Myofascial Release Techniques Overview (04:12)
Dr. Michael Higgins will lecture and Dr. Patty Ponce will demonstrate, assisted by Natalie Senese, Mary Nadelen, and Sherry Drysdale. Lecture objectives are to define MFPS and MFTrP and understand their clinical presentation; define fascia layers; and perform treatments.
Myofascial Pain Syndrome and Trigger Point (02:23)
Hear definitions for MFPS and MFTrP. Points may be active or latent.
What is Fascia? (02:54)
Fascia is a strong connective tissue surrounding and isolating muscles, and providing support and protection. It is a product of mesenchyme, which develops in embryo and forms bone, cartilage, and lymphatic system components. Fascia forms superficial, deep, and subserous layers.
Fascia Layers (03:29)
Superficial fascia may be mixed with fat, depending on location. Deep fascia covers muscles in connective tissue bundles and can create tight knots acting as trigger points. Subserous fascia lies between deep fascia and major organs; it can form fibrous knots.
Fascia like Muscle? (00:44)
Research shows fascia can contain actin and myosin, and may be contractile tissue rather than inert connective tissue.
Myofascial Pain Syndrome and Release (Barnes) (02:23)
Myofascial means "fascia related to the muscles," and involves deep fascia. John Barnes theorizes that trauma and inflammation create myofascial restrictions, pain, and a disease process.
MFPS (Barnes) (02:44)
Trauma and inflammation dehydrate fascia. It becomes rigid; compresses muscles, nerves, and blood vessels; and produces pain and pressure. Myofascial release releases the cross-links and rehydrates the ground substance, decreasing restriction.
Myofascial Trigger Points (02:13)
Trigger points are tender when pressed and can cause referred pain, motor dysfunction, and autonomic phenomena. Active trigger points are hypersensitive and display continuous pain in the zone of reference—defined as the area of perceived pain referred from the trigger point.
Associated and Latent Trigger Points (01:32)
Secondary trigger points become active due to synergistic substitution or overworked muscles from primary trigger points. Latent trigger points do not cause spontaneous pain, are tender when palpated, and may restrict movement and predispose the area to injury.
Myofascial Restriction Pathology (02:04)
Myofascial restriction imbalances muscle length, which alters muscle force and leads to neurological adaptations and improper posture and mechanics. Trauma also imbalances muscle length.
Clinical Characteristics (01:47)
Learn about biochemical, neurological, and radiological changes caused by trigger points. Muscle biopsies show increased muscle fiber diameter.
Local Myofascial Tissue (02:20)
Hypotheses for trigger point etiology include: local myofascial tissue, the central nervous system, and biomechanical factors. There is spontaneous electrical activity in TrP, which comes from dysfunctional motor end plates—the neuromuscular junction where the motor neurons contact the target.
Vicious Cycle (01:44)
Trigger points compress local nerves, reducing nerves inhibiting Ach release, depleting local ATP supply, and decreasing energy and oxygen compression of blood vessels. View an energy crisis diagram. The energy crisis releases bradykinins, serotonin, histamine, prostoglandins, and substance P chemical mediators.
Myofascial Feedback Loop (01:03)
An acidic pH stimulates bradykinin production during local ischemia and inflammation perpetuates pain in patients with active trigger points. Substance P and calcitonin release locally in response to nociceptor activation, repeating the process.
Central Nervous System (00:46)
Abnormal impulse generating sites (AIGS) and sustained muscle contractions sensitize the CNS. These events can act as multipliers in trigger point pathogenesis. Myofascial release aims to decrease chemical activity around trigger points.
Biomechanical Factors (00:55)
Trauma or repetitive microtrauma leads to postural dysfunction, increasing the load in surrounding muscles and causing satellite TrPs.
Autonomic Phenomena (00:34)
Autonomic phenomena during myofascial release include skin vasoconstriction or vasodilation, pilometer response, sweating, or the same referral region as the pain pattern for a given TrP.
MFPS Signs and Symptoms (00:56)
View a list of trigger point pain symptoms. There are generally no neurological deficits associated with MFP except in cases of nerve entrapment syndrome.
Localized tenderness indicates the presence and severity of MFP. Palpating the active trigger point will alter pain in the zone of reference. This can occur immediately or after seconds.
Differential Diagnosis of Myofascial Trigger Points (01:33)
Characteristics include sudden onset with overload stress or gradual onset with chronic overload; characteristic referral pattern; possible weakness and restriction; a taut band in the affected muscle; pain reproduction by pressure on the TP; and symptoms eliminated with the proper treatment.
MFPR Indications and Contraindications (00:30)
Indications include pain, postural and alignment dysfunction, muscle spasm, muscle imbalance, and decreased blood flow. Contraindications include malignancy or aneurysm, anticoagulant or steroid cortisone therapy, obstructive edema, systemic fever, open wounds, and localized infection.
Myofascial Release (Barnes) (02:54)
Approach the patient slowly and use gentle but firm touch. Stretch out the elastic and muscular component as the first release. The collagenous barrier requires 90 to 120 seconds to soften, and multiple layers of fascial restrictions require three to five minutes.
Treatment Techniques (00:45)
Direct techniques start at the collagenous barrier and move away while indirect techniques start at the barrier and move deeper. Techniques include longitudinal release, oscillation, stripping, wringing, TP pressure release, and press and stretch.
Treatment Adjuncts and Referral (02:55)
Treatment adjuncts include "seek and destroy," ice and stretch, and manual therapy. Home exercise programs include trigger point pressure, foam rollers, stretches and postural exercises. If the trigger points do not resolve, the team physician can use injections or medications.
Longitudinal Release (07:13)
Dr. Patty Ponce demonstrates starting at the trigger point and lengthening away along the muscle. This increases blood flow to the area. Using an ice cup reveals the trigger point through blanching. View footage of students practicing the technique.
Rectus Femoris Release (03:04)
Dr. Ponce shows where the trigger point occurs on the rectus femoris and vastus medialis. She recommends using skin-on-skin contact and powder when using the longitudinal release technique.
Quadratus Lumborum (05:23)
Dr. Ponce recommends using the Travell and Simons approach of gradual pressure. She demonstrates releasing a latent trigger point on the lower back using a stretch and press technique.
Piriformis Release (02:50)
Dr. Ponce demonstrates using the pressure release technique to release a trigger point with her thumb pads. A student demonstrates using her elbow.
Oscillatory Release (02:31)
Dr. Ponce demonstrates using the oscillation technique to release the piriformis trigger point. View footage of students practicing the technique.
Stripping and Wringing (06:25)
Dr. Ponce discusses using the "spray and stretch" technique to cool pain pathways; an ice cup will also work. She demonstrates stripping and wringing techniques to release a trigger point on the calf.
Spray and Stretch (06:44)
Dr. Ponce demonstrates using the spray and stretch technique to release trigger points on the levator scapulae and upper trapezius muscles. View footage of students practicing the stripping and wringing techniques.
Credits: Myofascial Release Techniques (00:23)
Credits: Myofascial Release Techniques
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