Manual Therapy and Myofascial Techniques

Vocabulary flashcards covering manual therapy principles, trigger points versus tender points, palpation techniques, Swedish massage strokes, and myofascial release methods.

Manual Therapy

The application of skilled hands-on techniques to treat and improve the status of neuromusculoskeletal conditions by affecting the body neurologically and mechanically.

Plastic Deformation

The mechanical alteration of connective tissue achieved through manual therapy application to break down adhesions and improve flexibility.

Direct Techniques

Manual therapy maneuvers that load or bind tissue and structures by directing the treatment force at the point where tissue mobility is limited (e.g., stretching, joint mobilization, and trigger point release).

Indirect Techniques

Manual therapy maneuvers that apply treatment forces to move tissue away from the direction of limitation or barrier to help tissue relax and allow more motion (e.g., positional release therapy / strain-counterstrain and muscle energy).

Inhibit (Corrective Exercise Continuum)

The first step in the Corrective Exercise Continuum (CES), which utilizes myofascial techniques to reduce overactive tissue tension.

Lengthen (Corrective Exercise Continuum)

The second step in the Corrective Exercise Continuum (CES), which employs static stretching, neuromuscular stretching, and dynamic stretching to improve tissue extensibility.

Activate (Corrective Exercise Continuum)

The third step in the Corrective Exercise Continuum (CES), focused on isolated strengthening to re-educate and engage underactive tissues.

Integrate (Corrective Exercise Continuum)

The fourth step in the Corrective Exercise Continuum (CES), which uses integrated dynamic movement to restore coordinated functional movement patterns.

Tender Points

Neurological areas of pervasive tenderness and global hyperalgesia with no palpable tissue texture changes or electromyographic (EMG) abnormalities, which do not produce referred pain upon palpation and are unresponsive to local treatment.

Trigger Points (TrPs)

Foci of hyperirritability within tissue (most commonly myofascial) that are locally tender upon compression and give rise to characteristic referred pain patterns, tenderness, autonomic phenomena, and distortion of proprioception.

Taut Band

A hypertonic group of muscle fibers containing a trigger point nodule that demonstrates a decreased threshold to stimulation and contracts first, but inefficiently, during voluntary movement.

Active Trigger Point

A trigger point that is constantly tender and produces referred pain whether the muscle is active or inactive, accompanied by muscle weakness, reduced motion, and a local twitch response upon palpation.

Latent Trigger Point

A trigger point that is painful only upon direct palpation, harbors a taut band that displays a twitch response, and can be reactivated when muscle stress is induced.

Tonic Muscles (Janda)

Postural muscles identified by Janda as prone to tightness or hypertonicity (such as the upper trapezius, levator scapulae, sternocleidomastoid, scalenes, and quadratus lumborum) that commonly harbor active trigger points.

Histopathological Hypothesis of Trigger Points

A model stating that continuous $\text{Ca}^{++}$ release produces sustained sarcomere contraction, leading to localized ischemia that prevents $\text{ATP}$ entry and results in an energy crisis.

Neuroelectrical Pathology Hypothesis of Trigger Points

A model proposing that low-level stress causes excessive leakage of acetylcholine across the motor end plate, triggering sustained $\text{Ca}^{++}$ release from the sarcoplasmic reticulum and localized muscle fiber activation.

Spontaneous Electrical Activity (SEA)

End plate noise detected via electromyography ($\text{EMG}$) in trigger points, believed to result from excessive acetylcholine release and motor end plate dysfunction.

Flat Palpation

A palpation technique where finger pads move across muscle fiber orientation while compressing against an underlying bony structure, useful for trapping trigger points in broad, flat muscles or deep muscles like the diaphragm and psoas major.

Snapping Palpation

A technique where a rigid finger performs a brisk transverse pluck across a taut band while maintaining surface contact, used on superficial long muscles (such as the erector spinae and rectus abdominis) to elicit a local twitch response.

Pincer Palpation

An assessment technique where the thumb and a rigid finger assume a C shape to pinch and roll target tissue between the fingers, assessing for taut bands and a local twitch response.

Local Twitch Response

A transient, involuntary contraction of muscle fibers elicited when a trigger point is provoked by mechanical stimulation such as snapping or pincer palpation.

Effleurage

A Swedish massage stroke using flat hands and fingers gliding smoothly over the skin from distal to proximal toward the heart to relax muscle, reduce pain, and relieve edema.

Pétrissage

A Swedish massage stroke performed mid-massage where fingers flex at metacarpophalangeal ($\text{MCP}$) joints to lift and knead skin and underlying tissue, improving tissue mobility, circulation, and relaxation.

Friction (Massage)

A Swedish massage technique using small cross-section or circular motions with finger pads, thumb pads, or elbows to break adhesions and soften scar tissue.

Tapotement

A Swedish massage stroke consisting of rhythmic percussive tapping or gentle slapping using cupped hands or relaxed fingers to release fluid blockages or stimulate afferent nerves.

J-Stroke

A myofascial release technique using a finger or thumb pad to apply downward pressure and pull the skin in a J-shaped curve over underlying tissue to relieve restricted fascial and scar adhesions in small, localized areas.

Oscillation (Myofascial Technique)

A myofascial technique where one or both cupped hands move back and forth over muscle in a rhythmic rolling motion to relax muscle spasms.

Wringing

A myofascial technique where both hands simultaneously move in opposite directions, applying deep-tissue force to move underlying structures against each other and release multidirectional restrictions.

Stripping

A deep-tissue myofascial release technique where one hand anchors tissue while the other hand, forearm, or elbow applies downward and forward force to release adhesions of scar tissue or adherent fascia.