tag:blogger.com,1999:blog-90163644370664473372024-03-20T13:51:19.152-07:00MyoFascial Therapy and Research Foundation®MFTRF®, India is the first registered foundation of its kind, formed with the aims of conducting education, research and awareness programs in the field of Myofascial Release practice and delivering quality hands on care for various ‘Osteo Myofascial Dysfunctions’. The courses available are ‘CMFRT and ADMFT’. Currently more than ten studies are going on regarding the effectiveness of MFR under the MFTRF®.Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.comBlogger58125tag:blogger.com,1999:blog-9016364437066447337.post-44973490807030559272023-05-22T11:02:00.002-07:002023-05-22T11:02:18.667-07:00External Myofascial Mobilization Myofascial Mobilization (MM) is a specialized manual therapy technique employed to address fascial dysfunction in a systematic anatomical pattern. It can be applied either externally or internally, depending on the specific needs of the individual. External myofascial mobilization (EMM), in particular, is an approach that draws upon the principles of myofascial connectivity (Ajimsha et al., 2020) and myofascial force transmission (Ajimsha et al., 2022), as established by research.
In EMM, the therapist carefully examines and mobilizes the fascia to identify and alleviate myofascial dysfunction. The key aspect of this technique lies in following a traceable pattern, allowing for a methodical and targeted treatment approach. The most commonly utilized procedures within EMM are myofascial release (MFR) and fascial manipulation (FM).
MFR involves the application of variable loads and sustained stretches to the myofascial complex. This technique aims to restore optimal length, reduce pain, and improve overall function (Barnes MF, 1997). On the other hand, FM focuses on manipulating the fascia through predefined myofascial units. By appropriately treating these units, the therapist endeavors to restore tensional balance within the fascial system (Stecco L, 2004).
The External Myofascial Mobilization (EMM) technique, developed and refined by Dr. Ajimsha MS, a dedicated researcher and enthusiast in the field of fascial studies, provides a personalized and comprehensive approach to managing fascial dysfunction. By utilizing a combination of scientifically derived fascial mobilization methods, the EMM approach effectively addresses complex soft tissue dysfunctions and associated pain in a traceable and anatomically precise manner.
The primary goal of EMM is to restore normal mobility and function to the affected area by examining and mobilizing the fascia in a systematic and traceable pattern. Although the evidence supporting the effectiveness of EMM is largely anecdotal, it has shown promising results in treating a variety of musculoskeletal conditions. For example, a recent study conducted by Ajimsha et al. (2021) demonstrated the efficacy of EMM when applied to the pelvic area, leading to a reduction in pain and improved function in patients with chronic pelvic pain. Similarly, another study (Ajimsha 2023) found that EMM effectively improved pain and functional status in patients with moderate Fibromyalgia syndrome.
EMM is a safe and non-invasive technique that can be used as a standalone treatment or in combination with other therapeutic modalities to address osteo-myo-fascial dysfunctions. It serves as a valuable tool for healthcare professionals seeking an effective and evidence-based approach to manual therapy. By integrating the principles of myofascial connectivity and force transmission, EMM offers a comprehensive approach to managing fascial dysfunction and promoting overall well-being (Ajimsha MS).
Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-1736209338332662452023-05-22T10:47:00.001-07:002023-05-22T10:47:23.853-07:00Soft Tissue Rolling In Practice (STRIP)Soft Tissue Rolling In Practice (STRIP)
'Soft tissue rolling in practice' (STRIP) is a versatile and systematic approach to the evaluation and management of soft tissue alterations, pathologies, body dysfunction, and pain, where patient education and follow-up are given more emphasis (Ajimsha MS).
Soft Tissue Rolling
Soft tissue rolling, a form of self-myofascial release, is a soft tissue mobilization approach that aims to improve tissue mobility and flexibility, thereby modifying the functional potentials of the human body through its intricate interconnections. This technique involves the use of cylindrical or spherical instruments to apply pressure and soft tissue gliding to targeted areas of the body (Ajimsha MS).
Goal of STRIP
The intended goal of STRIP is to alter the biomechanical, histochemical, and neuronal properties of the tissue, which is typically performed for longer durations. STRIP can have a variety of effects on the body, both locally and systemically, including tissue alteration, hydration, improved tissue gliding, enhanced neural control, tissue healing, improved immune function, and a return to homeostasis. Soft tissue rolling has been proven to be effective in increasing proprioception, improving blood circulation, lymphatic drainage, range of motion, muscle activation, improving posture, inducing relaxation, reducing pain and muscle soreness. By addressing multiple aspects of tissue function and health, STRIP can be a valuable tool for improving physical and mental performance. Moreover, soft tissue rolling can have pro and anti-inflammatory effects.
The benefits of STRIP extend beyond the physical, as it can also help to improve mental relaxation and reduce stress, making it a valuable technique for athletes, individuals recovering from injury, or anyone looking to improve their overall well-being (Ajimsha MS).
<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWwzEOBNbUGnrNMBYcu5JjjXvQSqoTtAAMo7EjdSr1gg3aMt0NFpNGWRH7a3uobAU-8KlIq67UgcqTel4Va4OcOw5J6HXXbTBJXJxq7ELW0PrdFW9qb7JOcXpwwrzIiZcTILA4P4aCKVrlUVXb3bfs619hMH1ofMpDJT0ofaEAcMeR9Y_VQz8UgBzAGw/s1440/315661665_5560244200695528_2784517790823226147_n.jpg" style="display: block; padding: 1em 0; text-align: center; "><img alt="" border="0" width="320" data-original-height="756" data-original-width="1440" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWwzEOBNbUGnrNMBYcu5JjjXvQSqoTtAAMo7EjdSr1gg3aMt0NFpNGWRH7a3uobAU-8KlIq67UgcqTel4Va4OcOw5J6HXXbTBJXJxq7ELW0PrdFW9qb7JOcXpwwrzIiZcTILA4P4aCKVrlUVXb3bfs619hMH1ofMpDJT0ofaEAcMeR9Y_VQz8UgBzAGw/s320/315661665_5560244200695528_2784517790823226147_n.jpg"/></a></div>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-76276049605778496112014-04-13T18:49:00.003-07:002014-04-13T18:50:56.722-07:00Effectiveness of myofascial release in the management of plantar heelpain: A randomized controlled trial
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</iframe>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com1tag:blogger.com,1999:blog-9016364437066447337.post-74308074031689729562011-08-02T22:54:00.000-07:002011-08-03T01:08:32.671-07:00Core Stabilization Program for Low Back Rehabilitation<div>Dr. Ajimsha. M S, MPT (Neuro), ADMFT, PhD (Neuro), School of Physiotherapy, Faculty of Allied Health Professions, AIMST University<br /><br /><strong>Introduction</strong><br /><br />A strong foundation of muscular balance and core stability is essential for normal movements and lumbo pelvic integrity. Weakness or lack of sufficient co-ordination in core musculature can lead to less efficient movements, compensatory movement patterns, strain and overuse and injury. The program starts with restoration of normal muscle length and mobility to correct any muscle imbalances. Next, fundamental lumbopelvic stability exercises are introduced, teaching the patient to activate the deeper core musculature. When this has been mastered, advanced lumbo-pelvic stability exercises using the Physioball are added for greater challenge. As the patient makes the transition to the standing position, sensory-motor training is used to stimulate the sub-cortex and provide a basis for more advanced functional movement exercises, which promote balance, co-ordination, precision, and skill acquisition. </div><br /><br /><div><strong>Concept of Core Stability</strong><br />The core musculature is composed of 29 pairs of muscles that support the lumbopelvic-hip complex. These muscles help to stabilize the spine, pelvis, and kinetic chain during functional movements. When the system works efficiently, the result is appropriate distribution of forces; optimal control and efficiency of movement; adequate absorption of ground-impact forces; and an absence of excessive compressive, translation, or shearing forces on the joints of the kinetic chain.<br />The term core has been used to refer to the trunk or more specifically the lumbopelvic region of the body (Bergmark, A, . Mcgill, S.M, Mggill, S.M et al, Panjabi, M.M,). The stability ofthe lumbopelvic region is crucial to provide a foundation for movement of the upper and lower extremities, to support loads, and to protect the spinal cord and nerve roots (Panjabi, M.M). Panjabi defined core stability as "the capacity of the stabilizing system to maintain the intervertebral neutral zones within physiological limits". The stabilizing system has been divided into 3 distinct subsystems: the passive subsystem, the active muscle subsystem, and the neural subsystem (Panjabi, M.M).<br /><br />The passive subsystem consists of the spinal ligaments and facet articulations between adjacent vertebrae. The passive subsystem allows the lumbar spine to support a limited load (approximately 10 kg) that is far less than body mass. Therefore, the active muscle subsystem is necessary to allow support of body mass plus additional loads associated with resistance exercises and dynamic activities (Mcgill, S.M, Mggill, S.M et al, Panjabi, M.M).<br /><br />Bergmark divided the active muscle subsystem into "global" and "local" groups, based on their primary roles in stabilizing the core. The global group consists of the large, superficial muscles that transfer force between the thoracic cage and pelvis and act to increase intraabdominal pressure (e.g., rectus abdominis, internal and external oblique abdominis, transversis abdominis, erector spinae, lateral portion quadratus lumborum). Conversely, the local group consists of the small, deep muscles that control intersegmental motion between adjacent vertebrae (e.g., multifidus, rotatores, interspinal, intertransverse). The core muscles can be likened to guy wires, with tension being controlled by the neural subsystem.<br /><br />As tension increases within these muscles, compressive forces increase between the lumbar vertebrae; this stiffens the lumbar spine to enhance stability (Mcgill, S.M, Panjabi, M.M). The neural subsystem has the complex task of continuously monitoring and adjusting muscle forces based on feedback provided by muscles spindles, Golgi tendon organs, and spinal ligaments. The requirements for stability can change instantaneously, based on postural adjustments or external loads accepted by the body. The neural subsystem must work concomitantly to ensure sufficient stability but also allow for desired joint movements to occur (. Mcgill, S.M, Mggill, S.M et al, Panjabi, M.M).<br />A key muscle that works with the neural subsystem to ensure sufficient stability is the transversis abdominis. Cresswell and Thorstensson (Cresswell & Thorstensson) demonstrated that this muscle functioned primarily to increase intra-abdominal pressure, which reduced the compressive load on the lumbar spine. Other studies have demonstrated that the transversis abdominis was the first muscle activated during unexpected and self-loading ofthe trunk (Cresswell, Oddsson et al) and during upper and lower extremity movements, regardless of the direction of movement. Hodges and Richardson proposed a feed-forward mechanism associated with function ofthe transversis abdominis.<br /><br />The neural subsystem utilizes feedback from previous movement patterns to coordinate and preactivate this muscle in preparation for postural adjustments or the acceptance of external loads. In another study, Hodges and Richardson demonstrated delayed activation of the transversis abdominis in subjects with low back pain, suggestive of neural control deficits.<br /><br />Some practitioners mistakenly believe that the smaller local muscles are involved primarily with core stability, whereas the larger global muscles are involved primarily with force production (Johnson, P, Verstegen, M., & P. Williams). This mistaken belief has prompted ineffective training strategies designed to train the local and global muscle groups separately in nonfunctional positions. For example, the abdominal draw-in maneuver, typically performed in the quadruped or supine body position, has been widely promoted to train the stabilizing function of the transverses abdominis (Johnson, P, Verstegen, M., & P. Williams). Although this muscle is a key stabilizer of the lumber spine, several other core muscles, both local and global, work together to achieve spinal stability during movement tasks (Cresswell & Thorstensson,). For example, local muscles, such as the multifidus and rotators, contain high densities of muscle spindles. Therefore, these muscles function as kinesiological monitors that provide the neural subsystem with proprioceptive feedback to facilitate coactivation of the global muscles to meet stability requirements (Nitz, A.J., & D. Peck).<br />McGill stated, "The relative contributions of each muscle continually changes throughout a task, such that discussion of the most important stabilizing muscle is restricted to a transient instant in time". Core stability is a dynamic concept that continually changes to meet postural adjustments or external loads accepted by the body. This suggests that to increase core stability, exercises must be performed that simulate the movement patterns of a given activity. The co-contraction of the deeper-layer transverse abdominus and multifidi muscle groups occurs prior to any movement of the limbs, and believe that this neuromuscular pre-activation is critical in stabilising the spine prior to any movement. </div><br /><div><br /><strong>The core program</strong><br />Stability work should be started only after the patient has achieved good mobility, as adequate muscle length and extensibility are crucial to proper joint function and efficiency. Although beyond the scope of this article, a thorough evaluation of the muscular system should include an assessment of the muscles for over-activity, shortening, weakness, inhibition, and quality of motion. This is best accomplished by a skilled physician or therapist using muscle-length tests, strength tests, and tests for the efficiency of basic movement patterns and neuromuscular control. A thorough postural observation and video taping of the patient's gait will help in assessing and identifying any movement imbalances.<br /><br />Preliminary stretches for shortened muscles should include proprioceptive neuromuscular facilitation (PNF) type or contract-relax stretches that strive for isometric contraction, followed by end-range stretching. These are effective techniques for maintaining muscle length and joint mobility. Myofascial Release Techniques when used in conjunction with stretching techniques, have shown great promise in restoring muscle length and soft-tissue extensibility. Patients can be taught to do their own self-mobilization with use of a foam roll.<br />Specific exercises for the patient should progress from mobility to stability, to reflexive motor patterning, to acquiring the skills of fundamental movement patterns, and finally, to progressive strengthening. These sequences may not be applicable to all patients; therefore, the key is to analyze the individual in each exercise category and then to tailor an exercise regimen that will best suit that patient's needs. For example, patients with iliotibial band syndrome often have weakness in their hip abductors that predisposes them to increased stress on the iliotibial bands. Thus, a preventative training program for patients with this syndrome must target the hip abductors, particularly the posterior aspect of the gluteus medius that assists external rotation or in decelerating internal rotation of the hip. Other muscles that prove weak or inhibited on evaluation should also be strengthened on a case-by-case basis.<br /><br /><strong>Fundamental lumbo-pelvic stability</strong><br /><br />The purpose of basic core stabilization exercises is not only to increase stability, but more importantly it is to gain co-ordination and timing of the deep abdominal-wall musculature. It is extremely important to do these basic exercises correctly, as they are the foundation of all other core exercises and movement patterns. These basic exercises emphasize maintaining the lumbar spine in a neutral position.<br />This first stage of core stability training begins with the patient learning to stabilize the abdominal wall. Proper activation of these muscles is considered crucial in the first stages of a core stability program, before progressing to more dynamic and multi-planar activities.The exercise program should progress sequentially through the fundamental movements as detailed below. The following exercises are to be performed regularly to maximize results, you have to continue the basic pattern even you have mastered the advanced patterns. The patient begins with one to two sets of 15 repetitions and progresses to three sets of 15-20 repetitions. These exercises are taught initially in either a supine, hook-lying position. The patient can progress to the more functional standing exercises, as control is developed. Important concepts taught at this stage include not tilting the pelvis or flattening the spine. We also emphasize normal rhythmic breathing </div><br /><br /><div><strong>Abdominal Hollowing</strong></div><br /><img id="BLOGGER_PHOTO_ID_5636536837294077186" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 300px; CURSOR: hand; HEIGHT: 195px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVH01pI3RbvkYhtHOaxqsMIvCJikXk3kDR6IPbSrqEjCtk4v9qJm0qoX8aaTN50uN1d-JoiL-FQP1WaKzhUvqURbhzpc-ThdHf-_5qdv2U3Y5MTvlBlyrCOWxUagCxi9RSPB6Gcg2ahuPe/s400/image001.jpg" border="0" /> <br /><div></div><br /><div>The Abdominal Hollowing method to stabilize the spine is based on the Richardson philosophy of trunk stabilization. Often rehabilitation and exercise specialists will use this method of stability as they feel that trunk stabilization retraining should start with reestablishing local lumbar stability first.<br />To instruct your client to perform the Abdominal Hollowing technique follow the following directions:<br />1. Let your client lay down on the floor or on a treatment table in a supine hook-lying position.<br />2. Stand next to the client.<br />3. Ask the client to put both of their hand on their lower abdominal region at he level of their belly button.<br />4. With permission from the client put your hand on top of their hand as if covering their belly button.<br />5. Instructions: “Breath in and out normally for a few breaths until relaxed. To accomplish Abdominal Hollowing, take a deep breath then breath out completely, draw your belly button towards your spine at about 30% intensity – hold this position for 10 seconds. breath in, relax and repeat this maneuver.<br />6. Cues: “Try to suck in your belly button as if you walk on the beach in a bathing suit ”.<br />7. The pattern will be ‘breath in, breath out, abdominal hollowing (press down your belly button), relax and breath in’. </div><br /><div><br /><div><br /><div><br /><div><br /><div><br /><div><br /><div><br /><div><br /><div><br /><strong>Supine Bent-Knee Raises<br /></strong>This is a fundamental exercise for recruiting the deep abdominal muscles and for lumbopelvic control. The patient lies on her back, with knees bent and feet flat on the floor. She then braces the abdominal wall, holding the lumbar spine in a neutral position as described above, and slowly raises one foot 15-30cm off the ground with alternate legs. Common errors when performing this exercise include rocking the pelvis, abdominal protrusion, or an inability to maintain the neutral lumbar curve. If this happens, discontinue the exercise for a rest period. Quality more than quantity is stressed.<br /><strong>Progression:</strong> The exercise can progress to alternately extending the legs and lowering to the ground. Once the patient can maintain stability with alternate leg lifts. She can add alternate, overhead arm raises for greater challenge. The arm raises should be performed slowly, while maintaining lower abdominal bracing.<br /><br /><br /><p><img id="BLOGGER_PHOTO_ID_5636509659605175490" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 433px; CURSOR: hand; HEIGHT: 217px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjN5ApaypWzguQA5Ni4Hv9TqpKxBgCwXHuLT7l_focpquRVP40eIfs3wP5T61vWofAovYuqkUad1vmvL33EqQ4Ol0RTKVOFAuAnVnpmzFOssostRMpJxvKodVHVIvulToUyFZ3j15MQbxxL/s400/image002.jpg" border="0" /><br /><strong>Figure 1: Supine Bent-Knee Raises<br /></strong><br /><strong>Quadruped with Alternate Arm/Leg Raises<br /></strong>This exercise prepares the patient for the proprioceptively more challenging, more dynamic exercises of the trunk. It specifically engages the multifidi-the deep transverse spine stabilizer and extensor of the lumbar spine.<br />The patient should position herself on all fours. She then braces the abdominal wall as described above. While maintaining a midrange/neutral curve of the lumbar spine, the patient should raise the right arm and the left leg (opposite upper and lower limbs) into a line with the trunk, while preventing any rocking of the pelvis or spine (excessive transverse or coronal-plane motion). If it helps to maintain alignment, the patient may use an object, such as a foam roller or wooden dowel, placed along the spine, for added tactile feedback. The leg should be raised only to the height at which patient can control any excessive motion of the jumbo-pelvic region. She then performs the exercise raising the left arm with the right leg.<br /><strong>Progression:</strong> A Physioball underneath the trunk can provide significantly more proprioceptive challenge owing to its unstable surface. The goal once again is for the patient to maintain lumbar stability while the opposite arm and leg are raised slowly.<br /><br /><img id="BLOGGER_PHOTO_ID_5636518808804282082" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 478px; CURSOR: hand; HEIGHT: 477px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOIafmc2VKGTZ4wUF5HA-ePTUNSzKsZgZGJn152MzcDnSgYtWjzO6AmveOgo0vCeVearpL2Xo9mKEIPWu5vdfF5Y0zFQp1UFLmfqclW6i-F85RE4gIyWOknkI4pWb_v5rH-54-RRxlaXMO/s400/image003.jpg" border="0" /> <strong>Figure 2: Quadruped with Alternate Arm/Leg Raises</strong><br /><br /><strong>Bridging</strong><br /><br />Bridging is a fundamental core-stability and gluteal-strengthening exercise.<br />The patient begins the exercise on her back, in a hook-lying position, with arms resting at her sides. She activates the abdominals and squeezes the gluteal cheeks prior to initiating the movement. The patient lifts the pelvis and hips off the ground while maintaining neutral lumbar alignment. There should be no rotation of the pelvis. The hips should be aligned with the knees and shoulders in a straight line. The patient should hold the position for 10sec and then slowly lower the pelvis to the floor.<br /><strong>Progression</strong>: In the lifted-bridge position, while maintaining neutral lumbar and pelvic alignment. the patient can lift one foot off the ground and extend the leg. By placing her arms across her chest, she can increase the challenge of stabilising the lumbo-pelvic region. To progress further, the patient can raise both arms up to the ceiling and then move one arm out to the side. She should bring the arm back to the centre and repeat with the other side.