we would inhibit Triceps to allow this movement to occur

Gto indications

spasm in muscles hypertonic muscles (when onsite massage is too painful)

CONTRACT/RELAX/CONTRACT DEFINITION

"Combo of CR + AC" Def: A technique that combines Contract-Relax and Agonist Contraction: First, a contraction of the muscle being stretched (CR) and Second, a contraction of the opposite muscle that is being stretched (AC) Uses Autogenic AND Reciprocal Inhibition

AGONIST CONTRACT DEFINITION

"Fire the opposite muscle" Def: Contraction of the opposite muscle being stretched Uses Reciprocal Inhibition Indications: Muscle Spasms, Pain, Restricted and/or Decreased ROM

CONTRACT RELAX DEFINITION

"Let the client "WIN" while contracting" Def: Contraction of the muscle being stretched Uses Autogenic Inhibition Indications: Restricted and/or Decrease ROM

MLD TECHNIQUE

1. Elevate Limb 2. Pump correct Terminus; pressure should not be be more than weight of 4 dimes. 3. Pump lymph terminus and nodes up to 30 times (5 in op) 4. Correct sequence lymph nodes 5. Correct rate and depth 6. Variety of strokes; shavings, wave, stroking towards the prox node. 7. Correct direction 8. End pumping terminus 9. 5 times OP; state 20 times in real life.

FRICTION PROCEDURE

1. Establish a pain scale 2. 7/10 within tolerance; it will be uncomfortable 3. GSM; SUCH AS COMPRESSIONS.0.. 4. Use heat pad 5. No lotion 6. PUT tissue in taut position 7. Cross Fiber frictions on specific location, use reinforced fingers 8. Appropriate depth and rate 9. No glide 10. 2 minutes or until client reaches numbness 11. Tissue reassessed and state repeated up to 20 minutes 12. STRETCH AFTER 13. APPLY ICE UNTIL ACHY; CHECK FREQUENTLY ; EXPLAIN CBAN 14. GSM AFTER.

MYOFASCIAL RELEASE PROCEDURE

1. Establish pain scale of 7/10 2. State referral pattern, be specific. 3. palpate tissue; cross fiber entire muscle belly, until muscle nodule is felt; 4. comment that you notice a twitch response (jump sign) ; indicating a TrP 5. state that we are doing ischemic compression for 30 sec-2min or until pain is gone. 6. Appropriate depth, reinforced compression, state pain level, remind them not to hold their breath. 7. Check in with client 8. Flush tissue after 9. Stretch muscle after, state you will hold stretch for 30 seconds 10. Either apply heat or tell them to apply heat when they get home

Behaviour of Connective Tissue

1. Fluid Free fluid quickly accumulates in tissues subjected to pressure, friction, vascular stasis, irritation and inflammation, which facilitates the rapid spread of diffusible substances. During manual techniques this may produce dampness on the skin which is a positive effect of fascial release. 2. Fiber Reorientation Cells exposed to tension align themselves and reproduce in the direction of stress. They produce fibres which also align in the direction of stress due to the piezoelectric effect.

PROPRIOCEPTIVE PROCEDURES.

1. GSM before 2. Correct technique for issue 3. Correct location; entire area 4. Correct Depth; moderate pressure 5. Correct Rate; Slow 6. Correct Duration; State 30 seconds or until muscle tension releases. 7. GSM after

PROM PROCEDURE

1. Proper draping 2. GSM to warm up joint 3. ASSESS THE JOINT 1X FIRST TO SEE RANGE 4. Correct direction & Force 5. Perform all pain free ranges required 6. Move to anatomical range, not beyond 7. PROM TO BE DONE 7-10 X (FOR OP ONLY 3 X) 8. GSM AFTER

JOINT MOBILIZATION PROCEDURE

1. Warm up tissue 2. PROM for joint before and after PLACE JOINT IN OPEN PACK POSITION; DISTRACT AND THEN CHOOSE; OSCILLATION OR SUSTAINED GLIDE. 3. Correct amplitude and grade A. Oscillation: Grade 1 & 2 = reduce pain Grade 3 & 4= stretch the tissue B. Sustained Glide Grade 1= loosen the joint/reduce pain Grade 2=Assess the joint Grade 3=Increase joint play 5. Correct hand position and stabilization 6. Slow and controlled A) sustained glide for 7-10 seconds; repeat up to 2 minutes B) oscillation: 2-6 per second for 10 seconds ; state up to 2 minutes.

