SRP $14.95 AUS PHYSIO A PRACTITIONER S GUIDE TO THERAPY

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1 P H Y S I O _ R O L L E R _ P H Y S I O _ R O L L E R SRP $14.95 AUS PHYSIO ROLLER A PRACTITIONER S GUIDE TO MYOFASCIAL THERAPY C Copyright 2007 AOK Health Pty Ltd w w w. a o k h e a l t h. c o m

2 INTRODUCTION This booklet introduces you to Physio Roller applications in the context of myofascial releases, explaining how the use of Physio Roller encourages heating of ground substance, changes in intercompartmental pressure, and changes in length-tension relationships in the myofascial unit. The myofascial Physio Roller applications are linked back to the key principles of observation, assessment and corrective strategy developed by the Australian Graduate School of Health & Sport Science for their ICE (Integrated Corrective Exercise) and Myofascial Therapy programs. In these programs corrective strategies and preferred techniques are the focus of the treatment protocols. The majority of the courses are again of a practical nature with ongoing assessment throughout the program. MYOFASCIAL TREATMENT Its History The term myofascial was used by Dr Janet G. Travell in the 1940s referring to musculoskeletal pain syndromes and trigger points. In 1976 Dr. Travell began using the term Myofascial Trigger Point and in 1983 published the famous reference Myofascial Pain & Dysfunction: The Trigger Point Manual. Some practitioners use the term Myofascial Therapy or Myofascial Trigger Point Therapy referring to the treatment of trigger points, this is usually in the medical clinical sense. In this booklet the term Myofascial Release refers to soft tissue manipulation techniques using Physio Rollers. Myofascial release here refers to the Physio Roller techniques for stretching the fascia and releasing bonds between fascia and integument, muscles, and bones, with the goal of eliminating pain, increasing range of motion and balancing the body. Fascia is located between the skin and the underlying structure of muscle and bone. It is a seamless web of connective tissue that covers and connects the muscles, organs, and skeletal structures in our body. Muscle and fascia are united forming the myofascia system. Injuries, stress, inflammation, trauma, and poor posture can cause restriction to fascia. Since fascia is an interconnected web, the restriction or tightness to fascial occurring at one point, with time, can spread to other places in the body like a pull in a sweater. The goal of myofascial release is to release fascia restriction and restore its tissue health. 2 A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

3 OUTLINE OF TREATMENT PROTOCOLS The amount of force applied (a proportion of your body weight) when using a Physio Roller lets you divide the techniques into 2 basic groups. DIRECT MYOFASCIAL RELEASE The direct Myofascial Release method works directly on the restricted fascia. By applying a higher proportion of your body weight you are seeking changes in the myofascial structures by stretching, elongation of fascia, or mobilising adhesive tissues. This may be painful as the force you apply moves slowly through the layers of the fascia until the deep tissues are reached. INDIRECT MYOFASCIAL RELEASE The indirect method, or gentle stretch method, is where the pressure is in a few grams, only allows the fascia to unwind itself. The gentle traction applied to the restricted fascia will result in heat and increased blood flow in the area. The intention is to allow the body s inherent ability for self correction to return, thus eliminating pain and restoring the optimum performance of the body. Copyright 2007 AOK Health Pty Ltd 3

4 FASCIAL FACTS Fascia is made of Collagen Fibres These are constructed primarily of the fibrous protein collagen. Collagen molecules are secreted into the extracellular space, where they assemble spontaneously into cross linked fibres. Collagen fibres are extremely tough and provide high tensile strength (white fibres). Elastin Fibres These are formed from elastin which is a fibrous protein. Elastin has a randomly coiled structure that allows it to stretch and recoil like a rubber band. It gives fascia a rubbery or resilient quality (yellow fibres). Recticular Fibres These are fine collagenous fibres and are continuous with collagen fibres.they branch extensively, forming delicate networks that surround small blood vessels and support the soft tissue of organs. Ground Substance This is an unstructured material that fills the space between the cells and contains the various fibre types. It is composed of cell adhesion proteins which act as a connective tissue glue allowing connective tissue cells to attach themselves to the matrix elements. Protoglycans which consist of a protein core to which glycosaminoglycans are attached. These attachments trap water forming a substance that varies from fluid to a semi-stiff hydrated gel. The ground substance holds fluid and functions as a molecular sieve, or medium, through which nutrients and other dissolved substances can diffuse. Cells Each major class of connective tissue has a fundamental cell type that exists in immature and mature forms. 4 A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

5 FASCIA Connective Tissue Profile GROUND SUBSTANCE hydration, fluid/gel consistency COLLAGEN FIBRES tensile strength ELASTIN FIBRES stretch and recoil RETICULAR FIBRES delicate collagen networks CELLS determine cell type Copyright 2007 AOK Health Pty Ltd 5

