Myofascial release technique(MFR).pptx

This is most widely used manual technique which is widely used nowadays in as advanced rehabilitation processes. it is used in several conditions like stroke, cardiovascular disorders,to release diaphragm muscles,to release muscle tightness,to decrease spasticity,to increase range of motions of joints etc.

1. SUBMITTED BY-KHUSHBOO ANJUM MPT 1 ST SEMESTER,NEUROLOGY. MYOFASCIAL RELEASE SCHOOL OF HEALTH SCIENCE C.S.J.M.UNIVERSITY KANPUR A DEFINITION B INDICATIONS CONTRAINDICATIONS PRECAUTIONS PHYSIOLOGY C TECHNIQUES D REFRENCES

2. CONTENTS . WHAT IS MFR? DEFINITIONS WHAT IS FASCIS? PHYSIOLOGY CAUSES OF SOFT TISSUE DYSFUNCTIONS EFFECTS-PAIN/SLEEP/QUALITY OF LIFE INDICATIONS CONTRAINDICATIONS PRECAUTIONS EXAMINATION TECHNIQUE TECHNIQUE BY ARTICLES REFRENCES

3. WHAT IS MYOFACIAL 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 Myofascial Release (MFR) is a holistic, therapeutic approach to manual therapy, popularized by John Barnes, PT, LMT, NCTMB. MFR offers a comprehensive approach for the evaluation and treatment of the myofascial system, the system of tissues and muscles in the body. This technique is designed to release restrictions such a trigger points, muscle tightness, and dysfunctions in soft tissue that may cause pain and limit motion in all parts of the body. It has shown success in decreasing pain and increasing mobility.  (1)

4. DEFINITION

5. DEFINITION “ Myofascial release is a manipulative treatment that attempts to release tension in the fascia due to trauma ,posture ,or inflammation. Connective tissue called fascia surround the muscles ,bones,nerves , and organ of the body .Points of restriction in the fascia can place a great deal of pressure on nerves and muscles causing chronic pain” . Spine-health.com

6. WHAT IS FASCIA? Fascia is a layer of fibrous tissue that surrounds groups of muscles , bone , blood vessels and nerves. It binds some structures together ,while permitting other structures to glide smoothly over each other . Fascia are dense regular connective tissues, containing closely packed bundles of collagen fibres oriented in a wavy pattern parallel to the direction of pull .

7. PHYSIOLOGY Neuromotor controls and the central nervous system- The thixotropy theory

8. CAUSES OF SOFT TISSUE DYSFUNCTION Congenital factors (short/long leg, small hemipelvis, short upper extremity, fascial, cranial and other distortions) ● Overuse, misuse and abuse (and disuse) factors (such as injury or inappropriate patterns of use involved in work, sport or regular activities) ● Postural stresses ● Reflexive factors (trigger points, facilitated spinal regions) ● Chronic negative emotional states (anxiety, repressed anger, etc.) ● Nutritional deficits ● Toxic accumulations ● Infection ● Endocrine (hormonal) imbalances

9. EFFECTS MFR techniques affect the continuous, contiguous, connective tissue system, which envelops every cell and fiber in the body. ● The goal is to relieve fascial restrictions and to normalize the health and tension of this body system. ● At the cellular level, MFR affects the elastacollagenous complex as well as the consistency of the ground substance. ● MFR increases soft-tissue flexibility and relieves tissue tension while decreasing the density and viscosity of the ground substance, thus increasing the metabolic rate and improved metabolism and health

10. EFFECTS

11. EFFECTS Myofascial release have greater effects in releasing upper trapezius TrP with significant reduction in neck pain and improved neck movements as compared to spray and stretch technique and there would be minimal chances of early recurrence of TrP after about 3 days of receiving it.

