Fascial manipulation (brief introduction)

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Basic Concepts 2014 20 14-1 -15 5 NT NTWC WC Allied He Health alth Trainin g Grant Sharing on overseas study Fascial Fa scial Manipulation Level I

• A myof myofasc ascial ial unit 3 elemen elements: ts: 1. Force Force exert exerting ing elements elements-- unidirec unidirectiona tionall muscle fibres 2. Coord Coordina inatin ting g elements elements-- the fasci fascia a

Mr. Richard Wong

3. Percepti Perceptive ve element elementss- the nerve structur structures, es, the joint capsule and ligaments

PTII NTWC/TMH

22-10-2014

 A myofascial unit (MFU)

 A myofascial unit (MFU)

• Huij Huijin ing g (2009 (2009)) - Biarticular fibers in each MFU:  intervene

in synchronizing the activity of two in-series MFUs

 Modifying

the position of the proximal proximal segment in relation to movements of the distal segments or vice versa

- Monoarticular Monoarticular fibers of the respective MFUs: provide added added stability for joints as as they move www.balanceorlando.com

Superficial and Deep fascia

Superficial and Deep fascia

Superficial Layer 

Deep Layer 

http://true.massage-research.com/2013/06/fascia-and-reflexology.html

http://gb.ethicon.com/hea hicon.com/healthcare-professionals/products/wound-closure

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Comparison of deep fascias

Features of the superficial fascia 1.

Maintain mobility of skin respect to the deep planes - Age ptosis and wrinkles

2.

Protection of the superficial vessels and nerves

3.

Lymphatic drainage - lymphoedema, fasciitis, cellulitis

4.

Separation between esteroception (i.e. skin) Proprioception (i.e. deep fascia)

Principles of treatment

Limbs

Trunk

Thicker (0.5 -1.8 mm)

Thinner

Partially separated from the underlying muscle

Strongly adherent to underlying muscle

Multilayered with few elastic fibers

Superficial layer of muscles of the trunk developed inside the superficial layer of fascia



Force transmission

 Action

of muscle is related to the fascia of the trunk

Center of coordination (CC)

• Center of coordination (CC)

• In the deep muscular fascia

• Center of perception (CP)

• Fascia lodges form the myofascial units 

permit the movement of the distal articulation in the three planes of the space • From the muscle spindle to endomysium, perimysium until epimysium where is present to the CC

Center of perception (CP) • A precise area of the joint • Point of convergence of the tension of the ipsodirectional motor units • Vectorial centre of the traction of capsules, tendons, ligaments 

region of proprioception of the joint movement in one direction

Schleip R et al (2012)

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Distributions of CCs and CPs • 14 body segments and 6 directions 

Principles of treatment • Body segments and myofascial sequence

Total 84 CC and CP

Schleip R et al (2012)

Schleip R et al (2012)

Example: ANTEMOTION 1. AN-SC: forward movement of scapula, motor units: pectoralis major and minor  2. AN-HU: forward movement of humerus, motor units: clavicular head of pectoralis major, long head of biceps, anterior deltoid 3. AN-CU: forward movement of elbow, motor units from biceps brachii, brachialis 4. AN-CA: forward movement of wrist, motor units from FCR, FPL 5. AN-DI: forward movement of fingers, motor units from FPL, APB

Schleip R et al (2012 )

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Principles of treatment

Hyaluronic Acid

• Dysfunction of the myofascial unit

http://erikdalton.com/motion-lotion-how-bodywork-lubricates-joints-fascia/

Dysfunction of fascia

Dysfunction of fascia

• Increased concentration and size of hyaluronic acid chains

Pedrelli et al. 2009

entangle

muscle

into complex groupings

changing hydrodynamic properties altering

normal viscoelastic properties

• Reduced elasticity of the fascia spindle contraction interfere

with motor unit activation unidirectional

forces of the myofascial

unit are unsynchronized uncoordinated movement

Dysfunction of fascia non-physiological

or excessive

Principles of Fascia Manipulation • Stecco A et al (2013)

tractions mechanoreceptors in the

 Abnormal HA fragmentation can be reversed by

capsules, ligaments and tendons

1. increased temperature

(i.e. densification) 

excessive stimulation to pain afferent



pain! or joint instability

2. local alkalization 3. deep massage or physical therapies *** Disaggregation of the pathologic chain chain (HA) aggregations .

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Principles of Fascia Manipulation Chen & Ingber 1999 • Create a deep friction to a precise, limited area 

create increase temperature



enhance fluidity of extracellular matrix



relieve the tension embedded in the fascia

Principles of Fascial Manipulation • Compares sensations perceived (e.g. needle- like pain, referred pain) • Compares quality of fascial tissue

Principles of Fascial Manipulation • A system to evaluate myofascial dysfunction • Clear recording of patient’s history  perform specific movement test to highlight non-functional MFUs  comparative palpation of potentially altered CC as indicated by movement test

Treatment techniques • Use of finger tip • Use of knuckles • Use of elbows

(e.g. fibrotic, lack of elasticity)

Treatment techniques

Evaluation

• Directions of manipulation - Varies from region to region - Depth and direction of fascia

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Contradictions and Precautions • Relative contraindications 1. Fever  2. Suspected fracture 3. Seriously debilitated general health • Applied at a distance from the actual side of pain (i.e. CP)  relatively safe

References Websites: 1. Motion is Lotion…How bodywork lubricates joints and fascia. http://erikdalton.com/motion-lotion-how-bodywork-lubricates-joints-fascia/ 2. What is Myofascial Release? http://www.balanceorlando.com/we-specialize-in-resolving-chronic-pain/therapeuticmassages/myofascial-release/ 3. Wound Closure http://gb.ethicon.com/healthcare-professionals/products/wound-closure Literatures and textbooks: 1. Donald E. Ingber. Tensegrityand MechanotransductionJ BodywMov Ther. Jul 2008; 12(3): 198–200. 2. Helene M. Langevinand Peter A. Huijing.(2009). Communicating About Fascia: History, Pitfalls, and Recommendations. Int J Ther Massage Bodywork. 2009; 2(4): 3–8. 3. Schleip R et al. Fascia: The Tensional Network of The Human Body (1 st Edition). Churchill Livingstone. 2012; Chapter 7.7 p.336-341. 4. SteccoA, Gesi M, SteccoC, Stern R. Fascial components of the myofascial pain syndrome. Curr Pain Headache Rep, 2013;17:352.

THANK YOU! Questions?

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