<br /></p><img id="BLOGGER_PHOTO_ID_5636511041404349666" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 481px; CURSOR: hand; HEIGHT: 207px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglptPbKxH6QiRd8mCZaN1u7OlTNMcIpACtOeXlTJSHcufHUha3IvenWgiiJpVLzkcOAvzq4_NIXPnXG3gp7v4sgIeoxcJJZgE3JbroTj2ly24s-LyzlrkNMgZqe1P9m7ZmCIOw0L1BE93a/s400/image005.jpg" border="0" /><br /><strong>Figure 3: Bridging<br /></strong><br /><strong>Prone Plank</strong><br /><br />This is a fundamental, static core-stability exercise.<br />The patient supports herself with her forearms resting on the mat, elbows bent at 90 degree, and the toes resting on the mat. The patient maintains the spine in a neutral position, recruits the gluteal muscles, and keeps the head level with the floor. She is instructed to breath normally throughout the exercise, while maintaining the abdominal brace. We suggest holding the position for 20sec, working up to one minute for two to three repetitions. No compensatory motion, such as increased lumbar lordosis or sag, should be seen.<br /><strong>Progression:</strong> In this position, the patient can add leg lifts for more difficulty: one leg can be lifted off the mat, held for five seconds, and then repeated on the opposite side.<br /><strong></strong></div><img id="BLOGGER_PHOTO_ID_5636512115677684738" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 478px; CURSOR: hand; HEIGHT: 185px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhi3Eirf10-KHUefmbvO-KrWWIoszRbmCrQ96g5fJp1LCXK_PijQOHFOheqfjcH8Xk9-iNs6-fYtvwaXmskgmlNgNBAGnUVL8Uwb4BR66EP20TqcbVmp8ZvaxtdXcjLslWk4c-f5J3HWt49/s400/image007.jpg" border="0" /> <strong>Figure 4: Prone Plank<br /></strong><br /><br /><strong>Side Plank</strong><br /><br />This is a fundamental, static core-stability exercise designed to challenge the patient's body against gravity in the coronal/frontal plane and is an ideal exercise to train the quadratus lumborum.<br />The patient is lying on her right side with the right arm extended in a straight line up from the shoulder, with the forearm resting on the mat. She then raises the pelvis from the floor and holds it in a straight-line "plank" position. The hips should not be allowed to sag toward the floor. We suggest holding the position for 20sec, working up to one minute holds for two to three repetitions.<br /><strong>Progression:</strong> The top foot can be raised to increasingly challenge the core and gluteal musculature.<br /><br /><br /><br /><div></div><img id="BLOGGER_PHOTO_ID_5636512656204303618" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 453px; CURSOR: hand; HEIGHT: 206px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9-FCwkEYoShMrqjgHpx3P6gg_Oei3Ov0MNSGy2sxWWe1haHwlkQVwo8CxKK5s2tuRWz6AMVKZzREwNR4Rcyt3j9dy89P1OmMGiqPM1sXhlluhcrk-cTLN0qRtyiTk1CYKeUdghUdvjV-m/s400/image009.jpg" border="0" /><br /><strong>Figure 5: Side Plank</strong><br /><br /><strong>Advanced lumbo-pelvic stability</strong><br />Once the patient demonstrates good stability with all static core exercises, they can be replaced with more advanced exercises on the Physioball detailed below. These exercises should be performed at least two times per week to maximize results. The patient progresses to two sets of 10-15 repetitions. Quality is more important than quantity; the patient must maintain lumbar neutral and keep the spine in perfect alignment throughout the exercises. </div><br /><br /><div><strong>Seated Marching on a Physioball</strong><br />This exercise is more difficult because the patient positions her body against gravity in a seated position on an unstable surface.<br />The patient begins by sitting upright on a Physioball, with the lumbar spine in a neutral position. She places her feet hip-width apart While bracing the abdominal muscles, she lifts one leg and foot off the ground. (The limb does not need to be lifted very high, just enough to be off the ground approximately 5cm to start) The patient should focus on controlling the weight shifting to the weight-bearing limb while maintaining lumbo-pelvic stability.<br /><strong>Progression:</strong> Once lumbo-pelvic stability can be maintained with alternate leg lifts, the patient can add opposite arm lifts.<br /><br /><br /><div><img id="BLOGGER_PHOTO_ID_5636513199322672386" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 482px; CURSOR: hand; HEIGHT: 263px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFd8cfPZi1akW8IHL7cy-OEzAYP-faYWemg-Q01R9PwxJJaugcCW-HYvymBZ1Drd3bvVIn3Q5ugUWwANPSm_Mk-9sSFOcOQ9OXglXtx-UOW_KlpbP96dC0gaCayXmRkHQLkSD97M_vkx9A/s400/image011.jpg" border="0" /><strong>Figure 6: Seated Marching on a Physioball</strong><br /><br /><br /><strong>Spinal Flexion on Physioball (Advanced versions)</strong><br />If the patient’s progression is very good and she is mastering all the techniques perfectly; you can transform the program into the next level. The patient pre-activates her abdominal brace in the starting position and maintains this as she rolls back into spinal extension. She then slowly raises the body, focusing the rotation in the thoracic spine. Picture the head and neck as a rigid block on the thoracic spine to prevent flexing the cervical spine. The patient concentrates on attempting to touch the bottom of her ribs to her pelvis (ASIS). The hands can be placed over the ears to eliminate pulling on the neck.<br /><strong>Progression:</strong> The patient holds a 2.0 to 4.0kg medicine ball in front of the chest with the arms extended (see Figure 7b).<br /><br /></div><br /><div><img id="BLOGGER_PHOTO_ID_5636514118161993138" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 337px; CURSOR: hand; HEIGHT: 470px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQEHJQOZke17uMj5NKgFdphd1zy7wh_8Ry8NLsYu_EoHhnEVhUzhmCey727Oyfbnc2epBPjS2URgXA8AZ7fLCddwCrOxjaVtV18xjwKbw6JG4jb64huYBCzXFKRMtWibfKfteUDrvpgE3I/s400/image013.jpg" border="0" /><br /><strong>Figure 7a </strong><strong><br /></div></div></div></div></div></div></div><br /><div><img id="BLOGGER_PHOTO_ID_5636514123530491122" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 427px; CURSOR: hand; HEIGHT: 370px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLN3s97hppFEVbPxxbdqudggw5ZZVmRmGXDM1lQlLxPv1cobm1Y7Z8megz5gHZNTNiScK0DSlME780jHj1iwWZ5blMxXwv34sYrfyWSP8yIh9EWgC_8SIPqIznQnNjsTAOT8Yexq8xlwDk/s400/image015.jpg" border="0" /></div><br /><div>Figure 7b</strong><br /><br /><strong>Alternate Leg Bridge with Shoulders on Ball</strong><br />The patient starts this exercise sitting on the Physioball and walking forward with his feet on the ground, slowly leaning back until his back rests on the ball. This is called the bridge position. The head, neck and shoulder blades should be supported on the ball. Knees should be bent at a 90° angle, with feet on the ground. While bracing the abdominal muscles, the patient raises the foot and extends the leg off the ground. The weight will be shifted to one side, and the patient should focus on maintaining stability of the lumbo-pelvic region. The patient should strive for stability and balance, while holding this position for 10sec and alternating lower limbs.<br /><strong>Progression:</strong> The patient lifts the arms up in the air or out to the sides.<br /></div><br /><div></div><img id="BLOGGER_PHOTO_ID_5636514122150195874" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 425px; CURSOR: hand; HEIGHT: 406px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIi2KB2nnUsYjggWCZHjJI3oZkC8VzbDBNcfbmhNEPtPQ5MAk5schozl03r60a8y0AZegRXOWniHIeieN80f6IojW_1pvMQmzjXfsH3hXlgnhaPgr0SZnlIRFeh5K_8qJFPmKt3ighbyVJ/s400/image016.jpg" border="0" /><br /><strong>Figure 8: Alternate Leg Bridge with Shoulders on Ball</strong><br /><br /><strong>Abdominal Rollout</strong><br />The patient kneels behind the ball, with both hands on the ball. Keeping the abdominal muscles braced and lower back in a neutral position, she then rolls the ball away from her body a short distance until there is a straight line from the shoulder to hips. While maintaining alignment, she pulls the ball back a short distance, then pushes it away again. The movement should occur only at the shoulders, not the back<br /><strong>Progression:</strong> The patient can gradually straighten the body until she is up on her toes. There should be a straight line from the back of the head to the knees. Now she can again move the ball away and back toward the body a short distance with the arms.<br /></div><br /><div><br /><div><img id="BLOGGER_PHOTO_ID_5636514122201505042" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 415px; CURSOR: hand; HEIGHT: 479px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizpHMQMb80y5xCtaa3VqcOe98-jbMbYMVfW6EglIcF9eFPpklhAaQONWJTKcSqefuc_S5xeTUUB0XgkdomzecEUzaMlubSTGyd9iTUtmjkhQ-Oh9zdeCvbqWL7nAv7ISZGAN0pe35Jha5l/s400/image018.jpg" border="0" /><br /><strong>Figure 9: Abdominal Rollout</strong><br /><br /><br /><strong>Squat Ball Thrust</strong><br />Keeping the abdominal muscles braced and lower back and shoulder blades in a neutral position, he patient uses her abdominal contraction to move the ball forward and back. Keep the spine in neutral alignment throughout the movement. If the exercise shown is too challenging, start with the shins instead of the toes on the ball.<br /><br /><p><strong>Progression:</strong> The patient can perform the exercise with only one foot on the ball (see Figure 10b).<br /></p><br /><p><img id="BLOGGER_PHOTO_ID_5636514130219456338" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 417px; CURSOR: hand; HEIGHT: 424px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMhLq4_OC1K1zvqIa4435PahXM9KuS8ZeTXjo866q6VOOscwo2DzS0Klf_gF-bQgzkUsgbd14LasbtDINOdgxa-dZHkFHW9RW3h51mWAP5D8PwqMTEh8OURABfA7a4GceSfquoMKgMvM1m/s400/image020.jpg" border="0" /><br /><strong>Figure 10a</strong><br /><br /><img id="BLOGGER_PHOTO_ID_5636522335213501810" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 395px; CURSOR: hand; HEIGHT: 244px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVI-gYQCpA-_HiO8zBK_9PthFMw_xFeU6DBGFdhL927miVtQ8QsrEZBQjIo1Od1wIUCrDQzCS3NmZ5nTvF_Xii1ayKVYAed50vJbQaA7lwxQbu9Ur2Y62qIKEL4p2q0dNY0AXbiJRihYjc/s400/image021.jpg" border="0" /><br /><strong>Figure 10b</strong> </p><br /><p><strong>Development of balance and motor control</strong><br />The following movements require reflexive control. The patient can establish this control using an unstable surface and taking advantage of the numerous proprioceptors in the soles of the feet, and by activating the neck muscles, which contribute greatly to postural regulation. This sensory-motor training is an attempt to provide the sub-cortex with a basis for movement that is progressively more challenging. It involves exercises that stimulate balance, coordination, precision and skill acquisition.<br />Various devices are useful to progressively challenge balance, including a balance board with a whole sphere underneath the board (which creates multi-planar instability) or a rocker-board with a curved surface underneath the board (which allows single-plane motion). Dynamic foam rollers are an inexpensive alternative to the boards that also can be used to challenge balance, proprioception, and stability. These include half-rollers and full-sized rollers. Two other items that are invaluable to challenge balance and core stability and aid proprioceptive training in the standing position are the Bosu Balance Trainer and the Dyna Disk (these can be used interchangeably.) The Bosu has two functional surfaces that integrate dynamic balance with sports-specific or functional training: the domed surface is convex, the other side is flat and can be used for less challenge. The Dyna Disk is an air-filled plastic disc that can be firmly inflated. It has a smaller diameter than the Bosu and can be used like the Bosu Trainer, as it creates an increased proprioceptive challenge to the patient while standing on it. The Dyna Disk is unstable and does not have a base like the Bosu trainer. </p><br /><p><strong>Forward/Backward Rocking</strong><br />In this exercise, a rocker-board is used to challenge balance in the frontal plane of motion. Standing on the rocker-board with both feet in perfect postural alignment, the patient gently rocks forward and backward. (To maintain ideal posture, the patient can create an imaginary line through the joints of the ankle, knee, hip, and shoulder. The ear should align in a straight line with these joints, with no excessive extension [swayback] of the lumbar spine or anterior pelvic rotation.) While rocking, there should be no excess body movement in the coronal or transverse planes. This exercise should be performed for several minutes. The goal is to optimally align the spinal curves and lower extremities. </p><br /><p><strong>Progression:</strong> The patient can progress to a slight flexed-knee position, with fast and slow movements to stimulate the righting reflexes and balance reactions. She also can progress the stepping motion to the three axes of motion.</p><br /><p><img id="BLOGGER_PHOTO_ID_5636518817667789186" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 194px; CURSOR: hand; HEIGHT: 436px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNKxGlLxvxJAQPFPaqIv25l4W8aZsRtb76Q-XuR1qYfJwdV5dheORFPPtZNIrgNzhkFtDFxZNClIrMdxYIxq74dhvh_0i_HRdY_45E59rlMI4zJuOhLexRVafJALx8sL_IvCbpWxXPcs0K/s400/image022.jpg" border="0" /><br /><strong>Figure 11: Forward/Backward Rocking<br /></strong><br /><strong>Single-Leg Balance-3 Planes</strong><br />This next exercise progresses the patient to a single-leg stance. The rocker-board is used in the three planes of motion. This exercise also can be performed with a balance board, which is more demanding as it incorporates all planes of motion simultaneously. The patient takes one step forward while maintaining alignment and balance, controlling aberrant motion, mimicking a forward running motion. The goal is to maintain lumbo-pelvic alignment. The patient controls movement in the three planes of motions by placing her feet in various positions on the board. The patient then alternately steps forward and backward onto the rocker-board.<br /><strong>Progression:</strong> Once the patient achieves static stability and can remain stable while standing on the rocker board, she can add an accessory motion. The patient can swing the arm and the non-weight-bearing opposite leg (as though mimicking running). No excessive motion in the pelvis or lumbar spine should occur during the swing phase.</p><img id="BLOGGER_PHOTO_ID_5636518822641970978" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 489px; CURSOR: hand; HEIGHT: 266px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLgSTZzaeVTnw0_N3xNe14UiNaDXewAZYgwqxg54xvic1cyr9Abn4FMTbzflBmK3aZ7c_UvdWe52GK07JwnropIp8mePgL4oLin2xZSTdTg9VW8TX9oWxd9-JW5y3v4N-wOZ1Mi_mqEUS4/s400/image025.jpg" border="0" /><br /><strong>Figure 12: Single-leg Balance-3 Planes</strong><br /><br /><strong>Weight Transfers with Proper Alignment<br /></strong>The preceding exercise progresses to "falling" onto an unstable surface. Figure 13 shows a rocker-board and "falling" onto a circular balance board. Again, the emphasis is on spinal alignment from the head to the sacrum. The patient steps forward quickly and catches herself from falling over with a quick forward movement of the leg onto the board.<br /></div><br /><div><img id="BLOGGER_PHOTO_ID_5636522338587736130" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 451px; CURSOR: hand; HEIGHT: 335px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhIfocs9mWHZbBFm5rNxjS3kPkDOz4bsAcOhE8Ra-g8qwnlZ7l-oOM9uaalWNtys35QsNjTFWvgXQshkDxitUoEuZsycH3OG3K6lsj6pIf771t-cfgoBVTvHkU0-HCusGUictejCLOF4yO/s400/image026.jpg" border="0" /></div><br /><br /><div></div><br /><div><strong>Figure 13: Weight Transfers with Proper Alignment </strong></div><strong><br /><br /><div></strong><strong>Functional Movement Training</strong><br />Functional movements require acceleration, deceleration, and dynamic stabilization. A functional exercise regimen includes single-leg drills, three-dimensional lunges, resistive diagonal patterns of the upper and lower extremities, and tri-planar movement sequences. Patients can progress through the three planes of motion by performing similar exercises on balance boards, the Dyna Disk or Bosu type trainers, as static trunk and core stability have been mastered. Once these exercises are performed at a high level, the therapist can be assured the patient has the necessary core stability to start plyometric drills. </div><br /><br /><div><strong>Single-Leg Balance with Hip Flexion</strong><br />This exercise provides a functional movement pattern that is similar to running. The exercise seeks to increase stability of the lower abdominal muscles while using a forward motion at the hip. The exercise is designed to develop sagittal-plane control. While balancing on one leg, the patient imitates a running motion. As the upper thigh is lifted forward in a running motion, she concentrates on maintaining the abdominal brace and lumbo-pelvic stability while avoiding excessive anterior or posterior pelvic rotation. The patient raises the opposite arm simultaneously into flexion, while maintaining postural alignment with an erect spine, allowing only the extremities to move.<br /><strong>Progression:</strong> Once the patient can maintain lumbar spine stability without effort, she can attach a pulley or resistive cord to the ankle to increase the challenge to the hip flexors. </div><br /><p><img id="BLOGGER_PHOTO_ID_5636522344060153554" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 462px; CURSOR: hand; HEIGHT: 240px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZpTQdr02UN2KBj7y8jvKKrAs7zjNl2b5k16l0l3YJb-Gr6TbFOtZ0sO5YlYieDtnRPrJu2UUSJwLfcOwyu0RumJu5UZfVXmAVjL_KjXNlo5tx_d-5ejXOMFr3SIVOlj-OLvKqThf27jqK/s400/image028.jpg" border="0" /></p><br /><br /><div><strong>Figure 14: Single-leg Balance with Hip Flexion<br /></strong><br /><strong>Multi-Directional Lunges<br /></strong>The patient begins this exercise with a forward lunge. Again, the emphasis is on maintaining a neutral spine position and abdominal brace throughout the entire movement. As the patient steps forward, knee flexion of the forward leg is limited to 90°. The knee joint should be over the ankle joint and the patella aligned with the second toe. The lower part of the leg should be perpendicular to the ground, as shown in Figure 15.<br /><strong>Progression:</strong> Once strength and stability in the forward (sagittal) plane have been achieved, the patient can begin stepping out at oblique angles, creating a narrower lunge or a wider lunge in the coronal or transverse planes. The patient can also step out onto an unstable surface such as a Bosu Trainer or Dyna Disk, which vastly increase the proprioceptive and dynamic core-stability challenge.<br /><img id="BLOGGER_PHOTO_ID_5636522346371520594" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 451px; CURSOR: hand; HEIGHT: 370px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjU_Tj9Vk92uFO86MGgPZnLka4rPSiaAHlifLMXHm4aVSDLeL29oeJFaUZQyg_UJc-sIgcDAOF_MUEKOMxXlfgWtNt2jlWibUzhLoJQ2NO4RxnuVX9lM3m0m-z82IK_GNaE4aX1T3Q3kJN7/s400/image030.jpg" border="0" /></div><br /><br /><div><strong>Figure 15: Multi-directional Lunges </strong></div><br /><br /><div><strong>Resisted Alternate Arm/Leg Step-Ups</strong><br />This exercise is a continued progression of multi-directional lunges and must not be started until strength and stability in that exercise has been achieved.<br />This exercise utilises a sports cord to resist shoulder and hip flexion while doing Step-ups. The movement pattern is similar to the running gait. The patient's opposite arm and leg are resisted simultaneously to increase the strength and co-ordination of this movement pattern.</div><br /><br /><br /><p></p><img id="BLOGGER_PHOTO_ID_5636527842932634978" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 471px; CURSOR: hand; HEIGHT: 320px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5XLkW4YxqLNCtwvc6_mD0d1PAndcgaOL2Oboivhmr-H-v7lD7lxr5NRDdZfaS3Ss8hPBHTm2cYUWhoRwXMJpkFa4CQZfYdIDqsjqCjesTeMQTk9KnHMJ3lZOKYHF5Jrz4jeIaAjyBk8-7/s400/image032.jpg" border="0" /><br /><strong>Figure 16: Resisted Alternate Arm/Leg Step-ups</strong><br /><br /><br /><strong>Multi-Directional Resisted Alternate Arm/Leg Step-Ups<br /></strong>This is a continued progression of the previous exercise. Once strength and stability is achieved in the frontal plane of motion, the patient can begin stepping up at a 45°.<br /><br /><br /><br /><p></p><img id="BLOGGER_PHOTO_ID_5636522347861511378" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 440px; CURSOR: hand; HEIGHT: 348px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFbFvSy03qKahcAzARQJoc19N9BtU8QMcGRWMSyrwB-00XMABc0sxF50xVK-wvoM6TCvxu4OhGF7EVJlYGhe4UOUK0UD5x29ALjh9mb23VFjqwaVbWWIxnNZqAztl4KHl_Nxo6B2wY52Iw/s400/image034.jpg" border="0" /><br /><strong>Figure 17: Multi-directional Resisted Alternate Arm/Leg Step-ups</strong><br /><br /><strong>Standing Pulley or Medicine Ball Rotation<br /></strong>This resistive, dynamic trunk pattern challenges the core with a rotational movement pattern while the patient maintains stability in the hips and pelvis. It requires strict bracing of the abdominal muscles and locking the rib cage and pelvis together to avoid unnecessary stress from torsion on the spine.<br />The patient stands with feet about shoulder-width apart and knees slightly bent. She activates the abdominal brace prior to the movement. It is important to emphasize postural alignment, with the scapulae retracted and depressed. The patient should maintain neutral spinal angles throughout the movement. Holding a straight-arm position (elbows extended) while grasping the pulley handle or medicine ball with both hands, the patient rotates the trunk by activating the abdominal obliques and spinal rotators. She concentrates on keeping the arms extended in front of the chest. It is important that the pelvis remains stable in the movement. Resistance is perpendicular to the body.<br /><br />This exercise can be done in the same manner using a 2.0 to 4.0kg medicine ball. Progression: The patient can add diagonal motions with the pulley or medicine ball.<br /><img id="BLOGGER_PHOTO_ID_5636527843704714850" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 445px; CURSOR: hand; HEIGHT: 288px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGFydx-WSPfGsEOQcD4CjliqlGJIvDhUyzg8htxH4YPHKYktRfaRs7So5Phzg1pfZMrPxjUfHPmqh7dD4LiXFD9DBKWTu0HYvKah3jUcu6FyeaBpKCbN8D9tTgJJHCRS_47LcGTVZVLEAq/s400/image036.jpg" border="0" /><br /><strong>Figure 18: Standing Pulley of Medicine Ball Rotation</strong><br /><br /><strong>Forward Lunge with a Medicine Ball with Trunk Rotation</strong><br />The purpose of this exercise is to challenge the trunk muscles with appropriate weight shift, balance, and control on one leg. It uses a resistive movement of the trunk with a lunge that demands a high level of lumbo- pelvic and lower extremity stability as the patient moves the ball in a diagonal pattern across the body.<br />The patient will need approximately 30m to complete this exercise. She stands upright, holding onto a 2.0 to 4.0kg medicine ball, with arms outstretched, perpendicular to the body. She steps forward with the medicine ball in front of her chest with the arms extended. Once the lunge portion is completed, she rotates the trunk by bringing the ball across her body towards the same side as the front leg and then returns the ball to midline as the next step is made. It is important that the knee joint on the step- ping limb does not come forward past the vertical angle relative to the ankle joint. The second toe is aligned perpendicular with the patella.</div><br /><div></div><br /><br /><br /><div><img id="BLOGGER_PHOTO_ID_5636527848049159538" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 486px; CURSOR: hand; HEIGHT: 322px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGOtilO8r8z6LRAsOLQvUyTxa5Dn8De0vSp8uX0n_pAODUFarj-0HPnCU62nAiAxjZxO0iPEDCOB4Nxfex8qV2IC5g3Ud7cIin_cGcJzaT1BP5GQcb1letTxACXTyc74c8uD7n3kgdqhVx/s400/image038.jpg" border="0" /><br /><strong>Figure 19: Forward Lunge with a Medicine Ball with Trunk Rotation<br /></strong><br /><strong>Standing Reverse Wood-Chop with a Medicine Ball</strong><br />This exercise is a resistive diagonal pat- tern of the trunk that demands a high level of lumbo-pelvic stability and combines upper- and lower-chain integration as the ball is moved in a diagonal pattern across the body.