March 18, 2006
Fibromyalgia
by John F. Barnes, PT
What is fibromyalgia really? What do fibromyalgia, chronic fatigue syndrome, chronic pain, headaches, pelvic/menstrual pain and dysfunction, and PMS have in common? These are simply different labels of a common denominator, unrecognized myofascial restrictions. Myofascial restrictions do not show up in all of the standard tests that are now performed, nor have most health professionals been taught how to recognize them.
MYOFASCIAL RELEASE -- "THE MISSING LINK."
Myofascial release is a new state of the art therapeutic approach for the relief of pain and headaches and the restoration of motion.
Fascia surrounds and infuses every organ, duct, nerve, blood vessel, muscle and bone of the pelvic cavity. Fascia has the propensity to tighten after trauma, inflammatory processes, poor posture or childbirth. The American way of childbirth is extremely unnatural and can be very traumatic to the woman, especially if she has a pelvic torsion and/or fascial restrictions prior to delivery, and most do! *
Fascia has a tensile strength of over 2,000 pounds per square inch. In other words, fascial restrictions have the potential of exerting enormous pressure on pain-sensitive structures producing pain or malfunction of the delicate pelvic structures.
Certainly, not all problems have a fascial origin, but restrictions of the fascia are the cause of many of these problems in a surprisingly high percentage of cases, especially when all the tests turn out negative and medication only helps temporarily or surgery did not change the situation.
I cannot tell you how many times I have heard stories of women being seen by doctor after doctor, taking more and more medication, as months, and then years, pass. Desperation sets in ... psychiatrists, psychologists, surgery, more surgery ... nothing helps. In fact, it continues to get worse over time and begins to spread to assorted symptoms throughout the body. The woman begins to wonder if maybe it is "all in her head."
Myofascial release is utilized for the treatment of menstrual pain and/or dysfunction, back and pelvic pain, endometriosis and other inflammatory disorders. It can treat the unpleasant and/or painful symptoms of pregnancy and childbirth, recurrent bladder pain and infection, painful intercourse, sexual dysfunction, elimination problems, coccygeal pain, . painful episiotomy scars and the list goes on. These problems can in many cases be substantially alleviated or eliminated by myofascial release, nontraumatically and gently.
Inflammatory processes, such as endometriosis, can cause the fascial layers to adhere to adjoining tissue creating pain and symptoms. Many times the fascial tissues will adhere around the bladder and the urethral areas creating the environment for infection, since fascial restrictions impede proper elimination of toxins and waste products from the tissues. If the fascia tightens around the bladder it can limit the bladder's potential to enlarge sufficiently, creating the need to urinate frequently or painfully. When a woman coughs, sneezes or laughs, urine will tend to seep out since there is no give to the bladder.
Scars from abdominal/pelvic surgery, trauma or episiotomy scars can also create havoc in the pelvic area, causing menstrual dysfunction, pelvic pain, painful intercourse, constipation, diarrhea, and/or hemorrhoids. Recent statistics have shown that hysterectomies are performed on the average every 45 seconds in the United States and it has been determined that over half a million of these procedures a year are deemed unnecessary.
Another common problem we encounter is coccygeal disorders from trauma, pelvic torsion and childbirth. A malaligned coccyx can cause a multitude of problems in the pelvic area, including some of those just mentioned, as well as back and neck pain, and/or headaches due to the influence of the dural tube. When the coccyx moves closer to the pubic symphysis, the musculoaponeurotic fibers from the pubis to the coccyx become so slack that they lose their tonus. If the origin and insertion of a muscle move closer together, a great portion of the muscle's power is lost. Typical symptoms of a sacrococcygeal lesion in a female subject are the inability to sit for long periods of time, declining quality of sexual relationships and cystitis ... the coccyx can lead to a general decrease in the motility of the entire body, and it should be checked in people who are devitalized or suffering from general depression.*
Myofascial release has helped many women with menstrual and PMS symptoms. Just picture the fascia tightening like a powerful three-dimensional net around the pelvic structures. Then as the woman begins to bloat as her menstrual cycle begins, the combination of fascial tightness and increasing internal pressure begins to exert heavy pressure on nerves, blood vessels, etc., and the cramps begin, the back tightens and all the other unpleasant effects are a reaction to the abnormal internal pressure.
