THE EFFECTIVENESS OF SOFT TISSUE MANIPULATION OR MYOFASCIAL RELEASE, TRIGGER POINT

Kredit to our friends NOOR SYAFIQAH BT. SHAMSAIMON, SITI HASMAH BT. JOHARI, NUR NAZIHAH BT. ABR RAHIM and NUR SYAZWEEN BT. MOHD NASEERUDDIN while studying in UiTM. Bachelor of Physiotherapy, 2008-2013.^^

Definition Massage

Massage means to  touch, softly press, squeeze, rub , handle or knead with the hands.

– Massage is the application of force to the soft tissue without producing any movement or change in the position of the joints

therapeutic massage” applies to all method  and forms of massage, since provide all therapeutic benefits to the receiver.

– “massage therapy” defined as use of ( predominantly) hands to physically manipulate the body’s soft tissue for the purpose of effecting desirable change in the individuals.

– “relaxation massage” seeks to relax the patient, improve general wellbeing and reduce mental stress and general body tension.

– “remedial massage” is the application of more advanced technique of treatment and assessment for neuro-musculoskeletal dysfunction.

– The primary aim of remedial massage is to restore or promote motion and reduced or prevent pain.

General physiological effects

– Promote local and systemic relaxation and invigoration.

– Improvement the vascular and lymphatic circulation

– Regulation of the nervous system

– Reduction of muscular tension.

1- EFFLEURAGES

Technique: Stroking of the skin. Performed with the palm of the hand or knuckles to stimulate deep tissues , or with fingerpads to stimulate sensory nerves.

Superficial stroking

– Follow the contour of the body it self or follow the direction of the underlying muscles.

– Does not attempt to move underlying muscles.

Deep stroking

– Requires more pressure to target and elongate the muscle fibre and stretch fascia.

2- petrissages

– Technique:Lifting, kneading and rolling of the skin, subcutaneous tissue and muscles with fingers or hands.

– Its similar to myofascial skin rolling technique, but petrissage targets the underlying muscles.

– Petrissage free adhesion by stretching and separation muscles fibre, fascia and scar tissue.

3- Tapotement

– Technique: Gentle tapping or pounding  of the skin.

– Most common form of tapotement, “hacking”, use the ulnar side of the wrist to contact the skin

– Its performed with the wrist and fingers limp so that the hand more or less slaps the skin.

– Tapotements :Promote muscular and systemic relaxation.

– Tapping: promotes relaxation and desentization of irritated nerve endings.

4- Friction Massage

– There are two basic type of friction massage :-

– Circular

– Cross-fibre (transverse friction massage )

– Circular friction massage is applied with the thumbs working in circular motion and its often effective in the treatment of muscle spasm.

– In transverse friction massage, the thumb or finger tips stroke the tissue from opposite direction.

Friction massage mobilise muscle fibre and separate adhesion in muscles, tendon fibre or scar tissue that restrict motion and cause pain.

5- Vibration

– Technique:  Rapid shaking of the tissue

– Serves to soothe peripheral nerves and promote muscular relaxation

MYOFACIAL RELEASE

MYOFACIAL RELEASE

MFR can be classified as a combined direct and indirect manual technique, which applies the principles of biomechanical loading of soft tissue and the neural reflex modifications by stimulation of mechanoreceptors in the fascia.

1- Fascia and muscle

– Fascia forms interconnected networks that connects and surrounds muscle, tendons, nerves, and separate the skin and adipose tissue from the underlying muscle.

Myofascial release involves traditional effleurage, pétrissage, and friction massage strokes with simultaneously stretching of muscles and fascia.

– To obtain relaxation of tensed or adhered tissues and restore tissue mobility.

– The basic  MFR techniques involves:

  x- pulling the tissues in opposite direction

  x- stabilizing the proximal or superior position with one hand and apply stretch  with the opposite hand.

  x- using the patient body weight to stabilize extremity  while longitudinal stress is apllied.