12. INDICATIONS . ● Primary intervention for neuromusculoskeletalfascial impairments ● Secondary intervention for joint dysfunction, muscle fiber dysfunction, fascial dysfunction, neuronal dysfunction, periosteal and bone dysfunction, and circulatory dysfunction ● Positive findings with myofascial mapping ● Decreased fascial glide or compromised mobility ● Joint hypomobility ● Soft tissue tension ● Postural deviations ● Dynamic limitations in range of motio n

13. INDICATIONS . Current trials have shown that MFR may promote wound healing by affecting the extracellular matrix.(1 ) Myofascial Release Therapy on the Cardiorespiratory Functions in Patients With COVID-19.(Myofascial release techniques of the neck, thoracic, and diaphragm, along with respiratory physiotherapy, could immediately affect heart rate and ease of breathing and prevent increasing diastolic blood pressure. If a patient with COVID-19 is stable, pulmonary physiotherapists may consider using these techniques while monitoring cardiopulmonary function.)(3) Chronic low back pain(5)

14. contraindications MFR, although passive, can be a direct or indirect intervention. MFR, therefore, is not suitable for patients of all ages and conditions. The physician must reconsider treatment if the patient has:(1) Healing fractures Advanced diabetes Severe osteoporosis Rheumatoid arthritis Malignancy Aneurysm NOT IDEAL FOR (4) with burns, injuries, or painful wounds with fractures or broken bones with fragile or weak bones with deep vein thrombosis or deep vein issues taking blood-thinning medications

15. PRECAUTION S . ● Systemic disorder ● Malignancy ● Nonunion fracture ● Cardiopulmonary impairment, such as congestive heart failure

16. VIDEOS . https://youtu.be/xw3j1OANkjQ

17. VIDEOS . https://youtu.be/xw3j1OANkjQ

18. EXAMINATION Myofascial examination: ● Three layers of fascial glide are assessed, including skin on superficial fascia, deeper layers of fascia, and (3) mobility of soft tissue on bone. ● Tissues are palpated for mobility, flexibility, and freedom of tissue glide. ● Mobility is assessed in three planes: (1) superiorly-inferiorly, (2) medially-laterally, (3) clockwise-counter clockwise. ● If fascial glide is tight, hypomobile, or inflexible, document findings on the body diagram; MFR is indicated.

19. TECHNIQUES A variety of tools including the fingers, elbows , knuckles, forearms and, less frequently, the thumbs can be employed.

20. THE FINGERS Always keep the fingers slightly flexed with the wrists in a neutral position. Keep a slight arch at the MP joints as well as at the carpal tunnel. Correct: the wrists are in neutral and the fingers are in a slightly flexed position. https://youtu.be/DWnlfN6YBsI

21. INCORRECT WAY CORRECT - The wrists are flexed while the fingers are hyperextended with excessive force at the MP joints

22. TOOLS

23. TECHNIQUE BY ARTICLE Direct MFR for the TMJ        With the patient in a supine position: Sit at the head of the table and gently hold the mandible with one hand and the opposite mandible with your other hand; Gently abduct the mandible, holding a firm and static force at the barrier until tissue release finishes; Slowly rotate the mandible and move it into additional abduction, keeping the steady force at the barrier until tissue release finishes; Gently adduct the mandible while keeping external rotation, applying steady force at the barrier until tissue release finishes; Slowly restore the mandible to a resting position and reassess the TMJ in motion for checking engagement Nahian A ; Unal M; Mathew J;Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction ;SEPT17,2021.

24. TECHNIQUE BY ARTICLE 1. 2. 3. 4. Suboccipital release The physiotherapist raised his fingertips toward the ceiling and placed his hand just below the occiput, creating pressure to release the tissues in this area. The therapist then applied gentle traction between the occiput and the atlas Anterior thoracic myofascial release and sternal release The physiotherapist placed one hand under the patient’s head, just below the occiput, and held it between his thumb and forefinger, creating support in this area. The therapist’s other hand rests on the sternum, with the middle finger on the midline of the sternum and the heel of the hand just below the sternal joint. Distraction moves the fascia and sternochondral joints away from each other, and the pressure was maintained until the tissue was released Anterior cervical myofascial release The physiotherapist placed one hand on the lower angle of the jaw and the other hand just below the lower edge of the clavicle. The therapist exerted a downward force on the lower edge of the clavicle and an upward force on the jaw for both sides. This pressure was maintained until the tissue was released . Diaphragm release The patients were asked to lie on their backs and relax their limbs. The physiotherapist stood beside the patient’s bed, placing one hand on the diaphragm level exerting gentle pressure, while the other hand was placed under the patients’ trunks, parallel to the upper hand. The pressure was maintained until the tissue was released

