Myofascial Release Presentation

Presentation slides from our recent workshop on Myofascial Release. This workshop was delivered from our St John Street Clinic in Manchester on Saturday 17th March.

1. @Physiocouk #manchesterphysio facebook.com/physiocouk

2. Welcome @Physiocouk #manchesterphysio facebook.com/physiocouk Myofascial Release (MFR) workshop With Louise Rigby & Kate McNally

3. @Physiocouk #manchesterphysio facebook.com/physiocouk Kate’s LinkedIn: www.linkedin.com/katemcnally Twitter: @KateMcPhysiocouk Louise’s LinkedIn: www.linkedin.com/Louiserigby Twitter: @LouPhysiocouk Who are we?

4. @Physiocouk #manchesterphysio facebook.com/physiocouk Let’s connect Website: www.massage.physio.co.uk Twitter: @physiocouk Facebook: www.facebook.com/physiocouk

5. Aims of today @Physiocouk #manchesterphysio facebook.com/physiocouk Learn and understand fascia structures and it's anatomy Learn the indi cations and contraindication to myofascial release techniques. Learn different myofascial release techniques and how to perform them safely. Learn which outcome measures and other treatment techniques to use with myofascial release.

6. Itinerary @Physiocouk #manchesterphysio facebook.com/physiocouk 10.00 - 10.30 - Induction / Arrival 10.30 - 11:15 - Theory: MFR 11.15 - 12:15 - Practical: MFR (Upper Limb) 1 2:15 - 1 2 . 45 - Lunch 12:45 -13:45 - Practical: MFR (Lower Limb) 1 3 . 45 - 1 4 . 3 0 - Treatments alongside MFR 1 4 .30 - 1 5 .00 - Evidence and Case Studies

7. @Physiocouk #manchesterphysio facebook.com/physiocouk   Theory: Myofascial Release

8. @Physiocouk #manchesterphysio facebook.com/physiocouk   Definition Myo= Muscle Fascia = a band / sheet of connective tissue Release = relaxation / stretching of tight structures

9. @Physiocouk #manchesterphysio facebook.com/physiocouk   What is fascia? Where is it found? •Fascia is a layer of fibrous tissue that surrounds groups of muscle, bone, blood vessels and nerves. •It binds structures together, whilst permitting other structures to glide smoothly over each other. •Fascia is dense, regular connective tissue, which contains closely packed bundles of collagen fibres aligned in a wavy pattern parallel to the direction of pull.

10. @Physiocouk #manchesterphysio facebook.com/physiocouk   Layers of Fascia Fascia is classified depending on it’s distinct layers, functions and anatomical position: Superficial, deep and visceral

11. @Physiocouk #manchesterphysio facebook.com/physiocouk   Muscle anatomy •All muscle tissues have a superficial covering of vary thicknesses of fascia , made of connective tissue and laced with adipose tissue. A singular muscle fibre is referred to as a myofibril and contains thick and thin myofilaments.

12. @Physiocouk #manchesterphysio facebook.com/physiocouk   Function of Fascia Reduce friction during a muscular contraction Support the nerves and blood vessels as they glide through the muscle. The fascia holds the muscle together and keeps it in the correct place. The fascia separates the muscles so they can work independently of each other.

13. @Physiocouk #manchesterphysio facebook.com/physiocouk   Fascia- why does it go wrong? Age and injury can cause an increase of laying down of collagen, increased cross linkages and restrictions (adhesions) Fascia increases its density and decreases its ability to slide freely following: Trauma and injury Poor posture Infections or disease Over and under use Ischaemia Local and systemic inflammation Tissue dehydration Emotional stress and centralised pain

14. @Physiocouk #manchesterphysio facebook.com/physiocouk   How can we treat fascia? Theory of fascial lines. Structures are grouped together in recognised fascial lines and when one structure is released the benefits may be present further along the line. The point of restriction may be away from the point of pain.

15. @Physiocouk #manchesterphysio facebook.com/physiocouk   Anatomy Trains Superficial Back Line (SBL) Function is to support the body in full upright extension With the knees extended the line is continuous It has a higher degree of slow twitch endurance muscle fibres and extra heavy sheets of fascia to overcome the postural demands. There is no deep back line although some aspects of the SBL are deeper than others. There is no consistent and connected layer deeper than the SBL

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17. @Physiocouk #manchesterphysio facebook.com/physiocouk   Anatomy Trains Superficial Front Line Function is to balance the SBL and provide tensile support from the top to lift those parts of the skeleton which extend forward of the gravity line (pubis, ribcage and face) Viewing the patient from the side reveals the state of imbalance between the SFL & SBL

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19. @Physiocouk #manchesterphysio facebook.com/physiocouk   Anatomy Trains Deep Front Line Infused with slow twitch endurance muscle fibres, the DFL provides stability and subtle positioning changes to core structure. Failure of the DFL does not cause an acute change but more functional restriction over a period of time which may appear in another line. Its role in surrounding the heart and lungs has a significant effect upon respiration.

