Myofascial techniques

Myofascial techniques are a group of specific maneuvers that are directed toward the soft tissues of the body, particularly the muscles and fasciae. For this reason, they are also referred to as soft tissue techniques. These can be used as the primary modality of treatment or in combination with or preparation for other methods. 

There are several goals that may be achieved through the use of myofascial techniques. Among others, these include ... 

Myofascial techniques are useful in breaking the pain-muscle tension-pain cycle. Increasing the circulation to and drainage from the tissues may aid in diminishing the inflammatory response. 

Some of the physiologic principles applied in myofascial techniques include the following ... 

Stretch reflex. The stretch of a muscle excites the muscle spindle mechanism, resulting in reflex contraction of that muscle. This is to be avoided when applying passive myofascial techniques to contracted or con-tractured muscles. It can be avoided by applying slow, even force and releasing that force slowly and evenly. However, the stretch reflex is to be used during active myofascial... 

Muscle spindle reflex. This is used in active resistive myofascial techniques. If the ex-trafusal fibers contract less than the intrafusal fibers, the muscle spindle will maintain a stretch reflex, further exciting the extrafusal fibers. 

Golgi tendon organ reflex. This is used in active myofascial techniques. When the tension on the tendon becomes extreme, the inhibitory effect from the Golgi tendon organ can cause sudden relaxation of the entire muscle. 

Reciprocal inhibition. This is used in active myofascial techniques with or without resistance. When a stretch reflex stimulates one muscle, it simultaneously inhibits the antagonist muscle e.g., if the stretch reflex excites the biceps, reciprocal inhibition inhibits the triceps. 

The physician uses passive myofascial techniques with the patient relaxed. Passive techniques entail application of a manual traction... 

In active techniques, the patient assists the physician by actively contracting certain muscles under the guidance of the physician. There are two forms of active myofascial techniques. Active direct techniques are those in which the patient is asked to contract the involved muscle. These techniques use the Golgi tendon organ reflex to result in relaxation of the involved muscle(s). In these techniques, the physician applies isometric resistance to the contraction. (Isometric resistance The physician apphes resistance to the patient s contraction such that little shortening of the muscle is permitted but a great increase in muscle tension results.)... 

There are a few general rules to follow when applying myofascial techniques. 

This chapter describes passive, direct active, and indirect active myofascial techniques used to treat cervical somatic dysfunction as well as muscle or fascial tension in the cervical region. These techniques may entail a passive linear or perpendicular stretch of the neck muscles or an active use of neuromuscular methods to create relaxation of the suboccipital and paravertebral muscles. 

FIG. 26-8 Active direct myofascial technique to suboccipital region with isometric resistance. 

FIG.37-14 Active direct myofascial technique for thoracolumbar muscles. Patient pushes arm toward ceiling while physician gives isometric resistance. 

All functional scolioses are benefited by osteopathic manipulation once the cause has been eliminated or corrected. Myofascial techniques, muscle energy, and exercises are most helpful when working on the muscles. 

FIG. 48-1 Passive myofascial technique applied to lumbar spine, patient recumbent. 

This chapter describes high-velocity, low-amplitude thrusting techniques for treating somatic dysfunctions of the lumbar spine. The soft tissues in the region should be prepared with myofascial techniques or muscle energy before a thrust being performed. 

R.T. was treated with osteopathic manipulation. He received soft tissue myofascial techniques to the neck and upper back. The somatic dysfunctions were treated with facilitated positional release techniques, as was the first rib. The T3-4 somatic dysfunction was also treated with high-velocity, low-amplitude thrusting technique. 

A.L. was treated with general myofascial techniques to the entire spine passive and active were used. Spencer techniques were used to improve shoulder motion. Muscle energy was used to treat the cervical muscles and the lumbar muscles, as well as the trapezius. Fascial release was performed on the sternum and both scapulae. The first ribs were treated with counterstrain. 

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. 

The primary focus of the initial treatment was to perform a full evaluation for primary and secondary sites of somatic dysfunction. Although the primary concern of the patient was the cervical region, it was important to correct any structural problems affecting the other parts of the body. Soft tissue and muscle energy techniques were complemented with moderate velocity-low amplitude (MVLA) techniques except for the cervical spine, where myofascial release techniques were the primary modality used. Trapezius inhibition techniques were performed with a compression myofascial technique to the right trapezius. 

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