пятница, 29 апреля 2011 г.
суббота, 23 апреля 2011 г.
пятница, 22 апреля 2011 г.
воскресенье, 17 апреля 2011 г.
Soft Tissue Manipulation and Pelvic Pain
Soft Tissue Manipulation and Pelvic Pain By Leon Chaitow, ND, DO
Bialowsky (2009) reports that the effects of soft-tissue-focused manual therapies includes:
- Changes of blood levels of b-endorphin serotonin (Degenhardt et al 2007)
- Endogenous cannabinoids (McPartland et al 2005)
- Improved circulation and drainage
- Decreased muscle spasm
- Relaxation
- Re-alignment of soft tissues
- Breaking of adhesions
- Increased range of motion
- Removal of cellular exudates
Manual Therapy Approaches
The listing below of a selection of currently utilised manual therapy approaches that address fascial and myofascial dysfunction takes for granted that there would be simultaneous or subsequent focus on etiological features. Also, the seven modalities listed should not be regarded as definitive, as there are many other variations. However, those listed (and briefly discussed) represent a variety of validated biomechanical approaches, some of them novel and others well established.
- Connective tissue manipulation (ctm), as practised in relation to chronic pelvic pain, is a variation on the work of Dicke (1953) and Ebner (1975). Known in Germany where it was developed as "Bindegewebsmassage", it involves direct manual strokes, or forms of vigorous skin rolling, focused on connective tissue. Connective tissue is treated/mobilized until there is: improvement in mobility, decrease in sensitivity, and increase in warmth. Goals include: improved circulation; improved tissue integrity; decreased ischemia; reduced nocigenic chemicals in restricted connective tissue; decrease or elimination of visceral pain or dysfunction---possibly involving reflex effects; decrease in adverse neural tension on peripheral nerve branches.
- Fascial manipulation (FM). The key premise of FM is that fascia presents a specific organization and relationship with the underlying muscles. In particular, the fascia is seen as: coordinating element for motor units (grouped together in myofascial units); uniting element between unidirectional myofascial units (myofascial sequences); connecting element between body joints via myofascial expansions and retinacula (myofascial spirals). This model is supported by in-depth studies of fascial anatomy and physiology. Numerous dissections of unembalmed human cadavers have evidenced: muscular fibre insertions directly onto deep fascia (Stecco et al 2007); fibre distribution according to precise motor directions (Stecco et al 2008, 2009); myotendinous expansions that link adjacent segments (Stecco et al 2009). Extensive histological analysis of deep muscular fascia has also provided evidence for hypotheses concerning fascia's role in proprioception and tensional force distribution within the fascial system. (Stecco et al 2006, 2007)
- Muscle Energy Technique defined as "a form of osteopathic manipulative diagnosis and treatment in which the patient's muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed physician counterforce". (ECOP 2009) Various studies have demonstrated that muscle energy techniques increase muscle extensibility (Ballantyne et al 2003) and range of motion (Burns & Wells 2006) including thoracic rotation. (Lenehan et al 2003)
- Myofascial release. King (2010) notes that myofascial release (MFR) is "a system of diagnosis and treatment first described by AT Still, and his early students, which involves continual palpatory feedback to achieve release of myofascial tissues."
Direct MFR: A myofascial tissue restrictive barrier is engaged for the myofascial tissues and the tissue is loaded with constant force, until tissue release occurs.
Indirect MFR: The dysfunctional tissues are guided along the path of least resistance, until free movement is achieved. (ECOP 2009) - Scar tissue release. Kobesova et al (2007) suggest that scars may develop adhesive properties that compromise tissue tensioning, altering proprioceptive input, behaving in much the same way as active myofascial trigger points. It is suggested that faulty afferent input can result in disturbed efferent output leading to (for example): protective postural patterns, increased neurovascular activity, and pain syndromes. The term active scar is designated to describe the ongoing additional neural activity associated with adhesive scar formations.
- Straincounterstrain (SCS). Osteopathic system of diagnosis and indirect treatment, in which the patient's somatic dysfunction is treated, using passive positioning, resulting in spontaneous tissue release. (ECOP 2009) SCS technique involves shortening myofascial structures to reduce the nociceptive experience arising from firm palpation of a tenderpoint in the dysfunctional tissues.
- Trigger point deactivation methods. Montenegro et al (2009) insist that myofascial pain syndrome should always be considered as part of the differential diagnosis of chronic pelvic pain. Systematic reviews have investigated the effectiveness of soft tissue manual intervention for inactivating trigger points (TrPs) (Fernandez-de-las-Penas et al 2005, Rickards 2006, Vernon & Schneider 2009). Anderson et al (2009) have identified the most common location of TrPs related to pelvic pain: pubococcygeus (90%), external oblique (80%), rectus abdominis (75%), hip adductors (19%), gluteus medius (18%).