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21. @Physiocouk #manchesterphysio facebook.com/physiocouk   Anatomy Trains Demonstration of Theory

22. @Physiocouk #manchesterphysio facebook.com/physiocouk   What is Myofascial Release? Myo = muscle Fascia = a band or sheet of connective tissue Release = the relaxation and/or stretching of tight structures

23. @Physiocouk #manchesterphysio facebook.com/physiocouk   What is Myofascial Release? “Myofascial Release is a specialised physical and manual therapy used for the effective treatment and rehabilitation of soft tissue and fascial tension and restrictions” Myofascial Release UK

24. @Physiocouk #manchesterphysio facebook.com/physiocouk   What is Myofascial Release? Safe and effective hands-on technique that works on the fascia to release restrictions. Applied with prolonged pressure to restricted tissue. Aims to release tension and stretch out restricted parts of the fascia.

25. @Physiocouk #manchesterphysio facebook.com/physiocouk   Aims and benefits Myofascial Release can decreases Pain:  Endorphin release/ increased temperature/ pain gate theory. Myofascial release can help the immune system. Increased lymphatic flow. Myofascial Release promotes healing Increased blood flow and cell nutrition Myofascial release can reduce tension Stretching/ elongation of fascia/ Increased heat in tissues

26. @Physiocouk #manchesterphysio facebook.com/physiocouk   How is myofascial release applied? Gentle and sustained, pressure should be applied for a prolonged period of time 60 – 120 seconds This amount of time permits fascia to naturally elongate and return to normal resting length which will restore the healthy status quo, giving greater flexibility, mobility and eliminating pain. Techniques applied for shorter periods will temporarily lengthen the elastic fibres in the muscles and fascia and the tissues will feel looser for a while but gradually tighten up again.

27. @Physiocouk #manchesterphysio facebook.com/physiocouk   Manual handling and body position Posture Bed height Stance Patient position Use different parts of your hands/ arms to apply pressure Keep arms straight to utilise body weight when applying pressure/resistance. Move from the hips and knees as much as possible Oil (or cream)- only needs to be a little bit - some advise not to be able to tack and pin effectively. Look after yourself before you look after the patient!

28. @Physiocouk #manchesterphysio facebook.com/physiocouk   Post Rx soreness? Very common for people to experience post Rx soreness for up to 72 hours after treatment. Side effects can include: Bruising Redness Tenderness/Increased Sensitivity Increased symptoms Aching similar to DOMS

29. @Physiocouk #manchesterphysio facebook.com/physiocouk   Post Rx soreness? Causes The release of toxins/waste products from muscular tissue Neurological sensitisation Increased blood flow and micro trauma can lead to bruising and redness Advice Reassure the patient it's a normal response to be sore after soft tissue treatment Advise them to use ice (safely) Recommend they drink water to keep hydrated

30. @Physiocouk #manchesterphysio facebook.com/physiocouk   Indication for Rx Loss of mobility and range of motion Increased amounts of scar tissue and adhesions Increased tone of overactive muscles Poor quality of movement

31. @Physiocouk #manchesterphysio facebook.com/physiocouk   Specific Pathologies treated with myofascial release Whiplash associated conditions Fibromyalgia / Non- specific chronic pain Lower back pain Individuals with reduced ROM Postural Tension Reduced blood flow from trauma or post surgery Reduced immune system

32. @Physiocouk #manchesterphysio facebook.com/physiocouk   Contraindications for Rx Local Systemic Broken skin/Open cuts Cancer (Malignancy) Skin conditions Acute Circulatory disorders Haematoma Blood Thinning Medications (e.g. Warfarin) Healing Fracture Bleeding disorders (e.g. Haemophilia) Active infections Systemic Infection Obstructive Oedema Acute RA Advanced Diabetes

33. @Physiocouk #manchesterphysio facebook.com/physiocouk   Precautions to Rx Pregnancy Hypersensitivity Hyper or Hypo- tension Patient Anxiety or lack of communication during Rx Acute/ Inflammatory stage of healing

34. @Physiocouk #manchesterphysio facebook.com/physiocouk   Research Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety, Quality of Sleep, Depression, and Quality of Life in Patients with Fibromyalgia Castro-S anchez A, Guillermo A, Narrocha, Granero-Molina, Aguilera-Manrique,Quesada-Rubio J and Moreno-Lorenzo,(2011). Evidence based complementary and alternative Medicine.