<br />The patient stands, holding onto a 2.0 to 4.0kg medicine ball with both hands, with the feet approximately shoulder-width apart. While holding the arms in front of the body with elbows extended, the patient moves the ball from a lower position at the hip, raising it across the body to the opposite shoulder, simulating a wood-chopping motion. The motion is then reversed by starting at the lower knee position and bringing the ball diagonally across the body, ending overhead at the opposite shoulder. This exercise also can be performed with resistive cords or a pulley system simulating the same motions.<br /><strong>Progression:</strong> The patient can progress to standing on one leg, using the opposite arm to complete the motion.<br /><br /><strong>Conclusion</strong> <br /><p>This article is intended to provide an understanding of the importance of core musculature to low back pain patients and to offer exercises that will help them achieve desired stability, balance, and neuro- muscular control. 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Theory, Basic Exercises and Clinical Applications. Berlin: Springer, 1998.<br />Check, P. Swiss ball exercises for swimming, soccer and basketball. Sports Coach 21:12–13. 1999.<br />Cram, J.R., and G.S. Kasman. Introduction to Surface Electromyography. Gaithersburg, MD: Aspen Publishers, Inc., 1998.<br />Cusi, M.F., C.J. Juska-Butel, D. Garlick, and G. Argyrous. Lumbopelvic stability and injury profile in rugby union players. N. Z. J. Sports Med. 29:14–18. 2001.<br />Franklin, B.A. ACSM Guidelines for Exercise Testing and Prescription. Philadelphia: Lippincott, Williams, and Wilkins, 2000.<br />National Institute of Occupational Safety and Health (NIOSH): National Occupation Research Agenda. Washington, D.C.: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, NIOSH; 1996.<br />Morse L, Owen D, Becker CE: Firefighter's health and safety. In Environmental and Occupational Medicine Edited by: Rom WN. Boston: Little Brown; 1992:197-1204.<br />Rivera F, Thompson D: Systematic reviews of injury- prevention strategies for occupational injuries. Am J Prev Med 2000, 18:1-3.<br />Firefighter Injuries for 2003. NFPA Journal 2004, 1:56-78.<br />U.S. Fire Administration. Topical fire research series 2001, 2:2-22.<br /></p></div></div>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com2tag:blogger.com,1999:blog-9016364437066447337.post-83025752963562483862011-03-27T18:00:00.000-07:002011-03-27T18:06:05.327-07:00Dr. Ajimsha’s new research gives hope to headache sufferers<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXqFG6akUH1LWosey7CoMkE8dvOdxCOEqY0DZq3HM_gBogJo0e0W531AVu6eaujj803lmIbPuwlb0ieZMwd5qTXGuvTot30ewmDU32vL7GmeOQc8Dk6VAYkTSYog7Cy010kI1cuwrRwZAx/s1600/MFR-1.JPG"><img id="BLOGGER_PHOTO_ID_5588930271167652226" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 316px; CURSOR: hand; HEIGHT: 275px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXqFG6akUH1LWosey7CoMkE8dvOdxCOEqY0DZq3HM_gBogJo0e0W531AVu6eaujj803lmIbPuwlb0ieZMwd5qTXGuvTot30ewmDU32vL7GmeOQc8Dk6VAYkTSYog7Cy010kI1cuwrRwZAx/s400/MFR-1.JPG" border="0" /></a> <br /><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBelM1KzeM9VsdsWYsqUxeUWM6ChZGX7_TwWGHfocLHUlNwn4nbFFbKsXPIQzb9GJUdW1AOKvFvIvkACj4oE15RA09VwvL05uMPTVXu79iJxq1cA9rSvdVRoRlGr8LzJBOGNOd_hVJka78/s1600/MFR-2.JPG"><img id="BLOGGER_PHOTO_ID_5588930149186103010" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 270px; CURSOR: hand; HEIGHT: 276px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBelM1KzeM9VsdsWYsqUxeUWM6ChZGX7_TwWGHfocLHUlNwn4nbFFbKsXPIQzb9GJUdW1AOKvFvIvkACj4oE15RA09VwvL05uMPTVXu79iJxq1cA9rSvdVRoRlGr8LzJBOGNOd_hVJka78/s400/MFR-2.JPG" border="0" /></a> <br /><div>A new drug-free, non-surgical therapy called Myofascial Release has been clinically proven to cure tension type headaches. This is good news for the millions of people who suffer from acute and chronic tension type headaches. The new therapeutic approach may bring hope and much needed relief. Tension-type headache (TTH) is a bilateral headache of a pressing or tightening quality without a known medical cause. Tension-type headache is classified as episodic if it occurs on less than 15 days a month and as chronic if it occurs more often. A survey from the United States by Schwartz et al in 1998 found a one-year prevalence of 38% for episodic tension-type headache and 2% for chronic tension-type headache. </div><br /><div>With so many people suffering with headaches, there has been an enormous amount of research into finding a cure. Much of the effort has been directed to pharmaceutical interventions (including numbing agents, muscle relaxants, anti-depressants, non-steroidal anti-inflammatories and others). However, myofascial release has proven as powerful and effective breakthroughs in headache treatment, which is practiced by physiotherapists and osteopaths across the world for common musculoskeletal conditions. </div><br /><div>According to Dr. Ajimsha. M.S; researcher and lecturer of School of Physiotherapy, AIMST University, Kedah – “this approach seemingly goes after the cause of the problem instead of merely masking symptoms (as is the case with so many drug approaches)”. He has done a study on 63 individuals with tension type headache by applying two different types of myofascial release techniques to different groups and compares it with a control group which received soft stroking around the head and neck. </div><br /><div>In the clinical study published by the ‘journal of body work and movement therapies’ by Elsevier Ltd; Dr. Ajimsha. M.S proved that after the application of myofascial release the proportion of responders who had at least 50% reduction in headache days per month were 81.8% and 86.4% in the two myofascial release groups where as it was 0% in the control group. After the treatment patients in the myofascial release group reported 59.2% and 54% reductions in their headache frequencies compared to the 13.3% reduction in the headache frequency of the control group. Both the myofascial release techniques studied here were equally effective in reducing the headache frequencies. This study provides evidence that myofascial release is highly effective for tension type headaches and a significant proportion of patients with tension type headache might benefit from the use of myofascial release.</div><br /><div></div><br /><div><strong>Reference:</strong> </div><br /><div>Ajimsha, M.S., Effectiveness of direct vs indirect technique myofascial release in the management of tension-type headache, Journal of Bodywork & Movement Therapies (2011), doi:10.1016/j.jbmt.2011.01.021.</div></div>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-9075273252892650482010-10-15T01:35:00.000-07:002010-10-15T01:36:30.251-07:00Fascia is able to contract in a smooth muscle-like manner and thereby influence musculoskeletal mechanicsR Schleip,W Klingler, F Lehmann-Horn<br /><br />Summary<br />With immunohistological analysis we demonstrate the presence of myofibroblasts in normal human fasciae, particularly the fascia lata, plantar fascia, and the lumbar fascia. Density was found to be highest in the lumbar fascia and seems to be positively related to physical activity. For in vitro contraction tests we suspended strips of lumbar fascia from rats in an organ bath and measured for responsiveness to potential contractile agonists. With the H1 antagonist mepyramine there were clear contractile responses; whereas the nitric oxide donator glyceryltrinitrate induced relaxation. The measured contraction forces are strong enough to impact upon musculoskeletal mechanics when assuming a similar contractility in vivo.<br /><br />Introduction<br />Fascia is usually considered to be a passive force transmitter in musculoskeletal dynamics. Nevertheless the literature mentions indications for an active contractility of fascia due to the presence of contractile intrafascial cells. This study for the first time shows clear evidence, that human fascia is able to actively contract and thereby may influence biomechanical behavior.<br /><br />Methodology<br />Rodent, porcine and human tissue samples from different fasciae were collected and used for the experiments according to the guidelines of the ethics committee of Ulm University, Germany. Fascia samples from 32 human bodies (ages 17-91, 25 male, 7 female) were analyzed for the presence of myofibroblast, by immunostaining for α- smooth muscle actin, which was digitally quantified. Samples of lumbar fascia from rats and mice were used for comparison. Additionally fresh samples of fascia were exposed to mechanographic force registration under isometric strain in vitro. These were conducted in an immersion bath and in a specifically modified superfusion bath. Tissues were challenged mechanically, electrically and pharmacologically, and changes in tissue tension were registered electronically. Unviable fascia tissues were investigated to elucidate the cellular contribution.<br /><br />Results<br /><br />The histological examination revealed that myofibroblasts are present in normal fasciae. The human lumbar fascia with its lattice-like fiber orientation exhibits a higher myofibroblast density, compared with other examined fasciae of both humans and rats. There is generally a large variance in myofibroblast density between different persons. The data indicate a positive correlation between myofibroblast density and physical activity. It was shown that the increase in initial stiffness in response to repeated in vitro stretching (as reported in the literature) was due to changes in matrix hydration. No responses could be detected with electrical stimulation. However, smooth muscle-like contractions could be induced pharmacologically. High dosages of the antihistaminic<br />substance mepyramine had most reliable and sustaining effects (n=29, p<0.05); while histamine and oxytocin induced shorter contractile responses in selected fasciae only; and addition of an NO donator triggered brief relaxation responses in several samples.No response could be elicited with epinephrine, acetylcholine, and adenosine. The mepyramine induced tissue contractions demonstrated very slow and enduring response curves, lasting up to 2 h. Since the histological examination had revealed an increased myofibroblast density in endo- and perimysial intramuscular fasciae, mepyramine was additionally applied to whole muscular tissue pieces including their fasciae, which showed similar contractile response curves as pure fascia, apparently not due to myogenic contraction. The maximal in vivo contraction forces were hypothetically calculated and applied to the human lumbar area. The resulting forces are strong enough to alter normal musculoskeletal behavior, such as mechanical joint stabilization or ¡-motor regulation.<br /><br /><br />Conclusions<br />These results suggest, that fascia is a contractile organ, due to the presence of myofibroblasts. This ability is expressed on the one hand in chronic tissue contractures which include tissue remodeling; and on the other hand in smooth muscle-like cellular contractions over a time frame of minutes to hours, which can be strong enough to influence low back stability and other aspects of human biomechanics. This offers future implications for the understanding and clinical management of pathologies which go along with increased or decreased myofascial stiffness (such as low back pain, tension headache, spinal instability, or fibromyalgia). It also offers new insights for treatments directed at fascia, such as osteopathy, the Rolfing method of myofascial release, or acupuncture. Further research on fascial contractility is indicated and promising.<br />(For details please read the original articles)Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com6tag:blogger.com,1999:blog-9016364437066447337.post-79775829275006781442010-05-26T17:50:00.000-07:002010-05-26T17:53:27.089-07:00Manual Therapy Choices for Parkinson’s Disease<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqgxfB_2h7gWXFVFwixp0PrXijeRNmvoPWOfNXbDmoejWomZoVfMfGYdhyY2AxSx2QV0l0lxPikz_dnmPv3TCUHn-EMZzhwFSxu-eOw6YbN399wjwYWKMuG3zyLaCK8dXZO5CAj2GBmSj4/s1600/sceb+capt+032.jpg"><img id="BLOGGER_PHOTO_ID_5475746524296979058" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 300px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqgxfB_2h7gWXFVFwixp0PrXijeRNmvoPWOfNXbDmoejWomZoVfMfGYdhyY2AxSx2QV0l0lxPikz_dnmPv3TCUHn-EMZzhwFSxu-eOw6YbN399wjwYWKMuG3zyLaCK8dXZO5CAj2GBmSj4/s400/sceb+capt+032.jpg" border="0" /></a><br /><div></div><br />In treating dysfunction, it is normal for most therapists to use a variety of modalities and methods including myofascial release, muscle-energy techniques, positional-release techniques and many more. The assumption must be that different tools achieve different effects, and the ones we choose reflect our perception as to the needs of the individual and/or of the tissues involved. Sledgehammers and walnuts are a reminder that there are appropriate and inappropriate tools for achievement of specific tasks.<br />A question arises as to whether there exists potential patient benefit to use a general, nonspecific, manual therapy approach, as well as specific focus on identified dysfunction (short, tight, restricted, etc). Evidence (see below) suggests that this is the case, particularly in situations of general poor health.<br />The variables as to why a particular method is chosen may include: how acute or chronic and how general or local the problem is; age, history and current overall health status of the person; known and/or hypothesized effects of the method in question in relation to identified dysfunctional conditions (i.e., the aimed-for objectives); and the skills, training and licensing restrictions associated with the person providing treatment.<br />Of course, if only a limited range of skills and modalities have been acquired, choice may be limited by that alone. In contrast, a therapist who has acquired multiple skills and a range of modalities from which to choose may be virtually spoiled for choice as to which therapeutic approach(es) to adopt.<br />I was reminded a few days ago of the importance that therapists acquire multiple skills when I came across a research study that evaluated a range of osteopathic methods (compared with dummy modalities) in the treatment of patients with Parkinson’s disease (PD).4 In this study, 10 patients with Parkinson’s disease and a group of eight age-matched normal control subjects were subjected to gait analysis before and after a single session of an osteopathic manipulative treatment (OMT) protocol that involved mobilization and muscle-energy procedures rather than manipulation. A separate group of 10 patients with Parkinson’s disease was given a sham-control procedure and tested in the same manner.<br />In the treated group of patients with Parkinson’s disease, statistically significant increases were observed in stride length, cadence, and the maximum velocities of upper and lower extremities after a single treatment.<br />There were no significant differences observed in the control groups. The data demonstrates that a single session of an OMT protocol has an immediate impact on Parkinsonian gait.<br />So, what methods were used (all of which are within the scope of practice of massage therapists, once they have acquired the skills)?<br /><br />Antero-posterior and lateral mobilization of the thoracic and lumbar spine (patient seated).<br />Myofascial release of the thoracic spine (patient seated).<br />Atlanto-occiptal release (patient supine; not manipulation).<br />Mobilization of the cervical spine (patient supine).<br />Muscle-energy technique (MET) release of cervical muscles (patient supine).<br />General mobilization of the shoulder joints including use of MET (patient side-lying).<br />Mobilization of the forearms (patient supine).<br />Mobilization of the wrists (patient supine).<br />Mobilization of the SI joint (patient supine).<br />MET to the hip adductors (patient supine).<br />MET to psoas muscles (patient supine).<br />MET to hamstrings (patient supine).<br />Mobilization of the ankles (patient supine).<br />MET to the ankle in dorsi and plantar flexion (patient supine).<br />Note: This sequence was performed in this order in 30 minutes.<br /><br />Obviously (and the researchers note this), these procedures would probably have been even more effective if combined with approaches that targeted restrictions and dysfunctions specific to particular individuals.<br />However, in the context of a research study, it was considered that it would be useful to evaluate the benefits - or lack of thereof - when a standardized set of methods were used on all patients.<br />The outcome was clear. There is a major general benefit to be gained from a broad, generalized, constitutional approach involving myofascial release, muscle-energy techniques and mobilization. Would the results have been even more profound if they had been combined with massage or associated approaches such as Trager therapy and/or trigger point deactivation utilizing neuromuscular techniques?1-3I would bet the farm - and more -on this!<br />Leon Chaitow, ND, DO<br /><br />References<br />1. Craig L, et al. Controlled pilot study of the effects of neuromuscular therapy in patients with Parkinson’s disease. Movement Disord 2006;21(12):2127-33.<br />2. Duval C, et al. The effect of Trager therapy on the level of evoked stretch responses in patients with Parkinson’s disease and rigidity. JMPT 2002;25(7):455-64.<br />3. Hernandez-Reif M, et al. Parkinson’s disease symptoms are differentially affected by massage therapy vs. progressive muscle relaxation: a pilot study. J Bodywork Movement Ther 2002;6(3):177-82.<br />4. Wells M, et al. Standard osteopathic manipulative treatment acutely improves gait performance in patients with Parkinson’s disease. J Am Osteopath Assoc 1999;99(2):92-8.Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com2tag:blogger.com,1999:blog-9016364437066447337.post-21980893234101152542010-05-26T17:31:00.000-07:002010-05-26T17:40:51.091-07:00Myofascial Release for Athletes<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqJVLIrSD9os2kGAUmIf_PGJR3X1cThSEu6gTx4zPYdLYC4VpXI8RlLnGR4tdYl5GWXir69leVW9uK5Re5L0-RbF42SLyuGDhOOKtyYR1HtEFgxlibfdPeu3WQarUCdzIxti6cOMC87NnX/s1600/Photo100.jpg"><img id="BLOGGER_PHOTO_ID_5475742838999479874" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 300px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqJVLIrSD9os2kGAUmIf_PGJR3X1cThSEu6gTx4zPYdLYC4VpXI8RlLnGR4tdYl5GWXir69leVW9uK5Re5L0-RbF42SLyuGDhOOKtyYR1HtEFgxlibfdPeu3WQarUCdzIxti6cOMC87NnX/s400/Photo100.jpg" border="0" /></a><br /><div></div><br /><strong>Introduction<br /></strong>Athletes commonly suffer from functional pain or restrictions in flexibility due to scar tissue or adhesion build-up in the muscle and fascia. This is usually caused from strains to the muscles. Myofascial Release is a massage technique that utilizes the stretching of the fascia and muscle to help increase Range of Motion or to decrease pain by breaking up these adhesions in the fascia. Fascia is the connective tissue that covers all muscle and tissue in the body. Breaking up these adhesions between the fascia and muscle allows the muscle and fascia to move smoothly over each other and helps alleviate the problem7.<br />The idea of Myofascial Release is to slowly stretch the fascia because fascia does not respond to quick tensile forces. Rather it will elongate with a slow moderate stretching7. This will help the muscle to glide over the fascia because it is giving the muscle more space to move, increasing flexibility. Other techniques help break down different adhesions to also increase flexibility and decrease associated pain.<br />In this paper I will explain Myofascial Release. I will talk about its history, the physiology and anatomy behind its use, the physiology behind static stretching, how Myofascial Release and Static Stretching increase Range of Motion, and finally different techniques used for Myofascial Release.<br /><strong>History of Myofascial Release<br /></strong>Myofascial Release, or similar theories has been around since the 19th century, however there is no documentation that suggests the exact origin of Myofascial Release. Dating back to the 1940’s the term Myofascial was used in Janet Travell’s research of different pain syndromes. In the 1950’s there were articles that were published that talked about trigger points and Myofascial pain. As we went into the 1960’s and 1970’s, the acknowledgment of Myofascial trigger points in causing pain and restrictions in Range of Motion was increasing3.<br />The actual term of Myofascial Release was not used until 1981. It was used in the title of a course on Myofascial Release at Michigan State University3. Myofascial Release is based on the concepts created by Andrew Taylor Still, the founder of Osteopathic Medicine, in the 19th century. The first form of Myofascial Release that was used By Still was the indirect method. This method involves the gentle stretching of the fascia, such as the cross-hand technique. The indirect method was growing at the Kansas City College of Osteopathy and Surgery. Dr. George Andrew Laughlin and Dr. Esther Smoot were very influential in the growth of this indirect method3.<br />The Direct Myofascial Release most likely came about in the 1920’s. This technique has developed much more slowly than the indirect technique3. Dr. William Neider developed this technique that was named “fascial twist,” which was more forceful then the gentle stretching of the indirect method3. Many of his concepts are present in today’s techniques of Myofascial Release.<br />To effectively use Myofascial Release, a thorough understanding of its techniques is necessary. To best utilize Myofascial Release, knowledge of the anatomy and the neurology is needed.<br /><strong>Physiology of Myofascial Release<br /></strong>Fascia is a connective tissue along with tendons, ligaments, bone, and muscle. Fascia is divided into three different layers. The first layer, which is the superficial fascia, consists of connective tissue and adipose tissue. It provides a path for nerves and blood supply3.<br />The second layer of fascia is called the potential space. This area can become inflamed, which shows that it can be injured or stretched with any type of injury3. The final layer of fascia is the deep layer. This layer is a very dense connective tissue that covers all the muscles and organs of the body. This layer also divides the different muscles from each other. The function of this layer is to allow movement of the muscles over each other, can provide attachments of some muscles, and it fills the spaces between some muscles and organs3.<br />At times the muscles that are beneath and surrounded by this fascia become large rather quickly. This can cause the fascia to be too small and tight around the muscle. This causes restrictions in Range of Motion of a particular muscle. One function of Myofascial Release is to help stretch the fascia to allow more motion of the muscle therefore increasing the Range of Motion of the body.<br />Restrictions in motion and the cause of pain can also occur as a result of a muscle strain. A muscle strain can lead to chronic issues and inflammation. This pain can be a result of Myofascial Pain Syndrome. Treatment of this type of pain has no real plan like the treatment of an acute injury has. This pain begins in the fascia and the muscle. This causes restrictions in Range of Motion and causes pain. If this is untreated, Myofascial Trigger Points can then develop3.