– No structured pattern

MYOFASCIAL TECHNIQUE

HOW DOES IT WORK?

– By breaking the adhesions and restoring fascia length.

– Fascia will elongate when a slow,  moderate-intensity force is applied to it, an effect referred as ‘creep’.

– The gentle and sustained pressure of myofascial release supply mechanical & thermal energy will

x- converts ground substance into gel state

x- facilitate sliding movement of collagen & elastin fibers

x- freeing up fascia that may be impeding blood vessels or nerves

TRIGGER POINT

Definition

– Myotherapy.

– A technique by applying pressure to “trigger point” (painful irritated area in muscle).

– To break the cycle of muscle spasm and relief the pain.

– Finger, knuckle or elbow.

– Moderate to heavy pressure cause the pain to initially decrease.

– Then, as the muscle relaxes, the pain will fade.

– Pressure should be applied slowly and also released slowly.

– The pressure should be maintained until there is a change in pain.

– Methods: ischemic compression, trigger point compression.

 

Physiological Effect of Trigger Point

– The chemical/pressure cycle is interrupted

– Help to stop the contraction and the pain in the muscle

– The pressure inhibit the pain cycle by blocking transmission of pain signal

– Help to increase the circulation and remove the metabolic waste product

– The muscle fiber become stretched and lengthened which result in sacromere elongates and release actin myosin element to stop the sustained muscle fiber contraction

– Hence, it reduce the pain, increase the ROM and allow the muscle to lengthen.

EVIDENCE BASED STUDY 1

Title: Lower back pain and sleep disturbances are reduced following massage therapy
( Field, T., Hernandez-Reif, M., Diego., M. & Fraser, M.)

Problem  :  Chronic low back pain and sleep disturbances.

Aims  :  To evaluate massage therapy vs. relaxation therapy   effects on chronic low back pain

Objectives  :  To reduce the pain, depression, anxiety, and sleep   disturbances, for improving trunk ROM and for reducing   job absenteeism.

Groups  :  Randomly divided into two groups ; massage and   relaxation group.

Sessions  :  30 minutes, twice a week for 5 weeks.

Participants : 30 adults ( 14 women) with low back pain duration of at   least 6 months.

– Averaged 41 years of age.

– Exclusion criteria : Back pain due to fracture vertebrae, degenerated or herniated disc. Patients who had undergone surgery for their back pain. Patients with sciatic nerve involvement.

Discussion

– The massage participants reported less depressed mood.

Massage therapy is more effective than relaxation therapy for reducing pain and anxiety, and for improving mood.

– Pain was lessened and less disturbed sleep by the end of study.

– Immediate increase in the measures of the trunk flexion with and without pain after the first and last session.

Limitations of the study :

– Ensuring the control participants actually practiced muscle relaxation.

– Small sample size and lack of long term follow up assessment.

Conclusions:

Massage therapy effectively reduce pain, sleep disturbances and the anxiety and depressed mood states associated with lower back pain.

EVIDENCE BASED STUDY 2

Massage therapy helps to increase ROM, decrease pain and assist in healing a client with low back pain and sciatica symptoms.
Bell., J (2008)

Problem  :  Low back pain and sciatica symptoms

Objectives  :  To evaluate the effectiveness of massage therapy   as a component in increasing ROM, decreasing   pain and assisting in healing of a client with low   back pain (LBP) and sciatica symptoms.

Subject/s  :  58 year old healthy female presented with an insidious   onset of LBP and pain that radiated into the right lower   extremity (sciatica). Experience the pain daily for the past 9   months.

Sessions  :  Once a week, each session lasted 45 min and consisted   of a structured protocol directed mainly toward   muscles of the lumbar spine, pelvis, thigh and leg   regions.

Results  :  Massage therapy was effective at reducing Low Back Pain intensity and   increasing Range Of Motion.

Discussion

 – This study might support the idea that massage helped to assist the healing of tissues in this client due to increase in ROM.

– Massage therapy in this study was successful in increasing the client’s lumbar ROM as well as reducing the client’s LBP and overall pain.