ISOMETRIC STRENGTHENING PROCEDURE

1. Warm up tissue before tech. 2. Explain directions above; step by step, breath in/ exhale with effort. 80 percent of your strength and state meet my resistance. 3. Hold contraction for 7-10 seconds 4. We will do this three times. 5. Slow and controlled 6. Flush tissue, gsm after.

FASCIA GENERAL TREATMENT CONCEPTS

1. Warm up tissue with compressions, static contact (heat). 2. Inform about possible sensations-sharp, burning, achy, prickling, itchiness (decrease as tissue frees). May need to modify treatment via pressure, speed for client comfort. 3. Inform about pain scale - some techniques may be painful but that the client should be able to breathe through the technique. No more than 4/10 on pain scale. Prepared by Krystal Mayer Raymond For the Canadian College of Massage and Hydrotherapy 7 | P a g e 4. Assess the tissue in various directions by "Loading" or "Stacking" the tissue slowly. 5. Begin by taking the tissue to the restriction and hold at the barrier to increase tissue hydration. (On subsequent treatments you can move through the restricted barrier and then past the barrier to re-align tissue fibers). 6. It may take up to 90-120 seconds for release to begin. 7. Tissues can be held for up to 3-5 minutes to maximize the amount of release. 8. Unload tissues slowly to prevent recoil of collagen fibers. 9. A successful release is indicated by: softening or lengthening of the tissues- hydrated more pliable heat hyperemia- redness decrease in symptoms such as pain possible moistening of the skin 10. Tissues should be soothed after fascial techniques with petrissage and/or local heat application. Note: both the therapist and the client may have difficulty perceiving the releases in fascial tissue while the technique is being performed. The distance travelled is usually fully appreciated once the tissue is let go. Note: Heat should not be applied to tissue prior to fascial release so as to gain as much release in cross-linking as possible via the piezoelectric effect

Techniques which push in to the body An aggressive group of techniques that require both strength and sensitivity from the therapist.

CUTTING J STROKE ANCHOR AND SPREAD

PROPRIOCEPTIVE DESCRIPTION AND PURPOSE

DESCRIPTION AND PURPOSE Is a technique whereby the brain tricks the muscles into relaxing; we are using this technique because it decreases tone and spasm and muscle tension. We have 2 types of proprioceptors : 1. golgi tendon organs and 2. muscle spindles GTO'S are located in the musculotendinous junction and MUSCLE SPINDLES are located in the belly of the muscle.

FRICTION DESCRIPTION AND PURPOSE

DESCRIPTION AND PURPOSE Repetetive, non gliding techniques; it is a deep tech. to help increase extensibility of connective tissue. Helps with fiber realignment AND Remodeling of collagen fibers More mobile scar tissue

PROM DESCRIPTION AND PURPOSE

DESCRIPTION AND PURPOSE Rom is the distance and direction a joint can move Prom can be performed if active rom is restricted It increases jt. Nutrition; Decreases or inhibits pain and Assists with healing process.

PROPRIOCEPTIVE MUSCLE APPROX TECH.

Decreases Tone or spasm in muscle by affecting the muscle spindle. Technique whereby we squeeze the muscle belly together for up to 2 minutes or until muscle releases; Ex. Quads; gastrocs; erectors.

JOINT MOB DESCRIPTION AND PURPOSE

Description and purpose The purpose of joint mobilization is to increase rom and decrease adhesion in the joint capsule. Passive manipulation of a joint. It decreases pain and treats joint dysfunction Graded oscillation is used primarily for pain management and spasm in the muscle that cross the joint being treated. Sustained Glide is used primarily for regaining functional range of movement.