<br />Myofascial Trigger Points are “…a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena,” quoted by J.G. Travell and D.G. Simons in The Manual of Trigger Point and Myofascial Therapy2. There are a few different theories regarding the origin of Myofascial trigger points. One of them is the thought that abnormal muscle spindles send signals that may cause a trigger point. Another theory deals with scar tissue formation, while a third one talks about nerve signals can cause a Myofascial Trigger Point2. All of these can be causes of trigger points, however researchers are not exactly sure of the origin of the trigger points.<br />Different techniques of Myofascial Release can help work out these trigger points and decrease pain and restore motion. Adhesions and scar tissue build-up can also be a cause of decreased motion and increased pain. Myofascial Release can be used to reduce these adhesions and restore motion and decrease the associated pain from the lack of function7.<br /><strong>Physiology of Stretching<br /></strong>Static Stretching is a technique very commonly used to help improve Range of Motion of a particular body part and help reduce the risk of injury. The principal behind static stretching is the stress-strain curve, which demonstrates the extensibility and breaking point of tissue. Muscle will stretch when a force is placed on it. When the muscle is stretched beyond its original length it will then stay at the new length if the force is great enough.<br />Continuous stretching over a long period of time will result the muscle to elongate and become more flexible. This will cause the Range of Motion to increase and therefore help reduce the risk of injury from a tensile force. If the muscle is more flexible, it obviously can stretch further. When a strong tensile force is placed on the muscle, it can go further than it originally could, making it harder for the muscle to tear.<br /><strong>Myofascial Release Techniques and Guidelines</strong><br />Some contraindications to Myofascial release are its use on acute fractures, someone with osteoporosis, arthritis, on anyone with skin conditions, and over areas with heavy edema8. If the athlete does not have any of these conditions, Myofascial Release is very helpful in their treatment as will be explained later in this paper.<br />There are several different techniques for Myofascial Release. Some focus more on the actual stretching of the fascia, while others focus more on trying to release and work out the Myofascial Trigger Points and adhesions that can form between the fascia and the muscle. Myofascial Release can be performed anywhere there is fascia in the body and you can work out either superficial or the deep fascia.<br />Before you can perform this type of therapy you must find out where the restrictions are in the person. You can do this by looking for any areas of restriction or pain in the person. For example, a person may complain of chronic hamstring pain and may demonstrate hamstring tightness. This could be a candidate for the use of Myofascial Release. The athlete may also reveal previous hamstring injuries, which could be a cause of Myofascial Pain Syndrome.<br />One technique is the “transverse fascial-plane release” technique, which used commonly used on the diaphragm, thorax area, and the spinal column area9. Also, the cross-hand technique, in which you have your hands crossed and apply pressure in opposite directions to slightly stretch the fascia9. Another technique, which is used to help break up adhesions within the fascia, is the J-stroke method. With this technique, you hold the fascia on stretch with one hand, and move the other hand over the restricted area in a J pattern7. Another form o f release is the skin rolling technique, in which you just roll the skin between your fingers trying to work out the trigger points and adhesions that can form within the fascia to help the athlete restore his or her normal Range of Motion7. If you are looking to work the superficial fascia, you only need one hand, and just place less pressure. To release deeper fascia, a more intense pressure should be applied.<br /><strong>Myofascial Release and Static Stretching To Improve Function</strong><br />As was stated above, Myofascial Release can help increase Range of Motion and decrease chronic muscle pain caused by either Myofascial Trigger Points or other adhesions with the Myofascia. One case report looked at a female runner who had extremely chronic hamstring pain. She was unable to run because of the pain. She also had deficits in her Flexibility in the involved leg. Also, she had tightness in many other areas such as her pectoralis major. She received Myofascial Release on her Posterior leg as well as back, and was also doing manual hamstring exercises at home 2 times per day6.<br />After a few treatments she had a significant reduction in pain. She also began hamstring exercises for strengthening. She was able to begin running again with no pain, and her flexibility was also increasing6. The release and stretching together helped this athlete restore her Range of Motion and reduce her pain.<br />The next article was a clinical study that wanted to analyze the differences between Myofascial Release and Static Stretching on increasing the Flexibility of the Hamstrings. While Static Stretching has been a known treatment of Range of Motion deficits, Myofascial Release is more commonly a secondary treatment and often coupled with other treatments. This study looks at the two different treatments alone to compare the results4. The participants of this study needed to have at least a 15-degree deficit in Hamstring flexibility to qualify to participate. Also, the participants could not have any hamstring injury or lower back pain within the last 6 months before the study4.<br />There were three different groups in the study: the control group, the Myofascial Release group, and the Static Stretching group. The two groups that were receiving treatment underwent four weeks of treatment, while recording the results of the active knee extension as they progressed through the study4. The stretching group did four thirty second stretches during each session. The release group did four treatments per session. The control group obviously did not do any stretching exercises during the study4.<br />Both the Static Stretching group and the Myofascial Release group showed significant increases in the flexibility of the athlete’s Range of Motion. However, the researches found no difference between these two groups. The study found that the two methods are both effective in increasing Range of Motion4.<br />Another study which is similar to the one above, focused on Myofascial Release and stretching on Range of motion and also Muscle activity. This study focused more on the hip flexors, rather than the hamstrings. This study was similar to the one above and found similar results. Both the Static Stretching and the Myofascial Release showed great increases in hip flexor flexibility. However, the two treatments had no effect on the muscle firing activity of the antagonistic muscles; in this case the gluteus maximus5.<br /><strong>Conclusion<br /></strong>Myofascial Release is a very good tool for Athletic Trainer’s to utilize in treatment of their athletes. It has been shown to greatly increase Range of Motion, the same amounts as static stretching. As well as decreasing pain and myofascial trigger points associated with chronic myofascial pain syndrome commonly from hamstring strains and the build-up of scar tissue2. Myofascial release is mostly used with another treatment, usually not as the initial treatment of injuries. I believe that coupled with static stretching, the function of the athlete can be greatly increased. One study on Static Stretching’s effect on muscle soreness found that stretching has a very small effect on the reduction of muscle soreness1. Therefore Myofascial Release and Static Stretching will greatly increase the function of an athlete.<br />However, to come to a definitive conclusion there needs to be more research comparing the use of Myofascial Release and Static Stretching. Also there needs to be research that compares these two treatments along with Myofascial Release and Static Stretching together.<br /><br />Works Cited<br /><br />1. Anderson, J.C. "Stretching Before and After Exersice: Effect on Muscle Sourness and Injury Risk." Journal of Athletic Training 40 (2005): 248-255.<br /><br />2. Kostopoulos, Dimitrios, Rizopoulos K. The Manual of Trigger Point and Myofascial Therapy. (2004): SLACK Incorporated, Thorofare, NJ.<br /><br />3. Manheim, Carl. The Myofascial Release Manual ed. 3 (2001)<br /><br />4. McClellan EC, Padua DA, Guskiewicz KM, Prentice WE, Hirth C. " Effects of Myofascial Release and Static Stretching on Active Range of Motion and Muscle Activity." Journal of Athletic Training 39 (2004): 98.<br /><br />5. Shulzt, SP, Padua DA, Petschauer MA, Hirth CJ. "Effects of Myofascial Release and Static Stretching on Hamstring Flexibility." Journal of Athletic Training 39 (2004): 90.<br /><br />6. Spina, Andreo. “Treatment of Proximal Hamstring Pain using Active Release technique applied to the Myofascial Meridian: A Case Report.” Sports Performance Centres. <http:>.<br /><br />7. Starkey, Chad. "Myofascial Release." Therapeutic Modalities ed. 3 (2004): 299-303<br /><br />8. Sefton, JoEllen. “Myofascial Release for Athletic Trainer’s, Part 1: Theory and Session Guidelines.” Athletic Therapy Today 9 (2004): 48-49.<br /><br />9. Stone, Jennifer A. “Prevention and Rehabilitation: Myofascial Release.” Athletic Therapy Today 5 (2000): 34-35<br /><br />10. Zainuddin, Zainal, Mike Newton, Paul Sacco, Kazunori Nosaka. "Effects of Massage on Delayed-Onset Muscle Soreness, Swelling, and Recovery of Muscle Function." Journal of Athletic Training 40 (2005): 174-180.Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com2tag:blogger.com,1999:blog-9016364437066447337.post-2705294081335733322010-01-02T00:43:00.000-08:002010-01-02T00:53:18.663-08:00Home based MFR managements for pelvic floor dysfunctions<p align="left"><strong><span style="font-size:130%;">Home based MFR managements for pelvic floor </span></strong><span style="font-size:130%;"><strong>dysfunctions</strong> <strong>(5 Series)</strong></span></p><br /><br /><p align="center"><strong><span style="font-size:180%;">Part I to V</span></strong></p><br /><br /><p align="center"><strong>Myofascial Release for Women’s Health Problems</strong></p><img id="BLOGGER_PHOTO_ID_5422061554364238562" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 301px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtrauSSLvJTkPTSyqTSLpmSEPCn2RbvZF36ymj9PMjTGWzsZqQjJEAcRHMFRcA-vIUJbAAlrXi5t852mWILTMMdLIIwQoyn3L9-NKDcBfhty-qj7gA8fNv34zeYt2ZK4eO9NFQKmbHrKjj/s400/vulva+with+trigger+points.JPG" border="0" /><br /><p align="center"><strong>(Read one by one from Part I)</strong></p><br /><p><strong></strong></p>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-3158329438544504112010-01-02T00:36:00.000-08:002010-01-02T00:42:20.250-08:00Home based MFR managements for pelvic floor dysfunctions: Part I<span style="font-size:130%;"><strong>Myofascial Release for Women’s Health Problems<br /></strong></span><br /><strong>Pelvic Floor Dysfunctions and Treatments</strong><br /><br />There are thousands of women and men who believe that incontinence (loss of bowel or bladder control) and pelvic floor dysfunctions are normal part of aging. It is NOT a normal part of aging. We do not have to endure pads and medication - there are non-surgical options for retraining the bladder and pelvic floor that are proven through research as effective and efficient.<br /><br />For Women, normal pelvic function also means that there is not supposed to be pain in the pelvic floor. Insertion of tampons, sexual intercourse, gynecological examinations and clothing should never cause pain. The muscles and tissues of the pelvic floor can be aggravated by many conditions including vulvodynia, vestibulitis, prolapse or cystocele/rectoceles or pudental Neuralgia. Myofascial release is a new tool to ‘down train’ the muscles of the pelvic floor, and to help restore normal flexibility and tolerance to the soft tissues both externally and internally.<br /><br />Myofascial practitioners specialized in perineal, external and internal pelvic floor releases can help those sufferers retrain the muscles of the pelvic floor and assist with bladder and bowel training to return women and men to normal function.<br /><br /><strong>Normal function means you can:</strong><br /><br />Allow the bladder to expand (fill) and contract (empty) normally and without pain.<br />Have the sensation and awareness of when the bladder is full – and be right.<br />Have the ability to get to the bathroom.<br />Have the ability to remove your clothing.<br />Participate in sexual intercourse without pelvic pain<br />Sit comfortably<br />Tolerate gynecological examinations<br /><br /><strong>Myofascial Release Eases the Pain of Women's Health Problems</strong><br /><br />Myofascial Release has been on the forefront of health care for the past two decades particularly in the resolution of complex chronic pain problems. In that time, there has been an increasing number of women reporting problems such as urinary incontinence, pelvic pain, menstrual problems, fibromyalgia, chronic fatigue syndrome, and/or headaches. It is unclear whether this rise in these complaints is due to an increased prevalence or that women are just communicating more about their problems.<br /><br />Whatever the case may be, it remains clear that the numbers are staggering in terms of the women who are affected by these problems. For instance, in 1996 the US Department of Health and Human Services reported that 13 million Americans are incontinent; 11 million of them are women. One in four women ages 30 to 59 have experienced an episode of urinary incontinence. 16.4 billion dollars are spent each year on incontinence-related care and 1.1 billion dollars is spent yearly on disposable products for incontinent adults.<br /><br /><strong>How the Myofascial Release can help:</strong><br /><br /><strong>Incontinence:</strong> Some women undergo pelvic or abdominal surgery to help resolve incontinence, menstrual, or pelvic pain problems often associated with pelvic floor muscle weakness following multiple child births. This solution, however, often puts these same women at risk for developing other pelvic pain problems or reproductive dysfunction and infertility problems because of the scar tissue that forms following surgery.<br /><br />Myofascial Release has been a tremendous help to women suffering with incontinence and pelvic pain. Myofascial Release techniques specific to the pelvis are helpful in decreasing the restrictions in that area that lead to incontinence and pelvic pain. This technique has also been adopted in areas such as the urology department at Stanford University, as noted in “A Headache in the Pelvis: A new understanding and treatment for prostatitis and chronic pelvic pain syndromes” by Dr. Anderson, MD.<br /><br /><strong>Infertility</strong>: It is common to hear about the infertility problems that many women suffer with through the media or through family and friends. Many women go through expensive hormonal therapies and attempts at in vitro fertilization that offer no guarantees and are generally not covered by insurance. Expenses can run into the tens of thousands of dollars for the best technological advances that modern medicine have to offer in order to merely bypass what often is a structural imbalance in the body caused by myofascial restrictions.<br /><br />Many women who have gone through all types of fertility treatments and had given up on ever becoming pregnant have been pleasantly surprised of the effects that Myofascial Release have had on their infertility...they became pregnant when all else failed! While they may have originally been receiving Myofascial Release for other pain problems, the effects of Myofascial Release particularly in freeing the pelvic region of adhesion has allowed for more normal reproductive function in these women.<br /><br /><strong>The Myofascial system and chronic symptoms:</strong><br /><strong></strong><br />The myofascial system surrounds and interpenetrates every organ, nerve, blood vessel, and duct within the pelvic floor. Trauma, inflammation, surgical scars, and child birth very commonly tighten the myofascial system around these delicate and pain sensitive structures. Tightness and restriction within the myofascial system can cause or contribute to many women's health issues including pelvic floor pain and dysfunction, infertility, incontinence, vulvodynia, coccydynia, pelvic adhesion from endometriosis and surgical scars, painful episiotomy scars, interstitial cystitis, fibromyalgia and pregnancy related back pain and sciatica.<br /><br />It is estimated that a large number of women experience infertility as a result of fascial restrictions from scar tissue, endometriosis or inflammatory processes. These fascial restrictions may physically interfere with fertility by compressing the reproductive structures such as the fallopian tubes or ovaries and can be helped with Myofascial Release. In addition, because the fascial system surrounds every system of the body, including the endocrine system, fertility problems related to hormonal imbalance may be helped using Myofascial Release. For example, the pituitary gland, the master gland of the body is housed within the sphenoid bone of the skull. Fascial restrictions throughout the neck, dural tube and particularly the suboccipital region often create compression of the sphenoid bone, which houses this delicate gland. Releasing fascial restrictions helps to free these structures and restore more normal function of the endocrine system thus helping to resolve fertility problems related to hormonal imbalance.<br /><br />Painful or tight episiotomy scars are another common cause of pelvic floor pain and dysfunction and can be effectively treated by the therapists using this highly specialized form of Myofascial Release.<br /><br />In addition to the various general and specialized myofascial release techniques for women with pelvic pain and incontinence, the therapists at the Myofascial Release Treatment Centers also address problems with back pain, neck pain, headaches and pelvic imbalance and instability that are frequently associated with these problems. Special techniques are utilized to eliminate pelvic torsions and upslips. Patients also learn valuable home self-treatment techniques to ease their pain.<br /><br />Understanding the relationship between pain, anxiety, and structural changes allows trained therapists to restore the normal length and tension of the structures and connective tissues supporting the pelvic organs. Along with this, specific exercises and home care techniques are taught to correct faulty postural and movement patterns and restore function.<br /><br /><br /><strong>Don’t settle for less than health</strong><br /><br />You can contact Dr. Ajimsha through his official mail <a href="mailto:scebcaptmfr@gmail.com">scebcaptmfr@gmail.com</a> to discuss these treatment techniques and the possibility for you regaining control and use of your pelvic floor. Pain, loss of function for sex, inability to exercise and bladder problems are not a normal part of aging.Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com1tag:blogger.com,1999:blog-9016364437066447337.post-51118275921721056142010-01-02T00:32:00.000-08:002010-01-02T00:35:53.096-08:00Home based MFR managements for pelvic floor dysfunctions: Part II<span style="font-size:130%;">Myofascial Release for Pelvic Pain and Infertility</span><br /><br /><br />Myofascial Release has been on the forefront of health care for the past two decades particularly in the resolution of complex chronic pain problems. In that time, there have been an increasing number of women reporting problems such as urinary incontinence, pelvic pain, menstrual problems, fibromyalgia, chronic fatigue syndrome, and/or headaches. It is unclear whether this rise in these complaints is due to an increased prevalence or that women are just communicating more about their problems.<br /><br />Whatever the case may be, it remains clear that the numbers are staggering in terms of the women who are affected by these problems. For instance, in 1996 the US Department of Health and Human Services reported that 13 million Americans are incontinent; 11 million of them are women. One in four women ages 30 to 59 have experienced an episode of urinary incontinence. 16.4 billion dollars are spent each year on incontinence-related care and 1.1 billion dollars is spent yearly on disposable products for incontinent adults.<br /><br />One of the missions of this article series is to turn these numbers around if they can receive this. It is pathetic that the best our healthcare system has to offer incontinent women is disposable pads and adult diapers. Some women undergo pelvic or abdominal surgery to help resolve incontinence, menstrual, or pelvic pain problems often associated with pelvic floor muscle weakness following multiple child births. This solution, however, often puts these same women at risk for developing other pelvic pain problems or reproductive dysfunction and infertility problems because of the scar tissue that forms following surgery.<br /><br />Myofascial Release has been a tremendous help to women suffering with incontinence and pelvic pain. Myofascial Release techniques specific to the pelvis are helpful in decreasing the restrictions in that area that lead to incontinence and pelvic pain.<br /><br />Nowadays, it is common to hear about the infertility problems that many women suffer with through the media or through family and friends. Many women go through expensive homonal therapies and attempts at invitro fertilization that offer no guarantees and are generally not covered by insurance. Expenses can run into the tens of thousands of dollars for the best technological advances that modern medicine have to offer in order to merely bypass what often is a structural imbalance in the body caused by myofascial restrictions.<br /><br />Many women who have gone through all types of fertility treatments and had given up on ever becoming pregnant have been pleasantly surprised of the effects that Myofascial Release have had on their infertility...they became pregnant when all else failed! While they may have originally been receiving Myofascial Release for other pain problems, the effects of Myofascial Release particularly in freeing the pelvic region of adhesion has allowed for more normal reproductive function in these women.<br /><br />The myofascial system surrounds and interpenetrates every organ, nerve, blood vessel, and duct within the pelvic floor. Trauma, inflammation, surgical scars, and child birth very commonly tighten the myofascial system around these delicate and pain sensitive structures. Tightness and restriction within the myofascial system can cause or contribute to many women's health issues including but not limited to pelvic floor pain and dysfunction, infertility, incontinence, vulvodynia, coccydynia, pelvic adhesion from endometriosis and surgical scars, painful episiotomy scars, interstitial cystitis, fibromyalgia and pregnancy related back pain and sciatica.<br />It is estimated that a large number of women experience infertility as a result of fascial restrictions from scar tissue, endometriosis or inflammatory processes. These fascial restrictions may physically interfere with fertility by compressing the reproductive structures such as the fallopian tubes or ovaries and can be helped with Myofascial Release. In addition, because the fascial system surrounds every system of the body, including the endocrine system, fertility problems related to homonal imbalance may be helped using Myofascial Release. For example, the pituitary gland, the master gland of the body is housed within the sphenoid bone of the skull. Fascial restrictions throughout the neck, dural tube and particularly the suboccipital region often create compression of the sphenoid bone, which houses this delicate gland. Releasing fascial restrictions helps to free these structures and restore more normal function of the endocrine system thus helping to resolve fertility problems related to hormonal imbalance.