6 SKELETAL MUSCLE Skeletal muscle is a type of striated muscle, attached to the skeleton. Skeletal muscles are used to facilitate movement, by applying force to bones; via contraction. They generally contract voluntarily (via nerve stimulation), although they can contract involuntarily. Muscles have an elongated, cylindrical shape, and are multinucleated. The nuclei of these muscles are located in the peripheral aspect of the cell, just under the plasma membrane, which vacates the central part of the muscle fiber for myofibrils. This unique arrangement of the nuclei allows for higher efficiency. Skeletal muscles usually have one end (the origin ) attached to a relatively stationary bone, (such as the scapula) and the other end (the insertion ) is attached across a joint, to another bone (such as the humerus). MUSCLE is an organ FASCICLE is a portion of muscle MUSCLE FIBRE multinucleate elongated cell MYOFIBRIL (FIBRIL) complex organelle composed of bundles of myofilaments MYOFILAMENT extended macromolecular structure composed of contractile proteins A thin myofilament contains actin molecules A thick myofilament contains myosin molecules 6 A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

7 THE MYOFASCIAL UNIT The myofascial unit, the muscle and surrounding fascia (connective tissue). The fascia wraps the muscles into sections and forms muscle groups. FASCIA MUSCLE & FASCIA interwoven myofascia FASCIA covers the muscle (epimysium) covers the fascicle (perimysium) covers the fibre (endomysium) MUSCLES located in fascial compartments connect to bones through forms of fascia - tendon and periostium MYOFASCIA interactive and communicative pathway Copyright 2007 AOK Health Pty Ltd 7

8 MYOFASCIAL CONTINUUM One Muscle Many Fascial Compartments PROFILE THE MYOFASCIAL CONTINUUM impacts the following systems Integumentary Skeletal Muscular Nervous Endocrine Cardiovascular ONE MUSCLE one muscle in 600 or more fascial compartments FASCIA houses the muslces MUSCLES do not move bones, periostial attachments do! MUSCLES react quickly to the nervous system FASCIA has a slower reaction Lymphatic Respiratory Digestive Urinary Reproductive We are interwoven, interconnected, we are one. 8 A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

9 MYOFASCIAL PAIN MODEL Movement, loading and imbalances can cause trauma and injury to the myofascial unit. This causes the fascia to become distorted, resulting in reduced mobility, pain, skeletal malalignments, and compression of nerves and blood vessels. Copyright 2007 AOK Health Pty Ltd 9

10 FOAM ROLLER APPLICATIONS PRINCIPLES As fascia covers muscles, muscle tone directly affects the tightness of fascia. Pressure on the myofascial unit causes lengthening of the muscle. This then reduces the muscle tone and tightness of the fascia, resulting in a healthier myofascial unit A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

11 THE THREE KEY PRINCIPLES OF MYOFASCIAL APPLICATIONS O A C BSERVATION Ability to gather information relative to physical appearance of the client SSESS Investigate your observation through appropriate musculoskeletal assessments ORRECTIVE STRATEGY The result of skillful observation and appropriate assessment creates a pathway for corrective myofascial applications OAC = CLIENT SAFETY OBSERVATION CORRECTIVE ACTIVITY REPEAT THIS CYCLE REGULARLY Copyright 2007 AOK Health Pty Ltd 11

12 THE ROLL AROUND The Roll Around is designed to be an exercise sequence that anyone can do to release common trigger points in the myofascial unit. SACRUM to OCCIPUT SEGMENTAL LATS & TERES (right) SEGMENTAL LATS & TERES (left) 12 A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

13 THE ROLL AROUND TENSOR FASCIAE LATAE (right) RECTUS FEMORIS (right & left) TENSOR FASCIAE LATAE (left) PIRIFORMIS (right) PIRIFORMIS (left) HAMSTRING (right & left) GASTROC/SOLEUS (right & left) Copyright 2007 AOK Health Pty Ltd 13

14 THE ROLL AROUND SACRUM TO OCCIPUT OBSERVATION Observe your client in standing. Do you see any changes in the spinal curvature? The thoracic spine needs to be able to extend to maximise shoulder flexion and reduce the risk of shoulder impingement/capsule pathology. With client in a standing position ask them to raise their arms above their head through the sagittal plane. Return them to start position and ask them to repeat it whilst you place your index and middle finger on the thoracic spine T4-7. Does the thoracic spine extend in shoulder flexion in sagittal plane? CORRECTIVE STRATEGY Position the client supine on the Physio Roller. The occiput and sacrum should be on the Foam Roller. Place the hands interlocked supporting the cervical spine. Initiate transverse plane motion (gently). Work 0-60 sec A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

15 THE ROLL AROUND SEGMENTAL MOTION OBSERVATION Observe your client in standing (anterior, posterior, & lateral), do you see any changes in the spinal curvature? The thoracic spine segments should be able to move in the sagittal plane. While observing the thoracic spine assess the motion of the spine segments. As your client raises their arms can you see any regions of restriction in the thoracic spine? CORRECTIVE STRATEGY Position client supine on the Physio Roller. Place the Physio Roller targeting the restricted segments of the thoracic spine. Work through the thoracic spine to ensure sagittal plane motion. Work 0-60 sec. Copyright 2007 AOK Health Pty Ltd 15

