Combined Cupping Class

Myofascial Decompression Techniques; MFD

TM

 A Movement Movement Based Myofascial Myofascial Course Presented by

Christopher DaPrato, PT,DPT,SCS,CSCS,PE PT,DPT,SCS,CSCS,PES S Christy Kennedy MS,L.Ac.,Dipl.O.M. Level 1 Course Syllabus © Copyright 2009

COURSE OUTLINE 8:00-9:00 Intro. Anatomy, histology, & physiology review. East/West perspectives, cuptherapy historical perspective 9:00-10:30 Literature review, collagen, ECM, Tensegrity, trigger point theory, fascial lines, and Janda syndromes 10:30 Getting started, operation/application. MFD approach and techniques, precautions & contraindications. 10:45 Instrument Assisted Soft Tissue (IASTM) (IASTM) Demos.. Demos.. 11:30-12:30 Breakout labs: Junctional Zones. ITB. Upper traps and levator scap, PNF patterns 12:30-1:15 Lunch 1:15-1:45 Recovery, sports medicine, and performance performance 1:45- 2:30 Treating T/L fascia, shoulder impairments 2:30-3:15 Treating PFPS, P/O ACL, flexion contractures, Hamstring strain vs tears. 3:10-3:45 Treating lower leg dysfunction, ankle/foot. ankle/foot. Tendonosis. 3:45-4:30 Clinical case studies, appropriate athlete care, future research/evidence. Summary, evaluations * Course is 60% lab, and 40% didactic. Student to Faculty PT ER ROM restriction, lateral scapular border, symmetry of angle of medial border Patient positioning = sidelying on contralateral, arm flexed to pain free tolerance Cup placement = 1@ infraspinatus laterally and 1 near medial border, 1@ t. minor and major, 1 @ inferior angle scapula, 1 @ triceps proximally Time and motion = 2-4’ static, then proceed with arm elevation and ER PROM

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

ER bilateral with Scap squeeze  French

doors

Doorway pec stretch High row for Lower trap Wide grip lat pulldowns Foam roller is a must 

Don’t forget Subscap and Pec minor manual release

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Testing for Dx = Thomas test, gait, prone knee bend lateral, and always intersection of gastroc to H/S. Active quad set and DF ankle b) Supine with contralateral leg hooked over table; anchor proximal, glide distal end

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

Glute firing pattern  Prone hip extension= ipsi

glute, contra, ipsi

Eccentric unilateral bridge H/S ball curls with core and obliques Lateral band squats Pilates reformer hip ABD Clam shells 

Ajimsha

(Truyols-Domí JOSPT 2013) (Renan-Ordine JOSPT 2011)

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Testing for Dx = DF ROM loss, pain SLB, LE kinetic chain dysfunction Patient positioning = prone with STJ clear of end of table Cup placement = 1@ posterior lateral joint

line, 1 @ lateral gastroc muscle belly, sometimes 1 @ distal lateral hamstring, 1@ achilles

Time and motion = 3’ static, 2’ with DF/PF

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Testing for Dx = palpation, decreased DF ROM, patient Hx and S/S Patient positioning = supine or prone- knee at 90 PROM w/ankle motion, minus achilles Cup placement = Anchor at proximal or distal

and ROM through glide or static. May also use medium or small cup over heel pad Time and motion = move into DF and hallux extension

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Case Presentations

MFD Results

Rib dysfunctions 



21 y/o lacrosse player, chronic rib tension T6 facet and down rib 5, four weeks HVLAT and MFD diagonal line , resolved after 2 sessions

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 A/C joint Impingement  





45y/o female Short head BB and pec minor restrictions after SAD and mumford Chronic anterior shoulder pain MFD anchored glide with AROM

Weight lifting injury 





22 y/o rugby player in 2 weeks after max squat Moderate flexion restrictions, but tolerates prayer well. 4 treatments over 3 weeks and back to practice

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Lumbar pain with running 







22 y/o male elite distance runner Left lumbar pain with >1 mile runs MFD over L5/1 and L glute medius MFD 2 cup static with child’s pose

Bicipital tendonosis 







22y/o softball player Pre treat flexion painfree ROM=135 MFD BB long head above bicipital groove, and short head to coracoid Post treat flexion painfree ROM=158

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Chronic LBP 





47 y/o female with 9 weeks chronic LBP, secondary to increased activity Limited SB AROM to 3 inches fingertip to knee MFD Erectors and QL diagonal line, with ipsilateral gapping and PNF

Nerve Entrapments  





32y/o radiculitis SLR pre-Tx =30 degrees (+) MFD spiral line and superficial back line SLR post-Tx = 57 degrees, mild L/S referral only, with Add/IR

5/27/2015

Upper trap overuse II 





NCAA National champion relay swimmer Anterior Impingement and A/C joint irritability No pain after 2 treatment sessions

Chronic H/S tension   

21y/o decathlete, with L H/S pulled 1 y/a Sensations of “getting tight again”  MFD in elongated position, with secondary thickened indurated prominence

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Pain with running 







31y/o male, training for ½ marathon R lateral/superior knee pain greater than 3 miles Ely’s Prone knee bend R=128, L=140 MFD linear line with PROM

Post-Op Bankart

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Scoliotic soft tissue changes 

 

29 y/o grad student with bilateral L>R interscap pain with lifting and working on computer Mild levoscoliosis FRS correction and MFD L interscap and lat chain release

THANK YOU!!!