The non-traumatic, gentle nature of myofascial release is reassuring in that the patient need not worry, since these effective procedures will not worsen the patient's symptoms or cause harm.
Myofascial release can free the structures producing pain and can also relieve the emotional pain associated with past unpleasant events or traumas. The painful memories or emotions from beatings, rapes, molestation, or miscarriages seem to be stored in the body's memory.*
Many times the woman has dealt with these situations intellectually, but on the subconscious level, the body (the myofascial structures in particular) stores these past painful events. As myofascial release frees the adhered tissue, the trapped emotions and painful memories fade away leaving the person with a sense of peace. This return to balance is sort of like letting the steam out of a pressure cooker. The comment I hear quite frequently from my patients is "I finally feel like myself again," or "My sense of calm has returned."
Myofascial release is not meant to replace the important techniques and approaches that you currently utilize, but acts as a very important added dimension for increasing your effectiveness and permanency of results in relieving pain and restoring function and the quantity and quality of motion.
References: 1.Visceral Manipulation, Jean-Pierre Barral, D.O. (Europe) and Pierre Mercier, D.O.(Europe) Eastland Press, Seattle, WA 1983 pp 260-261 2. The Wisdom of the Receptors: Neuropeptides, the Emotions and the Bodymind, Candace Pert.
Article reprinted by permission.
For Additional Information Contact:
The Myofascial Treatment Center of Modesto
1317 Oakdale Road, Suite 610
Modesto, California 95355
(209) 492-0355
e-mail: myofascialtxcenter@sbcglobal.net
March 14, 2006
The Fair, Cotton Candy, and Fascia
Most everyone loves to go to the fair. It's full of rides, smiles, competitions, and of course food. There are things that you only have at the fair, like those giant corn dogs and cotton candy.
Most everyone loves to go to the fair. It's full of rides, smiles, competitions, and of course food. There are things that you only have at the fair, like those giant corn dogs and cotton candy. Mmmm, cotton candy. The sweet fluffy puff of cotton candy. You can almost taste its overly sweet goodness melting on your tongue as you take the first bite of the summer. You can practically feel the cavities forming as you take those second and third bites. The heat of summer must affect the brain, because you don’t care what the sugar does to your insides as you taste and enjoy the sweet cloud you clutch in your hand. Now, I’m not trying to make you hungry, but I want you to fully envision cotton candy. Remember the stringy, sticky texture? This is what collagen, which is fascia, is like (Mowen, 69). Of course I’m pretty positive fascia doesn’t taste as good, but I am also sure you understand the imagery.
Fascial tissue is what helps define us in our early embryonic state. This tissue helped to keep our rapidly replicating cells together in their proper order when we were growing in our mother’s womb (Mowen, 69). This adaptable tissue is to primates what cellulose (what the cell wall is made of) is to plants (Mowen, 69).
The other amazing thing about fascial tissue is it has no definable beginning or end (Mowen, 69). It is similar to our skin in this sense, and it is basically one large organ that goes from head to toe and from birth to death (Mowen, 69). (Actually the saying should be from development to death, but that doesn’t sound as good.) There is no getting rid of it. Basically you are stuck with it whether you like it or not!
While we developed in our mother’s womb, the fascial tissue was stretched and folded many times over (Mowen, 69). This was to provide the six hundred pockets for muscle tissue, dozens of bags for organs, and all the supporting tissue in the organs (Mowen, 69). It is all of this folding and stretching that creates planes in the fascial tissue and allows movement of the body’s tissue. No wonder we scream when we are born, all that stretching and folding must be painful!