<br /><br />The therapists at the Myofascial Release Treatment Centers are highly trained in performing techniques specifically geared at releasing restrictions in the pelvic region. Painful or tight episiotomy scars are a common cause of pelvic floor pain and dysfunction and can be effectively treated by the therapists using this highly specialized form of Myofascial Release.<br /><br />In addition to the various general and specialized myofascial release techniques for women with pelvic pain and incontinence, the Myofascial Release Therapists also address problems with back pain, neck pain, headaches and pelvic imbalance and instability that are frequently associated with these problems. Special techniques are utilized to eliminate pelvic torsions and upslips. Patients can learn valuable home self-treatment techniques to ease their pain.<br /><br /><strong>NORMAL PELVIC FLOOR DYSFUNCTIONS</strong><br /><br />Myofascial Pelvic Pain<br />Vulvodynia<br />Dyspareunia<br />Endometriosis<br />Adenomyosis<br />Pelvic Inflammatory Disease (PID) <br />Abdominal Pain<br />Coccygodynia<br />Vaginismus<br />Vulvar Vestibulitis<br />Interstitial Cystitis<br />Anismus<br />Levator Ani Syndrome<br /><br />Women with pelvic pain, urinary incontinence, urinary frequency, fertility problems and menstrual problems are encouraged to do these guidelines or else contact Dr. Ajimsha through his official e-mail <a href="mailto:scebcaptmfr@gmail.com">scebcaptmfr@gmail.com</a> with any questions. <strong>Our goal is to return you to a pain free, active lifestyle.<br /></strong>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-31049539792748761242010-01-02T00:10:00.000-08:002010-01-02T00:31:48.401-08:00Home based MFR managements for pelvic floor dysfunctions: Part III<span style="font-size:130%;"><strong>Self Myofascial release for chronic pelvic floor pains</strong></span> <div><div><div><div><div><div><br /></div><div><span style="font-size:130%;"><strong>AJIMSHAW’s Approach part I</strong><br /></span><br />Self Myofascial release (SMFR) for chronic pelvic floor pains for the easiness of description can be divided into ‘External Pelvic Release’ and ‘Internal Pelvic Release’. ‘External Pelvic Release’ focuses on pelvic release by manipulating fascia externally and ‘Internal Pelvic Release’ is via either vagina or rectum. This techniques can be practiced either yourself or by the help of your counterpart. Some of these techniques are of moderate difficulty if you will practice alone. Anyway it will take at least a month to get your result. Be patient and do it regularly. Some times there will be an exaggeration of symptoms initially because body will attempt some self healing when fascia starts releasing. Don’t worry this will be for a short time. Please don’t stop the release apply some ice over the pain full area after the release. Application of some heating pads on the painful area ‘<strong>before</strong>’ the release is also found useful. If pain is unbearable you can use some over the counter type pain medications. But please don’t stop the release.<br /><br />To get the maximum effect try to combine some of the below components to your SMFR program. Descriptions for these are out of this article’s scope. Refer other citations for its details.<br /><br /><strong>‘Adjunctive of SMFR’<br /></strong><br />Perineal and Pelvic Hygiene (24 Hrs)<br />Breathing control or Diaphragmatic breathing program.<br />Relaxation programs(Yoga, T.M, Tai Chi etc)<br />Daily aerobics (walking, jogging, cycling, swimming etc)<br />Twice in a week sauna bath or steam bath if possible.<br /><br />If you can add these four components to your SMFR program, I can assure you will praise us later.<br /><br /><strong>I. External Pelvic Release </strong></div><div><strong><br /></strong>In EPR we have to use some sort of semi foam rolls or some balls of different sizes. You can buy these from any shops or can order specific items (Eg:- foam rolls, myoballs etc) from e-markets.<br /></div><img id="BLOGGER_PHOTO_ID_5422053654627129122" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 300px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOT7zp9_vE53LHAch85o-nRaoEKH0-NUxJqiaRp7pr88hE3vV9CpgvxGiAgNNSykwe0bbWUMngf-qVx1G-eDrylnDxeTWDYp7cvsaYIyntrw_kfYtIckJp0u9pHAcbAADN9rgjHaCfPl50/s400/image001.jpg" border="0" /><br /><br /><strong>General guidelines</strong> </div><div><br />Start with the ‘Adjunctive of SMFR’<br />Before starting the SMFR have a hot shower, or hot pad application.<br />Slowly palpate superficially and then deeply in areas specified by us during our successive descriptions.<br />Concentrate and exactly locate the pain spot and mark it. Try for some other related areas for pain spots and mark it too. (More latent pain points will be activated so that you will find out more points as treatment progresses.)<br />Position your ‘release device’ around the area of pain and position your self over so that gravity can release your fascial restrictions.<br />Roll the device or roll over the device slowly and two and fro. Stop moving when and where you feel the pain. Apply firm and tolerable pressure over the pain spot for ’90 seconds’. Start moving again and reach the pain full area (new or previous) stop again for 90 seconds.<br />Repeat it three times for an area then move to the next area.<br />Apply ice on the treated area for 7 minutes.<br />Practice some more aerobics or stretching programs.<br /><br /><br /><strong>CONTRAINDICATIONS </strong><br /><br /></div><strong><div></strong>The following are several reasons you may not want to include SMFR, or areas to avoid:<br />Recently injured areas<br />Circulatory problems<br />Bony prominences/joints (if it is inflamed)<br /><br /><strong>MODALITIES</strong><br /><strong>GENERAL THOUGHTS<br /></strong>Like all things training related, we need to have a rationalized progression if we want to see continued progress. SMFR techniques are no different—there are multiple ways we can change pressure, density, and other factors to progress the training.<br /><br /><strong>DENSITY AND PRESSURE</strong><br />Before we discuss the specific modalities you can use, let’s briefly review the concepts of density and pressure from a physics sense.<br />The formula for density is:<br /><strong>Density = Mass/Volume</strong> </div><div><br />Regarding density and SMFR techniques, we have three options if we want to increase the density: </div><div><br />Increase the mass<br />Decrease the volume<br />Increase mass and decrease volume<br /><br />Typically, the easiest option is to increase the mass. This is seen when we progress someone from a tennis ball to a lacrosse ball, or from a lighter foam roller to a heavier foam roller. We don’t necessarily increase the volume (size) of the object, but we most definitely increase the mass.<br />The formula for pressure is:<br /><strong>Pressure = Force/Area</strong> </div><div><br />Much like density, if you want to increase pressure, you either need to<br />Increase the force<br />Decrease the area<br />Increase force and decrease area<br /><br />As is the case with SMFR techniques, force doesn’t necessarily change all that much. If you want to increase the force, here are a few options:<br />If you have both legs on the roller, take one off.<br />If possible, stack one leg on top of the other.<br />If you have a hand/foot on the ground for stability purposes, take it off (this will put more of the body’s weight on the area being rolled).<br /><br />Rather than trying to increase force, it’s generally easier to decrease the area. This is accomplished by using progressively smaller (or more focal) implements. We’ll discuss the different modalities below, starting with the largest surface area and working down to the smallest surface areas.<br /><br /><strong>FOAM ROLLER </strong></div><div><strong><br /></strong>A foam roller is the largest implement we would use from a pressure perspective. The foam roller is very versatile, as you can work almost every muscle group using a foam roller alone. Rollers also come in varying densities, which allows for progression as well.<br /></div><img id="BLOGGER_PHOTO_ID_5422053657947993250" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 384px; CURSOR: hand; HEIGHT: 123px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFw5Ft-wkqWSHY-24HHRmQgZxnCz7DJdFtmf_m1BPsp9inGXvyg-QvPuM4eJeXBuVwfyPXzCsLAPJSKTwC1n4ElI8ROhtLcRQiC93A1LqY3P23UsvIm-TOWkfS0sCBHEkpd0VFMb_u22UK/s400/image003.png" border="0" /><br /><br />Foam rollers are best used for the big muscle/fascial areas like the gluteals, quadriceps, and IT band. </div><div><br /><strong>MEDICINE BALL </strong></div><div><strong><br /></strong>While not as popular as the foam roller, the medicine ball may actually be a more versatile tool for SMFR purposes. Not only is it more focal when compared to the roller (the surface area being worked is smaller, which increases pressure), but it also allows you to work in a more three-dimensional fashion.<br /></div><img id="BLOGGER_PHOTO_ID_5422053665125074450" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 199px; CURSOR: hand; HEIGHT: 151px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTt2wHAWqP47a55tokMu4jvHSxaiApKNkOPoQewmTD3Xx_n1VUzgKmB3BPD40-ck41ATCHkocXdxwvlccaIcQgDJ7G8hSyouXxfUAMgkIlt_eFOrnYS-IWkkMwxJT4ZQ4MJDqmsKc9XD8r/s400/image006.gif" border="0" /><br /><br />Virtually any muscle group that can be addressed with a foam roller can also be addressed with a medicine ball. Once the foam roller becomes comfortable, I generally progress my trainees to a medicine ball. The medicine ball can be progressed as well; simply moving to a smaller ball (and further decreasing surface area being rolled) will increase the pressure and intensity of the exercise.<br /><br /><strong>TENNIS BALL/LACROSSE BALL </strong></div><strong><div><br /></strong>A tennis ball is generally the smallest implement we would use for SMR purposes. It’s very convenient for muscle/fascial groups with smaller surface areas (such as the plantar fascia, calves, and peroneals) as well as upper body muscles where the ball must be placed against a wall (such as the pecs and posterior shoulder capsule). Once the tennis ball becomes easy, move on to a lacrosse ball.<br /><br /><strong>THE STICK</strong> </div><div><br />The Stick is yet another convenient tool when it comes to soft-tissue work. While it’s not necessarily better or worse than the other modalities discussed, it’s narrow diameter allows you to work on some tendons (e.g., quadriceps, hamstrings) better than a medicine ball or foam roller would. As well, the Stick is a good option for the hamstrings, which generally don’t respond that well to foam rolling since your hands/arms are supporting the majority of your body weight to hold yourself up.<br /></div><img id="BLOGGER_PHOTO_ID_5422053666320500450" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 271px; CURSOR: hand; HEIGHT: 170px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfKphEQgxp2oUCiTdiI_ePwjKq_GbUq2X4oKUfhSshe49yKXL9xiUuHUlHY-esVDLL2A2ckj9RVT4OwbKnsRk1Z0JdGt0A6_ItR7God2l7GJR7S2hQsdJzp0W2X08lZyV8p3EJ9sXDQCDH/s400/image008.gif" border="0" /><br /><strong>MORE POINTED OBJECTS </strong></div><div><strong><br /></strong>More pointed objects are needed for perineal releases. Different trigger point release tools can be available. You can modify some house hold utensils for this too provided that all are hygienic.<br />Eg:-<br /><img id="BLOGGER_PHOTO_ID_5422055832039912578" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 280px; CURSOR: hand; HEIGHT: 280px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_4Mxg1djE_amTf2QMbj2cbY1viI6ZjzmWy_DAb0vLv5TsyLSuBXkS1O123YO0foVGDgynb4Me3QH5OES06PYKoPx9YszNMsvBmrH98rFTUV3R5nIf2xbRpGJ5z1IMIGBLFFlr_pMr-fBK/s400/image009.jpg" border="0" /><br /> Indexnobber<br /><div> </div><div> </div><div><img id="BLOGGER_PHOTO_ID_5422054919279590050" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 280px; CURSOR: hand; HEIGHT: 280px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizjabXwZMmYyXFKH06Kdp98rQkH_EIV3VWqbP75JLdIlXmOznKr1Hxm4dFouOqPC0cddRq-12A4mvPvNjFSIiWGud9vz36-KNJRr8IvKZ6YElFEbGvxKyV5zhte16PiHiL1IfgMJacmR1B/s400/image011.jpg" border="0" /></div><div> </div><div><br /> Jacknobber </div><div> </div><div> </div><div> </div><div><img id="BLOGGER_PHOTO_ID_5422054916998150130" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 150px; CURSOR: hand; HEIGHT: 127px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHHbWEoqP0zbvxWiWiIub3Ejlk-PvJxSpJv5EXjhiFDDlTtSUOYYovCwQNJhCvCHzZWlCrNQDjSs9cGIGMrvO3GtbshsKSrQ8_KgkOsTS6QNl83_OeVkTrcI38NciuMugugoOiT2aEKyYi/s400/image013.jpg" border="0" /></div><div><br /> nobbers </div><br /><div></div><div> </div><div> </div><div><img id="BLOGGER_PHOTO_ID_5422054930840488930" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 250px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2iJBFwKW2bOk_DSlku-Y952BUcNXb5Dd8A49LeA691Ym67V4e_nrMoCChfK9amb9kE6azp_ddhI3vCq_TaVVNN_t2ObCK021GpN8ZenvfMyh65GXpGho1BkN2g2DckT7GGSBD4eIvmjBc/s400/image015.png" border="0" /></div><div> Thera cane </div><br /><div><br />Whatever the tools the techniques of application is always the same.<br /><br />Women with pelvic pain, urinary incontinence, urinary frequency, fertility problems and menstrual problems are encouraged to do these guidelines or else contact Dr. Ajimsha through his official e-mail <a href="mailto:scebcaptmfr@gmail.com">scebcaptmfr@gmail.com</a> with any questions. <strong>Our goal is to return you to a pain free, active lifestyle.<br /></strong></div></div></div>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-51604907142434471912010-01-01T21:28:00.000-08:002010-01-01T23:53:40.506-08:00Home based MFR managements for pelvic floor dysfunctions: Part IV<div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><span style="font-size:130%;"><strong>Self Myofascial release for chronic pelvic floor pains</strong><br /><strong>AJIMSHAW’s Approach part II </strong></span></div><div><span style="font-size:130%;"><strong><br />SPECIFIC SESSIONS</strong></span> </div><div><br /> </div><div><div><div><strong><span style="font-size:130%;">I. External Pelvic Release</span> </strong></div><strong><div><br />This session explains how to do External Pelvic Release by using SMFR. Follow the same guidelines for all releases.<br /></strong>(‘X’ mark in pictures indicates the pain spot or trigger points. When you are applying sustained pressure or release you will feel tenderness (pain on palpation) on these sites and pressure on this area will cause radiating or dull aching pain in particular areas shown in shades) </div><div><br /><strong>GRAPHIC OF PELVIC FLOOR AND REFERRED PAIN<br /></strong>The muscles of the pelvic floor support and raise the pelvic organs. The trigger points in the pelvic floor are in the sphincter ani, levator ani and coccygeus muscles. The sphincter ani surrounds the margin of the anus. The levator ani's contraction increases intraabdominal and pelvic pressure for defecating and straining in general. The coccygeus muscle is attached to the coccyx (the tail bone). It relates to the levator ani and the piriformis muscle (see the illustration of the piriformis).<br />Release of the pelvic floor. You will learn in the next part. </div><div><br /><br /></div><div></div><img id="BLOGGER_PHOTO_ID_5422013713427968930" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 164px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhD4DtDvzZdLaL7tUffkdUDTRoZvagrFTRqgZ5QDYwCNxKlQDnn0sgBmeA3fAUhMZ1h_8SfMHgmh0HgQMtQcOJZ04S0V2bRzb_hEc9rkMiHBGchePrbPqXwPImCteBsaKIp94TpuysNAxcs/s400/image001.gif" border="0" /> </div><div> </div><div><br /><strong>The Tender Muscles in Pelvic Dysfunction</strong><br /><br /></div><img id="BLOGGER_PHOTO_ID_5422013718058689794" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 367px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbluj1pK0pVHVZimZ2GymVVLkpqo1ELrHDRgWKLcwx_9BoaLgwNlvRlt4Ia60j3TSWpG6pjA0BYbZJDtYMPo-IIZWKFCYTMSW4VlI99VR_wCwSNqS6laKy8K59fwYd-8DqfYT6_iU7nEaI/s400/image002.png" border="0" /><img id="BLOGGER_PHOTO_ID_5422013722201159858" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 360px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKs3gNquGUZSB0jqVpOKJYvQ55i0J9n1oQElQpcZ9H9OY3wkoB8w1TaPzpvxD3y4UPh_PUDKe1y3TVT8tvqp2Ch3EsKQrcx9FV3BP68iqoeAWDc54pGID8Lcn20xCr7adzOyIhLiChXNfh/s400/image004.png" border="0" /><br /></div><div><br /></div><div><strong>THE PIRIFORMIS </strong></div><div><strong><br /></strong>Piriformis is one of the important muscles involved in chronic pelvic pain of any reason. Release of Piriformis is having its own importance in pelvic pain.<br />The muscles of the pelvis are made of two groups, the pelvic floor muscles and the hip-joint muscles. The piriformis muscle, which is located partly in the pelvis and partly at the back of the hip joint, is a hip rotator muscle as well as a support muscle of the pelvic floor. The piriformis is under the gluteus (buttock), and attaches the lower part of the sacrum (the triangular composite bone in the back of the pelvis) to the great trochanter (the top of the thigh). The graphic below of the piriformis illustrates the location, trigger points, and areas of referred pain. (Stars or X's represent the trigger points. The shaded areas represent the referred pain caused by the trigger points.)</div><img id="BLOGGER_PHOTO_ID_5422013723664871378" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 218px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUfoXHBjeDEzuxCzN7pvlhBh3w7hmszexpEfAepLRubzRyGszmXCK57rcFv26miu02XuIYOJfSl78D7xVBAiqBX9h9FrQSJMRIGtBFUTzP3Gbj498O4-S0rJcfGaZxZR2pxx13sb6UP4gA/s400/image006.gif" border="0" /> <img id="BLOGGER_PHOTO_ID_5422019824163427458" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 358px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2MPnS9Y473mv9zr-AeaUEPC7RG_xqi4mUYFAxbmvR8mRfM9wXC2QYiZfXR8YQGGkJZWMulc-AKujeTM6CbtmDbKi06sDGGM5YOOZ81EgFjZMy6StgQ6WQZfGh5dUzUPwS6FyoL_aF4vn-/s400/image008.gif" border="0" /><br /><img id="BLOGGER_PHOTO_ID_5422019829338012050" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 353px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwOKqyVYhle4uSpABuupJ7bjpUSSzUFGawUQauIs9ORnCYMM7J69kIYe8mQt84TCQUqgkwHEHtpiYCjrcp8iyjzYos_rDQJQRZvpOIq9ULOb3CKMwvVCxNFX9NEveCFa3cFtUhljU9YOqN/s400/image010.gif" border="0" /><br /><br /><div>Alternate Position</div><div> </div><img id="BLOGGER_PHOTO_ID_5422019835750702130" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 360px; CURSOR: hand; HEIGHT: 310px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvm_zV7slp1R4B2E2imH572p99b0sj8hiDeTf3HNZMdR_OYhzkvETytURQs3riBZm15RBeUm9BzCzBUsTVr2C_6V1G_5KFfrLacezj1ZBYQzxB5rxH3ltsb9Y__25juP1Yq5jtz6dUOjbV/s400/image011.jpg" border="0" /><br /><img id="BLOGGER_PHOTO_ID_5422019843047825698" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 235px; CURSOR: hand; HEIGHT: 150px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqG8Y3c_PTlhuCeJKkR1ofHxjeTekiUnJIJ_ojDXNbn8H5LbiigKHma3OtZq3tNHRAzW83wbCmTZQ712ml3OZJWr95gMUAunfMuynvjXMofWdH_8mFqO731KDXwpBx2m7BEog6FkwNmDms/s400/image013.jpg" border="0" /><br /><br /><div><strong>THE OBTURATOR INTERNUS </strong></div><div><strong><br /></strong>The piriformis often blends with the tendon of the oburator internus muscle. The oburator internus, like the piriformis muscle is a hip rotator located partly in the pelvis and partly at the back of the hip joint. It is attached to the ramus (see the illustration of the pelvic floor for location of the ramus). The anatomical graphic below illustrates the inside of the pelvic girdle at a three quarter front view. Locate the thigh bones and spine to understand the illustration. Refer to the trigger points and affected areas.<br /><br /></div><img id="BLOGGER_PHOTO_ID_5422019845461911794" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 176px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxPkGLcMCTLJd5UVzlvVAL3AaKs2VRqunG8nzotgmoTnenciEZZ-7aSTeSSDOdy0pUYSIqdEKyxGiQMTXLdhsRxc3pPCsgFiWw5jHiS3Y3OTmZlaCKMuD6A5bgyZexF0Wnf5ocweRu0joc/s400/image014.gif" border="0" /><br /><br /><div>Release of the obturator Internus will be explained under the session Internal Pelvic Release. </div><div><br /><strong>THE GLUTEUS MEDIUS</strong> </div><div><br />The muscles of the buttocks work the hip joint. The gluteus medius is an important hip stabilizer, as well as a postural muscle. This muscle keeps the hips stable while walking and running. The gluteus medius is partly covered by the large buttock's muscle, the gluteus maximus. Refer to the following illustration to understand this muscle's role in pain.</div><img id="BLOGGER_PHOTO_ID_5422021392240481634" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 359px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvyBteyMEUpy6UTi45ylo3F2QGxIKHFVImJJooB9pyraDqWsbZ38A4FMOsYP0gSHO_hlLU5E39YPWdUHm_2ptlQQPwwqiDHkhs-8UharNsvQmRf6vIx5hg8SQGPnHbBpq1YLJnsF5YKp6h/s400/image015.gif" border="0" /><img id="BLOGGER_PHOTO_ID_5422021396658580338" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 325px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPJcIDRJDQspbX_7j7CkGxHtHqWBhitED8Iwn1OpR3GfIvWbfxluTdKtCSSfVHrK8UGw5ykVQllAuhav3MfEnoQQu-hx0TJLnLDE-1ccnb3ndM9VR7QeafA4w1SC1gw6PVqNIEqFYTwswo/s400/image016.png" border="0" /><br /><img id="BLOGGER_PHOTO_ID_5422021404522054162" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 329px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBCyRHmRhPpUSdzxqwNI7qpz4GWGkOQ9amOemxXe6HXZ4n1CFN1hzbUIL-RGViH3dkHAI95avZKBTEWBiiwf6oUpyBNn7YTfalVvgQowHAv-KpxwE524HSHZK02SQWTGFRSqMg6t00VD5X/s400/image019.gif" border="0" /><br /><br /><div><strong>THE GLUTEUS MAXIMUS </strong></div><div><strong><br /></strong>The gluteus maximus is a large buttocks muscle that relates to many of the joints and muscles of the pelvis, including the ilium, sacrum, coccyx, ischial tuberosity (sitz bone), great trochanter (top of the thigh bone), the hip rotators mentioned above, as well as some of the muscles of the thigh. The gluteus maximus assists the trunk in an erect posture. It's function helps mostly with running and climbing.</div><br /><br /><img id="BLOGGER_PHOTO_ID_5422021409439432834" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 344px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXWkx6q7TG9Fbw30Y8Nbb_98ZB8Il1CqUfBmGeSly1RnXhYL75HDjLNLCMunPSTrQjB6q-5v9uT3mTCu2-DMaDO2fZIYIJ5D-jjfZB53g62ojArM6TC4Ei3XRo7h7RBVJEcfFY6Dpfwfg-/s400/image020.gif" border="0" /><br /><br /><img id="BLOGGER_PHOTO_ID_5422021415138900130" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 360px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZOBGpNrvLZvom1YgWbAh5NV_VCPY82_xtavog-lz-Ihi8hDNzsd8LN1nR565CFMRbKR1pV_kQU1_9PUT7a4IvSR9iQkHi0rfFGUOHI2uM13kKQRTFmOA6_OpzYOiry76z_6IqhQX0hNd5/s400/image022.gif" border="0" /><br /><div><strong>THE TENSOR FASCIA LATAE, ANTERIOR GLUTEUS MEDIUS, AND GLUTEUS MINIMUS </strong></div><div><strong></strong> </div><img id="BLOGGER_PHOTO_ID_5422026159976269474" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 346px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQJo1Ypf42ozUpH6AEGAU8pmgP5NZFp3PJ1_U5BPWH6sglmwC7If4B945qy5adUGJhaZ2WyN-7FDzevQW7jD_rYM0M0HOvGurtOtMB0GuYVdam0Fy-38maRA1uGSwqQ2z7yb8Zivwwx0tz/s400/image024.gif" border="0" /><br /><strong><br /><div>THE ILIOSPOAS MUSCLE</div><br /><br /><div></div><img id="BLOGGER_PHOTO_ID_5422026163081132482" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 211px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieYVWz20S2ORoyy_81cT2TVuxUn6p9BbxT-uN30nlrOPErCgzrngzw_prIowTwZAH_GvH-90ickCNewLUM2yuN2ZBlSZUihxHgtdMiYpZxwM-xzj72BQ1m4F_-itOuChFB1tC-4C6woSID/s400/image025.gif" border="0" /><br /><br /><img id="BLOGGER_PHOTO_ID_5422026173371634082" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 350px; CURSOR: hand; HEIGHT: 246px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVEOnMwLC9hwPTPAbrAyaL0ns7IQJ7EmCHB63VT_4QEMOapM2S0f__7FIFgqyLqzD6UjZFPeLUAxBEI0v3FmdQMj8dwMRVGjDk03-v1972bJT38lhodO3TpWOj5IY_g6uFgeHd7Hr3uHEm/s400/image026.png" border="0" /><br /><br /><div></strong>The psoas muscle runs from the 12th rib (the last rib) down along the lumbar spine to the sacroiliac joint (sometimes including the sacrum and buttock). It then follows the border of the pelvic brim and attaches to the front of the hip joint. The psoas tendon attaches to the pubic bone. The psoas muscle is a powerful hip flexor and postural muscle that assists the body when rising to a sitting position from a lying position.