MFR & Soft Tissue (Coleman)

Learning Objectives

  • Discuss muscle and fascia responses to myofascial release and soft tissue techniques.

  • Understand mechanics behind these techniques.

  • Examine principles of performance and differences/similarities between techniques.

  • Review contraindications and indications for both techniques.

Preparatory Material

  • Review prior materials:

    • Osteopathic techniques overview.

    • Lecture on myofascial release.

    • ACA and member manual sections on soft tissue and myofascial release.

    • Fascia and integrity video lectures.

  • Remember osteopathic principles:

    • Body Unity: Body as a unit of body, mind, and spirit.

    • Self-Regulatory and Self-Healing: Body can heal itself with assistance.

    • Structure and Function: Structure is interrelated with function; rational treatment based on understanding these principles.

Muscle Composition

  • Muscle structure consists of:

    • Cylinders of fascicles made of myofibrils, composed of myofilaments.

    • Tissues are linearly oriented with fibers aligned in specific directions.

Definitions

  • Hypertonic: Tissues are shortened/tight.

  • Hypotonic: Tissues are slack/loose.

Biomechanics of Techniques

  • Tissues can be plastic (permanent deformation) or viscous (temporary deformation).

  • Myofascial release induces muscle or fascial creep over time, resulting in changes:

    • Strain applied gradually can reveal a point of maximal ease.

    • Additional stress after easing induces a further change in fascia.

Elastic vs Plastic Model

  • Elastic Model: Temporary changes; returns to original shape after force removal.

  • Plastic Model: Permanent shape change; remains altered after force is removed.

Treatment Techniques

Direct Techniques

  • Engage restrictive barrier across three planes.

  • Examples include:

    • Muscle Energy: Techniques using the patient's muscle effort.

    • High-Velocity, Low-Amplitude (HVLA): Quick force through the barrier.

    • Articulatory Techniques: Low-velocity, high-amplitude movements.

Indirect Techniques

  • Move away from the restrictive barrier to a point of ease; facilitates ease of movement.

  • Examples include:

    • Counterstrain: Positioning to alleviate discomfort.

    • BLT (Balanced Ligamentous Tension): Gentle balance of tension.

Myofascial Release

  • Diagnosis and treatment system using palpatory feedback for somatic dysfunction.

  • Can be direct or indirect; monitors tissue movement to achieve release.

Soft Tissue Technique

  • Direct approach involving:

    • Lateral stretching, deep pressure, traction.

    • Monitoring tissue response through palpation.

    • Typically more focused on specific muscles.

Functional Differences

  • Myofascial Release: Can address multiple types of fascia, including connective tissue inside bones.

  • Soft Tissue: Focused on hypertonic muscles or areas with excessive tension.

Activating Forces

  • Use of patient’s breathing to facilitate movement or ease tension.

  • Gentle springing or vibratory motions can assist in tissue mobilization.

Techniques in Lab

  • Overview of key techniques to be practiced:

    • Parallel Traction: Stretching in line with muscle fibers.

    • Perpendicular Traction (Kneading): Manipulation against muscle fibers.

    • Direct Inhibitory Pressure: Applying pressure to relieve hypertonic muscles.

Indications for Techniques

  • Myofascial Release:

    • Global treatment for multiple fascial types.

    • Can prepare tissues for additional manipulation types.

  • Soft Tissue:

    • More targeted, focusing on hypertonic muscles.

    • Commonly used prior to HVLA techniques.

Contraindications

  • Absolute:

    • Lack of patient consent.

    • Absence of somatic dysfunction diagnosis.

  • Relative:

    • Fractures, open wounds, infections, tumors.

    • Clinical judgment needed for treatment decisions.

Safety and Recovery

  • Techniques are generally safe but should not apply excessive force to damaged tissues.

  • Post-treatment reactions may occur 1-3 days later, akin to mild exercise soreness.

  • Recommendations for recovery include:

    • Hydration, rest, warm baths, gentle movements.

    • Avoid strenuous activities, focus on maintaining mobility.

Conclusion

  • End on a positive note with a presentation image of Bryce Canyon National Park in winter.

  • Importance of being prepared for upcoming lab sessions.

Muscle Composition

  • Muscle structure consists of:

    • Cylinders of fascicles made of myofibrils, constructed from myofilaments consisting of actin and myosin.

    • Tissues are organized linearly, with fibers precisely aligned in specific orientations according to their functional roles, enhancing contraction efficiency.