This blanket of fascial tissue can be cut with a scalpel, torn with injury, thickened by bad posture habits, and dried out by loss of movement (Mowen, 69). These injuries will create a binding down of fascia resulting in too much pressure on nerves, muscles, blood vessels, bone structures, and/or organs. Unfortunately this binding down can result in pain that will range from the mild to the intense. Fascia loves it’s flexibility, and when it can’t have the flexibility it becomes extremely tight, like a gigantic rubber band expanding so far it almost accomplishes the breaking point. This tightness may become a source of tension for the rest of the body, creating more pain than what the original injury would have produced on it’s own. Fascia also tends to become “glued” down when it has been injured. When this happens, you don’t just feel it where the injury is, but in other areas of the body as well (Riemer, 1).
Do you remember that I told you that fascia is all over the body and continuous with no beginning or end? This is why you can have an injury in your leg and it will affect your back. To help this, Myofascial Release is prescribed.
Ahhh, another question. What is Myofascial Release? Well, to say it simply, it is a series of deep tissue release techniques that help in stretching and ungluing the fascial tissue (I guess that is not as simple as I would have liked, but it is short). One technique is to sustain pressure on the back for specific amount of time. With continuous pressure this technique will melt any restrictions that the tissue has graciously bestowed upon the patient. When a therapist is properly trained, the therapist and the patient can actually feel the fascia ungluing and stretching itself (Reimer,1). The therapist will continue this until they hit a barrier. When the barrier releases, the therapist will follow the unraveling tissue with their hands going wherever it goes until the therapist finds the next barrier. The therapist never tries to aim the tissue or force it along (Riemer, 1). When the cotton candy like fascia releases endorphins (your body’s natural hormone for pain relief) the pain disappears and blood rushes, like a race, to that area of the body (Reimer, 1).
Myofascial Release is very versatile, and has been found effective for patients in hospitals, sports medicine facilities, geriatrics, pediatrics, and dental practices with chronic or acute pain (Riemer, 1). Although treatments are not limited to specific conditions, they are effective for back and neck injuries, headaches, postural stress, and TMJ (temporomandibular [jaw] joint) (Riemer, 1).
Now you are probably wondering if it is so effective why you haven’t heard of it before, or why many doctors don’t prescribe it. Well, most medical schools don’t emphasize the fascia system. If a doctor does not have a background in a particular treatment, he or she might be skeptical of it and it’s results (Riemer, 1). I am not trying to put down doctors. If they were not skeptical of new treatments, they would have us doing all sorts of crazy things.
Fascia is an important part of our body. Once we are aware of it and its purpose, we will be healthier, wealthier, and wiser. Well, maybe not wealthier, but you get the idea.
For more information, call the Myofascial Treatment Center of Modesto at (209) 492-0355 or visit us at 1317 Oakdale Road, Suite 610.
Works Cited
Mowen, Karrie. “All Aboard!: Anatomy Trains Keep Body workers On Track.” Massage & Bodywork. (April/May, 2000)
Riemer, Jan. “I Became Unglued.” The Main Line Community Magazine. (April, 1989)
Myofascial Release and Sports
Myofascial release techniques not only benefit patients with chronic pain, but can also aid patients with acute injuries by preventing the injuries from becoming chronic pain conditions.
"What people typically do when they first have pain is to ignore it. That's the reason why there are so many patients with chronic pain," said Teresa Stayer, PT. "If they would get treated at the time of injury, they would recover sooner and would not have to live with pain forever."
Stayer has used the myofascial release approach on patients in an acute-care hospital beginning in 1986 and now continues to use it in an outpatient setting as vice president of SpecTraMed Inc., her private practice, in West Bloomfield, MI.
In her experience, myofascial release can be used quite effectively on acute patients and has even treated patients who sustained severe injuries on the same day they were admitted to the hospital, i.e., motor vehicle accidents and orthopedic injuries. "That's when you want to treat them. One of the positive effects of myofascial release is to increase localized circulation in the injured area which will enhance and quicken the healing response," Stayer said.
FASCIA is a three dimensional web surrounding every tissue of the body which runs from head to toe without interruption, she explained. Myofascial spans have the propensity through trauma, inflammatory process and poor posture to become solidified and shortened down, and can produce enormous tensile strength of up to 2,000 pounds per square inch. This pressure from the myofascial restrictions can put abnormal pressure on the nerve that innervates the muscle, compromises the circulation and pulls the osseous structures to close together, which can jam the facet joints and bulge the disk.