These themes are explored further on my blog http://chaitowschat-leon.blogspot.com/ and Web site www.leonchaitow.com/index.htm.
To Study
1) Active Isolated Stretching (AIS). Aaron Mattes Technique
http://www.stretchingusa.com
2) Orthopedic Massage with James Waslaski
http://www.healingartsinstitute.com/shop/category.asp?catid=370
http://www.orthomassage.net/
3)Resistance Release Training with Deane Juhan
http://www.jobsbody.com/
Combination
PNF->AIS->Orthopedic Massage
http://www.stretchingusa.com
2) Orthopedic Massage with James Waslaski
http://www.healingartsinstitute.com/shop/category.asp?catid=370
http://www.orthomassage.net/
3)Resistance Release Training with Deane Juhan
http://www.jobsbody.com/
Combination
PNF->AIS->Orthopedic Massage
Iliotibial Band Treatment
Iliotibial Band Treatment
Some therapists work directly on the IT band, but because it is a long tendon it does not stretch. A much better way of lengthening the IT band is to stretch the muscles that attach into this long tendon, which are the tensor fascia lata and the lateral fibers of the gluteus maximus.
This 22 minute video shows a treatment of a client with a knee replacement and a tight iliotibial band. Rather than focusing only on the problem area, the therapist does an assessment and treatment of all the related structures, using techniques from a number of different modalities. Techniques used include PNF Stretching, Reciprocal Inhibition, Active Isolated Stretching, and lengthening of muscles while using eccentric contraction.
The therapist, Mike Sweet, is a graduate of Healing Arts Institute. He has taken many advanced classes, including Orthopedic Massage with James Waslaski, and Resistance Release Training with Deane Juhan.
Greate Video
The iliotibial band is a thickening of the fascia on the lateral side of the thigh. The IT band goes from the lateral side of the ilium down to the tibia. When it is tight it can cause pain on the lateral side of the knee, proximal to the knee joint.
Some therapists work directly on the IT band, but because it is a long tendon it does not stretch. A much better way of lengthening the IT band is to stretch the muscles that attach into this long tendon, which are the tensor fascia lata and the lateral fibers of the gluteus maximus.
This 22 minute video shows a treatment of a client with a knee replacement and a tight iliotibial band. Rather than focusing only on the problem area, the therapist does an assessment and treatment of all the related structures, using techniques from a number of different modalities. Techniques used include PNF Stretching, Reciprocal Inhibition, Active Isolated Stretching, and lengthening of muscles while using eccentric contraction.
The therapist, Mike Sweet, is a graduate of Healing Arts Institute. He has taken many advanced classes, including Orthopedic Massage with James Waslaski, and Resistance Release Training with Deane Juhan.
Pain Caused By Low Back Ligaments
Pain Caused By Low Back Ligaments
Check Humstring by Resisted Test.
Pain in calf cause only Sac.Tub.Lig.
Do Palpation Test.
Usualy Trauma in Lateral Margin of the Sacrum.
Check Humstring by Resisted Test.
Pain in calf cause only Sac.Tub.Lig.
Do Palpation Test.
Usualy Trauma in Lateral Margin of the Sacrum.
YouTube - Muscle energy technique for posterior sacroiliac ligamant
YouTube - Muscle energy technique for posterior sacroiliac ligamant
Интересно как он позиционирует пациента cравнить с
Right on left sacral torsion - Muscle Energy Technique (M1) by Tom Ockler
Muscle Energy Seminars and Courses
Muscle Energy Seminars and Courses
Internationally Recognized Physical Therapist, Teacher and Author Tom Ockler, P.T.
Video Excerpts from the M1 Course
Ortho-Bionomy by Jim Berns
Ortho-Bionomy was developed by a British doctor, Arthur Lincoln Pauls, in his early years as an Osteopath. Before practicing Osteopathy Dr. Pauls was a Judo instructor. Every day in Judo he practiced the principle of following someone's movement and energy in the direction they were going, and if possible exaggerating that direction. Yet when Arthur went to Osteopathy school and learned all the medical and manipulative techniques at that time, he was disturbed to find that his teachers did not understand this principle.
When I was first introduced to Ortho-Bionomy, I had been doing massage therapy for a few years and was close to being burned out. I had studied (and was quite good at) a wide variety of therapies from deep-tissue to subtle energy work. But there was a part of me that was frustrated with the chronic reoccurrence of the same problems.Clients would come in with certain muscle contractions; I would stretch them out and then they would come back a week or two later with the same patterns. I was worn out by the struggle of fighting their body: trying to move it from where it was to where I thought it should be. Inside of me somewhere, I believed there must be an easier way to help people out of their pain.