Definitions

  • Hypertonic: Defines states where tissues exhibit excessive tightness or shortening, often resulting in pain or limited movement.

  • Hypotonic: Refers to conditions where tissues are excessively loose or slack, potentially leading to instability and weakness in movement.

Biomechanics of Techniques

  • Tissues can exhibit two behaviors:

    • Plastic: Characterizes tissues capable of permanent deformation, altering their structure over time.

    • Viscous: Indicates tissues that can undergo temporary deformation, allowing the tissue to return to its original state after force application.

  • Myofascial release encourages gradual muscle or fascial creep over time, facilitating changes such as:

    • Strain applied gradually can reveal a point of maximal ease, resulting in muscle relaxation.

    • Additional stress beyond this point may further modify the fascia, enhancing flexibility and functionality.

Elastic vs Plastic Model

  • Elastic Model: Describes temporary changes that occur when a force is applied, with tissues reverting to their original shape once the force is removed.

  • Plastic Model: Represents a permanent change in shape, where tissues retain their altered form even after the force is no longer applied.

Treatment Techniques

Direct Techniques

  • Aim to engage a restrictive barrier across three planes and may include:

    • Muscle Energy: Techniques that require the patient’s own muscle effort to facilitate a stretch or mobilization of the targeted tissue.

    • High-Velocity, Low-Amplitude (HVLA): Quick, precise force delivered through the barrier, often resulting in an audible release or pop.

    • Articulatory Techniques: Involve low-velocity and high-amplitude movements to improve range of motion.

Indirect Techniques

  • Focus on moving away from a restrictive barrier to find a point of ease, promoting natural movement; examples include:

    • Counterstrain: Positioning the body to relieve discomfort without direct pressure on tender points.

    • BLT (Balanced Ligamentous Tension): A gentle manipulation aimed at rebalancing the tension across ligaments to restore mobility.

Myofascial Release

  • A diagnostic and treatment methodology employing palpatory feedback to identify and rectify somatic dysfunction.

  • Can be executed via direct or indirect methods, consistently monitoring tissue movement to achieve optimal release for the patient.

Soft Tissue Technique

  • A direct approach focusing on techniques such as:

    • Lateral stretching, deep pressure, and traction.

  • Involves close monitoring of tissue response through palpation to ensure effective treatment outcomes.

Functional Differences

  • Myofascial Release: Capable of addressing multiple types of fascia, encompassing visceral and somatic tissues, including connective tissue within bones.

  • Soft Tissue: Prioritizes focus on hypertonic muscles or localized areas of excessive tension, promoting relaxation and increasing blood flow.

Activating Forces

  • Employing the patient’s breathing rhythm as a critical facilitator for enhancing movement or alleviating tension.

  • Gentle springing or vibratory motions may assist in mobilizing tissues to support recovery and health.

Techniques in Lab

  • Overview of key techniques to be practiced during lab sessions includes:

    • Parallel Traction: Stretching performed in line with muscle fibers to promote elongation.

    • Perpendicular Traction (Kneading): Manipulation involving motion against the direction of muscle fibers, enhancing tissue flexibility.

    • Direct Inhibitory Pressure: Focused application of pressure to relieve tight or hypertonic muscles, facilitating relaxation.

Indications for Techniques

  • Myofascial Release: Suitable as a global treatment for various fascial types; may prepare tissues for further manipulative approaches.

  • Soft Tissue: Employed in targeted applications, emphasizing hypertonic muscles and frequently used prior to HVLA techniques to optimize patient readiness.

Contraindications

  • Absolute:

    • Lack of patient consent for treatment.

    • Absence of a confirmed diagnosis of somatic dysfunction.

  • Relative:

    • Comorbidities such as fractures, open wounds, ongoing infections, or tumors necessitate clinical judgment to guide treatment decisions.

Safety and Recovery

  • Treatment techniques are generally safe but must refrain from applying excessive force on compromised tissues.

  • Post-treatment reactions, similar to mild exercise soreness, may occur 1-3 days later; recommendations for recovery include:

    • Adequate hydration, sufficient rest, warm baths, and gentle movements.

    • Patients should avoid strenuous activities while focusing on maintaining mobility throughout recovery.

Conclusion

  • The session concludes with a positive reflection on the importance of effectively implementing these techniques in practice, reinforced with visual inspiration from Bryce Canyon National Park in winter.

  • Emphasizes the necessity of being well-prepared for upcoming lab sessions and engaging in ongoing education to enhance skill set.