Stayer prefers to treat patients before they become chronic. A physician on the hospital softball team, for example, pulled his quadriceps while running to first base. Stayer performed a deep cross hand myofascial release across the pulled muscle and the doctor went out and finished the rest of the game. "He didn't have to live with that pull for a week, a month or a year before it got treated [as other people might have done]," noted Stayer. Getting to the injury right away is the best treatment short of avoiding the injury altogether.
In sports medicine, avoiding injury is the name of the game, and myofascial therapy can help in that arena, also. While using myofascial therapy is just one method that therapists have to treat patients, it can be a very effective one in the right situation, noted John Woolf, PT, ATC.
Woolf is the director of the Arizona Athletic Treatment Center at the University of Arizona, in Tucson. He presented a program on using myofascial techniques for athletes at the National Athletic Trainers' Association annual conference in June.
Myofascial techniques are beneficial for stretching and preventing injuries, as well as treating injuries, Woolf indicated. He explained that in traditional orthopedic rehabilitation, a stretch seems to exist only in one plane. A standard hamstring stretch might require a patient to lie supine, lift the leg in the air, and hold and relax the muscle. The myofascial technique leg pull, on the other hand, involves traction to the entire leg combined with range of motion.
Both techniques are appropriate in their own situations. Woolf described that the myofascial leg pull technique, for example, may be used when the athlete resists the raised straight-leg stretch, rolls the hip up because it's uncomfortable or doesn't feel it's working.
IN SUCH CASES, the leg pull provides more relaxation and control of increasing range of motion. Athletes have said that the stretch feels deeper and muscles feel looser, noted Woolf.
He acknowledged that myofascial therapy is often delivered for outpatient orthopedic or chronic pain patients. But when he began to apply it in the sports medicine setting, he was surprised to find how many athletes have chronic pain syndromes.
These include back pain, neck pain and recurring tendinitis, which could be incorrectly classified among general athletic diagnoses as strained or pulled muscles. The athlete may realize that what feels like a pulled muscle could be the result of a long-time fascial restriction.
Woolf also incorporates the techniques into pregame and preworkout warm-ups. He gave the example of a football place kicker who has a soccer-style kick; the kicker does not run at the ball head on but comes more form the side and across. The kicker moves from abduction to adduction and by using the leg-pull technique, the therapist is able to stretch him throughout his functional motion.
Furthermore, this technique provides a relaxation throughout the lower limb and even into the low back, as opposed to just stretching the hamstring. Woolf reminded that the myofascial extends throughout the entire body. That reflects how treatment should be provided.
In traditional orthopedic treatment, and the way anatomy is view, the body is segmentalized: an arm or leg is treated. For patients in general, and athletes in particular, Woolf said he disagrees with the notion. "We don't do anything with just a segment. We use our entire bodies in sports, so that has to be kept in mind when determining the problem and providing treatment."
Woolf keeps it in mind when treating acute injuries. If he needs to include a myofascial technique within his treatment of an acute injury, he can treat the proximate area. "You can get more intense with the technique as you get further away from the injury and still have a positive impact," he said.
That's exactly how myofascial release treatment works, said Stayer "You find the pain and look elsewhere for the cause."
She described a woman with low back pain who had come to the hospital for physical therapy prior to scheduled surgery. The woman had torsion of the sacrum which was compressing the nerve roots and causing weakness in the lower extremities. The woman was treated with myofascial release techniques to initially balance the pelvis by releasing the psoas piriformis, iliotibial band, soleus and hamstrings. As a result, the woman became pain free and was able to avid a lumbar laminectomy.
"The techniques, however, have to be done properly in order to work," emphasized Stayer. Although holding the stretch for 90 to 120 seconds will get the myofascial release started, it's usually not enough to make a permanent change. She recommended holding the stretch, in each area, for three to five minutes to allow the release cycle to complete.
