Dermomyofascial Restoration. The ProSport Academy Therapist Mentorship Dave O Sullivan

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1 Dermomyofascial Restoration The ProSport Academy Therapist Mentorship Dave O Sullivan

2 Dermomyofascial Restoration Includes: 1. Dermomyofascial Testing 2. Dermomyofascial Restorative Mobilisations

3 Dermomyofascial Testing

4 What is it in a nutshell? Has replaced Manual Muscle Testing in my system and the new thought process brings an easy to change system with long term results because we are focusing on the clients nervous system output versus muscles Easily understandable with easy to implement changes, no hocus pocus bullsh*t Is an important part of Dermomyofascial Restorative Output

5 Traditional MMT Applied Kinesiology and other manual muscle testing techniques use various concepts and techniques. Go to various points in the body and use various options with no real clear common sense approach or very limited evidence. Essentially it is the ability of the nervous system to give a motor output on demand. If the nervous system does not give a desirable output then we need to ask why? What has to happen for it to give a normal output?

6 Understanding Dermomyofascial Testing To understand Dermomyofascial Testing (and MMT), we need to understand the physiology of the muscle contraction, i.e the process of the nervous system allowing an appropriate motor output. We need to understand and be aware of the implications of the nervous system providing protective tension to the body. Dermomyofascial testing is simply a method to detect nervous system protection, nothing more!

7 Key Components Excitability - Receive & Respond To A Stimulus Conductivity - Receive A Stimulus & Transmit A Wave Of Excitation (Electrochemical Activity) Contractility - Fibres Engage When Stimulated Extensibility - Ability To Be Lengthened Elasticity - Ability Return To Original Legnth

8 Don t Waste Too Much Energy Worrying About This Too Much, It Is Hard To Influence Directly

9 This, On The Other Hand Is Much Easier To Influence

10 Physiology of the Muscle Contraction An impulse for a motor DIRECTION and NOT a specific muscle is generated in the brain (INTENTION) Descends the spinal cord and arrives at the muscle by passing along the motor nerves via the gamma fibres.

11 The gamma circuit excites the intrafusal contractile fibres of the muscle spindles. When these contract, they stretch the annulospiral terminations, which are coiled around them, as well as the connective tissue in which they are innervated.

12 The contraction of these fibres is insufficient to exert a force on the tendons but it does propagate a stretch along the connective tissue structure. Due to the conformation of the muscle, a part of this stretch propagates towards the inelastic tendon and a part goes along the fascia towards a centre of coordination, which is elastic and adapts to the stretch.

13 The adaptation of the fascia to this stretch allows the muscle spindle to shorten and the primary spindle afferents are excited. These convey impulses via Ia fibres to the motorneurone pool and from here, secondary motor efferents part via the alpha fibres in the direction of the muscle. This secondary efferent stimulus activates the extrafusal fibres, or the voluntary muscle fibres.

14 The contraction causes articular movement, which stretches the joint capsule and the receptors. A second afference then parts from the fascial centre of coordination, arrives at the spinal cord and ascends to the brain, conveying information that the programmed movement has taken place in the periphery.

15 Regulation of movement would not be possible without these circuits, especially considering all of the possible movement variables combinations for any given movement. These reflex adaptations are organised within the myofascial units according to tensional adjustments (This is the reason that muscle spindles, ruffini corpuscles and golgi tendon organs are sensitive to stretch).

16 Golgi Tendon Organs Consist of a mesh of collagen fibres entwined in series with muscle fibres along with a part of nerve axon arranged in spiral form. According to the direction of the muscular traction these spirals rotate around themselves compressing the nerve or they open themselves out and don t provoke any nerve discharge.

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19 Isometric Contraction Of Gastrocnemius Gastrocnemius Tendon

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22 So Practically What Do You Need To Understand? TENSION and DIRECTION of superficial and deep fascia precede a muscle contraction output When we Muscle Test we are essentially applying a minimal stretch of the deep fascial system and asking for an appropriate motor output response that happens with a normal physiological muscle contraction Practically; placing a muscle in a shortened position, applying a stretch stimulus which should respond with an appropriate muscle contraction. I.e can the contractile units overcome the muscle slack in the system.