<br /><br /><img id="BLOGGER_PHOTO_ID_5422026180496515538" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 300px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkp1ks5PbvyAPLovrRTpScISFgB8iGp_R129_fPQN3jYJVRoXzd4rRKZL31GQe6vZLckHm4xMFtq-FVDzQQcXZ7dv_PJGGM6O7U2K12pM5cNdUCNBubg7PNIJJPsimKckBCQ4_CILHMnvt/s400/image030.jpg" border="0" /><br /><img id="BLOGGER_PHOTO_ID_5422026177821039330" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 300px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9PWDUxXRhKESSNDON96UMI0QIBQQSchUZ_C_K4iJ8YLM2HzNYnI_nLzXIj3pBFiGBHWn0qiYYH6CNh-cRG8iP0KSg8Xm4aAQgQrPxww3xE3CRDmiCkVyZPBehMUIa6qs0-P-eanEdDoeA/s400/image028.jpg" border="0" /><br /><strong>ADDUCTOR COMPARTMENT</strong> </div><div> </div><img id="BLOGGER_PHOTO_ID_5422029542291520434" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 284px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhG0Zb43G67XPYagHgx6dZx2VIMrL7J6a5qdmlhp7MRKWW8pXPpSYp78yA3_0LBtvzUmgwsi9tp5sDkJ3dBMyWT1C2XWhwcML1-m9oQhA7pXpve-t33U6BKKIrrhrsc8WMbDHtypB8XDccJ/s400/image032.png" border="0" /><br /><img id="BLOGGER_PHOTO_ID_5422029549716257570" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 133px; CURSOR: hand; HEIGHT: 147px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmicCG8OXslxgvkPl-KGl4HvXs3F_ZyaNCGGj_7dkCrOm-f8kWzbLpWVP2uccPBESmu-6CbQt1c3XJGBiYfAjaJ_7ZW3g1uyOsWC3_IV1UkC2fddB839uaAntf24S-I13Z8Q-0Bh-zpm4R/s400/image034.jpg" border="0" /><br /><br /><div>Adductor brevis and longus: Pain from the adductor longus and brevis goes deep into the groin above and below the crease of the thigh.</div><div> </div><img id="BLOGGER_PHOTO_ID_5422029552017668466" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 157px; CURSOR: hand; HEIGHT: 142px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkEwLo2UQD0OvjhgXX2leIdR_MtUKGvYVBPDuE13Emrma6Kl671IFm75p0KHi8t5-yKQR1su1wGz9dk1jM_6T5d4pXTjmsf12skFm6k1AtsYb0Q_oYwuh09CiJBa5CF7XXb9qTEVhv8FXD/s400/image035.jpg" border="0" /> Adductor magnus Trigger Points are deep in the groin and inner thigh, but go farther into the pelvis. These deeper pains are described as internal pelvic pain, but sometimes referrals are felt in the pubic bone, vagina and rectum. Occasionally patients even describe bladder pain. </div><div><br /></div><img id="BLOGGER_PHOTO_ID_5422029555777947810" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 137px; CURSOR: hand; HEIGHT: 150px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiVDp8XJnIdAEpXh9a5C16CldV9SoUJCCqkxubO320lcvrnewYnApghHCCwcdizEZJFPxeMobreuSo4LpZRyXesNrotpalMW3ETsoqEg9Wz_Qx3q8atOZcS9gqkg6W0g9tMPKvm4pXfnLQ/s400/image036.jpg" border="0" /><br /><br /><div>Pectineus pain is similar to the short adductors but referring pain mostly below the inguinal ligament as well as deep into the groin. Pain can feel as if it were in the hip joint itself.</div><div> </div><img id="BLOGGER_PHOTO_ID_5422029564651776514" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 345px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0BmukYim4sBmOHtuaX9Vt4ef1nSA_0dDrvDmLyflKeHM57CbnXJjXTHd9VIPM2zD8gmQmigFRHBOrH2itsJ2lLv0kqG5s-S7MQqAj5o9acGHZRE6a02QvMcuIVlNJnTaMV5YBYgODhp_F/s400/image038.gif" border="0" /><br /><br /><div><br />Alternate technique.</div><div> </div><img id="BLOGGER_PHOTO_ID_5422033794446662066" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 355px; CURSOR: hand; HEIGHT: 273px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUNny705UdpF5wNSb5DyDAt4sUmYnSoGpx6QNG6uGCo0tR-c708nmLp8mOpfQaO_M0ngY0-IeiNHlbSqfGqP6tO8jsPZ8Tr9dQATdHQVoeJN1k7__AJOG3ZrcpGqlt45LL9g3tBQi9mMb2/s400/image040.gif" border="0" /><br /><br /><div>Via palpation find out the painful points in your adductor area (Inner thigh area) apply 90 sec pressure to such points, repeat it for three times. Progress more deeply and incorporating more areas.<br /><br />You have to concentrate more on this area as this area will be under tremendous spasm in patients with pelvic pain.<br /><br /><strong>THE QUADRICEPS - I </strong></div><div><strong> </div><img id="BLOGGER_PHOTO_ID_5422033806118970514" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 325px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnEwuVYGMYgAznodKiBiNGVlVF36xz3nKtU23myTKc5niGgChZ5w3V3Hf_LtWe8iPRYE1ohh2dD4NFscVNSkhj19zJq7bWkpitQsa75Ae5UYGLmUOVCZskzjQCKQzRr2cjuEce2e2QIaOK/s400/image042.gif" border="0" /><br />THE QUADRICEPS - II<br /></strong><br /><strong>RECTUS FEMORIS (2 POSITIONS)</strong> </div><div><br /><img id="BLOGGER_PHOTO_ID_5422033807969697954" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 338px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZs0SLJfjwn6fRKYvrLZrMMeev-dCSd2rdIBWkKCq4siz4ap4Mwf82OnfwxtBCDer4u1tGn3GJtlVpfudTdvFTkIqWgRtoP5XigGMtHjKqNmVmIVQX8G73tLrVgCaUrWvJuRiw0jS2XISx/s400/image044.gif" border="0" /><br /><div><strong>THE QUADRICEPS - III<br /></strong>VASTUS LATERALIS </div><br /><img id="BLOGGER_PHOTO_ID_5422045308785259250" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 343px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQRUpm5-h25g9wmZhoDp3fvkjS6yOfS7ksdEpRSeqgrUjIOjn9ThQOOKJmkgh1kjOZkXoXWfgP0_Ple3srRfjXWdl3xivzA2WHEQKPsAsuSceZDjtCfHc6AJuN3y63lDHgkALSkOATRvqs/s400/image046.gif" border="0" /><br /><div><strong>THE IT BAND</strong> </div><br /><br /><div><img id="BLOGGER_PHOTO_ID_5422033821605504978" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 346px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ01Yi_ED76il2SqKxh_aJKIhpiN8x2UF-tvaDGDC34ushACNsv25LJm4bkNrOpLiHbtRuIMlUO_lJsxvskoYNaWFjfAe4mF27rCPZMBcBk8QhmxPFGGjApSdxiGCrsXHHn0ssi4k-L23h/s400/image048.gif" border="0" /><br /><strong>THE HAMSTRINGS</strong></div><br /><div><strong></strong></div><img id="BLOGGER_PHOTO_ID_5422041046075289346" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 300px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5RcOxPAS4MQNJqwtSpbynYFeQ4nUtMdJBSp1JGQNoIbGWwhfs24XMb5q1r3PaXf9JBTzYcvQhdOymGbtLyKC2qH76PUUID9cNypza0zOz2ic-mKeLtCO1RP_aS10nOpzSJDEnEgb-CcB7/s400/image049.jpg" border="0" /><br /><br /><div><br /><strong>THE QUADRATUS LUMBORUM</strong></div><div><strong></strong> </div><img id="BLOGGER_PHOTO_ID_5422041048147860386" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 319px; CURSOR: hand; HEIGHT: 400px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgekOhTb0mn43DEacuwJT3fNk88hSAK-KzJ4Go2FM4OwdZyxnMdmhIPTOr5I2DyfT99J9dYUG8WMvEpl8ihgrNoeboCtr60gZ8LCbqM6XRB2wvwPUDPrCkFyRf4sPJKtN7D7zqED2OgxGpW/s400/image051.jpg" border="0" /><img id="BLOGGER_PHOTO_ID_5422041055921179234" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 300px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGudveueSzp020g0nUiWr23BvnOuAP30FgTGLefRZQQ3eiRLluPHE23_okfgKOsEbBLXDjkHn2pN1t-1JwXMI-JYK2I02ztnRf-sbGNOzytx10GdUrBiE_5OkD0RKlrVrj_6cIq-0mn_8t/s400/image053.jpg" border="0" /><strong><br /><br /><div></strong><strong>GENERAL MUST DO RELEASES</strong></div><div> </div><img id="BLOGGER_PHOTO_ID_5422041056063329570" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 400px; CURSOR: hand; HEIGHT: 300px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihonT7G0iT-yXzPzyn0XaolNqK-R32Dd025q4OyGCyPO3YhkT5bVrM2SgJtK3IeOkylvAWgP8YOVReyj7edZ66552KxJJ6IdMMGHr_tDMiZdTUUXqvmouv3m7pmbXMcLMAipOXf3KKncrr/s400/image055.jpg" border="0" /><br /><br /><div>Follow the next session named ‘Internal Pelvic Release’ for the complete series.</div><br /><div></div><br /><div>Women with pelvic pain, urinary incontinence, urinary frequency, fertility problems and menstrual problems are encouraged to do these guidelines or else contact Dr. Ajimsha through his official e-mail <a href="mailto:scebcaptmfr@gmail.com">scebcaptmfr@gmail.com</a> with any questions. Our goal is to return you to a pain free, active lifestyle.</div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com1tag:blogger.com,1999:blog-9016364437066447337.post-56954014640040711022009-12-31T21:12:00.000-08:002009-12-31T22:32:38.745-08:00Home based MFR managements for pelvic floor dysfunctions: Part V<span style="font-size:130%;"><strong>Self Myofascial release for chronic pelvic floor pains</strong><br /></span><strong>AJIMSHAW’s Approach part III<br />SPECIFIC SESSIONS<br />II. Internal Pelvic Release<br /></strong><br />Fascial tightness of the perineum and its structures have major role in pelvic floor dysfunction and pain. Inorder to balance the pelvic floor it should be managed both externally and internally. This session explains the techniques of ‘Internal Pelvic Release’.<br />To understand the importance of ‘Internal Pelvic Release, have a look at the below picture. The “X” marked are trigger points in pelvic floor muscles and the reddish areas are the referred pain due to the trigger points. ‘Internal Pelvic Release’ is the most advanced way to release these triggerpoints.<br /><br /><div><div><div><div> </div><div><div><img id="BLOGGER_PHOTO_ID_5421637240304127266" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 288px; CURSOR: hand; HEIGHT: 320px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi68W2fZdx6i_NKl0rh25gdEEj08vkdPGqtnqyGcNAiaYUHldec8lvdjzUgQF9d4x140WQAODvWx-yke4kzjUMkTpJi4q8UMhrgB3dYw-Q_X65VtEmwZSFUG_hdpY_dHng3AIJ4toW6SLey/s320/image001.png" border="0" /><br /><br /><strong>60-80% DID NOT RECEIVE AN ACCURATE DIAGNOSIS (GPWPP 2007)<br /></strong><br /><strong>Causes of Pelvic Myofascial Trigger Points</strong><br />Excessive tension on muscle fibers<br />Straining<br />Habitual tightening<br />Trauma as in pregnancy, injury<br />Inflammation<br /><br /><br /><strong>Types of Pelvic Floor Muscle Trauma</strong><br />Severe trauma from accidents of falls (coccygeal injury)<br />Urological or gynecological surgery<br />Repetitive minor trauma from bicycle seats, uncomfortable chairs<br />Childbirth<br /><br /><strong>Inflammation of the Pelvic Organs<br /></strong>Infections eg:- prostate, bladder, vaginal<br />Endometriosis<br />Inflammatory bowel disease/IBS<br /><br /><strong>Feet position and Pelvic Dysfunction</strong> </div><div>Inward or outward rotated feet can lead to muscle imbalance and tension in the hip rotators causing abnormal tension in the pelvic nerves (Pudental Nerve)<br /></div><img id="BLOGGER_PHOTO_ID_5421637251771610786" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 87px; CURSOR: hand; HEIGHT: 179px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgThubxNTn9Mw_FZDgG43FxKGYfjqqTtyzNCxr0i3NV9tiF2flw5ZzqUHPBDWN__qLaSJCQHZhhnsvuS_TrPGEK7AN-adohNO1TJycmHaaiaCHgyx_9MrruWqbJesj1dWCFufMBsWFnXLof/s320/image004.gif" border="0" /><br />Correct your Foot deformity and improve your pelvic floor function!<br /><strong>THE PERINEUM<br /></strong><br /><img id="BLOGGER_PHOTO_ID_5421637252830735730" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 250px; CURSOR: hand; HEIGHT: 272px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgq4wVc1jtqoP77-4N266r1bXpJjpBiSHhgKFeppv4fw-ZTDwKlS9vAHC5FbREIpaufBXhgrUdu6LYf4nancp3rz1zuUAihWuzZasNXV0Qcmcg7TT7oL1d0dA39-3xOw8yjtf7zUpUHh8Is/s320/image005.png" border="0" /> The perineum and perineal body lies between the vagina and the anus on a female and between the bulb of the penis and the anus on a male. The Perineal body is essential for the integrity of the pelvic floor, particularly in females. Its rupture during delivery leads to widening of the gap between the anterior free borders of Levator Ani muscle (pelvic floor muscles) of both sides, thus predisposing the woman to prolapse of the uterus, rectum, or even the urinary bladder.<br /><br />The following muscles converge and are attached to the perineum:<br />External anal sphincter<br /><a title="Bulbospongiosus" href="http://en.wikipedia.org/wiki/Bulbospongiosus">Bulbospongiosus</a><br />Superficial transverse perineal muscle<br />Anterior fibers of the <a title="Levator ani" href="http://en.wikipedia.org/wiki/Levator_ani">levator ani</a><br />fibers from external urinary sphincter<br />Deep transverse perineal muscle<br /><br /><br />Because of different reasons myofascial dysfunctions and trigger point developments are very common and most of the time these trigger points will be unidentified and its importance is being ignored. Result; increasing pelvic floor dysfunctions and pain.<br /><br />As we have discussed in the previous sessions the success of ‘Self Myofascial Release’ lies in the ability of finding the exact sites of myofascial restrictions and trigger points. Palpation with your finger tips and application of firm pressure over 90 seconds is the basics of SMFR. </div><div><br /></div><img id="BLOGGER_PHOTO_ID_5421637259532569042" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 308px; CURSOR: hand; HEIGHT: 320px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXegQA2peLTXa2bYNApUbt403YScmdG6tJlatEHQLvdAoY0c2qXX_hDpz2PWnwcGXxRyeSaQdBw9bdy0Q_wEJofNgvGMnZ_W9hyphenhyphenoCE0X7npWySzvEo-UfdHsoY0gOnV4OTOvOpJCjfQfvu/s320/image007.png" border="0" /><br />The picture illustrates the techniques of palpation of myofascial restrictions and trigger points. When you reach the restricted area you can find or feel nodules, bands or thickness. Pressure on this area will produce pain over there and you will feel pain radiating to adjacent or distant areas which is called radiating pain.<br /><br /><strong>Trigger points in the perineum and vulva.</strong><br />The picture below is a true representation of myofascial restrictions and trigger points in the perineal area and the vulva(female external genitalia) the ‘blue’ shades represents triggerpoints which can be approached externally and ‘yellow’ shades represents triggerpoints which only be approached internally. Every person’s myofascial restriction patterns and dysfunctions vary. You have to examine each of this area using the below picture as reference. On palpation if you feel pain marks that area with a non irritant marker.<br /><img id="BLOGGER_PHOTO_ID_5421639411724364306" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 241px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsXQVUW1kj-3kQbMbxWYer1OuhribYM5cgr9ijLalRsnW08eq1AaotfqqbT2xMOtM3RlerrJOthXQhgYu4B4FJUpmfqh15v4NKwHb_Mvw-YTvX5EEkZHpf3UX4TLbMc-e6VtQEFBVyB-Ye/s320/image009.jpg" border="0" /> Vulva with triggerpoints<br />(Save this picture or take a print out for reference during SMFR)<br /><br /><strong>Common Sites of Connective Tissue Restrictions in pelvis</strong> </div><div><br /></div><img id="BLOGGER_PHOTO_ID_5421639416241910098" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 205px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZ5N9ivUxwPIXIHx62cS04zhrRhptfPH7E2P1IgWCtsJu5R0r_yHSH4yVKODuWpwNaiG1OSN_PwNEFuXcf71en9brhylEVum99eu0kr_XmC4BAZ6GnS8BYvicee3wIoeKSSNCfciqY4zV2/s320/image011.gif" border="0" /> </div><div><strong>Steps to follow for Perineal SMFR</strong><br /><br />Perineal SMFR is a technique which slowly and gently releases the myofascial trigger points and restrictions around the vagina, perineum and rectum.<br /><strong>CAUTIONS:</strong><br />Avoid the urinary opening (see diagram) to prevent urinary tract infections.<br />Do NOT do Perineal SMFR if you have active herpes lesions or any other infections, as you could spread the infection to other areas.<br /><strong>General Hints:<br /></strong>The first few times it’s helpful to use a mirror to find the vagina and perineum and see what they look like.<br />If you feel tense, take a warm bath or use warm compresses on your perineum for 5 to 10 minutes.<br />If you have had an episiotomy with a previous birth, concentrate part of your SMFR on that area, Scar tissue isn’t as stretchy as the rest of your skin and needs extra attention.<br />After Perineal SMFR, tone up the muscles in the vagina by practicing the pelvic floor (Kegel) exercises regularly.<br /><strong>Directions:<br /></strong>1. Wash your hands. </div><div> </div><img id="BLOGGER_PHOTO_ID_5421639420026325890" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 150px; CURSOR: hand; HEIGHT: 150px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNcxGqx1ad_ncKNrWu4IMb5vctte-91C1PJLWiYrAYd7G-hGk70M8Npalt1jXggXdiJJImKvhnTnIeveF4lGQijpRa4aKhkorMORdFklj5sz9m3nU0I8DZkOPa1T7IYY_avD5x8tuH655o/s320/image012.jpg" border="0" /><br />2. Find a private, comfortable place and sit or lean back in a comfortable position. <div> </div><div align="left"><img id="BLOGGER_PHOTO_ID_5421639422277800562" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 150px; CURSOR: hand; HEIGHT: 150px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh58X9khAma7AqavieclUjgAQxj9MILMrZUYKHOUTlAH-2HOoKjFcMcBMbbt5ND6tNP6-fPoa2NiSlAyKu5t2VdOd2183RB7xhMOqyKe7xYRXsJtO8BHK1IfC6EYWhEXm7GdJGIQLt8X4Nr/s320/image013.jpg" border="0" /> 3. Put a lubricant such as KY Jelly, vitamin E oil, or pure vegetable oil on your thumbs and around the perineum if the skin is very dry/ scaly. Care should be taken for extra hygiene and use lubricant in a lesser quantity. For Perineal SMFR you can use the tools which we have discussed earlier (nobbers, myoballs etc)<br /><img id="BLOGGER_PHOTO_ID_5421639428374060130" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 150px; CURSOR: hand; HEIGHT: 150px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglt7reTQrX_kmFqdz05Co6nqWAt2Th0CFykB5hiRq9Ul1kvolcvqxAhE9Auv0X1ei_ExZKiU2YyjKTZA8yJRRkZeJGBoBN-5sQTG2VN7XA5vkes11ldQV00vfXhZ8i1Mu6feju5fNGWEmj/s320/image014.jpg" border="0" /> </div><div align="left"><strong>The techniques<br />4. a. Pelvic diaphragm Release</strong><br />Use the below description if your partner or care giver can help you other ways apply pressure over the prescribed area by using appropriate tools. </div><div align="left"> </div><img id="BLOGGER_PHOTO_ID_5421646023782436338" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 266px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjdls-4vwtK6hFI9QGWqFHQ694ZKI6ZftegHo9tHLYbZfHOhvEruBKomASUvyIkz6ke0CRwbZh7szj5sZhZ5gn2B5tqPSTsWpBrXKiqynmGOMnkVExUZsCHH39QsmijJ32CiGwXkO1TH5p/s320/image015.png" border="0" /><br /><img id="BLOGGER_PHOTO_ID_5421646031742159010" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 302px; CURSOR: hand; HEIGHT: 320px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj24F1aqg4XNkg3yP0IzAfyRQk8uhTGKABquUa5vvG-kuKrTguDrxktCWORZcr86SQu9Yg2fy-CLtUGnT2m_rKFcb3Zhidjk0523Pst3rsexzQqMxoIASBsmCg3cOkbSzlQTx2byNM31UFm/s320/image017.png" border="0" /> • Lie on your back in a comfortable position<br />• Let your partner to sit at side of pelvis to be treated, facing your head<br />• Bend your knee and hip and introduce index & middle fingers medial to ischial tuberosity (the ischiorectal fossa)[when you are palpating the area as shown in the picture above you can feel a bony prominence over there]<br />• Take a deep inspiration and during exhalation, press fingertips superiorly as shown I the picture in a slow and sinking way.<br />• Maintain this position, during next exhalation, continue to follow and press fingers more superiorly (and deeply)<br />• Repeat several cycles<br />• RE-TEST<br />• Alternately you can use myo balls, nobbers etc for this release.<br /><br /><strong>4.b. Perineal SMFR</strong> </div><div><br />Trigger points (which cause referred pain in persons with chronic pelvic pain/ic) in the perineum can refer pain and sensation to the rectum, vagina, and site of palpation. It is very important that you have to release this area by SMFR.<br />Apply pressure to the perineal body ----the technique is far gentler, for the tissue and muscles here can be very sensitive. Take it easy when applying pressure to perineal body; find out the restrictions and trigger points, apply pressure and gradually sink into the area, hold there for 90 second time, concentrate on your breathing, try to sink down during deep exhalation. Treat multiple areas as necessary. Remember you are trying to soothe pain, feed the area blood and oxygen, not beat it into submission.<br />You will need either of a comfortable tool as we mentioned earlier. If you don't have one apply pressure using finger tips or a dilator until you can purchase one. It is important that you find a comfortable place to lay down where you will be ensured privacy.(Note: perineal SMFR is especially helpful before and after sexual activity.)If you use gloves they should be non-latex and lubricants should be paraben-free and have no propylene glycol which can irritate the tissue. Check labels.<br /></div><img id="BLOGGER_PHOTO_ID_5421646035232041954" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; HEIGHT: 253px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7ECUsU-7L-fUTTLwTBvwQCvH5JyyDtbgE8R9xpv2_BYdEsD4s-_TZXtz1Fr6rnsjnu4zMvZifoe86l9SnrbIcalYNX8CuTgQcYK7sghT8EVmQXO2JVdH7OwoZjxYrkBqDHJfSxvJJ6jDo/s320/image019.jpg" border="0" /><br /><strong>4. c. Vulvar SMFR<br /></strong><br />The SMFR procedure for the vulva is same as for other SMFR. But in vulva you have to check for restrictions in a systematic manner. There can be inactive or multiple fascial restrictions. So palpate areas by dividing it into multiple sections (refer the trigger point diagram above and compare)<br /><br /><strong>4. d. Vaginal SMFR<br /></strong>For vaginal SMFR a clean hand with or without a sterile glove is enough. Our goal is stretching the pelvic floor muscles through either vagina or rectum. Use your finger (index finger, some finds comfort by using both the thumbs together for the opposite sides, select as per your convenience)<br /><br />Stretch the vaginal wall with an aim to go deep and find out the restrictions at the internal pelvic floor muscle. We used to call his as “Palpation through stretching” move around the vagina while maintaining the stretch, apply firm pressure to the restrictions or trigger points for 90 seconds and repeat the treatment.<br /><br />This treatment is especially useful for all type of female genital discomforts and pain especially after the menopause.<br />Follow the pictures<br /><br /><br /><p><img id="BLOGGER_PHOTO_ID_5421646039764021554" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 287px; CURSOR: hand; HEIGHT: 216px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiC1Fwu85irKdKOlCMDKu6MPUVjvKpY0VVjepXKKjgYqa-lIMJ8ULJUo5acikaYEVaLMrP8iHe6F-Xjw_zQbP9DiyAYIPDm6opSKvN1Sw_bdiX4Rcu6-bz4ax4rQMil6loQWrDArI3xuV0q/s320/image021.gif" border="0" /><img id="BLOGGER_PHOTO_ID_5421646050684780818" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 291px; CURSOR: hand; HEIGHT: 215px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhc5X4HIadG4AHoYN9B3B7NY1KFAIa3HfV0_6MA_UPHG2dV5zfMLogwEKnN1b19XIcSs6JalKNPM-xL2p75AxXN3NDP6QPV1z9Y9zaaBY3GCJp3WQrKrE2uYeMtHOM37VjxmgLWv8jIqrSF/s320/image023.gif" border="0" /> Home program for painful intercourse </p><p><br /></p><p><img id="BLOGGER_PHOTO_ID_5421648292100656274" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 235px; CURSOR: hand; HEIGHT: 147px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHj86gDMDM9hGvtoWCTUxSgA0UmA8K84FKnYKRK8909QnarKbALZP3vegVpK_2lbCCoO2I4lcC6snwEa13s7hOYCcDGswkuM6K6XghFgQ6W7EgvNsCO96kFQmgHSJFPZBkGNGjg7GAtGVx/s320/image025.gif" border="0" /> SELF TREATMENT: URGENCY/ FREQUENCY </p><p><img id="BLOGGER_PHOTO_ID_5421648295192849442" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 215px; CURSOR: hand; HEIGHT: 160px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhX0WRMtLAExae2gJTKk3zAXes-k-ZdjwFfV60ltrSrQNS1CrlfOyh4zLY-fKCFBtpm1owSwDFdbAykMWvGCP-idI3mB0y5rvwTuwrvr8YCQnYi6I91WiZTcsgbZBUAwCuACDRJheXVArmm/s320/image027.gif" border="0" /><img id="BLOGGER_PHOTO_ID_5421648301666787922" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 294px; CURSOR: hand; HEIGHT: 225px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEga4nUIPK1cGBWqnKTZJb1_95krsjppITv1jfrwb-Q6fXL2H894QJRmFx0cZp8K_NI8nmDCmzlF-AMEW7MIInYNczt-_637y8Fedy3CJXXhWgemwqs67mOUgHXUMqLhIxRSYtGs3pDDR_Pv/s320/image028.gif" border="0" /><br />Use the picture “Vulva with trigger” point as reference<br /><br /><strong>4. e. Rectal SMFR</strong><br /><br />Rectal SMFR is indicated for those females who are having chronic pelvic/sacral/coccygeal pains and for males. The techniques of application is same like the ‘vaginal SMFR” provided that a sterile glove should be used always. Most of the clients finds it difficult , but the difficulty depends on your physique. A partner can help you in this regards.