Introduction of Myofacial Stretch Release Technique..

The myofascial release approach is a form of soft tissue therapy used to treat somatic dysfunction and resulting pain and restriction of motion.

History of Myo facial technique Andrew Taylor Still MD, DO (August 6, 1828 December 12, 1917)

Andrew Taylor Still

Andrew Taylor Still in 1914 Born August 6, 1828 Lee County, Virginia December 12, 1917 (aged 89) Kirksville, Missouri

Died

Citizenship US Nationality American Fields osteopathy, medicine

Institutions Baker University, A.T. Still University

Anatomy OF Fascia..

Fascia is the soft tissue component of connective tissue system that permeates the human body. It interpenetrates and surrounds muscle, bones, organs, nerves, bloodvesseles and other structures. Fasica is uninterrupted there dimensional web of tissue that extends from head to toe from front to back and also from interior to exterior. Its a term applied to masses of connective tissue large enough to be visible to unaided eye. Muscles with the help of its fascial binding supplies the tension that life gives to osseus frame work. Muscles and fascia are functionally linked combining the properties of Muscle trapezius Origin down the midline, from the external, the nuchal ligament, the medial part of the superior nuchal line, and the spinous processes of the vertebrae C7-T12 spinous processes ofthoracic T6T12,thoracolumbar Insertion Artery Nerve

at the shoulders, into transverse major nerve supply is retraction of s thelateral third of cervical the cranial nerve the clavicle, artery XI.cervical the acromion process nerves C3and C4 receive and into the spine of information about pain the scapula in this muscle

latissimus dorsi

floor of intertubercular grooveof

artery, dorsal

thoracodorsal nerve

pulls the forelimb d

fascia, iliac crest and the hummers inferior 3 or 4 ribs rhomboids nuchal ligaments, spinous processes of C7T5vertebrae medial border of the dorsal scapula scapular artery dorsal scapular nerve(C4 and C5)

Retracts the s to depress the fixes the scap wall.

rhomboid spinous processes of medial border of the dorsal major the T2to T5 vertebrae scapula, inferior to scapular the insertion artery of rhomboid minor muscle rhomboid nuchal minor ligaments andspinous processes of C7toT1 vertebrae medial border of the dorsal scapula, superior to scapular the insertion artery of rhomboid major muscle dorsal scapular artery

dorsal scapular nerve(C4 and C5)

Retracts the s to depress the also fixes the the thoracic w

dorsal scapular nerve(C4 and C5)

Retracts the s to depress the also fixes the the thoracic w

levator scapulae

posterior superior part tubercles oftransverse of medial border of processes of C1 scapula C4 vertebrae

cervical nerve (C3,C4) and dorsal scapular nerve (C5)

Elevates scap itsglenoid cav rotating scapu

Fascia in the body parts..

ROLE OF FASCIA IN BODY It is responsible for maintaining structural integrity. It provides support and protection. It acts as schok absorber and stabilizes helping our body to stand erect and move fluidly Facsia has an essential role in hemodynamic and bio-mechanical process and provides the matrix that allows for intercellular communication.

Fascia acts as the body first line of defense against pathogenic agents and infection. After injury it is the fascia that creates an environment for tissue repair. Fascia not only contributes contour to the body but also provides lubrication between structures for movement and nutrition

LAYERS OF FASCIA. There are three layers of fascia they are:A) Superficial fascia B) Deep fascia C) Visceral or sub serous fascia

Superficial Fascia :It is a general coating of the body beneath the skin made up of a loose areolar tissue with varying amounts of fat. The fibourus mesh filled with fat connects the dermis to the underlying sheet of deep fascia and particularly dense in scalp; the back of neck; the palms of hand and soles of the feet thus binding the skin firmly to the deep fascia. In addition to it sub-cutaneous prescence,this type of fascia surrounds organs and glands neurovascular bundles capillary channels and lymph vessels run through these layers.