25. TECHNIQUE BY ARTICLE 1. 2. 3. 4.

26. T HE LOWER EXTREMITY .

27. TENSOR FASCIA LATA . PATIENT’S POSITION- Sidelying with lower leg flexed to 30° at the hip and knee. The upper leg is supported on the lower leg but with less flexion at the hip and knee. The lumbar spine is in neutral THERAPIST POSITION- Standing behind the client at the level of their waistline and facing forward. TECHNIQUE- Locate the muscle, anterior to the gluteus medius . Use an elbow to sink into it until an obvious barrier to any more depth is encountered. Wait without increasing the pressure. If another layer becomes available, follow it down and wait once again. When there is an obvious and sustained tone change, add a line of tension and move slowly in an inferior direction. The movement across the surface might only be 2–3 cm. MOVEMENTS- Anterior–posterior tilt of the pelvis with direction. ‘Take your tailbone away toward the wall in front of you’ as an example of posterior tilt.

28. GASTROCNEMIUS PATIENT POSITION- Prone, with feet off the end of the table to allow for easy dorsiflexion. THERAPIST POSITION- Work from a stool for technique number 1. Face toward the feet while standing or sitting at the client’s side, at around mid-thigh level, for technique number 2. TECHNIQUE-1. Use an elbow flexed to 90° and take up a contact in the tendo Achilles. Establish a line of tension in a superior direction. Tether the tissue while the client dorsiflexes. Focus the release at the junction of the tendon and the muscles .

29. SOLEUS PATIENT’S POSITION- Prone with feet off the end of the table to allow for easy dorsiflexion. Use a bolster to induce 10–15° of knee flexion and put the gastrocnemius off stretch. THERAPIST POSITION- Sit on a stool at the end of the table, facing towards the head. Standing is also acceptable. TECHNIQUE- Use an elbow or fingers to sink into the tendo Achilles. Sink slowly through the tendon into the investing layer of fascia that lies between the soleus and the gastrocnemius. Take up a line of tension in a superior direction and tether the tissue while the client dorsiflexes.

30. ANTERIOR COMPARTMENTINTEROSSEUS MEMBRANE PATIENT POSITION- Sidelying with upper hip and knee flexed, and supported by a pillow. THERAPIST POSITION- Standing at the foot of the table. TECHNIQUE - Use an elbow with 90° of flexion and begin above the malleolus of the fibula.Glide proximally 2–3 inches at a time between the tibia and fibula. Superficial fascia can be treated more quickly – the interosseus membrane will respond to slow, steady contact. Encourage the client verbally to fully allow the weight of the treated leg into the table .

31. PLANTAR MYOFASCIAE PATIENT’S POSITION- Prone with feet off the end of the table to allow for easy dorsiflexion. THERAPIST POSITION- Sitting on a stool at the end of the table. TECHNIQUE- Use the knuckles, soft fist or elbow to engage the soft tissue just anterior of the calcaneus. Take up a line of tension in an anterior direction.Work progressively through to the ball of the foot as well as into deeper layers in subsequent passes . MOVEMENT- Have the clientlift their toes, with direction – ‘Lengthen the bottom of your foot by taking your toes up under the table towards your knee cap’.Dorsiflexion can also be used in this .

32. REFRENCES 1 Nahian A ; Unal M; Mathew J;Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction ;SEPT17,2021. Fareeda Shaheen Shah. (2020). EFFECTS OF MYOFASCIAL RELEASE AND VAPOCOOLANT SPRAY WITH STRETCH TECHNIQUE ON UPPER TRAPEZIUS TRIGGER POINTS.  Pakistan Journal of Rehabilitation ,  5 (2), 43–48. Retrieved from http://ojs.zu.edu.pk/ojs/index.php/pjr/article/view/803 3) Fereydounnia S, Shadmehr A, Tahmasbi A. Efficacy of Myofascial Release Therapy on the Cardiorespiratory Functions in Patients With COVID-19. jmr. 2022;16(1):77-84. 4) https://www.healthline.com/health/chronic-pain/myofascial-release#risks 5) Wu Z; Wang Y; Myofascial release for chronic low back pain: A Systematic review and meta-analysis; 2021 JULY. 6) . Dutton, Mark. Orthopaedic examination, evaluation, & intervention. New York : McGraw-Hill, c2004 pages 331-332, 1218 Stanborough M;Direct Release Myofascial technique;1ed;2004