Stayer said that she believes all physical therapists could benefit form learning how to do myofascial release. However, she cautioned that it is not appropriate for all patients. Contraindications include malignancies, systemic or localized infections, and aneurysms, for example.
Similarly, not all techniques can be done on all patients. While Stayer could use myofascial release on a pregnant woman for low back pain, she wouldn't use a psoas release, in particular.
The myofascial release approach has been around for years, but it is still a relatively new concept to insurance companies. As of 1995, myofascial release received its own CPT code (97250), although practitioners can only use it for one 15 minute unit per patient per day.
Stayer explained that with only 15 minutes, myofascial release is viewed as the equivalent of a modality, like a hotpack, which she considers to be much less effective. Nevertheless, she often complements this 15-minute treatment with soft tissue mobilization, neuromuscular re-education or therapeutic exercise.
Currently, Stayer is in contact with the American Medical Association in a effort to obtain approval on extending the treatment time. Insurance companies should know that sufficient myofascial release treatment, in the acute phase, in conjunction with other therapy, can head off potentially more serious (and more costly) chronic pain conditions. "The ultimate goal of myofascial release whether done in the acute or chronic state is to return patients to an active pain-free lifestyle." concluded Stayer.
No References
For additional information and appointments contact
The Myofascial Treatment Center of Modesto
1317 Oakdale Road, Suite 610
Modesto, CA 95355
(209) 492-0355
E-Mail: myofascialtxcenter@sbcglobal.net
Whiplash - Mind and Body
We have all experienced or treated patients whose symptoms after a whiplash accident far exceed what could reasonably be explained by the velocity of the accident. Full-blown symptoms have been frequently seen at automobile speeds below 10 to 15 mph.
Most victims of even relatively minor motor vehicle accidents usually describe a sense of detachment and shock. The major symptoms of the whiplash may not appear for 48 hours and then may progressively worsen for many days, weeks or even months despite extensive care. 1
In both the forward and backward motions involved, the front of the brain (which has the consistency of well-set Jell-O) slides forward and impacts against the rough and jagged edges of the eye orbits. The orbito-frontal areas are particularly susceptible to hematomas, contusions, and intercerebral hemorrhages. Particularly if the head is turned to either side at the impact, a phenomena called shearing may occur.
Psychoneuroimmunology research implies that "every cell in the body can communicate with every other cell." The reason that Myofascial Release and Myofascial Unwinding have been so effective with whiplash victims and other post traumatic injuries may be explained by the fight/flight/freeze response developed by Dr. Peter Levine. 2
He postulates that the fight/flight/freeze response is seen in animals in response to life-threatening experiences. In other words, the preyed upon animal will flee or attempt to fight, but if run to the ground will enter a freeze response where it assumes a state of immobility while physiologically still manifesting high levels of activity of both the parasympathetic and sympathetic nervous systems. 2
Myofascial Release and Myofascial Unwinding release the contracted tissue, the tissue memory, and allows healing to commence. Dr. Levine goes on to say that if the animal survives the attack, it will go through a dramatic period of discharge of this high level autonomic arousal through the motor system. This discharge involves trembling, profuse sweating and deep breathing. This type of discharge
is frequently seen after a deep myofascial release, followed by substantial improvement.
In the case of a motor vehicle accident, a holding pattern develops to protect the body against impact. As a result of the freeze response, this holding patterns is maintained indefinitely, manifesting sustained muscular contraction with resultant myofascial restrictions, leading to chronic myofascial pain and tightness. 1
This explains why traditional therapy's focus on symptoms is not enough for a complete resolution of the problem. Myofascial Release and Myofascial Unwinding release the muscular contractions, the myofascial restrictions and the holding patterns maintained by the "freeze response".
The fight/flight/freeze response answers many questions we therapists encounter with our trauma victims. I will write future articles on this fascinating therapeutic model.
References: 1. Robert Scaer, MD, Bridges Magazine, Observations on Traumatic Stress, The Whiplash Model. 2. Levine, Peter Waking the Tiger, Healing Trauma through the body.
