soft tissue treatment of musculoskeletal disorders - thomas e. hyde

SOFT TISSUE TREATMENT OF

MUSCULOSKELETAL DISORDERS

Utilizing Functional and Kinetic Treatment with

Rehab, Provocation and Motion (FAKTR-PM)

National University of Health Sciences

Thomas E. Hyde, DC, DACBSP, CSTI, ICSSD, FRCCSS (Hon)

How about an adjustment?

Don’t be afraid to jump into the unknown….

El Misti 08/05Summit being treated by Greg Doerr, DC at 19,223 feet

Objectives of this lecture

•Teach you something new to consider using in your practice•Not to teach you to be an expert by the end of the lecture•Stimulate you to learn more•To provide you options to better treat your patients

Objectives of this lecture

•Teach you something new to consider using in your practice•Not to teach you to be an expert by the end of the lecture•Stimulate you to learn more•To provide you options to better treat your patients

Before Treatment Begins

1. Take a complete history2. Perform a complete examination3. Make your best clinical decision regarding

whether you feel your diagnosis for this patient would be best served by you treating them with whatever technique/s you employ

4. If not, refer to someone you feel would be more likely to help them

Soft Tissue Techniques

Nimmo Cyriax Mattes (AIS) Buttler Never Flossing Myofascial Release Tech Active Release Tech ® Postisolation Relaxation Proprioceptive

Neurolmuscular Facilitation (PNF)

Stretching/gliding/pulling/pushing/compression

Stecco

Gua Sha Graston Technique® Sound Assisted Soft

Tissue Technique ASTYM Rolfing Massage Strain Counterstrain Pin and Stretch Mulligan Functional Position

Patterns by Gary Gray Muscle Energy Technique

Which Technique would you chose for these folks?

Lowe continues to state that when traumatized and inflamed, a fascial lesion heals by spider-webbing together with irregularly arranged collagen.

Lowe

Where fascia has been intermittently stressed, fibroblasts produce more linearly arranged collagen to reinforce the loaded myofascia.

Chamberlain, GJ. “Cyriax’s frictionmassage: a review.” JOSPT, 1082; 4: p 20

Muscle and fascia can’t be separated in that they function and dysfunction together. Where there is a tight muscle, there is usually tight fascia. Fascial-release techniques, then become important.

John Lowe, Ma, DC

Nimmo – lumbar spine

Nimmo - gluteals

Nimmo Anyone????

Race Track

Acu-Force

Another instrument assisted from of soft tissue treatment.

There are 4 instruments used in an attempt to break up fascial restriction.

There are a small and large star, an S-shaped instrument and a 7 pound larger I-shaped instrument

Acu-Force – forearm flexors

AcuForce

Acu-Force – trapezius/thoracic

Acu-Force – lumbar spine

I always feel better after my Acu-Force treatment.

Death Valley

Cyriax

Felt moving across the fibers at a right angle would not injure the normal healing tissue but would prevent the formation of or break down abnormal scar tissue.

Hammer

Cyriax

Stated TF moved the involved tissue while longitudinal friction affected the transportation of blood and lymph.

Hammer

Cyriax

In the acute phase, only necessary to use a light force

In the chronic stages a deep, stronger friction is necessary.

Hammer

Cyriax

Friction creates anesthesia

Usually within 3 minutes of friction, anesthesia begins

Cyriax – Shoulder - Knee

CyriaxElbow

Cyriax can repair any damaged tissue

DENMARK

MAJOR GOALS IN THE PROMOTION OF HEALING

1. Enhance proliferative invasion of vascular elements and fibroblasts followed by:

2. Collagen deposition and 3. Ultimate maturation. Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports

Med 22 (2003):

HEALING OF TENDINOSIS

Increased collagen alone is not enough to heal a degenerated tendinosis

Equally important is the correct orientation of the collagen fibers.

HEALING OF TENDINOSIS

Necessity of post treatment stretching & strengthening to provide the forces necessary for adaptive remodeling of new collagen in the affected areas.

Exercise creates collagen alignment and stimulates collagen cross-linkage formation thereby improving tensile strength.

Superficial Posterior Spinal Fascial Lamina

Barker PJ, Briggs CA. Attachments of the Posterior Layer of Lumbar Fascia. Spine 24 (17):1757-64.

DeepPosteriorSpinalLamina SERRATUS

POSTERIOR INFERIOR

SERRATUS POSTERIOR INFERIOR

GLUTEUSMEDIUS

GLUTEUSMEDIUS

SACROTUBEROUSLIGAMENT

SACROTUBEROUSLIGAMENT

FUSION OF SUPERFICIAL & DEEP LAMINAE

FUSION OF SUPERFICIAL & DEEP LAMINAE

Barker PJ, Briggs CA. Attachments of the Posterior Layer of Lumbar Fascia. Spine 24 (17):1757-64.