Other Recommended Courses: http://www.MyofascialDecompression.com http://www.instituteofphysicalart.com/ http://www.spinalmanipulation.org/ http://www.kaiserhaywardptfellowship.com/ http://www.imtsglobal.com/ http://www.neseminars.com/store/comersus_listItems.asp?Clini cian=28 http://comptsig.org/page-1589803 http://rolandlucaspt.com/ http://www.naiomt.com/www.naiomt.com/index.html http://www.richardjacksonseminars.com/ http://www.usa.edu/continuing_education.aspx www.physicaltherapycontinuingeducation.co/ContinuingEducation-Course-Schedules.htm References:  Abu-Hijleh MF, et Al. The membranous layer of superficial fascia: evidence for its widespread distribution in the body. Surg Radiol Anat. 2006 Dec;28(6):606-1  Ajimsha MS, Binsu D, Chithra S. Effectiveness of myofascial release in the management of plantar heel pain: a randomized controlled trial. Foot (Edinb). 2014 Jun;24(2):66-71  Aritan S, Oyadiji SO, Bartlett RM. A mechanical model representation of the in vivo creep behaviour of muscular bulk tissue. J Biomech. 2008 Aug 28;41(12):2760-5

Bai Yet al. Possible applications for fascial anatomy and fasciaology in traditional Chinese medicine. J Acupunct Meridian Stud. 2010 Jun;3(2):125-32 Benjamin M. The fascia of the limbs and back--a review. Journal of Anatomy. 2009 Jan;214(1):1-18 Birnbaum K, Siebert CH, Pandorf T, Schopphoff E, Prescher A, Niethard FU.  Anatomical and biomechanical investigations of the iliotibial tract. Surg Radiol  Anat. 2004 Dec;26(6):433-46 Bron C, Wensing M, Franssen JL, Oostendorp RA. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial. Biomed Central; Musculoskeletal Disorders. 2007 Nov 5;8:107 Couppé C,et. Al. Mechanical properties and collagen cross-linking of the patellar tendon in old and young men. J Appl Physiol. 2009 Sep;107(3):880-6 Cramer H, et. Al Randomized controlled trial of pulsating cupping (pneumatic pulsation therapy) for chronic neck pain. Forsch Komplementmed. 2011;18(6):327-34 Culav EM, Clark CH, Merrilees MJ. Connective tissues: matrix composition and its relevance to physical therapy. Phys Ther. 1999 Mar;79(3):308-19. Cummings M, Baldry P. Regional myofascial pain: diagnosis and management. Best Practice Research Clinical Rheumatology. 2007 Apr;21(2):367-87 Daly CH, Odland GF. Age-related changes in the mechanical properties of human skin. J Invest Dermatol. 1979 Jul;73(1):84-7 Delalleau A, Josse G, Lagarde JM, Zahouani H, Bergheau JM. A nonlinear elastic behavior to identify the mechanical parameters of human skin in vivo. Skin Res Technol. 2008 May;14(2):152-64 Edwards C, Marks R. Evaluation of biomechanical properties of human skin. Clin Dermatol. 1995 Jul-Aug;13(4):375-80. Egemen O, et. Al. Effective use of negative pressure wound therapy provides quick wound-bed preparation and complete graft take in the management of chronic venous ulcers. Int Wound J. 2011 Oct 12 Ehrlich HP. The modulation of contraction of fibroblast populated collagen lattices by types I, II, and III collagen. Tissue Cell. 1988;20(1):47-50 Farahani RM, Kloth LC. The hypothesis of 'biophysical matrix contraction': wound contraction revisited. Int Wound J. 2008 Jun;5(3):477-82. Fairclough J, et Al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Journal of  Anatomy 2006 Mar;208(3):309-16