For more information contact:
The Myofascial Treatment Center of Modesto
1317 Oakdale Road, Suite 610
Modesto, California 95355
(209) 492-0355
E-Mail: myofascialtxcenter@sbcglobal.net
March 13, 2006
An Introduction to the Patient
Gary D. Keown, PT and Tim Juett, PT of South Umpqua Physical Therapy Services in Winston, Oregon, have extensive experience in Physical Therapy and Myofascial Release. The integration of the Myofascial Release approach into their Physical Therapy practice has greatly enhanced their success. Their reputation for excellence and resolving difficult cases has led to the growth of four very successful Physical Therapy facilities in Oregon.
Tim has just completed our advanced Myofascial Release III seminar and said he would like to share some case histories with you which constitute a very valuable patient introduction to Myofascial Release. I suggest you modify this to fit your facility's particular requirements and print it as a handout for your patients and referring physicians and dentists.
INTRODUCTION
Myofascial Release is a relatively new addition to the armamentarium of the physical therapist. Because it is somewhat different from traditional physical therapy, many patients ask questions such as "What is it?" and "How does it work?" Myofascial Release is generally an extremely mild and gentle form of stretching that has a profound effect upon the body tissues. Because of its gentleness, many individuals wonder how it could possibly work. To help you understand, we are providing you with this article.
FASCIA
Fascia (also called connective tissue) is a tissue system of the body to which relatively little attention has been given in the past. Fascia is composed of two types of fibers: A) Collagenous fibers which are very tough and have little stretchability; B) Elastic fibers which are stretchable. From the functional point of view, the body fascia may be regarded as a continuous laminated sheet of connective tissue that extends without interruption from the top of the head to the tip of the toes. It surrounds and invades every other tissue and organ of the body, including nerves, vessels, muscle and bone. Fascia is more dense in some areas than others. Dense fascia is easily recognizable (for example, the tough white membrane that we often find surrounding butchered meat).
WHEN FASCIA IS INJURED
Because fascia permeates all regions of the body and is all interconnected, when it scars and hardens in one area (following injury, inflammation, disease, surgery, etc.), it can put tension on adjacent pain-sensitive structures as well as on structures in far-away areas. Some patients have bizarre pain symptoms that appear to be unrelated to the original or primary complaint. These bizarre symptoms can now often be understood in relationship to our understanding of the fascial system.
ANATOMY OF FASCIA
The majority of the fascia of the body is oriented vertically. There are, however, four major planes of fascia in the body that are oriented in more of a crosswise (or transverse) plane. These four transverse planes are extremely dense. They are called the pelvic diaphragm, respiratory diaphragm, thoracic inlet and cranial base. Frequently, all four of these transverse planes will become restricted when fascial adhesions occur in just about any part of the body. This is because this fascia of the body is all interconnected, and a restriction in one region can theoretically put a "drag" on the fascia in any other direction.
TREATING FASCIAL RESTRICTIONS
The point of all the above information is to help you understand that during myofascial release treatments, you may be treated in areas that you may not think are related to your condition. The trained therapist has a thorough understanding of the fascial system and will "release" the fascia in areas that he knows have a strong "drag" on your area of injury. This is, therefore, a whole body approach to treatment. A good example is the chronic low back pain patient; although the low back is primarily involved, the patient may also have significant discomfort in the neck. This is due to the gradual tightening of the muscles and especially of the fascia, as this tightness has crept its way up the back, eventually creating neck and head pain. Experience shows that optimal resolution of the low back pain requires release of the fascia of both the head and neck; if the neck tightness is not also released it will continue to apply a "drag" in the downward direction until fascial restriction and pain has again returned to the low back.
Muscle provides the greatest bulk of our body's soft tissue. Because all muscle is enveloped by and ingrained with fascia, myofascial release is the term that has been given to the techniques that are used to relieve soft tissue from the abnormal grip of tight fascia ("myo" means "Muscle").