Lighthouse Tasmania

New Research with IASTM

During the Fascial Conference at Harvard in 2007, research emphasized that ALL types of soft tissue mechanical loading including exercise, injury, manual muscle treatments such as fascial release, stretching techniques, and IASTM act by affecting the fibroblasts.

The fibroblasts are located within the ECM where repair, regeneration and maintenance of soft tissue takes place.

Hammer W. April 2008

Hammer continued

Use of light manual fascial methods stimulation of fibroblasts can respond with anti-inflammatory cytokines, growth factors and vasoactive compounds that underlie positive clinical outcomes.

Standley showed how injury strains fibroblasts and fascia in negative ways while manual muscle treatment strains fibroblasts in curative ways.

Hammer W. April 2008

Thomas Meyers

Anatomy Trains

SuperficialBackLine

FasciaRemoved From Cadaver

SuperficialBackLine

SuperficialFront Line

LateralLine

SpiralLine

ArmLine

FrontAndBackFunctionalLines

DeepFrontLine

Thinking Outside the Box

What size and shape is your box?

Are you willing to change that shape or size?

What will you do differently tomorrow, next week, next year and each year thereafter?

Is your box open or closed?

FAKTR-PM Developed by:

› Greg Doerr, DC, CCSP, CKTP› Tom Hyde. DC, DACBSP, CKTP, FCCSS (Hon)

› Contributions by: Vince DeBono, DC, CCSP, CSCS (KT Tape)

Warren Hammer, DC, MS Dick Vincent, DC

Shawn Burger, PT Mike Cicero, PT

Mike Schneider, DC, PhD Phil Page, ATC, PT, PhD, CSCS

Andre Labbe, PT Ed Feinberg, DC, CCSP Ted Forcum, DC, DACBSP

Kay Pearce Donna Strachan

Functional and Kinetic Treatment with Rehab, Provocation and Motion-FAKTR-PM

F - Functional and K - Kinetic T - Treatment with R - Rehab P - Provocation and M - Motion

Functional

What activity causes a reproduction of the patient’s pain, loss or ROM, tightness, loss of function

Is this with motion, without motion, active, passive, with resistance, without resistance

What activity can you patient NOT do

Kinetic

Once the patient has been treated in the position of provocation with functional assessment, they are brought back to a non-pain producing position, then asked to assume the position of pain once more with functional testing. Many times, the pain will move up or down the kinetic chain – you now chase that pain.

Treatment

Treatment is rendered in the position of provocation and with the function mechanism in play

Treatment can be performed utilizing many different soft tissue modalities

Rehabilitation (Rehab)

This entails the use of many types of low tech rehab devices such as the Swiss Ball, Both Sides Up (BOSU), balance pads and boards, tubing, Therabands, and more

Provocation

The patient is asked to assume the position of provocation, that is the position that will reproduce their pain

If the complaint is low back pain, you must determine if the pain is seated, standing, leaning, bending, etc

This applies to any area of the body where pain is secondary to musculoskeletal disorders

Motion

What motion, if any, will reproduce the patient’s pain

Consider treating the patient in motion such as low back pain brought on by getting up from a seated position for example

Myofascial treatment has always worked for me.

ARUNDEL CASTLE

Gua Sha involves palpation and cutaneous stimulation where the skin is pressured, in strokes, by a round-edged instrument; that results in the appearance of small red petechiae called 'sha', that will fade in 2 to 3 days.

Gua Sha

http://www.guasha.com/

Raising Sha removes blood stagnation considered pathogenic, promoting normal circulation and metabolic processes.The patient experiences immediate relief from pain, stiffness, fever, chill, cough, nausea, and so on. Gua Sha is valuable in the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and many other acute or chronic disorders.

Gua Sha

Gua Sha

Demonstration ShoulderActive Supraspinatus

Isometric Supraspinatus

Active Resisted Biceps

Active Resisted Subscap

Active Resisted Serratus

Active Resisted Scapular Stabilizers

Active Resisted Scapular Stabilizers

Shoulder w/Motion + Proprio

Knee Demonstration

Active Resisted Quad

Quad, Patellar Tendon with Ball Squat

QUAD JUMPERS

ANKLE DEMONSTRATION

Ankle Propiroception

ANTERIOR SHIN SPLINTS

Cervical Spine Demonstration

Cervical Flexion/Extension GT

Active Resisted CS Lateral Flexion

Active Resisted CS Flexion/Extension

Active Resisted CS with Rotation

Active Resisted Upper Trap/Levator Scap

CERVICAL SPRAIN/STRAINCorrection Strip

LUMBAR SPINE DEMONSTRATION

Questions and Answers

Every patient is different, and that’s why there is no cook book for care.

Helpful Websites

www.spine-health.com www.thera-bandacademy.com www.grastontechnique.com www.faktr-pm.com http://www.stretchingusa.com/ http://www.spidertech.com

Thank You

Thyde444@bellsouth.net