35. @Physiocouk #manchesterphysio facebook.com/physiocouk   Research Systematic review including x10 studies Myofascial release - more of an ‘umbrella term’ 8/10 studies also used trigger point and PNF as part of their Rx techniques Findings: effective for reducing pain in some pathologies such as plantar fasciitis. Most effective when combined with exercise, strengthening and electrotherapy.

36. @Physiocouk #manchesterphysio facebook.com/physiocouk   Research Myofascial release therapy in the treatment of occupational mechanical neck pain: a randomised parallel group study. Rodríguez-Fuentes, I., De Toro, F. J., Rodríguez-Fuentes, G., de Oliveira, I. M., Meijide-Faílde, R., & Fuentes-Boquete, I. M. (2016). American Journal of physical medicine & rehabilitation , 95 (7), 507-515.

37. @Physiocouk #manchesterphysio facebook.com/physiocouk   Research Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals Ajimsha, M. S., Daniel, B., & Chithra, S. (2014). Journal of bodywork and movement therapies , 18 (2), 273-281.

38. @Physiocouk #manchesterphysio facebook.com/physiocouk   Practical

39. @Physiocouk #manchesterphysio facebook.com/physiocouk   Back Gliding Longitudinal stretch Longitudinal stretching + “wind ups” and positioning Skin Rolling

40. @Physiocouk #manchesterphysio facebook.com/physiocouk   Shoulder/ Upper Traps Stripping Isolated MFR over trigger points Supine UFT Circular motions Press and glide using thumb - longitudinal

41. @Physiocouk #manchesterphysio facebook.com/physiocouk   Lunch

42. @Physiocouk #manchesterphysio facebook.com/physiocouk   Quadriceps Gliding Longitudinal stretch Skin rolling Forearm stretch and roll

43. @Physiocouk #manchesterphysio facebook.com/physiocouk   Hamstrings Gliding Longitudinal stretch Skin rolling Stripping Tack and stretch

44. @Physiocouk #manchesterphysio facebook.com/physiocouk   Calfs Gliding Gliding on stretch Tack and stretch Forearm stretch and roll

45. @Physiocouk #manchesterphysio facebook.com/physiocouk   Glutes Side lying position with muscles on a stretch Towel for pt comfort and dignity Communication! Pin under great trochanter

46. @Physiocouk #manchesterphysio facebook.com/physiocouk   Treatments that work well alongside MFR

47. @Physiocouk #manchesterphysio facebook.com/physiocouk   Taping

48. @Physiocouk #manchesterphysio facebook.com/physiocouk   Trigger pointing/ Soft tissue release

49. @Physiocouk #manchesterphysio facebook.com/physiocouk   Exercise

50. @Physiocouk #manchesterphysio facebook.com/physiocouk   Foam Rolling

51. @Physiocouk #manchesterphysio facebook.com/physiocouk   Outcome measures Pain scores (VAS) (Pre/ Post) Muscle length / stretching / special testing Anxiety Levels Quality of Sleep (Quality of Sleep Index Questionnaire) Ability to complete ADL’s Quality of Life Questionnaire

52. @Physiocouk #manchesterphysio facebook.com/physiocouk   Case study 1 Subjective: 40 year old male reports 4/10 dull ache pain into lower back. No neurological symptoms or red flags. Aggs- desk based job. Eases- hot baths, lying down. 24hr- stiffness in AM. Objective: Anterior tilted pelvis Excessive lumbar lordosis Reduced range into lumbar flexion/ side flexion bilaterally Positive modified thomas test Tender to palpate on Lx paraspinals and quads.

53. Which myofascial release techniques could you use? What outcome measures could be used to check it is effective? Any other treatments alongside MFR? Case study 1

54. @Physiocouk #manchesterphysio facebook.com/physiocouk   Case study 2 Subjective: 25 year old female reports 5/10 dull ache pain into calves and hamstrings following an increase in the frequency of running while she is training for a marathon. No neurological symptoms or red flags. Aggs- running Eases- rest, heat and stretching. Objective: Posterior tilted pelvis. Reduced range into lumbar flexion Limited range into ankle dorsiflexion bilaterally Restrictive 90/90 hamstring length test 120 bilaterally.

55. @Physiocouk #manchesterphysio facebook.com/physiocouk   Case study 2 Which myofascial release techniques could you use? What outcome measures could be used to check it is effective? Any other treatments alongside MFR?

56. Thanks for coming! Don’t forget to follow us on Twitter: @physiocouk @Physiocouk #manchesterphysio facebook.com/physiocouk