– Other factors may contributed such as spinal manipulation (used before study), physical therapy (used during study) and diaphragmatic breathing and the stretching techniques.

– Limitations in this study :

¤The use of a therapy other than massage,

¤The use of specific massage techniques

¤The use of only one subject

¤Lack of control group

– Conclusions :

Different techniques and stretches used during this study have the possibility of becoming useful interventions for reducing/ eliminating pain and sciatica symptoms associated with LBP.

EVIDENCE BASED STUDY 3

The effect of myofascial release (MFR) on an adult with idiopathic scoliosis
LeBauer, A., Brtalik, R., Stowe, K. (2008)

Problem  :  Spinal curvature progression in adolescents with   idiopathic scoliosis.

Objectives  :  To measure the effects of MFR as a manual therapy   technique in the treatment of idiopathic scoliosis.

Methods  :  18 year old female underwent 6 weeks of MFR   treatment. Each week, 2 sessions. Pain, pulmonary   function, and QOL were measured. Six goniometry   measurements were taken encompassing trunk   flexion, extension, and rotation.

Results  :  Results suggest that further investigation is needed   using MFR , as an effective manual therapy   treatment for idiopathic scoliosis.

Discussion

MFR uses gentle pressure and stretching to facilitate the release of fascial restrictions caused by accidents, injury, stress, repetitive use, and traumatic or surgical scarring.

– Pressure is sustained for a minimum of 90-120s.

– This is the only research that utilizes only manual therapy techniques in the treatment of idiopathic scoliosis.

Conclusions:

¤The subject improved with pain levels, trunk rotation, posture, QOL and pulmonary function.

EVIDENCE BASED STUDY 4

Locating and treating low back pain of myofascial origin by ischemic compression
Hains, G. (2002)

Aim: To describe a method to identify and treat trigger points of myofascial origin by ischemic compression among patients with LBP.

– Thumb pressure is used for the identification, localization and treatment of trigger points and tender spots within the muscles of the lumbar, pelvic, femoral and gluteal areas.

– Significant effects reported by patients, is soreness/ stiffness. Rarely some minor bruising in the area being treated.

Ischemic compression is a safe and effective method to treat elicited trigger points or tender spots.

Effective in treatment of fibromyalgia, shoulder pain and gastro esophageal  reflux disease.

EVIDENCE BASED STUDY 5

Fascial release effects on patients with non-specific cervical or lumbar pain
Tozzi, P., Bongiorno, D., & Vitturini, C. (2010)

  • Manual fascial techniques are generally incorporated in treatment protocols to release fascial restrictions and restore tissue mobility.

 – Objectives :  a)   To assess by dynamic US screening, the change of sliding   movements between superficial and deep fascia layers in   the neck, in people with non specific NP, before and after   application MFT.

b) To evaluate ‘if’ and ‘at what degree’ pain perception may   vary in patients with NP or LBP, after MFTs are applied over   the short term.

Conclusions:

¤MFTs are effective manual techniques to release area of impaired sliding facial mobility, and to improve pain perception over a short term duration in people with non specific  CERVICAL or LBP.

 

REFERENCES

¨Starkey, C. (2004), Therapeutic Modalities, 3rd ed., F. A. Davis Company: Philadelphia

¨Houglum P. A., Therapeutic Exercise for Musculoskeletal Injuries, 3rd ed., 2010 page 167-170

¨Casanelia, L., Stelfox, D., foundation of massage, Elsivier australia, 2009 page 1-2

¨Sinha, principle of practice of therapeutic massage , jaypee brother publisher, 2001 , page 1

¨Fielda T., Hernandez-Reifa M., Diegoa M., Fraserc M., Lower back pain and sleep disturbance are reduced following massage therapy. Journal of Bodywork and Movement Therapies (2007) 11, 141–145

¨http://carolinasportsclinic.racesonline.com/index.cfm?fuseaction=site.display&page_id=4299

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