Important Feautures of Superficial Myofascia. I. II. III. Superficial fascia is more distinct in lower part of anterior abdominal wall and limbs. It is very thin in dorsal aspects of hand ;feet and sides of neck Very dense in scalp palms and soles

Functions:I. II. III. Superficial fascia facilitates movements of skin. It serves as storage medium for fats and water. It serves as soft medium for the passage of vessels and nerves to the skin

Deep Fascia :It is the dense fibrous connective tissue that inter penetrates and surrounds the muscles ; bones; nerves and blood vessels of the body. It is the fibrous sheath which inserts the body beneath the superficial fascia. It is devoid of fat and usually inelastic and tough. It is continues with the fibires of superficial fascia and send wide partitions between muscles from its deep surface. Thus it ensheaths the muscels vesseles and nerves which lie between them. This sheath from a major part of attachment of many muscels for they pass deeply to become continues with the fascia which surrounds and tightly adherent to bones. Distribution :Deep fascia is best defined in limbs where it forms tough and sleeves and in neck where it forms a collar. It is ill defined in trunk and fascia. Important features :Fascia reacts readily by laying down collagen fibers parallel to any forces applied to it. Thus it becomes thickened

I.

Extension and prolongation of deep fascia formed a) A intramuscular septum which divides the limbs into compartments.

b) The fibro areolar sheath for the muscels and nerves.

II.

III. IV.

Thickenings of deep fascia a) Retinaculae of certain joints like wrist and ankel b) Palmar and plantar aponurosis for protection It provides connection and communication in the form of ligaments,tendons,aponurosis,joint capsule and septa. The deep fascia envelopes all bone,cartilage and blood vessels and become specialized in muscels and nerves.

Functions : Deep fascia keeps the underlying structure in position and preserve the characteristic surfaces contour of the limbs It provides extra surfaces for muscular attachments. It helps in venous and lymphatic return It assist muscels in there action by the degree of tension and pressure. It exerts upon there surfaces The retinaculae acts as pulleys and serve to prevent the loss of power.

Visceral fascia :Visceral fascia suspends the organs within the cavity and wraps them in layers of connective tissue membrane. Each organ is covered in a double layer are separated by a thin serrous membrane. The outermost wall of organ is the partial and skin of the organ is visceral layer. The organs have specialized names by visceral fascia i.e.. a) b) c) d) In brain known as meninges. In heart known as pericardia In lung known as plurea. In abdomen known as peritonea.

BIOMECHANICS OF FASCIA:The fascia one connected network from the fascia attached to the inner aspects of the skull to the fascia in the soles of feet there exists only one fascia structures. If any part of this deformed or distorted there may be negative stress imposed on distant aspects and on the structures which it divides, envelopes support and with which it connects. The musculoskeletal system the mechanical component of human machine compromising 60% of the masses of the body, exists in a state of structural and functional continuity between all of its hard and soft tissue and it the fascia that provides movement and continuity. Symbiotically functioning assortment of t issue comprising skin, muscles ,ligaments ,tendons neural structures vessel and lymph chnn els all given shape cohesion and functional ability by the fascia. A part its immense roll in the support structural organsation and motion of the body fascia is involved in numerous complex biomechanical activities. Connective tissue provides a supporting matrix for more highly organized structures and attaches extensively to muscles . It provides by its fiscal planes path ways for nerves vessels and structures. blood and lymphatic

Where the connective tissue is loose in texture it allows movement between adjecent structures. Deep fascia ensheaths and preserves characteristics contour of the limbs and promotes the circulation in the veins and lymphatic vessels. Superficial fascia allows for the storage of fat and also a surface covering which aids in conservation of body heat . It aids in repairs of injuries by deposition of collagenous fibers.

The ensheathing layer of deep facsia as well as inter muscular septa and interosstus membraine, provides vast surfaces areas used for muscular attachments. The histocytes of connective tissue comprise part of an important defense mechanism against bacterial invasion by their phagocytic activity. Fascia is not only a background structures with little function a part from its obvious supporting role, but is an tenacious connective tissue . Which is deeply involved in almost all of the fundamental processes of body structures function and metabolism.

PATHOMECHANICS OF

FASCIA.