PROPRIOCEPTIVE GTO TECHNIQUE

Done at the musculotendinous junction using a release technique called C BOW or S BOW. Held for 30 seconds or until tone decreases. It helps release muscle tension Ex; Achilles , biceps brachii, hamstrings, and forearm tendons

Techniques which glide and stretch Techniques are used to treat superficial (glide, roll, bow) then deep fasciae (anchor and spread, cutting, j-stroke). Usually a broader contact surface is used first, like the palms, heel of the hand, finger pads, or even the forearm. Patience and a light touch are helpful for achieving releases. Releases are often non-linear so be prepared for movement in any direction as tissues release

FASCIAL GLIDE CROSS HANDED FASCIAL STRETCH FASCIAL SPREADING

Techniques which pick-up the tissues To directly engage the superficial fascia (and indirectly effect the deep) grab the skin and all subcutaneous tissues and lift them away from the body. This may produce a dimpling affect similar to the appearance of an orange peel which feels crunchy, crinkly or popping. To directly engage the deep fascia, grab whole muscles or muscle groups. Pick up the tissuE

FASCIAL SKIN ROLLING FASCIAL TORQUING; S BOWING AND C BOWING

Gto procedure

GTO Release Technique Procedure Warm up affected tissue with effleurage and specific petrissage Direct compression or torqueing of the tendon near the musculotendinous junction using finger or body reinforcement wherever possible Compression Pressure: moderate to deep or within "S" bowing "C" bowing Duration: 30 seconds or until tone decreases Rate: slow smooth application the client's pain tolerance

Gto release technique

Golgi Tendon Organ (GTO) Release Technique Reduces tone and spasm. Particularly when onsite petrissage is too painful or ineffective. Best for treating tendons which are long and easily palpable. ex: the Achilles, biceps brachii, hamstrings and forearm tendons

GTO Types of proprioceptors

Golgi Tendon Organs Detect the stretch and tension on tendons. An inhibitor of muscle contraction. Muscle spindles Detect the stretch and tension on muscle tissue. Located in the muscle bellies. Causes reflexive contraction of muscle, sets muscle resting tone

RESPIRATORY SYNKINESIS

INHALE DURING CONTRACTION, EXHALE DURING RELAXAITON.

FRICTION COMMONLY FOUND

IT BAND, TFL

PAIN ANALOG MODERATE DISTRESSING, VERY DISTRESSING, INTENSE

Interferes with many activities. Requires lifestyle change but patient remains independent. Unable to adapt to pain.

MLD DESCRIPTION AND PURPOSE

MLD is a gentle, relaxing technique intended to encourage natural drainage of lymph. Lymph is the excess fluid from our blood cells that helps supply our cells with nutrition. It also helps decrease the swelling in an injury.

Muscle spindle

Major sensory receptor within the muscle belly.

GTO Muscle Approximation Technique

Muscle Approximation Technique Decreases tone or spasm in muscle by affecting the muscle spindle. Used for muscles with many origins, insertions or tendons that is not easily palpable Ex. Quadriceps Used also in situations where the muscle is in a lengthened position and is tight. ex. Erector Spinae through thoracic spine with hyper kyphosis Uses the muscle stretch reflex response to decrease muscle tone.

GTO MUSCLE APPROXIMATION TECH. PROCEDURE

Muscle Approximation Technique Procedure Warm up tissue using effleurage and specific petrissage Approximating - bringing the ends of the muscle together With a broad contact surface, press into the ends of the muscle and bring your hands closer together Do not glide over the skin Rate: Slow smooth application Duration: 30 seconds - 2 minutes or until muscle tone decreases Pressure: according to Rattray, use 2 lbs of pressure to approximate the ends of the muscle

ASSESSING FASCIA

Observations of posture and gait Observe the contours and shapes of the body Look for: Asymmetries Does it look like there is "pulling" anywhere?, head tilt, skin folds

Reciprocal Inhibition -

Opposite muscle is being contracted vs the one being stretched

GTO O an I techniques used

Origin and Insertion (O&I) Technique Reduces tone and spasm. When direct petrissage of a muscle belly is too painful or ineffective. A variation of the GTO Release technique. Used on muscles with a large, broad bony attachment. ex: infraspinatus, rhomboids, gluteus maximus and pectoralis major,

GTO O and I procedure

Origin and Insertion Technique Procedure Warm up tissue using effleurage and specific petrissage Systematic friction-like strokes along the entire origin and insertion. Cross-fiber and with-fiber strokes are applied on the same spot creating a "+" at least 2 times each way within the one spot. Force is applied with a reinforced thumb or finger Rate: slow smooth application Pressure: moderate to deep or within the client's pain tolerance

Cross-handed fascial stretch

Performing two glides in opposite directions at the same time held for 90-120 seconds.

