1/2/2013 Journ Journey to y to Healt Health 1. Everything is connected! ATC, CMT CMT Kate P Kat Peck ATC, 1113 Washi 1113 Washingt gton Stre Street Newton wton, MA MA 0214 02146 (508) 508) 245-29 245-2922 Myofascial Release and Connective Tissue Soft Tissue Approaches in the Treatment of Athletic Injuries Kate Peck ATC, LAT, CMT Types of Connective Tissue 1. Everything is connected! • Blood 2. Look at the bigger picture! • Lymph 3. What role does the fascia • Bone play in injuries? • Cartilage 4. What injuries/conditions can be helped • Tendons by myofascial release? • Ligaments 5. What role do ‘myofascial chains’ have on • Joint capsules the treatment of injuries? • Fascia • Nerve sheaths 6. Feel for the “snag”! • Blood vessels 7. Treating the “snag”. 1
1/2/2013 Components of Connective Tissue Components of Connective Tissue • Cells • Fibers • Fibers - Collagen fibers - Elastin fibers • Ground Substance • give fascia its extensibility • may stretch to 150% of resting length without tearing Components of Connective Tissue Components of Connective Tissue • Ground substance • Cells – Intercellular fluid in all connective tissue – Fibroblasts – Made up of: – Mast cells • Water – Macrophages • GAGs – Hydrophilic glycoaminoglycans – keep the ground substance fluid, preventing adhesions – Plasma cells • Hyaluronic acid – keeps ground substance viscous (jelly-like) – The proportion of these 3 components determines the consistency of the ground substance, more gelatinous or more liquid. Components of Connective Tissue Components of Connective Tissue • Fibers • Ground substance - Collagen • In fascia it has the consistency of egg whites • tough • It is how the fascia is nourished • very little ability to stretch • provides lubrication so fibers slide over one another • fibers unwind but do not stretch • keeps the spatial relationship between the fibers to • provide the tensile strength & resiliency keep them from adhering to one another. • disperses shock - Elastin 2
1/2/2013 Why are we talking about all the different kinds of connective tissue? • To understand the concept that the tissue is 2. Look at the bigger picture! continuous from the periosteum of the bone to the tendon, to the muscle belly, back to tendon and back to periosteum. Why are we talking about all the different kinds of connective tissue? • When we evaluate injuries with this concept of a “fascial net”, we need to evaluate the body as an interconnected • And that the tissue is whole. continuous from the periosteum of the bone • An injury in one area of the body can be to the ligament & joint the result of a “snag” in the fascial net capsule, and back to somewhere else in the body. periosteum. • The problem may not be where the pain is! Why are we talking about all the different kinds of connective tissue? • Therefore, there is a “fascial net” made up 3. What role does the fascia of all the different play in injuries? kinds of connective tissue that connects us from head to toe and from superficial to deep. 3
1/2/2013 What is Fascia? Superficial Fascia • Strolling Under The Skin • It surrounds every tissue and organ in the body including muscle, bone, nerves, arteries & veins. Three Layers of Fascia Three Layers of Fascia • Superficial • Superficial • Deep - also called the Investing fascia. • Deep – surrounds and supports all of the organs of the body • Deepest – surrounds muscle group (ie. quadriceps) – surrounds each muscle (epimysium) – surrounds the fascicles within each muscle (perimysium) – surrounds each muscle fiber (endomysium) • Deepest Three Layers of Fascia Deep Fascia • Superficial – lies directly under the skin. • Muscle Attitudes video – is highly elastic & flexible. – The majority of pain sensors are found here. • Deep • Deepest 4
1/2/2013 Three Layers of Fascia • Superficial • Deep • Including – makes up fascial structures such as retinaculum, aponeuroses, ITB, lumbodorsal fascia, palmar fascia, nerves planter fascia, etc. – has more collagen fibers and less ground substance so is dense. – fiber orientation is multidirectional so can respond to multidirectional stresses. • Deepest Three Layers of Fascia • Superficial • Deep arteries • Deepest – forms the dural membrane that surrounds the brain & spinal cord. – It is continuous with the fascia of the body. – we work with this in craniosacral therapy. • Restrictions in the fascia can and veins effect every other tissue and organ in the body. 5
1/2/2013 A word about immobilization . . . An orthopedic surgeon wrote that normally when...one opens a thigh to remove fascia for surgical procedure, • Releasing the restrictions in one will be struck by the smooth surfaces of contact the fascia can improve the between the fascia and the underlying muscle and that these surfaces fairly glisten and are not adherent....On function of every other tissue the other hand, when one opens a thigh that has been at rest, either in a cast or in a splint, or as a result of rest in and organ in the body. bed, one finds that the fascial surfaces, as well as the surface of the underlying muscle, is dull and does not glide; often times many small adhesions have formed between the muscle and fascia. - Ralph K. Gormley, 'The Abuse of Rest in Bed in Orthopedic Surgery', J.A.M.A., August 19, 1944 Fascial Dysfunction • Results in: – Formation of adhesions Fascial Dysfunction – Dehydration / thickening of the ground substance – resulting in fibers being closer together, so more likely to form adhesions. Fascial Dysfunction Myofascial Release (MFR) • Common causes: – Trauma (sudden or cumulative) Myofascial release: – Postural misalignment – Breaks up adhesions – Patterns of repetitive overuse, underuse, or misuse – Changes the viscosity of (liquifies) the ground – Illness/disease substance. – Immobilization – Aging 6
1/2/2013 Myofascial Release (MFR) Myofascial Release (MFR) • Indications: – Area of muscle feels tight & restricted. • Cautions: – Muscle group or compartment feels tight & – Lymphedema – need specific training restricted. – Advanced osteoporosis – Skin is “stuck down”. – Advanced diabetes – History of an old injury and still has decreased – Hemophilia or anticoagulant therapy ROM and/or pain. – Restricted ROM without specific injury. – Decreased power or strength Myofascial Release (MFR) Myofascial Release (MFR) • Indications: • Local Contraindications: – Painful movement. – Open wounds or burns – Cast is removed. – Sutures – After surgery. – Hematoma – Visible scars in the area of complaint or the – Localized infection myofascial chain. – Suspected or healing fracture – Palpable thick, adhered, and/or fibrous tissue. – Tumor – Series of overuse injuries in one fascial chain. Myofascial Release (MFR) • General Contraindications: 4. What injuries/conditions can – Malignancy be helped by myofascial release? – Aneurysm – Acute rheumatoid arthritis – Systemic infection – fever, cellulitis 7
1/2/2013 Superficial Back Line • After the acute phase of any injury – Splinting/holding • Plays a major role in – Compensatory patterns maintaining posture & creating extension in the • Itis’s body. – Tendinitis/Tendinosis • Conditions involving the – Bursitis SBL: – Plantar fasciitis, achilles’ – Fasciitis tendonitis, chronic • Pain hamstring tightness & hamstring tendonitis, – Neck pain chronic low back strain, chronic neck strain & – Back pain headaches. – Joint pain Superficial Front Line • Functions to balance the SBL & maintain the 5. What role do ‘myofascial general flexion tension of the body. chains’ have on the • Conditions involving the treatment of injuries? SFL: – Tibial stress syndrome, patellar tendonitis, pubic symphysitis, head forward posture & headaches. Myofascial Chains Lateral Line • Functions to create a lateral bend in the body – lateral • The anatomic connective tissue links flexion of the spine, abduction among muscles, bones, and fascial of the hip, eversion of the foot. membranes that go from head to toe. • Important in treating left side- right side imbalances. • Conditions involving the LL: – IT band syndrome & headaches. 8
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