Muscle hypertonicity

Topical anesthesia has also been used to improve motor function in some patients with skeletal muscle hypertonicity resulting from a cerebrovascular accident (CVA) or head trauma.53 In this situation, a local anesthetic (e.g., 20% benzocaine) can be sprayed on the skin overlying hypertonic muscles, and then various exercises and facilitation techniques can be performed to increase and improve mobility in the affected limbs. The rationale of this treatment is that it temporarily decreases abnormal or excessive excitatory feedback of cutaneous receptors on efferent motor pathways so that normal integration and control of motor function can be reestablished. Preliminary evidence has suggested that repeated application of this... 

Physical therapists may encounter the use of local anesthetics in several patient situations because of their various clinical applications. For example, therapists may be directly involved in the topical or transdermal administration of local anesthetics. As discussed earlier, repeated topical application of local anesthetics may help produce long-term improvements in motor function in patients with skeletal muscle hypertonicity, so therapists may want to consider incorporating topical anesthetics into the treatment of certain patients with CNS dysfunction. Therapists may also administer local anesthetics transdermally, using the techniques of iontophoresis and phonophoresis. Agents such as lido-caine can be administered through this method for the treatment of acute inflammation in bursitis, tendinitis, and so on. 

Baclofen is an agonist at the GABA(B) receptor and can produce profound CNS and respiratory depression as well as paradoxic muscle hypertonicity and seizure-like activity. Hallucinations, seizures, and hyperthermia have occurred after abmpt withdrawal from baclofen. 

Use in biliary surgery or disorders of the biliary tract as significant morphine is released into the systemic circulation from neuraxial administration, the ensuing smooth muscle hypertonicity may result in biliary colic. 

The steps are the same as for treating superficial muscle hypertonicity, except for step three. The physician places the vertebra into its planes of freedom of motiom For example, a somatic dysfunction diagnosed as C5FSrRr is treated by placing the fifth cervical vertebra into a position of flexion, right side-bending, and right rotation with respect to the sixth cervical vertebra. 

SUPERFICIAL MUSCLE HYPERTONICITY, POSTERIOR RIGHT SIDE, IN REGION OF C4 VERTEBRA... 

FIG. 29-1 Facilitated positional release treatment of superficial muscle hypertonicity of cervical region application of axial compression. 

The soft tissues of the thoracic area should be palpated for texture changes skin, fascia, subcutaneous tissues, and muscle. Large muscle hypertonicity or small localized areas of muscle tension should be noted. Areas of tenderness or specific Jones tender points or trigger points should be noted. 

SUPERFICIAL MUSCLE HYPERTONICITY (LEFT POSTERIOR REGION OF 17 VERTEBRA)... 

FIG. 40-1 Facilitated positional release treatment for thoracic superficial muscle hypertonicity application of compression at the left cervico-thoracic junction. 

Muscle hypertonicity. A long musele on one side of the spine that is hypertonie ean have a bowstring effect on the spine. Relaxing and stretehing that muscle will allow the spine to straighten. This may be eaused by a type I somatie dysfunetion. 

The condition of "flat back" in the thoracic spine may be caused by an exaggerated "military" type of posture or may be caused by bilateral paravertebral muscle hypertonicity or spasm. Extension somatic dysfunctions may cause the individual to keep the back in an unusually straight posture because of discomfort or pain on flexing. The cause of the problem must be determined. Most of the causes are responsive to osteopathic manipulation. 

Examination revealed lhat the previous areas of muscle hypertonicity were no longer present, nor were the previously found somatic dysfunctions. 

The patient was treated using facilitated positional release techniques for relief of the muscle hypertonicity as well as the restrictions and somatic dysfunctions found. Special attention was given to the treatment of the piriformis and tensor fascia lata muscles. A prescription was given for nonsteroidal antiinflammatory (NSAID) medication. 

The patient was seen again in 3 days and reported partial relief of symptoms. Re-evaluation found that the muscle hypertonicity had partially returned in all areas. The lumbar lateral shift had lessened, and the restriction of the left sacroiliac articulation and the extension somatic dysfunction at 1-5—SI had returned. Osteopathic manipulative treatment was repeated, as needed. The bed rest and NSAlDs were continued for an additional week. Mild exercises were prescribed. 

ANTERIOR RIB CAGE AND COSTOCHONDRAL DYSFUNCTIONS OR MUSCLE HYPERTONICITY... 

Muscle Hypertonicity (Point Tenderness) of the Shoulder Region (Right)... 

Muscle Hypertonicity (Tenderness) of the Ankle Joint at the Midpoint and on Its Medial Aspect (Left)... 

Osteopathic manipuiation was added to her treatment pian. The muscle hypertonicity was treated with passive myofascial techniques and facilitated positional release. The somatic dysfunctions were treated with muscle energy, facilitated positional release, and balanced ligamentous tension. Rib-raising was used to induce adequate lymphatic drainage and normalize sympathetic tone. 

He received osteopathic manipulative treatment (OMT) to relieve the muscle hypertonicity, the somatic dysfunction, and to increase the cranial-sacral motion. In addition, he was given al-lopurinol and K-citrate to assist in reducing his uric acid as well as to create alkaline urine. 

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