суббота, 16 апреля 2011 г.
To review. Ilio-Sacral Diagnosis and Treatment, Part Three: Gluteus Medius, Piriformis and Pubic Symphysis - Positional Release and Rehabilitation Exercises
Ilio-Sacral Diagnosis and Treatment, Part Three: Gluteus Medius, Piriformis and Pubic Symphysis - Positional Release and Rehabilitation Exercises: "- Sent using Google Toolbar"
Довольно интересная статья
Counterstrain for Gluteus Medius
Positional release: extension, abduction и если надо external rotation of the hip
"Classic counterstrain requires you to hold this position for 90 seconds. (Yes, 90 seconds seems like forever, and some say you can shorten the time to 20 to 30 seconds by doing a brief, gentle contract-relax of the muscle involved or its antagonist.[???тут вот мне не совсем понятно надо подумать???]) When you are done, slowly let the leg back down. Don't let the patient help you; come out of the position with the patient as passive as possible. Retest with pressure on the tender point. When you are done, if the technique was correct, there will be a dramatic diminishing of the tenderness."
В очередной раз говорится о важности укрепления gluteus medius для стабилизации pelvis, обычно ослаблены
Ногу надо поднимать прямо на 8 inch (20см ) ето немного
как я понимаю если поднимать сильнее будут включаться
transverse obliqu, quadratus lumborum
живот втянуть, стопа параллельно полу
Также рекомендуется растягивать periformis, он обычно tight & short
"You are both pulling your leg up with your arm toward the opposite shoulder, and pushing your leg down toward the table"
Shears - это upslip downslip
Flares - это открытый закрытый полутаз (inflare outflare)
Примечательно что автор счтитает rotation in sa
Довольно интересная статья
Counterstrain for Gluteus Medius
"Classic counterstrain requires you to hold this position for 90 seconds. (Yes, 90 seconds seems like forever, and some say you can shorten the time to 20 to 30 seconds by doing a brief, gentle contract-relax of the muscle involved or its antagonist.[???тут вот мне не совсем понятно надо подумать???]) When you are done, slowly let the leg back down. Don't let the patient help you; come out of the position with the patient as passive as possible. Retest with pressure on the tender point. When you are done, if the technique was correct, there will be a dramatic diminishing of the tenderness."
В очередной раз говорится о важности укрепления gluteus medius для стабилизации pelvis, обычно ослаблены
как я понимаю если поднимать сильнее будут включаться
transverse obliqu, quadratus lumborum
живот втянуть, стопа параллельно полу
Также рекомендуется растягивать periformis, он обычно tight & short
Shears - это upslip downslip
Flares - это открытый закрытый полутаз (inflare outflare)
Subluxation | Qualities | Keys |
shears upslip/downslip | all landmarks are inferior or superior; stiff side resists inferior or superior motion | assess both supine and prone nonphysiological shear |
flares internal/external | ASIS stuck medial or lateral | tender medial side of ASIS |
sagittal rotation PI and AS | usually a compensation; ASIS inferior or superior | don't correct over and over |
ilio-sacral separation | ilium resists medial motion; can coexist with hypermobility of same side | check gluteus medius |
pubic symphysis | separation and inferior/superior | tender lateral border of tubercles |
Примечательно что автор счтитает rotation in sa
THE BOOK. Positional Release Therapy
| Positional Release Therapy -- Assessment and Treatment of Musculoskeletal Dysfunction | |
| Kerry J. D'Ambrogio, PT, George B. Roth, DC, ND Very good book about strain counterstrain. Excelent pictures. Discussion about effects & mechanic of CS. |
пятница, 15 апреля 2011 г.
Low Force MethodologyBy Marc Heller, DC |
A 1979 cum laude graduate of National College of Chiropractic, (NUHS), Dr. Marc Heller has had a private practice in Ashland, Ore., for 31 years.
He emphasizes low-force adjustment methods including muscle energy, counterstrain, and craniosacral and visceral manipulation techniques. He uses many soft-tissue approaches, including Graston technique and Stecco fascial??? manipulation, as well as various myofascial release methods. He has studied and incorporated international rehabilitation principles, including the work of Dr. Vladimir Janda and Dr. Craig Liebenson ???, as well as physical therapists Mark Comerford ??? and Mark Bookhout???, into his practice.
The Books TO READ
Myofascial chains/meridians etc
*****1) Fascial manipulation for muscuskeletal pain By Luigi Stecco //the best book about facsia
Fascia coordinate movements. Important role in movements. Motion unit. Control Point in Motor unit.
New approach for reabilitation. Parallel with meridians Tr.Points etc.