The type of myofascial release technique chosen by the therapist will depend upon where in your body the therapist finds the fascia restricted. If it is restricted through the neck to the arm, he/she may apply a very gentle traction to the arm, very slowly moving the arm through range as restrictions are released. If it is restricted in the back (more superficial than deep) he may apply a very gentle stretch on the skin across the back, with the use of two hands. If the thoracic inlet, deep transverse fascia is suspected of being restricted, the therapist may place one hand on the upper back and one over the collarbone area in front and apply extremely gentle pressure.
A key to the success of myofascial release treatments is to keep the pressure and stretch extremely mild. Muscle tissue responds to a relatively firm stretch, but this is not the case with fascia. Remember the collagenous fibers of fascia are extremely tough and resistant to stretch. In fact, it is estimated that fascia has a tensile strength of as much as 2000 pounds per square inch. (No wonder when it tightens, it can cause pain.)
However, it has been shown that under a small amount of pressure (applied by a therapist's hands) fascia will soften and begin to release when the pressure is sustained over time. This can be likened to pulling on a piece of taffy with only a small, sustained pressure.
Another important aspect of myofascial release techniques is holding the technique long enough. The therapeutic affect will begin to take place after holding a gentle stretch and following the tissue threedimensionally with skilled, sensitive hands.
Myofascial Release is gentle, but it has profound effects upon the body tissues. Do not let the gentleness deceive you. You may leave after the first treatment feeling like nothing happened. Later (even a day later) you may begin to feel the effects of the treatment.
In general, acute cases will resolve with a few treatments. The longer the problem has been present, generally the longer it will take to resolve the problem. Many chronic conditions (that have developed over a period of years) may require three to four months of treatments three times per week to obtain optimal results. Experience indicates that fewer than two treatments per week will often result in fascial tightness creeping back to the level prior to the last treatment. Range of motion and stretching exercise given to you will, however, keep this regression between treatments minimal.
Frequently there is increased pain for several hours to a day after treatment, followed by remarkable improvement. Often remarkable improvement is noted immediately during or after a treatment. Sometimes new pains in new areas will be experienced. There is sometimes a feeling of lightheadedness or nausea. Sometimes a patient experiences a temporary emotion change. All of these are normal reactions of the body to the profound, but positive, changes that have occurred by releasing fascial restrictions.
It is felt that release of tight tissue is accompanied by release of trapped metabolic waste products in the surrounding tissue and blood stream. We highly recommend that you "flush your system" by drinking a lot of fluid during the course of your treatments, so that reactions like nausea and lightheadedness will remain minimal or nil.
If patients have any questions or concerns that arise concerning myofascial release, they should be encouraged to discuss them with the therapist.
CASE HISTORY
Chronic Low Back Pain (Post Surgery)
A 32-year old choker-setter had a lumbar laminectomy in 1983, followed by decompression surgery at the same level in October, 1985. Five months after his second surgery he was referred to physical therapy by his surgeon for three weeks of treatment for chronic low back pain and bilateral anterior thigh pain. His treatment included hot wet packs with concurrent interferential electrical stimulation, a home exercise program and myofascial release to the low back area as well as to the surgical scar itself. After two treatments there was no further leg pain and only mild low back pain with movement.
After four treatments, the patient called and canceled further appointments because he no longer was having any pain and had returned to his job as a chokersetter. Following up by telephone three months later, he reported having low back discomfort at times and never any leg pain. He is very pleased with his ability to continue his strenuous job. This is the most dramatic improvement I have experienced with any patient having similar symptoms after two or more low back surgeries. The only difference in treatment with this patient was the addition of myofascial release.
CASE HISTORY
Chronic Dislocating Patella
This 15-year-old female had a history of a chronic dislocating right patella for three years. At age 11 she fell and hit a curb on the lateral aspect of the right knee. Approximately one month later her patella began dislocating. Dislocations gradually became more frequent. She stated that with "just normal walking" the patella would dislocate and she would fall. She had been having constant pain at the lateral aspect of the knee for the past two years. Originally, her patella dislocated about twice per week, and this progressed to daily for a year prior to coming to us for therapy. The only treatment given her was quadriceps and hamstring "sets," and a trial of two types of braces until she came to see us in June of 1987.