The Piezoelectric Effect

Piezoelectricity is the charge accumulated in specific solids (crystals, DNA, bone/tendons (collagen), specific proteins) in response to mechanical stress. Which causes the fibres to reorient Dependant on hydration Gravity is arguably the most influential force on the body Generally fascial lines of tension occur in posterior and lateral body- inferior direction anterior and medial body - superior direction ex. Connective Tissue (collagen, tendons, DNA, bone)

ISOMETRIC STRENGTHENING DESCRIPTION AND PURPOSE

Purpose of this technique is to strengthen the muscle through isometric contraction which means I will ask you to meet my resistance at 80 percent of your strength. I will ask you to inhale and exhale on contraction

PROPRIOCEPTIVE ORIGIN AND INSERTION; (O'S AND I'S) TECHNIQUE

Reduces tone and spasm; When direct petrissage of a muscle belly is too painful or ineffective. Done at least 2 X in each spot. Ex. Infraspinatus, rhomboids, gluteus maximus, and pectoralis major.

Fascial torqueing,

S-bowing or C-bowing Pick-up the skin and subcutaneous tissue with the finger and thumbs or fingers and palms and lift it away from underlying tissues. Either twist the fold of skin and/or bow it in an S or C shape to engage the tissue barrier. This technique can be combined with a glide where the whole fold of skin is taken in a direction to engage a barrier to movement until releases are felt.

3 CATEGORIES OF FASCIA

SUPERFICIAL DEEP SUBSEROUS

Autogenic Inhibition -

Same muscle is being contracted or stretched

Fascial spreading

Similar to a cross-hand stretch but with the finger pads to focus on specific tissues.

Fascial glide

Similar to the assessment technique, however, the restrictive barriers are engaged (the slack is taken up) and held for 90-120 seconds.

FACILITATED STRETCHING

The use of muscle contractions during a stretch to neurologically inhibit tone in the muscle being stretched Allows for a deeper stretch Restores functional ability and allows for return to ADLs quicker Usually indicated for healthy and/or sports rehab clients Uses anatomical planes or opposing lines of pull of a specific muscle or muscle group Should only be used when the muscle to be stretched has proper innervation

Cutting technique

Tissues at one end of the treatment area are stabilized and a knuckle or reinforced finger of the other hand is pressed into the restriction and dragged across the area. This technique creates a lot of friction and is quite painful. Good for separating muscles which are adhered

PAIN ANALOG SEVERE VERY INTENSE, UTTERLY HORRIBLE EXCRUCIATINGLY UNBEARABLE UNIMAGINABLE

Unable to engage in normal activities. Patient is disabled and unable to function independently

GTO Proprioceptors

are specialized sense receptors found in muscle bellies, tendons, joint capsules and the special sense organs

Golgi tendon organ located wherre

at the musculotendinous junction

Fascial Restrictions/Adhesions DUE TO;

dehydration When the fascia is under stress, the water in the ground substance gets pushed out of the fascia causing the ground substance to turn from a lubricant-like solution to more like a glue like-substance. This dehydration reduces the critical fiber distance making the fascia less mobile. This also can cause a compression on the surrounding capillaries allowing for a decrease in circulation which then decreases tissue health and healing as well as decrease in the transfer and movement of metabolic toxins and nutrients. Excessive Collagen When the fascia is under stress, the body can increase the fibroblast activity along lines of stress, resulting in an increase in collagen formation. This will cause thickening and shortening of the fascia allowing for a decrease in extensibility.

MYOFASCIAL RELEASE DESCRIPTION AND PURPOSE

is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the Myofascial connective tissue restrictions to eliminate pain and restore motion. This essential "time element" has to do with the viscous flow and the piezoelectric phenomenon. • Technique whereby we use ischemic compression or stripping to decrease or eliminate the Trp • to reduce or eliminate pain • Increase range of motion • Increase local circulation • Decrease hypertonicity

PNF techniques PROPRIOCEPTIVE NEUROMUSCULAR FACILITATED TECHNIQUES.

use Autogenic Inhibition and/or Reciprocal Inhibition