<br /><br /><img id="BLOGGER_PHOTO_ID_5421648304536801042" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 291px; CURSOR: hand; HEIGHT: 218px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiog97hvOj8G-bXv3MPo751rO6-6cdbzl7U6lc2wM8wzpr87bQrSSVpimivJqKg1vqMLuRGj1DYEo5B2iNQlcsmJUdo3AdmnDZqm90EsENJ00hC-kEtVSY3s4FXcmHLKr4ZmzUDhzjm8yRB/s320/image030.gif" border="0" /><br /><br /><img id="BLOGGER_PHOTO_ID_5421648311184074994" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 291px; CURSOR: hand; HEIGHT: 213px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUuIyeCgcJcvT__YomdMlAOCFV-WgOBkQhwjVmBTdlQ63E-lhWpWdPhRlx5KOC15K81SYSE7JNiFv86_F6HOlLUKkXnNAQ4b48916llR9ZO_Hz_mn7tZ_UxnDL6C-ABC2OBdryUvqpH6RB/s320/image032.gif" border="0" /><br /><img id="BLOGGER_PHOTO_ID_5421650672957813058" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 291px; CURSOR: hand; HEIGHT: 216px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwKwx8omtWyaepqnojB7tpYbnN6XJNq9S-7gbGTDHDWgu51UlHoxML1NdYoCeUIIFqb0FU6p1VMu2hVWnabCsjjaP8yJQzhStK-Vx1fNlq1XG0ueqM8YRN_zZdz5I7HTBPMjTnYSRox7e2/s320/image034.gif" border="0" /><br /><strong>SUMMERY<br /></strong><br />Success in the management of all painful pelvic, gynecological conditions needs multidisciplinary approach. You need to remain active. Performing some back exercises and pelvic floor exercises immediately after the release is found to hasten the improvement. So be active and be cool. Don’t forget that there will be an increase in discomfort when you are starting the SMFR, don’t give up it’s a short period after that you will praise me.<br /><br />My advice is be cool, be active and be a master of pelvic SMFR. If you are having any queries please contact me via <a href="mailto:scebcaptmfr@gmail.com">scebcaptmfr@gmail.com</a>.<br /><br />Joining/ making pelvic pain interest groups are always good. So plan for that too. Discuss these topics among you. Please inform other pelvic floor dysfunction patients about this. </p>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com2tag:blogger.com,1999:blog-9016364437066447337.post-67258034496267102382009-12-05T02:38:00.000-08:002009-12-05T02:41:59.584-08:00Self Myofascial Release<p> <strong>What is Self Myofascial Release</strong><br /><br />Definition of Self Myofascial Release (SMR)<br /> Neurologically release adhesions, tender spots or “knots”<br /><br />1. Contractile fibers can be inhibited from releasing to normal resting length<br />2. This can be due to injury, muscle imbalances, muscles being overworked<br />3. Tension helps golgi tendon organ stimulate muscle spindles to relax<br /><br /><strong>Protocol for SMR<br /></strong> Using Styrofoam roller, stick, or tennis balls; find knots and hold position as close to tension area as possible<br /><br />1. Breathe; hold position for 30-45 seconds or until tension dissipates<br />2. Repetition of SMR makes it easier to bear and reduces tender spots in general<br />3. Potential contraindications<br />a. Large bruises, phlebitis, varicose veins, open wounds, undiagnosed lumps, and skin infections, circulation issues<br /><br /><strong>Benefits of SMR</strong><br /> Perfect for clients who feel tension but whose muscles do not need stretching/lengthening<br /> Releasing knots can facilitate blood flow and circulation<br /> Releasing knots can facilitate proper firing patterns<br /><br /><strong>SMR for Cycling<br /></strong> Potential tender spots/adhesions<br /><br />1. <strong>Lower extremity<br /></strong>a. Lateral chain: calf; peroneals; bicep femoris; IT band; piriformis<br />b. TFL; anterior hip/quads<br /></p><p>2. <strong>Upper extremity</strong><br /> a. Lats; teres major; upper middle back; pecs/anterior delts<br /><br /><strong>Program Design</strong> </p><p><br /> Sequencing release/stretching/strengthening<br /><br />1. <strong>Lower extremity</strong><br />a. SMR lateral chain<br />b. Stretch lateral muscles/external rotators<br />c. Strengthen medial muscles/core<br />- lateral lunges<br />- core with adductors<br />d. Check gluteus medius integrity<br /><br />2. <strong>Upper extremity<br /></strong><br />a. SMR upper middle back<br />b. Stretch anterior muscles<br />c. Mobility/strengthening exercises for upper middle back<br /><br /><strong>Suggested Reading</strong><br />1. Alter, Michael J. Science of Flexibility. Human Kinetics, 1996.<br />2. Biel, Andrew. Trail Guide to the Body. Harcourt Brace & Co., 1943.<br />3. Forem, Jack. Healing with Pressure Point Therapy. Penguin Putnam Inc., 1999.<br />4. Myers, Thomas, W. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Churchill Livingstone, 2001.<br /> </p>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-35645135473693644342009-12-05T02:14:00.001-08:002009-12-05T02:37:45.987-08:00How to do self Myofascial Release<strong>SELF-Myofascial Release Techniques Using Foam Rollers</strong><br /><br />Self myofascial release techniques (SMRT), although not new, have become more and more prominent amongst athletes and fitness enthusiasts alike.<br />Both allopathic and alternative Therapists have embraced the use of myofascial release massage to reduce chronic pain and rehabilitate a range of injuries. Some therapists claim a long list of benefits, from curing tennis elbow to IBS relief. While some claims may be contentious, it seems likely that many sports men and women can benefit from this regenerative therapy.<br />It’s important to understanding two key terms in order to appreciate how self myofascial release technique acts favourably on the body. They are ’fascia’ and ’trigger points’. Both are explored below before moving on to some sample self myofascial release exercises. <div><div><div><div><br /><p><strong>Fascia & Trigger Points<br /></strong>Fascia is a specialized connective tissue layer surrounding muscles, bones and joints and gives support and protection to the body. It consists of three layers - the superficial fascia, the deep fascia and the subserous fascia. Fascia is one of the 3 types of dense connective tissue (the others being ligaments and tendons) and it extends without interruption from the top of the head to the tip of the toes (1).<br />Fascia is usually seen as having a passive role in the body, transmitting mechanical tension, which is generated by muscle activity or external forces. Recently, however some evidence suggests that fascia may be able to actively contract in a smooth muscle-like manner and consequently influence musculoskeletal dynamics (2).<br /><br />Obviously, if this is verified by future research, any changes in the tone or structure of the fascia could have significant implications for athletic movements and performance. This research notwithstanding, the occurrence of trigger points within dense connective tissue sheets is thought to be correlated with subsequent injury.<br />Trigger points have been defined as areas of muscle that are painful to palpation and are characterized by the presence of taut bands. Tissue can become thick, tough and knoted. They can occur in muscle, the muscle-tendon junctions, bursa, or fat pad (3). Sometimes, trigger points can be accompanied by inflammation and if they remain long enough, what was once healthy fascia is replaced with inelastic scar tissue.<br />It has been speculated that trigger points may lead to a variety of sports injuries - from camps to more serious muscle and tendon tears. The theory, which seems plausible, is that trigger points compromise the tissue structure in which they are located, placing a greater strain on other tissues that must compensate for its weakness. These in turn can break down and so the spiral continues.<br />According to many therapists, trigger points in the fascia can restrict or alter the motion about a joint resulting in a change of normal neural feedback to the central nervous system. Eventually, the neuromuscular system becomes less efficient, leading to premature fatigue, chronic pain and injury and less efficient motor skill performance. An athlete's worst nightmare! </p><br /><p><strong>What causes a trigger point to form? </strong></p><strong><p></strong>The list of proposed causes includes acute physical trauma, poor posture or movement mechanics, over training, inadequate rest between training sessions and possibly even nutritional factors (4,5).<br />Self myofascial release is a relatively simple technique that athletes can use to alleviate trigger points. Studies have shown myofascial release to be an effective treatment modality for myofascial pain syndrome (6,7,8), although most studies have focused on therapist-based rather than self-based treatment.<br /><br /><strong>Self Myofascial Release Exercises</strong> </p><p>For these exercises you will need a foam roll You can also get them from anywhere that sells sports medicine or physical therapy supplies. </p><br /><p><strong>Adductor Self Myofascial Release</strong> </p><p>1. Extend the thigh and place foam roll in the groin region with body prone (face down) on the floor. 2. Be cautious when rolling near the adductor complex origins at the pelvis. 3. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.</p><br /><img id="BLOGGER_PHOTO_ID_5411695193156270434" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 156px; CURSOR: hand; HEIGHT: 71px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgju6k3KeJMh7r5trz-hZL_hug6UOfKffVV_WgTNyyiTW66MWjNHdAbcf3vYvX6dwqzJ2MPeDJrmN75wzig4zf68vfdVJ01cx3wbLLHIPLBZvpVk23iwh_q7juQzONBRN02fy6QUJfNRqXV/s320/Adductor.gif" border="0" /><br /><p><strong>Hamstring Self Myofascial Release</strong> </p><br /><p>1. Place hamstrings on the roll with hips unsupported. 2. Feet can be crossed so that only leg at a time is one the foam roll. 3. Roll from knee toward posterior hip. 4. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%. </p><br /><p><img id="BLOGGER_PHOTO_ID_5411695199047934946" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 83px; CURSOR: hand; HEIGHT: 56px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0NZyJOivaM8ulMXNh2TbZ_uqMMJnFGtJKB1JClZbAW0ZqrRhAKAY3BaeGk-fk4ya8Si1AW0xPiR9Kdfl_ujRBS5Ik7eA9fAz1umM_mK1cDuKIUSGf5I4vIr1Fk2F9Q-WOEnk3MaTvSjOh/s320/Hamstring.gif" border="0" /><br /><strong>Quadriceps Slef Myofascial Release</strong> </p><p>1. Body is positioned prone (face down) with quadriceps on foam roll 2. It is very important to maintain proper core control (abdominal drawn-in position & tight gluteus) to prevent low back compensations 3. Roll from pelvic bone to knee, emphasizing the lateral (outside) thigh 4. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.</p><img id="BLOGGER_PHOTO_ID_5411695207599647922" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 79px; CURSOR: hand; HEIGHT: 39px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOIJPgHXfRzoXg9XTrutOEq_uk8qJX04Pj7gMU7rxWouNa2fIL5z7ISqrnnAEF95tq1GLx8ltUfobKVnTQ5bUFOW_1hMWuHWvMlmSrIwQDSoKVmCKJsFzB8mcElsAzECUyr3UOlKqaFQRm/s320/Quadriceps.gif" border="0" /> <p><br /><strong>Iliotibial Band Self Myofascial Release</strong> </p><p>1. Position yourself on your side lying on foam roll. 2. Bottom leg is raised slightly off floor. 3. Maintain head in “neutral” position with ears aligned with shoulders. 4. This may be PAINFUL for many, and should be done in moderation. 5. Roll just below hip joint down the outside thigh to the knee. 6. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.</p><br /><img id="BLOGGER_PHOTO_ID_5411695203450749298" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 103px; CURSOR: hand; HEIGHT: 49px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieVM7K0ESRBAOXSAiOo7yu6rhRffRllycIfqI7vPpYaeQsdsuRtMFkW5ahGUdeqtXIuup2yysM4oqmRBBgjgVOpcfYIHfN2gQ0z-_Qrqzz-tRDRHAVWri1l6yFxa3O51C3nisKxw5Z8dwa/s320/Iliotibial+Band.gif" border="0" /><br /><p><strong>Upper Back Self Myofascial Release</strong> </p><p>1. Place hands behind head or wrap arms around chest to clear the shoulder blades across the thoracic wall. 2. Raise hips until unsupported. 4. Stabilize the head in a “neutral” position. 5. Roll mid-back area on the foam roll. 6. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.<br /><img id="BLOGGER_PHOTO_ID_5411695218362534802" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 87px; CURSOR: hand; HEIGHT: 41px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL6FLL6rpoUDgcdE16F867Abn7tBI-mkNcZBoeO7axdBHysy7Q5fNgyT7lEKkHBgX2enoCQwDcodEG6kYz3e7imxMJ7hqUxjSFtOhvmxHcDRKVRMDBScAAiqlUsK7sT4vXlWIikc4KcZlo/s320/Upper+Back.gif" border="0" /><br /><strong>General Guidelines</strong><br />• Spend 1-2 minutes per self myofascial release technique and on each each side (when applicable).<br />• When a trigger point is found (painful area) hold for 30-45 seconds.<br />• Keep the abdominal muscles tight which provides stability to the lumbo-pelvic-hip complex during rolling.<br />• Remember to breathe slowly as this will help to reduce any tense reflexes caused by discomfort.<br />• Complete the self myofascial release exercises 1-2 x daily. </p><p>• <strong>CONTRAIDICATIONS:</strong> Please discontinue exercises and consult your phycisian if you are experiencing sharp pains during foam rolling. Also consult your doctor if you are pregnant, healing from fractures or surgery, have been diagnosed with osteoperosis, rhumatoid arthritis, varicose veins or other chronic conditions.<br /><br /><strong>References</strong> </p><p>1) Scanlon, V.C., and Sanders, T. Essentials of anatomy and physiology, 3rd edition. Canada: F.A. Davis Company. 2002<br />2) Schleip R, Klingler W, Lehmann-Horn F. Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Med Hypotheses. 65(2):273-7. 2005<br />3) Borg, S. et al. Trigger points and tender points. One and the same? Does injection treatment help? Rheum. Dis. Clinics of North America. 22(2). 1996<br />4) Vecchiet, L., Giamberardino, M.A., Saggini, R. Myofascial pain syndromes: clinical and pathophysiological aspects. Clin J Pain. 7 Suppl 1:S16-22. 1991<br />5) Saggini, R., Giamberardino, M.A., Gatteschi, L., Vecchiet, L. Myofascial pain syndrome of the peroneus longus: biomechanical approach. Clin J Pain. Mar;12(1):30-7. 1996<br />6) Hanten, W.P., Olson, S.L., Butts, N.L., Nowicki, A.L. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther. Oct;80(10):997-1003. 2000<br />7) Hanten, W.P. et al. Effects of active head retraction with retraction/extension and occipital release on the pressure pain threshold of cervical and scapular trigger points. Physiotherapy Theory and Practice. 13(4). 1997<br />8) Hou CR, Tsai LC, Cheng KF, Chung KC, Hong CZ. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil. Oct;83(10):1406-14. 2002<br /></p></div></div></div></div>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-65449420357010383642009-12-05T01:56:00.000-08:002009-12-05T02:13:40.599-08:00How to do Self Myofascial Release<strong>Self Myofascial Release</strong><br /><br /><strong>Erector Spinae Stretch</strong><br />Exercise Description: Erector Spinae Stretch<br />Classification: Self Myofascial Release<br />Instructions: 1. Position the client on the foam roller at the level of approx. T-2.<br />2. Instruct client to perform a drawing in and pelvic floor contraction to aid in spinal stabilization. 3. Once the client is positioned correctly, instruct them to roll slightly to one side (so that they are on the muscle that runs parallel to the spine and not the spine itself) and HOLD. 4. SLOWLY, the client should roll the foam roller down the side of the spine toward to pelvis, feeling for an area of increased tension.<br />5. Once found, the client should HOLD on this area for 30 sec - 1 min or until the muscle has relaxed about 50% (AVOID rolling over this trigger point area).<br />6. Once released, roll to another spot and HOLD <div><div><div><div><div><div><br /><br /><p align="center"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTHJwj2PJ_Ae3kNVMBOZyWIcTOjbnwvaPNMpSPQ4GBnmNbkGmF_tF9N7BKFqwno4qt2FoOIzPB83nubohJn1Q6CArXI1jOWUCKNT95PgOeRnMZ_grgrfGxm-vGbNQ-OYnQ3fzOE8GZwEhu/s1600-h/Erector+Spinae.gif"><img id="BLOGGER_PHOTO_ID_5411689882079601346" style="WIDTH: 103px; CURSOR: hand; HEIGHT: 50px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTHJwj2PJ_Ae3kNVMBOZyWIcTOjbnwvaPNMpSPQ4GBnmNbkGmF_tF9N7BKFqwno4qt2FoOIzPB83nubohJn1Q6CArXI1jOWUCKNT95PgOeRnMZ_grgrfGxm-vGbNQ-OYnQ3fzOE8GZwEhu/s320/Erector+Spinae.gif" border="0" /></a></p><br /><p><strong>Gastroc Soleus Stretch</strong><br />Exercise Description: Gastroc Soleus Stretch<br />Classification: Self Myofascial Release<br />Instructions: 1. Place foam roll under mid belly of lower leg.<br />2. Cross left leg over right leg to increase pressure (optional).<br />3. Slowly roll calve area to find the most tender area.<br />4. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.<br /><img id="BLOGGER_PHOTO_ID_5411690662539356754" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 87px; CURSOR: hand; HEIGHT: 49px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUpOAeIAD2wzkc6bvU1pN_fyL0582T8_5cr2PEz8dFm95HSAzUONudRQ8x8P6383uuunhlLBRPKNkupUilg7JZZhwUurpQgMsVNT3Ga5us7_A5dzqkgXPo3GiOcwd9rOdQsJ8m1LlAgHkT/s320/Gastroc+Soleus.gif" border="0" /></p><br /><p><strong>Lattisimus Dorsi SMR1 stretch<br /></strong>Exercise Description: Lattisimus Dorsi SMR1 stretch<br />Classification: Self Myofascial Release<br />Instructions: 1. Position yourself on your side with arm outstretched and foam roll placed in axillary area.<br />2. Thumb is pointed up to pre-stretch the latissimus dorsi muscle.<br />3. Movement during this technique is minimal<br />4. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.<br /></p><img id="BLOGGER_PHOTO_ID_5411690991736743154" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 119px; CURSOR: hand; HEIGHT: 35px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWW7VKUVQmkMTTIjsNoNhRzRT0xE0XvqY8HNH38W8IBO0Hxh1eKr6EHXh4J1wUuLjWk8CCQ0K8Lm0AFQduBcfy8h-qYDqrl5U7RXEHozN1tAt-RGg-mopLQx4DtxI-IGy-NJPMzw49iLk0/s320/Lattisimus+Dorsi+SMR1.gif" border="0" /><br /><br /><p><strong>Lattisimus Dorsi SMR Stretch</strong><br /><br />Exercise Description: Lattisimus Dorsi SMR Stretch<br />Classification: Self Myofascial Release<br />Instructions: 1. Start in a side lying position with arm outstretched and thumb facing upward.<br />2. Place the foam roll in the axillary area.<br />3. Slowly move back and forth to find the most tender area.<br />4. Once identified, hold tender spot until the discomfort is reduced by at least 75%.<br />5. Progress to the next tender spot.<br />6. Repeat directions on opposite side.<br /></p><br /><p><img id="BLOGGER_PHOTO_ID_5411691301842680194" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 119px; CURSOR: hand; HEIGHT: 30px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiX_u_V7jEb_mxZSfD8Q70dvK5Vw7Ot_uNt6KgjpWVPoF1RrK4KKdrJQQ0mhSERyRSUAmaJhjQGsGBw0IN204KBit64v5RHxir6Mq6aDMhaMCMwnf0tfffqvNOvJ3kqkjhDFCMDh5oFIC3u/s320/Lattisimus+Dorsi+SMR.gif" border="0" /><br /><strong>Pereonal SMR Stretch<br /></strong>Exercise Description: Pereonal SMR Stretch<br />Classification: Self Myofascial Release<br />Instructions: 1. Position yourself on your side with elbow under the shoulder, opposing hand placed in front of the body and opposite leg bent forward to help stabilize.<br />2. Position the roller on the peroneals (lateral gastroc/soleus region).<br />3. Leave hip on the floor.<br />4. Activate the core/glutes by bracing and squeezing.<br />5. Raise the hips upwards increasing the pressure on the lower calf.<br />6. Roll in either direction until a “tender point” is found, hold on that point until you feel the tenderness release by approx 75%.<br />7. Muscles are 3 dimensional, so don’t just roll in the same plane-up & down. You are allowed to move across the peroneal also.<br />8. Don’t continually roll back and forth quickly, this will antagonize the muscle and have the opposite effect we are looking for.<br />9. Stop on the tender point until tenderness eases.<br /></p><img id="BLOGGER_PHOTO_ID_5411691715231477090" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 103px; CURSOR: hand; HEIGHT: 47px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4ukcQYGkS52FyayIDQADnttYl7C7pwzpoDsImBLka3rUisuaQ2frksNdHOQlpL12IIUJbimz0aGPa27SG1rd7H8H02zl8soDmMlNDQ1pPdNToYD6E3z7QxSq6k1yiVhVhhVV1auucbEuc/s320/Pereonal.gif" border="0" /> <strong>Rhomboid SMR Stretch</strong><br />Exercise Description: Rhomboid SMR Stretch<br />Classification: Self Myofascial Release<br />Instructions: 1. This serves as a GREAT THORACIC MOBILITY TECHNIQUE AS WELL. Preparation<br />2. Cross arms to the opposite shoulder to clear the shoulder blades across the thoracic wall.<br />3. While maintaining abdominal Draw-In position, raise hips until unsupported.<br />4. Stabilize the head in “neutral”.<br />5. Roll mid-back area on the foam roll. 6. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.<br /><br /><p><img id="BLOGGER_PHOTO_ID_5411692048491806290" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 91px; CURSOR: hand; HEIGHT: 43px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZ1dxnJG9-eLn-TvkkoHC2YMWtdFha-JhLg3ykykBI9rvVIdOOjOIKvizejc3nzD7YR0G4fIQhfBkrnc5B5RpQr5CrEsquXKflohtJh0aKiUlWGZl5e6nvt0plIffI1qCUPuzRvt4z7PUI/s320/rhomboidus.gif" border="0" /><br /><strong>Sternocleidomastoid SMR Stretch</strong><br /><br />Exercise Description: Sternocleidomastoid SMR Stretch<br />Classification: Self Myofascial Release<br />Instructions: 1. Standing beside a wall place roller against the wall and gently position the side of your neck against it.<br />2. Tilt the roller on a slight angle with the front being lower than the back. navel and squeezing your glutes. Also keep the scapulae retracted.<br />3. Apply a small amount of pressure to the roller in the sternocleidomastoid area, gently move it around/up & down that area until a tender point is located.<br />4. Stop on the tender point, once it has eased by approx. 75% move on. </p><br /><p></p><img id="BLOGGER_PHOTO_ID_5411692398902085346" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 55px; CURSOR: hand; HEIGHT: 98px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1IQ91oqb1kMl13FnEtBH3k8aieHsMYEaa-NGij8zslBJpk_qwerXmkt5J_TFtjLkons-uhBqhsx9ZyRiKFkZf-Eh_rnLdtLijsxWvCyam6fUdu6C3iUYHNzWpl9MycQsr3zHTGH3wTRJm/s320/scm.gif" border="0" /><br /><p><strong>Tensor Fascia Latae SMR Stretch<br /></strong>Exercise Description: Tensor Fascia Latae SMR Stretch<br />Classification: Self Myofascial Release<br />Instructions: 1. Body is positioned prone with quadriceps on foam roll.<br />2. It is very important to maintain proper Core control (abdominal Drawn-In position & tight gluteus) to prevent low back compensations.<br />3. Foam roll is placed just lateral to the anterior pelvic bone (ASIS).<br />4. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.<br /><img id="BLOGGER_PHOTO_ID_5411692401510868658" style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 103px; CURSOR: hand; HEIGHT: 51px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQbmb-hlTkQUTomiZoX1NqWxFQ-fhwowzu02kQgf74BWPuuRO1Qoz1nNptPS5zDjdt7w4ohfT6KjZIES5uREGY5wIMimeQ1KyqXEcGmbrEB3CYt5K6TuawJ42MZMFIBoxWQUYt88UwXZ-x/s320/TFL.gif" border="0" /></p></div></div></div></div></div></div>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-61808625033096149182009-09-18T01:26:00.000-07:002009-09-18T01:30:03.349-07:00Dr. Ajimsha<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZC3psfKp_rzhsSm3MSDaH88lBsInnfHH1l3sn8iMzv1GP6TCGI4TSil3TxG_kYJkgJydwDb2qcg7te-fjDsiKXK-mw9_2WMeICzsgD59mrwq1Oub0ZC_ud1A1smcAllU5-O47K2aBHMYX/s1600-h/OgAAAECTWi-BcNZGixwDCC62fAvue6sX14yyvBJDvWdjXyyVgIitlx8v6Yu8oc_z-u-R5DtDMYXwOLXWD9yagS9x7MAAm1T1UN2TNzwbK94dRuMrTO1tc2cO_YsD.