16 THE ROLL AROUND RIBS, LATS & TERES OBSERVATION Observe your client in standing (anterior). What is the position of the shoulder girdle, is it protracted? What is their hand position, is either hand moving into pronation? There should be adequate range of motion in the lats to raise the arms without incorporationg lumbar spine extension. Position client on the wall. Their heels, glutes, thoracic and occipital bone should be touching the wall. Ask them to raise their arms. Do they move into an increased lumbar lordotic posture? CORRECTIVE STRATEGY Position the client side lying with the Physio Roller placed on the ribs. Extend the underlying arm and access the teres and lats. Initiate transverse plane motion. Work 0-60 sec A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

17 THE ROLL AROUND TENSOR FASCIAE LATAE & ITB OBSERVATION Observe your client in standing (anterior). Focus on the relationship between the hip, knee and ankle/ foot. Is there external rotation of the femur in standing? Restriction in the TFL or ITB will decrease R.O.M between hip and knee in the frontal plane. Start Position the client in side lying, bottom leg straight top leg bent. Take the top leg by the ankle and support knee with the other hand. Take hip into extension and take the knee support hand away. Hip Extension CORRECTIVE STRATEGY Position client on their side on the Physio Roller. Position Physio Roller under the tensor fasciae latae and initiate movement up and down the roller. Work 0-60 sec. Copyright 2007 AOK Health Pty Ltd 17

18 THE ROLL AROUND RECTUS FEMORIS OBSERVATION Observe client in standing (laterally), is their pelvis moving anteriorly? The rectus femoris requires adequate length and tension for balance at the pelvis. Place the client in prone position, take the right ankle and move the heel towards the client s right gluteus maximus. Observe movement at the pelvis. Does the pelvis move anteriorly and/ or rotate? CORRECTIVE STRATEGY Place the client in prone position. Place the thigh inferior to the ASIS on the roller. Move forward and allow the roller to move towards the knee. Initiate transverse plane motion as you work through the rectus femoris and other quadriceps. Work 0-60 secs A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

19 THE ROLL AROUND PIRIFORMIS/GLUTE MEDIUS OBSERVATION Observe your client in standing (anterior). Is either or both feet in external rotation? In this position you can gain an idea of the piriformis length and tension. Place the client in prone position. Flex the client s knees, make sure the legs are hip width apart. Passively move the feet away from the midline. Is there a difference? CORRECTIVE STRATEGY Position the client in a seated position on the Physio Roller. Cross the knee with the target piriformis leg. This increases the tension through the myofascial complex of the hip. Initiate a sagittal plane and transverse plane motion. Work 0-60 sec. Copyright 2007 AOK Health Pty Ltd 19

20 THE ROLL AROUND HAMSTRINGS OBSERVATION Observe your client in standing (lateral). Is their pelvis moving into posterior rotation? The hamstring requires adequate length and tension to positively influence the pelvis. Position the client in a supine position. Take a leg and move the client into hip flexion and knee flexion 90/90 degrees. Position your other hand on the lumbar spinous process of L3, ask the client to extend the knee. Monitor the flattening of the spinous process CORRECTIVE STRATEGY Position the client in a seated position with the Physio Roller at the ischial tuberosity and initiate transverse plane motion. Work from the ischial tuberosity to the knee. Work 0-60 sec A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

21 THE ROLL AROUND GASTROC/SOLEUS OBSERVATION Observe your client in standing (lateral). Is the client moving anterior or posterior in their posture? The gastroc and soleus need to have adequate length and tension to enhance gait & mobility. Position the client in supine, dorsiflex the foot with leg straight (gastroc) then flex the knee and dorsi flex the foot (soleus). What is the mobility of dorsi flexion? CORRECTIVE STRATEGY Position the client in a seated position. Place the Physio Roller under the gastroc & soleus. Initiate transverse motion, while moving the roller from the knee to the ankle. Work 0-60 sec. Copyright 2007 AOK Health Pty Ltd 21

22 CLINICAL NOTES 22 A PRACTITIONERS GUIDE V1 Copyright 2007 AOK Health Pty Ltd

23 OTHER PRODUCTS USEFUL FOR MYOFASCIAL PRACTITIONERS MASSAGE BALL diameter: 100mm MUSCLE MATE LONG length: 900mm diameter: 150mm HALF ROUND length: 900mm radius: 75mm SHORT length: 300mm diameter: 150mm DURA DOME diameter: 250mm height: 125mm AOK HEALTH PTY LTD PO BOX 393 THE JUNCTION NSW 2291 PH_ F_ E_ W_ Copyright 2007 AOK Health Pty Ltd 23