The physician's referral to us requested SLR quadriceps strengthening and iliotibial band stretching. We treated her five times with ultrasound to the lateral retinacular area of the right patella, followed by myofascial release of the iliotibial band and lateral retinaculum. She was also given straight-leg raises against theraband with some external rotation of the hips, so as to emphasize strengthening of the VMO.
After the first treatment she had no further dislocations, even when running up and down stairs at home. Follow-up with this patient nine months later, she reported having no further problems at all with her right knee.
This patient was a possible candidate for surgical release of the lateral retinaculum of the right knee. Because she had done exercises in the past without reduction of chronic dislocation of the patella, we feel that the rapid resolution of her problem was due primarily to the non-invasive release of the scarred and adhered lateral retinaculum with manual myofascial release techniques.
CASE HISTORY
Myofascial Syndrome, Status Post Open Heart Surgery
This 73-year old patient had open heart surgery on January 15, 1988. She came for physical therapy on March 29,1988, complaining of excruciating pain at the sternal surgical scar region and spreading up the left sternocleidomastoid and into the left upper extremity to the elbow. She also complained of paresthesis of the left side of the face, episodes of dizziness, difficulty breathing when tilting the head back, and lack of pulse in the left side of the neck.
A total of four treatments were given in a ten-day period. They included moist heat, myofascial release and a home program of stretching the neck and shoulders.
Myofascial release was performed over the surgical scar, left chest, left neck, cranial base and left side of the face. A left "arm pull" was also performed. At the end of the fourth and final treatment, she reported feeling "100% improved." She had no pain. She could feel a pulse again in the left side of her neck, breathing was unrestricted with cervical extensions, there was normal sensation in her face and no further episodes of dizziness. Her six standard cervical motions had improved a total of 40 degrees, including a gain of 15 degrees of extension.
Upon follow-up by telephone exactly four weeks following her final treatment, she reported feeling as well as after the last treatment. She only had "soreness" in the left neck and left axillary region when strething while doing her home exercises, which I had recommended that she continue daily.
CASE HISTORY
Status Post Right Mastectomy and Radiation Burn
This 73-year old woman came for her initial physical therapy treatment on July 14, 1987. She had a right mastectomy in January, 1986. She received one year of chemotherapy following surgery, then six weeks (30 treatments) of radiation therapy. She had irregular shaped radiation burn with hypertrophic scarring over the distal third of the sternum (of approximately 6-7 mm. diameter). The right shoulder was drawn forward. The right shoulder and chest were extremely hypersensitive to mild touch and minor movement of the right shoulder. The radiation scar still had a small area of scab. She was referred to us as soon as the physician felt that the burn was sufficiently healed to begin physical therapy. Right shoulder external and internal rotation range of motions were within normal limits. Active flexion and abduction (standing) were respectively 0-130 degrees and 0-97 degrees.
She was given a home program of cane exercises and treated a total of 15 times (ending August 21, 1987) with moist heat and myofascial release to the chest, right upper extremity and neck. At the final treatment she had 160 degrees of motion of both right shoulder flexion and abduction (equivalent to the contralateral motions). She had no further discomfort, except for mild tenderness when pushing her range of motion exercises to the end of range.
On follow-up with this patient over seven months later, she had maintained her range of motion and reported no limitations of function and no pain. She felt fully recovered in every way other than "some tightness at the site of radiation." She expressed how thoroughly grateful she was for the remarkable increase of motion and reduction of pain which occurred with such gentle and relatively painless techniques.
Tim Juett, PT
Roseburg, Oregon
No References
Tim is a very caring and highly intelligent health professional who believes in a multi-faceted approach treating the whole person. I would like to thank Tim and request anyone else interested in sharing anything of this nature, case histories or their experiences to feel welcome to write me. I look forward to hearing from you.
John F. Barnes, PT
Article reprinted by permission.
For more information contact:
The Myofascial Treatment Center of Modesto
1317 Oakdale Road, Suite 610
Modesto, California 95355
(209) 492-0355
E-Mail: myofascialtxcenter@sbcglobal.net
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