Fernández-de-Las-Peñas C, Alonso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain: A blinded, controlled study. Man Ther. 2006 Jun 10 Fernández-de-Las-Peñas C, Ge HY, Arendt-Nielsen L, Cuadrado ML, Pareja JA. Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache. Eur J Pain. 2007 May;11(4):475-82 Ferreira LM, Gragnani A, Furtado F, Hochman B. Control of the skin scarring response. An Acad Bras Cienc. 2009 Sep;81(3):623-9 Ge HY, Fernández-de-Las-Peñas C, Madeleine P, Topographical mapping and mechanical pain sensitivity of myofascial trigger points in the infraspinatus muscle. Eur J Pain. 2008 Oct;12(7):859-65 Georges PC, Janmey PA. Cell type-specific response to growth on soft materials. J Appl Physiol. 2005 Apr;98(4):1547-53 Hou CR et. Al. . Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil. 2002 Oct;83(10):1406-14 Ingber DE. Tensegrity I. Cell structure and hierarchical systems biology. J Cell Sci. 2003  Apr 1;116(Pt 7):1157-73 Kassolik K, Jaskólska A, Kisiel-Sajewicz K, Marusiak J, Kawczyński A, Jaskólski A. Tensegrity principle in massage demonstrated by electro- and mechanomyography. J Bodyw Mov Ther. 2009 Apr;13(2):164-70 Kischer CW, Shetlar MR, Shetlar CL. Alteration of hypertrophic scars induced by mechanical pressure. Arch Dermatol. 1975 Jan;111(1):60-4. Kuan TS, Hong CZ, Chen JT, Chen SM, Chien CH. The spinal cord connections of the myofascial trigger spots. European Journal of Pain. 2007 Aug;11(6):624-34 Landau AG, et. Al. Full-thickness skin grafts: maximizing graft take using negative pressure dressings to prepare the graft bed. Ann Plast Surg. 2008 Jun;60(6):661-6 Lauche R,et al. The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain--a randomised controlled pilot study. BMC Complement Altern Med. 2011 Aug 15;11:63 Lauche R, et al. Effectiveness of home-based cupping massage compared to progressive muscle relaxation in patients with chronic neck pain--a randomized controlled trial. PLoS One. 2013 Jun 7;8(6)Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin. 2007 Dec;25(4):841-51 Lasheen AE, Saad K, Raslan M. External tissue expansion in head and neck reconstruction. J Plast Reconstr Aesthet Surg. 2009 Aug;62(8):e251-4 Lasheen AE. External tissue expansion using negative pressure in

upper-extremity reconstruction. J Hand Surg Am. 2006 Dec;31(10):1694-6. Lasheen AE, Salim A, Hefny MR, Al-Bakly E. External tissue expansion successfully achieved using negative pressure. Surg Today. 2004;34(2):193-6 Loukas M, Shoja MM, Thurston T, Jones VL, Linganna S, Tubbs RS. Anatomy and biomechanics of the vertebral aponeurosis part of the posterior layer of the thoracolumbar fascia. Surg Radiol Anat. 2008 Mar;30(2):125-9 Maas H,. Force transmission between synergistic skeletal muscles through connective tissue linkages. J Biomed Biotechnol. 2010 . Epub 2010 Apr 12 McPartland JM. Travell trigger points--molecular and osteopathic perspectives. J Am Osteopath Assoc. 2004 Jun;104(6):244-9 Nien YD, et. Al. Fibrinogen inhibits fibroblast-mediated contraction of collagen. Wound Repair Regen. 2003 Sep-Oct;11(5):380-5. Powers CM, et al. Role of peripatellar retinaculum in transmission of forces within the extensor mechanism. J Bone Joint Surg Am. 2006 Sep;88(9):2042-8 Roostayi MM,et Al. The effects of vacuumic bracing system on the patellofemoral articulation inpatients with patellofemoral pain syndrome. Complement Ther Clin Pract. 2009 Feb;15(1):29-34 Reinschmidt C, van den Bogert AJ, Nigg BM, Lundberg A, Murphy N. Effect of skin movement on the analysis of skeletal knee joint motion during running. J Biomech. 1997 Jul;30(7):729-32 Renan-Ordine R, Alburquerque-Sendín F, de Souza DP, Cleland JA, Fernández-de-Las-Peñas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011 Feb;41(2):43-50 Sciotti VM, et. Al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001 Sep;93(3):259-66 Silver FH, Siperko LM, Seehra GP. Mechanobiology of force transduction in dermal tissue. Skin Research and Technology. 2003 Feb;9(1):3-23 Silver FH, Ebrahimi A, Snowhill PB. Viscoelastic properties of self-assembled type I collagen fibers: molecular basis of elastic and viscous behaviors. Connect Tissue Res. 2002;43(4):569-80 Silver FH, Freeman JW, DeVore D. Viscoelastic properties of human skin and processed dermis. Skin Res Technol. 2001 Feb;7(1):18-23