Good for practitioner who suffer from mf pain
2) Anatomy trains: myofascial meridians for manual and movement therapists
3)
*****4) Myofascial Chains by Leopold Busquet //не знаю точно названия
*****1) Fascial manipulation for muscuskeletal pain By Luigi Stecco //the best book about facsia
Fascia coordinate movements. Important role in movements. Motion unit. Control Point in Motor unit.
New approach for reabilitation. Parallel with meridians Tr.Points etc.
Good for practitioner who suffer from mf pain
2) Anatomy trains: myofascial meridians for manual and movement therapists
3)
Trigger Points and Muscle Chains in Osteopathy
By Philipp Richter, Eric Hebgen*****4) Myofascial Chains by Leopold Busquet //не знаю точно названия
среда, 6 апреля 2011 г.
понедельник, 4 апреля 2011 г.
Proprioreseptive Input. Activation exercises
It is important to note that when performing concentric contractions alone, there may be a resultant unloading of the muscle spindle and decreased facilitation from the stretch reflexes as the muscle moves into the shortened range. Therefore, concentric contractions are ineffective and even detrimental when attempting to improve proprioceptive input to an inhibited muscle. [from MAT description]What is Proorioreceotive Input(PI).
Why Spindels have less PI in shortened position?
What is Activation Exercise?
How to do Activation Exercise?
http://www.coachr.org/ankleproprio.htm
http://www.muscleactivation.com/FAQ.html
воскресенье, 3 апреля 2011 г.
Kinesiology
Lecture Topics in Kinesiology
(from course materials developed for the Department of Rehabilitation Science, 1988-2001)
http://moon.ouhsc.edu/dthompso/namics/lecsked.htm
-----------------------------------------------------------------------------------------------------------
Effects of chronic lengthening or shortening of muscle: "stretch weakness" and "adaptive shortening" http://moon.ouhsc.edu/dthompso/namics/immob.htm
Length-associated (mechanical) properties of muscle http://moon.ouhsc.edu/dthompso/namics/actpass.htm
tug of war - перетягивание коната.
Моя идея конкурируюших muscle gourps
Идея что изменения длинны мышц в покое ведет к изменениям в мышце и к muscle imbalance
Force-length and Force-velocity relationships
суббота, 2 апреля 2011 г.
CROSS FIBER FRICTION TECHNIQUES
http://www.realbodywork.com/articles/crossfiber.html [GoodWebResource]
|
пятница, 1 апреля 2011 г.
Graston Technique
Trauma => Muscle Guarding & Scar Tissue
Joing Instability =>Guarding =>Tightness (Fascial & Muscle Fibrosis)
No Strengthen + Soft Tissue Mobilization => No Stability & Worsen Condition
balance mobility/stability
Shift from Dynamic Stability (muscles) to Static Stability (fibrous tissues)
Наращивание соединительной фиброзной ткани - процесс защиты и старения
Tight Fascia + muscle contracted => constrict muscle belly / unable to fully contract, ischemia, decreased circulation
Joing Instability =>Guarding =>Tightness (Fascial & Muscle Fibrosis)
No Strengthen + Soft Tissue Mobilization => No Stability & Worsen Condition
balance mobility/stability
Shift from Dynamic Stability (muscles) to Static Stability (fibrous tissues)
Наращивание соединительной фиброзной ткани - процесс защиты и старения
Tight Fascia + muscle contracted => constrict muscle belly / unable to fully contract, ischemia, decreased circulation
Gluteus Medius Tendenitis
В моем случае даже в сидячем положении возникает натяжение в Gluteus Medius Posterior fibers =>
тут же напрягается QL тк Hip Bone goes to Abduction + Posterior-External Rotation.
Psoas тоже напрягается так как Hip Bone идет в Posterior Rotation Psoas work eccentrically чтобы удержать осанку прямое положение спины.
При этом атрофируется Pectineus тк при данном движении Hip Bone уменьшается длинна покоя те уменьшается расстояние между точками прикрепления Pectineus. В результате происходит immobilization in short range / on slack=> атрофия
После часа сидения возникла постоянная боль. По всей площади бедра отдает в пах.
тут же напрягается QL тк Hip Bone goes to Abduction + Posterior-External Rotation.
Psoas тоже напрягается так как Hip Bone идет в Posterior Rotation Psoas work eccentrically чтобы удержать осанку прямое положение спины.
При этом атрофируется Pectineus тк при данном движении Hip Bone уменьшается длинна покоя те уменьшается расстояние между точками прикрепления Pectineus. В результате происходит immobilization in short range / on slack=> атрофия
После часа сидения возникла постоянная боль. По всей площади бедра отдает в пах.
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