23 + Intention Locally; force in a certain direction depends on Fascia To Elongate & Direct The Force Contractile Parts Of The Muscle To Overcome Muscle Slack And Send Energy To Tendon

24 Hamstring With Fascia Unable To Lengthen

25 Hennemann s Size Principle Hennemann s size principle states that under load, motor units are recruited from smallest to largest. In practice, this means that slow-twitch, low-force, fatigue-resistant muscle fibers are activated before fasttwitch, high-force, less fatigue-resistant muscle fibers.

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27 Normal Motor Output

28 Co-activation between muscles Hennmann s size principle appears to work with coactivation also

29 Pain (or nociception) Changes EVERYTHING

30 *Conduction Velocity Not Affected

31 Reduced Motor Output

32 Is the reduced motor output RELEVANT to the patients STORY and/or the TRUE DRIVER! Is the direction of force altered and hence the reduced motor output here a result and not a cause Is there a reason for the reduced motor output here? Higher threshold motor units may be recruited during the painful contraction to maintain force.

33 ? Different Motor Units Take Up The Work Load Higher threshold motor units may be recruited during the painful contraction to maintain force.

34 Hypertonic Motor Output

35 Hypothesis 1 Hypothesis 2 Adapted From Kylie Tucker, Private Seminar, 2016 Hypothesis 1 = Hypertonic Motor Output;? Long Standing Adaptations Hypothesis 2 = Decreased Motor Output In A Specific Direction;? Acute Strategy OR Extreme Strategy

36 Dermomyofascial Testing Outputs Efficient Output: Portrays Car Pedal Brake Qualities To Meet Your ADAPTING RESISTANCE & DIRECTION, not handbrake testing, is able to excite and inhibit output on demand to tension as happens in gait. Protective Output: Nervous system has caused protective tension elsewhere to the body causing a secondary inhibition of the dermomyofascia area of the body (physiological criteria unable to be met to elicit an appropriate muscle contraction output). Hypertonic Output: Nervous system has caused a HANDBRAKE output, extreme protection displaying reversible hypertonia qualities similar to spastic muscles or mild lower motor neuron disease.

37 Hypertonic Output Hypertonic Outputs are the jokers in the pack! These outputs will essentially be the reason your rehabilitation exercises are not effective at making fast changes. Want fast changes in motor output then need to address the hypertonic outputs first and foremost.

38 Hypertonic Muscles Muscles need to inhibit also to allow a balanced axis of rotation Hypertonic Muscles are Unable to Inhibit On Demand Due To Normal Physiological Response => Compression instead of Tension/Stretch of the Skin/Fascia Just Prior to Muscle Contraction Should Disrupt the Normal Physiological Response => If it doesn t then we potentially have decreased elasticity of the tissues due to perceived threat of the nervous system

39 Practical Tips For Assessing Hypertonicity Compress the skin in the direction of the muscle fibres and retest,? increasing muscle slack Retest again but even lighter pressure Change amplitude of movements

40 Restoring Hypertonic Outputs Lederman (2015) A Process Approach In Manual And Therapies: Beyond The Structural Model

41 When To Restore Hypertonic Output? Lederman (2015) A Process Approach In Manual And Therapies: Beyond The Structural Model

42 How To Restore Hypertonic Output Find a direction of tension of the connective tissues that allows the nervous system to restore the correct motor output for the action.

43 Restoring Efficient Motor Output Start With The Skin Stretch And Then Progress To Deeper Fascia Directional Tension

44 Restoring Efficient Motor Output The Direction of Tension That Normalises The Physiological Output Is The Direction of Force We Will Apply While Encouraging Normal Motion Of The Joints (Reducing The Threat). Start With The Skin Stretch And Then Progress To Deeper Fascia Directional Tension

45 Inflammatory substances travels between the skin and deep fascia - Assess skin directions first and encourage movement with joint to reduce threat - For both joints and over muscles to help the indirect effect Deep fascia between muscle intersections to reduce threat and allow coordination of muscles and normal physiological output to remain. (Inhibition is essentially a response to nervous system protection/threat - You know how to reduce this threat!)

46 Practical Example of Hypertonic Dermomyofascial Restoration

47 Questions?

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