Simons DG. Trigger points and limited motion. J Orthop Sports Phys Ther. 2000 Nov;30(11):706-8 Stecco A, et Al. Pectoral and femoral fasciae: common aspects and regional specializations. Surg Radiol Anat. 2009 Jan;31(1):35-42. Epub 2008 Jul 29 Tham LM, Lee HP, Lu C. Cupping: from a biomechanical perspective. Journal of Biomechanics. 2006;39(12):2183-93

Threlkeld AJ. The effects of manual therapy on connective tissue. Physical Therapy. 1992 Dec;72(12):893-902. Teut M, et.al. Pulsatile dry cupping in patients with osteoarthritis of the knee - a randomized controlled exploratory trial. BMC Complement Altern Med. 2012 Oct 12;12:184 Truyols-Domí Nguez S, Salom-Moreno J, Abian-Vicent J, Cleland JA, Fernández-deLas-Peñas C. Efficacy of thrust and nonthrust manipulation and exercise with or without the addition of myofascial therapy for the management of acute inversion ankle sprain: a randomized clinical trial. J Orthop Sports PhysTher. 2013 May;43(5):300-9 Ushiki T. Collagen fibers, reticular fibers and elastic fibers. A comprehensive understanding from a morphological viewpoint. Arch Histol Cytol.2002 Jun;65(2):109-26. Vasavada AN, Brault JR, Siegmund GP. Musculotendon and fascicle strains inanterior and posterior neck muscles during whiplash injury. Spine (Phila Pa1976). 2007 Apr 1;32(7):756-65 Vincent K, Maigne JY, Fischhoff C, Lanlo O, Dagenais S. Systematic review of manual therapies for nonspecific neck pain. Joint Bone Spine. 2013 Oct;80 5):508-15 Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy. 2007 Mar;23(3):269-74. Waller JM, Maibach HI. Age and skin structure and function, a quantitative approach (II): protein, glycosaminoglycan, water, and lipid content and structure. Skin Research and Technology. 2006 Aug;12(3):145-54 Wilhelmi BJ, Blackwell SJ, Mancoll JS, Phillips LG. Creep vs. stretch: a review of the viscoelastic properties of skin. Ann Plast Surg. 1998 Aug;41(2):215-9 Zhao H. Clinical observation on therapeutic effect of cupping combined with acupuncture stimulation at trigger points for lumbar myofascial pain syndrome. Zhen Ci Yan Jiu. 2014 Aug;39(4):324-8

Books: Magee, D.J. Orthopedic Physical Assessment. 4th ed., Philadelphia, Saunders; 2002. Maitland, D. Spinal Manipulation Made Simple. North Atlantic Books; 2001. Myers, T.W., Anatomy Trains. Myofascial Meridians for Manual and Movement Therapists. Edinburgh, Churchill Livingston; 2001. Travell, J.G., Simons, D.G., Myofascial Pain and Dysfunction. The Trigger Point Manual. Baltimore, Williams & Wilkins; 1983. Rehabilitation of the spine: a practitioner's manual By Craig Liebenson Rolfing : the integration of human structures / by Ida P. Rolf, Santa Monica, Calif. : Dennis-Landman, c1977 Rolfing and physical reality / Ida Rolf ; edited and with an introduction by Rosemary Feitis, Rochester, Vt. : Healing Arts Press , Distributed to the book trade in the U.S. by  American International Distribution Corp. (AIDC), c1990 Lyon, William S., Ph. D , Encyclopedia of Native American healing / William S. Lyon, New York : W.W. Norton, 1998, c1996 Chirali, Ilkay. Traditional Chinese Medicine. Cupping Therapy. 2nd Ed. Churchill Livingston, 2008.

NAME:_____________________________

DATE:__________

Overhead Squat Test  An ter io r View

Right YES

Foot

Foot Turns Out

Knee

Moves Inward

Left YES

Moves Outward

Lateral View (Righ t Side) L-P-H-C Excessive Forward Lean Low Back  Arches Low Back Rounds  Arms Fall Upper Body Forward

YES

Posterior View Foot

Right Yes

Left YES

Heel of Foot Rises Foot Flattens

L-P-H-C

 Asymmetrical Weight Shift

MODIFIED: HEELS ELEVATED

A RMS DOWN

FEET KNEES LPHC UPPER

NOTES:

Single Leg Squat Test RIGHT Leg

LEFT Leg Right YES

Left YES

Foot

Foot Flattens

Foot

Foot Flattens

Knee

Moves Inward

Knee

Moves Inward

Moves Outward L-P-H-C

Hip Hike

Moves Outward L-P-H-C

Hip Drop Upper Body

Inward Trunk Rotation Outward Trunk Rotation

NOTES:

Hip Hike Hip Drop

Upper Body

Inward Trunk Rotation Outward Trunk Rotation