Any mal function of fascia tissue due to trauma posture or inflammation can creative a binding down of fascia resulting in abnormal pressure on nerves muscles bones or organs. This can create pain or malfunction through out the body with bizarre side effects. Fascia surrounds infuses & protects every other tissue , tendon, muscel, bone Ligament & organ of the body. In healthy conditions the fascial system is relaxed and wavy in configuration . This provides a cushioning and support mechanism allowing us to move safely without restriction or pain. But in abnormal conditions the fascial system is tensed & can lead to pain & malfunction through out the body. Following and physical and emotional trauma & through poor posture fascia scars, and hardness is affected sited. This causes the fascial network to loose its cushioning mechanism and internal structures become pulled out of alignment. This inturn crates abnormal pressure crushing nerves blood & lymphatic vessels & further crating tension on adjacent pain sensitive structures and those along fascial pull. Any degree of degeneration however minor changes the bulk of the fascia modifies its thickness and draws into ridges in areas overlying deeper tension and rigidities. Sudden stress of fascial tissue will result in burning type of pain.

MYOLASCIAL CYCLE

Repetitive use Postural stress Exposure to cold Emotional tension

visceral disease Physical Trauma Structural inadequacies Un-co-ordinated movements

Muscle Strain

Pain

Retained Mobilities odema & Inflammation

Muscle Spasm

Vasoconstriction Ischemia

Sustained Contraction

Fibrous Reaction

Soft Tissue Contracture

Persistent joint and somatic dysfunctions

Myofascial conditions are triggered by many causes and can become self pre petuation cause of pain, spasm & joint dysfunction.

Trigger Points
Definition: Trigger Points are desecrating focal hyperirritable spots located in a taut band of skeletal muscles. They produce pain locally and in a referred pattern and often accompany chronic muscular skeletal conditions. Acute trauma or repetition micro trauma may lead to the development of stress on the fibers and the formation of trigger points. Patients may have riginol, persistant pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture such as those on the neck and shoulder and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus temporamandibulas joint pain decreased range of motion ion the legs and low back ache. Trigger points are usually associated with taut band a ropey thickening of muscles tissue. Typically a trigger points when pressed upon, will cause the pain to be felt. This is what considered as Referred pain . Types of Trigger Points:1) Active trigger points: - It is an area of extreme tenderness that usually lies within skeletal muscles and is associated with local / regional pain. 2) Lateral trigger points: - Its is an inactive area that has the potential to act like a trigger. 3) Secondary trigger points:-it is a highly irritable spot in a muscle that can become active due to a trigger point and muscular overload in another molecule.

4) Satellite trigger point: - It is highly irritable spot in a muscle that becomes inactive because the muscle is in the region of another trigger point.

Development of a Trigger Point:Trigger points develop as a results of muscular injuries, strains and trauma. Additionally structural imbalance body mechanism, poor nutrition or mental and emotional stresses are the factors. When muscle fibers fascia ligaments or tendons become weakened over stretched or inflamed tiny tears in the associated soft tissue can occur. As the tissue heals it contracts becoming twisted and knotted. These knotted fibers restrict the fresh blood supply needed by the muscle cells. In addition there is often shortening of a muscle fiber to protect itself from further injury.

A etiology
Stress cause lot of physiological abuse over the body which gives lots of muscular and skeletal problems and one of such common problems is development of trigger points and these trigger points are hall-mark clinical features of myofascial pains. The main causes of common myofascial pain are:1. 2. 3. 4. Muscular injury or trauma to musculo skeletal system. Exscenine strain on a particular limb or a group of muscles. Poor postures. Mall positioning | mal adjustments | poor bio-mechanics. E.g.:- sleep position, bicycle seat, running, jogging, etc. 5. Repetitive stress or over use injuries. 6. Prolonged constriction of soft tissue. 7. Ligamentous injury to interverisal disc. 8. Generalized fatigue. 9. Lack of physical activity. 10.Nutrition or vitamins deficiencies.

11.Nervous tension or stress. 12.Infection and allergies. 13.Psychological factors such as depression anxiety and tension.