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZC3psfKp_rzhsSm3MSDaH88lBsInnfHH1l3sn8iMzv1GP6TCGI4TSil3TxG_kYJkgJydwDb2qcg7te-fjDsiKXK-mw9_2WMeICzsgD59mrwq1Oub0ZC_ud1A1smcAllU5-O47K2aBHMYX/s320/OgAAAECTWi-BcNZGixwDCC62fAvue6sX14yyvBJDvWdjXyyVgIitlx8v6Yu8oc_z-u-R5DtDMYXwOLXWD9yagS9x7MAAm1T1UN2TNzwbK94dRuMrTO1tc2cO_YsD.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5382721783244802162" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4JblcyJilgd8jqSWAu_vRppOnoWE7CWDVjuyV8EngWbRQU2WFNBPQC7DIVqWUxpFOQLuGqmam73xFcu07HS1kgtTx88VY13Nxx-pU32VgbrVIvnaOhgRUQnH3t94YG-BiHT8EdJ-TOPVe/s1600-h/OgAAAK8AwwSHmWnfcc-1sKW3MUJSHLWMjHyB5sxYo9gcKelkm8inLIa77nJXtEJZcgDBKRfdvrs6VUq3-5wXozcrmfAAm1T1UI4IWWw2YHCldnU1U2CeAAsnMc8p.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4JblcyJilgd8jqSWAu_vRppOnoWE7CWDVjuyV8EngWbRQU2WFNBPQC7DIVqWUxpFOQLuGqmam73xFcu07HS1kgtTx88VY13Nxx-pU32VgbrVIvnaOhgRUQnH3t94YG-BiHT8EdJ-TOPVe/s320/OgAAAK8AwwSHmWnfcc-1sKW3MUJSHLWMjHyB5sxYo9gcKelkm8inLIa77nJXtEJZcgDBKRfdvrs6VUq3-5wXozcrmfAAm1T1UI4IWWw2YHCldnU1U2CeAAsnMc8p.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5382721775235301762" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXR7m72qC8GAUHbXA_D-rNsj4R7altVtDgJfacUWPmTy-KfoNpZdT7EXMUofFewoNVpe9ne6ydNpLGUV6v7DJFTq2aJTzHDptOpgDIPrtAorKUBzRK_GKuDQtddD61ZnILmSqfEZDDfFDH/s1600-h/OgAAANfzt-KPv4pM24ZFL78HZ6KgmfXgSCtyQFbWwRhvR1vZ9ScN8lmHo5xB1gCR1dU3o_pHIXJpA3b8jdBb5lwRcXoAm1T1UBBzkawOsfDiSEeQRWBlDrhpCJ9-.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXR7m72qC8GAUHbXA_D-rNsj4R7altVtDgJfacUWPmTy-KfoNpZdT7EXMUofFewoNVpe9ne6ydNpLGUV6v7DJFTq2aJTzHDptOpgDIPrtAorKUBzRK_GKuDQtddD61ZnILmSqfEZDDfFDH/s320/OgAAANfzt-KPv4pM24ZFL78HZ6KgmfXgSCtyQFbWwRhvR1vZ9ScN8lmHo5xB1gCR1dU3o_pHIXJpA3b8jdBb5lwRcXoAm1T1UBBzkawOsfDiSEeQRWBlDrhpCJ9-.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5382721763572487490" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUBy_v8yhqJnbUWFK8bcjfoGK_13W-c5MPzyU2928H7B_3dgOd2EpDNDzkk9wSup_g6d-n5uI_tyevmLszqHx43poSz41tMGgjuFM4JEpfZE3J1vaK3tYblz9OaIm-PzFMB0Ce_p_txU_6/s1600-h/OgAAAIFFFhie7iCuLfp1LmW4ySnjaXvIENcbLfDheWAB0qFAPC9VHw_CqBFlM3eMSwu7xW1CXHor30MPYLMRz7lhy-MAm1T1UKZUOhR9-vkLGcIc_4owKmyUTXi4.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUBy_v8yhqJnbUWFK8bcjfoGK_13W-c5MPzyU2928H7B_3dgOd2EpDNDzkk9wSup_g6d-n5uI_tyevmLszqHx43poSz41tMGgjuFM4JEpfZE3J1vaK3tYblz9OaIm-PzFMB0Ce_p_txU_6/s320/OgAAAIFFFhie7iCuLfp1LmW4ySnjaXvIENcbLfDheWAB0qFAPC9VHw_CqBFlM3eMSwu7xW1CXHor30MPYLMRz7lhy-MAm1T1UKZUOhR9-vkLGcIc_4owKmyUTXi4.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5382721768369645826" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJQmUK3qqcfixpSdBX0rsUmx1szh8UeBj3bjWIZl5i8So9VLSiVnp-bvIoKwyxym7johwwfR4TObfEq6sPJHL0Q6AuWDYiVIHqiKExwzqjPtrCRgQ4sNCNPTx219cJZOswRpV_NE6RtThJ/s1600-h/OgAAACFV5ZRCMMS8GjzuyS2npDWJXVj4AdSfR8ttMYR1fKONniqVOq50rtoP4fQ7LCaaCcwwnrJTlnXJDklmpsBwNY8Am1T1UG6mDqg3TNFB7TTYw92o89YcNsSV.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJQmUK3qqcfixpSdBX0rsUmx1szh8UeBj3bjWIZl5i8So9VLSiVnp-bvIoKwyxym7johwwfR4TObfEq6sPJHL0Q6AuWDYiVIHqiKExwzqjPtrCRgQ4sNCNPTx219cJZOswRpV_NE6RtThJ/s320/OgAAACFV5ZRCMMS8GjzuyS2npDWJXVj4AdSfR8ttMYR1fKONniqVOq50rtoP4fQ7LCaaCcwwnrJTlnXJDklmpsBwNY8Am1T1UG6mDqg3TNFB7TTYw92o89YcNsSV.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5382721751826906066" /></a>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-4007391783568700622009-09-18T01:13:00.001-07:002009-09-18T01:16:40.431-07:00Dr. Ajimsha. M.S<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl0uSgRnZL6w3LvitI-LBp6QeUaV1ADHf6qj-cLqsqKCv3VEQT2y-MSduZtzWIWw92ZzXnoImLgAj1Iy_g7H9HlzXk6OV8EYT2HBL4KwZ0wpmQTNjLttdtomCNgNL58QgJQZ2M3-xWnz4V/s1600-h/OgAAAHU7olualz2-X5OjCKHWRIfDWGWfUIxDO2FelkHCr731-dRZ-mzge3zY6IwCjcnUgBw7Kg5kjWobvOUrCANDojsAm1T1UETqtnjmsCnpvo3twbadzUCzf-Bf.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl0uSgRnZL6w3LvitI-LBp6QeUaV1ADHf6qj-cLqsqKCv3VEQT2y-MSduZtzWIWw92ZzXnoImLgAj1Iy_g7H9HlzXk6OV8EYT2HBL4KwZ0wpmQTNjLttdtomCNgNL58QgJQZ2M3-xWnz4V/s320/OgAAAHU7olualz2-X5OjCKHWRIfDWGWfUIxDO2FelkHCr731-dRZ-mzge3zY6IwCjcnUgBw7Kg5kjWobvOUrCANDojsAm1T1UETqtnjmsCnpvo3twbadzUCzf-Bf.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5382718337597808370" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKrCtETluTikGee1EYvV9Vhyphenhyphen0Njywfm1Fd6SbcR7U2dho6PsUZdwMdxXc_9jIloLxSf1swy1rTQwi-Uxbwag71OYOhqE2MM1Sn4ybTRlHsmeoXiCLLSWvnfl1vXL2WxeGSFPTQbrqCs__I/s1600-h/OgAAAC_a5cnukK980dK_BCP__ESpctYxKLo1QYR4xwcFHohH6gDd_RlDEukAbr_YB0HDnyivHcxUsiIV8s-aP_E16vMAm1T1UAEIDesYcQLBLSoC8WrgenJnRd2L.jpg"><img style="display:block; 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margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja4I7jLX5mVE1sF4vfAb_4AAXci0_tNGDw5vROsyfwwMjDOT_wwn3KUD6vHmslTXO_SO6_LOtwEwv5WozK3wf-Ae9dVmklYJvyWzkyIoZ_D188XtR95aULT3KlG4_0o2qw6VKlz4exENLu/s320/OAAAAANwDtKAvQSdbIL9afeIoxbPMizDsckTSKgrundlJ0mtzeaPNL1pJCOtDmw0emxzYnS7yRVnw6SaolE6IxxyCVQAm1T1UOiBPMtZYwBsFJ0ziVHhTACtKtFI.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5382718303705681778" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLoOMvQ3bEy-AX20rr86q0MJkE8QN-ozNzSBPtBuTEiHx8wyNGol-8oFQ2FvCXFo6tY1TqkzrJXwRfHSzCcpIaY-Xggo8e9kx30gRt_36ROj8IuvV-LE0Qv8Nb61WTsYKjad3eNOVl98nA/s1600-h/OAAAAMjgmp0Llee1F8ssWYlitrp8c4qVVQLtJ7J54DZ7VBnGgjifaHd38-YmK-t18hZIHSEAGqfUdp1lgpEkYwBanHAAm1T1UMdisZ9yvCe80X1ISYzYN2-s0Yid.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLoOMvQ3bEy-AX20rr86q0MJkE8QN-ozNzSBPtBuTEiHx8wyNGol-8oFQ2FvCXFo6tY1TqkzrJXwRfHSzCcpIaY-Xggo8e9kx30gRt_36ROj8IuvV-LE0Qv8Nb61WTsYKjad3eNOVl98nA/s320/OAAAAMjgmp0Llee1F8ssWYlitrp8c4qVVQLtJ7J54DZ7VBnGgjifaHd38-YmK-t18hZIHSEAGqfUdp1lgpEkYwBanHAAm1T1UMdisZ9yvCe80X1ISYzYN2-s0Yid.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5382718331106550802" /></a>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-52815166145751240112009-07-28T00:40:00.000-07:002009-07-28T00:43:41.881-07:00The art of MFR<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinvJctMF6I0Qzit2YfN6TXofYCGqw6-kVkxhysGI7_FDfMyukMNoFPztp_AXNxSQxNFnuRBuywNZ7IL8ZcbQ7_bMc_rkNhng5cN_GHe8-v5GxP41YRtq1R3K-B8Y9rxmVfhv2-3zq5cihP/s1600-h/myofascial.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinvJctMF6I0Qzit2YfN6TXofYCGqw6-kVkxhysGI7_FDfMyukMNoFPztp_AXNxSQxNFnuRBuywNZ7IL8ZcbQ7_bMc_rkNhng5cN_GHe8-v5GxP41YRtq1R3K-B8Y9rxmVfhv2-3zq5cihP/s320/myofascial.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5363413453034302450" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmqJpTOx4bx8pppu5qQv2G4yjDL3KmysQkDhEBzjV0S6vyf83_U6oA1J5ONQcZuZvOnKoJK846NREnsieVQRP2XRmFKQyT0Yi1xrQ7af0eVIW_xsCZ-L9acZBYyP121mVlLLrkaPnAMtS5/s1600-h/myofascial_release.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 258px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmqJpTOx4bx8pppu5qQv2G4yjDL3KmysQkDhEBzjV0S6vyf83_U6oA1J5ONQcZuZvOnKoJK846NREnsieVQRP2XRmFKQyT0Yi1xrQ7af0eVIW_xsCZ-L9acZBYyP121mVlLLrkaPnAMtS5/s320/myofascial_release.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5363413449846341970" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1OfJOXQ2eprrQLqKDrKX9NNGLpZr80nGeUSmyFLWMU3cKjL-SJILKNXFk-AOd7h94TtrHxsAWJwuE-JJKhQme0y1B0SlKwDaI24RUb0lmdHD7vf-m0su8qzPValj4ERaOmXR0a7Yh_rEi/s1600-h/still2.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 213px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1OfJOXQ2eprrQLqKDrKX9NNGLpZr80nGeUSmyFLWMU3cKjL-SJILKNXFk-AOd7h94TtrHxsAWJwuE-JJKhQme0y1B0SlKwDaI24RUb0lmdHD7vf-m0su8qzPValj4ERaOmXR0a7Yh_rEi/s320/still2.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5363413445138428482" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtozZOlbm4r7YmPWQre6ELf5Pa7_cujDFR4lAchsex6t5R1GA73dsEby2QMmrio6ZF6N6r-rcguR5RQTbvT9luFMzAfzPWQgjrqc_aceWHjYiSs72lJFrcuxCOlfTs9fAi2m4J0jvtR7H5/s1600-h/philosophy.gif"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtozZOlbm4r7YmPWQre6ELf5Pa7_cujDFR4lAchsex6t5R1GA73dsEby2QMmrio6ZF6N6r-rcguR5RQTbvT9luFMzAfzPWQgjrqc_aceWHjYiSs72lJFrcuxCOlfTs9fAi2m4J0jvtR7H5/s320/philosophy.gif" border="0" alt=""id="BLOGGER_PHOTO_ID_5363413440365514338" /></a>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-66444157193241541812009-07-28T00:38:00.001-07:002009-07-28T00:40:46.742-07:00The art of MFR<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMC3icEg_IeJCCl3eR2YFZ4TjkJUQeUUGQAWYlmmsMxaiKkE2w8D-LIrAiEbmfQmnLEDhWgqvEEDijOxERuRy6eUG-c04Tps7Qxtys8Fw19pTa_o1Chh7NEA-1-gsqBcKfGrxEBsw8UyzX/s1600-h/mfr1.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 300px; height: 225px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMC3icEg_IeJCCl3eR2YFZ4TjkJUQeUUGQAWYlmmsMxaiKkE2w8D-LIrAiEbmfQmnLEDhWgqvEEDijOxERuRy6eUG-c04Tps7Qxtys8Fw19pTa_o1Chh7NEA-1-gsqBcKfGrxEBsw8UyzX/s320/mfr1.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5363412659125412658" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMRM3ccboRr-Aj_svh1m4sxmb4XBOGFQnSaZ0u_oEvNVEgJ2Z0pIvNtq9bKQatoMfXO_ofLqD1lpANEDZuKGCbSNJAtD6zUjGZCpYPESbib1PwBUEMfQRFGM_3Zmsb04lAkztmQwKGwfyR/s1600-h/massage-feet.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 276px; height: 225px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMRM3ccboRr-Aj_svh1m4sxmb4XBOGFQnSaZ0u_oEvNVEgJ2Z0pIvNtq9bKQatoMfXO_ofLqD1lpANEDZuKGCbSNJAtD6zUjGZCpYPESbib1PwBUEMfQRFGM_3Zmsb04lAkztmQwKGwfyR/s320/massage-feet.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5363412651116789090" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSYFP0OfnZvx37Sri-3rOz0SlN62fS5k2xqFEL7u-3-hxa6wFR2b5S59bTZiHNs4i6L9ksgoeskiUtf22hQlkVIq1cjEKup0O1DicUMeh9OblUEnrF1eFRyJ6_wW7uqoGj33zWcM0vcDkZ/s1600-h/hamstring.png"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 305px; height: 205px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSYFP0OfnZvx37Sri-3rOz0SlN62fS5k2xqFEL7u-3-hxa6wFR2b5S59bTZiHNs4i6L9ksgoeskiUtf22hQlkVIq1cjEKup0O1DicUMeh9OblUEnrF1eFRyJ6_wW7uqoGj33zWcM0vcDkZ/s320/hamstring.png" border="0" alt=""id="BLOGGER_PHOTO_ID_5363412639295679842" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrCRcw04ivcfi7VVuuIQdTSxmMY8N2kghbDW2Ad8V_tg5EYTqaT5rlba9-BIEno4VMbM7wll_fq6_0Z8JVxSNY7fDJSKeifE_tatIrID268Ekimgt0AsBFSpRooz_2tq1M0v0M4_4RyXUu/s1600-h/dlrochamfr.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 166px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgrCRcw04ivcfi7VVuuIQdTSxmMY8N2kghbDW2Ad8V_tg5EYTqaT5rlba9-BIEno4VMbM7wll_fq6_0Z8JVxSNY7fDJSKeifE_tatIrID268Ekimgt0AsBFSpRooz_2tq1M0v0M4_4RyXUu/s320/dlrochamfr.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5363412632203198306" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDUjiFlWqjVq3MUSMlQYmdxYxzTOENc6ksIXafMTG6ijkkYs8JdkC7pbtBKOvDXyUIzVWpU2VJdjP0JuASusCbBS5W15JmiSf8B3S2tMAci5wc3vqL58VOL81YCsPAa_o3UDL-uZ074WRl/s1600-h/IMG_0383.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 301px; height: 212px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDUjiFlWqjVq3MUSMlQYmdxYxzTOENc6ksIXafMTG6ijkkYs8JdkC7pbtBKOvDXyUIzVWpU2VJdjP0JuASusCbBS5W15JmiSf8B3S2tMAci5wc3vqL58VOL81YCsPAa_o3UDL-uZ074WRl/s320/IMG_0383.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5363412641064893954" /></a>Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com2tag:blogger.com,1999:blog-9016364437066447337.post-18177312946083283922009-07-28T00:23:00.000-07:002009-07-28T00:29:19.705-07:00our physicians are accecepting its existance now...!!!!<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwEsCrdFAVSXGF1TyRldb5XBB7b1DxfbiIy1OUVaCHkCeH5fEsddusG-RIKPsfgQOZu9wOBv4PIGdogi24YX8UFx8142dMZnl23uIVp3U0xRZ-Ba-GoH9aki3dChHN9H3UW_D8wOfETCWp/s1600-h/fibromyalgia.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 279px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwEsCrdFAVSXGF1TyRldb5XBB7b1DxfbiIy1OUVaCHkCeH5fEsddusG-RIKPsfgQOZu9wOBv4PIGdogi24YX8UFx8142dMZnl23uIVp3U0xRZ-Ba-GoH9aki3dChHN9H3UW_D8wOfETCWp/s320/fibromyalgia.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5363409773028592306" /></a><br />The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee<br />Arthritis Rheum. 1990 Feb;33(2):160-72.<br /><br />Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, et al.<br /><br /> <br /><br />To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.<br /><br /><br />Fibromyalgia syndrome: Canadian clinical working case definition, diagnostic and treatment protocols- A consensus document<br />J Musculoskeletal Pain, 2004; 11(4): 3-107<br />Jain AK, Carruthers BM, van de Sande MI, Barron SR, Donaldson CCS, Dunne JV, Gingrich E, Heffez DS, Leung FYK, Malone DG, Romano TJ, Russell IJ, Saul D, Seibel DG.<br /><br /> <br /><br />Background: There has been a growing recognition of the need for information about objective abnormalities in people with the fibromyalgia syndrome [FMS] and for an integrated approach to its diagnosis and management by primary care physicians.<br /><br /> <br /><br />Objectives: To establish an expert consensus toward a working case definition of FMS and a working guide to its management for physicians in Canada.<br /><br /><br />Methods: An Expert Subcommittee of Health Canada established the Terms of Reference and selected an Expert Medical Consensus Panel representing treating physicians, teaching faculty, and researchers. The editors prepared a draft document which was reviewed by the Panel members in preparation for the Consensus Workshop, which was held on March 30 to April 1, 2001. Subsequent writing assignments produced subdocuments on key topics relevant to the objectives. The subdocuments were then integrated into a submission document which was approved by each of the panel members.<br /><br /><br />Results: The completed document is provided. It contains sections on a new approach to case definition, on proposed research to validate the new case definition, on a practical approach to assessment of severity, on empathetic management; and on what is known about pathogenesis.<br /><br /><br />Conclusions: A consensus document was developed to assist clinicians in distinguishing FMS from other syndromes/illnesses that may present with body pain. It is intended that this document serve as a guide: to a better understanding of FMS; to a more reasoned approach to its management; and to further research on the clinical care of people with FMS.<br /><br /><br />Fibromyalgia: more than just a musculoskeletal disease<br />Am Fam Physician. 1995 Sep 1;52(3):843-51, 853-4.<br />Clauw DJ.<br /><br /><br />Fibromyalgia is a common condition characterized by diffuse musculoskeletal pain and fatigue. The syndrome is defined by the presence of musculoskeletal tender points on physical examination. Additionally, persons with this syndrome have a high incidence of headaches, ocular and vestibular complaints, paresthesias, esophageal dysmotility, "allergic" symptoms, irritable bowl syndrome, genitourinary symptoms and affective disorders. Recent research has revealed a number of objective biochemical, hormonal and neurotransmitter abnormalities associated with fibromyalgia, making it a clearly identifiable condition. These abnormalities may clarify our understanding of the pathogenesis and treatment of fibromyalgia.<br /><br /><br />Fibromyalgia syndrome<br />J. Rheumatol. 2005 Nov;32(11):2270-7.<br />Mease PJ, Clauw DJ, Arnold LM, Goldenberg DL, Witter J, Williams DA, Simon LS, Strand CV, Bramson C, Martin S, Wright TM, Littman B, Wernicke JF, Gendreau RM, Crofford LJ.<br /><br /> <br />The objectives of the first OMERACT Fibromyalgia Syndrome (FM) Workshop were to identify and prioritize symptom domains that should be consistently evaluated in FM clinical trials, and to identify aspects of domains and outcome measures that should be part of a concerted research agenda of FM researchers. Such an effort will help standardize and improve the quality of outcomes research in FM. A principal assumption in this workshop has been that there exists a clinical syndrome, generally known as FM, characterized by chronic widespread pain typically associated with fatigue, sleep disturbance, mood disturbance, and other symptoms and signs, and considered to be related to central neuromodulatory dysregulation. FM can be diagnosed using 1990 American College of Rheumatology criteria. In preparation for the workshop a Delphi exercise involving 23 FM researchers was conducted to establish a preliminary prioritization of domains of inquiry. At the OMERACT meeting, the workshop included presentation of the Delphi results; a review of placebo-controlled trials of FM treatment, with a focus on the outcome measures used and their performance; a panel discussion of the key issues in FM trials, from both an investigator and regulatory agency perspective; and a voting process by the workshop attendees. The results of the workshop were presented in the plenary session on the final day of the meeting. A prioritized list of domains of FM to be investigated was thus developed, key issues and controversies in the field were debated, and consensus on a research agenda on outcome measure development was reached.<br /><br /><br />Fibromyalgia subgroups: profiling distinct subgroups using the Fibromyalgia Impact Questionnaire. A preliminary study<br />Rheumatol Int. 2008 Sep 27.<br /><br />de Souza JB, Goffaux P, Julien N, Potvin S, Charest J, Marchand S.<br /><br /><br />The main goal of this project was to identify the presence of fibromyalgia (FM) subgroups using a simple and frequently used clinical tool, the Fibromyalgia Impact Questionnaire (FIQ). A total of 61 women diagnosed with FM participated in this study. FM subgroups were created by applying a hierarchical cluster analysis on selected items of the FIQ (pain, fatigue, morning tiredness, stiffness, anxiety and depressive symptoms). We also tested for group differences on experimental pain, psychosocial functioning and demographic characteristics. Two cluster profiles best fit our data. FM-Type I was characterized by the lowest levels of anxiety, depressive and morning tiredness symptoms, while FM-Type II was characterized by elevated levels of pain, fatigue, morning tiredness, stiffness, anxiety and depressive symptoms. Both FM subgroups showed hyperalgesic responses to experimental pain. These results suggest that pain and stiffness are universal symptoms of the disorder but that psychological distress is a feature present only in some patients.<br /><br /><br />Chronic widespread pain and fibromyalgia: what we know, and what we need to know<br />Best Pract Res Clin Rheumatol. 2003 Aug;17(4):685-701.<br />Clauw DJ, Crofford LJ.<br /><br /><br />Fibromyalgia (FM) is currently defined as the presence of both chronic widespread pain (CWP) and the finding of 11/18 tender points on examination. Only about 20% of individuals in the population with CWP also have 11/18 tender points; these individuals are considerably more likely to be female, and have higher levels of psychological distress. There is no clear clinical diagnosis for the other 80% of individuals with less than 11/18 tender points, but it is likely that these persons, like FM patients, also have pain that is 'central' (i.e. not due to inflammation or damage of structures) rather than peripheral in nature. Research into FM has taught us a great deal about the confluence of neurobiological, psychological and behavioural factors that can cause chronic central pain. These conditions respond best to a combination of symptom-based pharmacological therapies, and non-pharmacological therapies such as exercise and cognitive behavioural therapy. In contrast to drugs that work for peripheral pain due to damage or inflammation (e.g. NSAIDs, corticosteroids), neuroactive compounds [especially those that raise central levels of noradrenaline (norepinephrine) or serotonin] are most effective for treating central pain. <br /><br /><br />Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment<br />J Rheumatol Suppl. 2005 Aug;75:6-21.<br />Mease P.<br /><br /><br />Fibromyalgia syndrome (FM) is a common chronic pain condition that affects at least 2% of the adult population in the USA and other regions in the world where FM is studied. Prevalence rates in some regions have not been ascertained and may be influenced by differences in cultural norms regarding the definition and attribution of chronic pain states. Chronic, widespread pain is the defining feature of FM, but patients may also exhibit a range of other symptoms, including sleep disturbance, fatigue, irritable bowel syndrome, headache, and mood disorders. Although the etiology of FM is not completely understood, the syndrome is thought to arise from influencing factors such as stress, medical illness, and a variety of pain conditions in some, but not all patients, in conjunction with a variety of neurotransmitter and neuroendocrine disturbances. These include reduced levels of biogenic amines, increased concentrations of excitatory neurotransmitters, including substance P, and dysregulation of the hypothalamic-pituitary-adrenal axis. A unifying hypothesis is that FM results from sensitization of the central nervous system. Establishing diagnosis and evaluating effects of therapy in patients with FM may be difficult because of the multifaceted nature of the syndrome and overlap with other chronically painful conditions. Diagnostic criteria, originally developed for research purposes, have aided our understanding of this patient population in both research and clinical settings, but need further refinement as our knowledge about chronic widespread pain evolves. Outcome measures, borrowed from clinical research in pain, rheumatology, neurology, and psychiatry, are able to distinguish treatment response in specific symptom domains. Further work is necessary to validate these measures in FM. In addition, work is under way to develop composite response criteria, intended to address the multidimensional nature of this syndrome. A range of medical treatments, including antidepressants, opioids, nonsteroidal antiinflammatory drugs, sedatives, muscle relaxants, and antiepileptics, have been used to treat FM. Nonpharmaceutical treatment modalities, including exercise, physical therapy, massage, acupuncture, and cognitive behavioral therapy, can be helpful. Few of these approaches have been demonstrated to have clear-cut benefits in randomized controlled trials. However, there is now increased interest as more effective treatments are developed and our ability to accurately measure effect of treatment has improved. The multifaceted nature of FM suggests that multimodal individualized treatment programs may be necessary to achieve optimal outcomes in patients with this syndrome.Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-39494035039749659852009-07-27T19:56:00.000-07:002009-07-27T19:57:12.371-07:00We can cure your FibromyalgiaAbout Fibromyalgia<br /><br />Fibromyalgia (pronounced fy-bro-my-AL-ja) is a common and complex chronic pain disorder that affects people physically, mentally and socially. Fibromyalgia is a syndrome rather than a disease. Unlike a disease, which is a medical condition with a specific cause or causes and recognizable signs and symptoms, a syndrome is a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause.<br /><br />Fibromyalgia, which has also been referred to as fibromyalgia syndrome, fibromyositis and fibrositis, is characterized by chronic widespread pain, multiple tender points, abnormal pain processing, sleep disturbances, fatigue and often psychological distress. For those with severe symptoms, fibromyalgia can be extremely debilitating and interfere with basic daily activities.<br /><br />Whether you have been diagnosed with fibromyalgia or suffer from its symptoms, or have a family member or friend with the disorder, this section is designed to provide you with a better understanding of this chronic pain disorder that affects millions of people worldwide.<br /><br />Prevalence<br /><br />Fibromyalgia is one of the most common chronic pain conditions. The disorder affects an estimated 10 million people in the U.S. and an estimated 3-6% of the world population. While it is most prevalent in women —75-90 percent of the people who have FM are women —it also occurs in men and children of all ethnic groups. The disorder is often seen in families, among siblings or mothers and their children. The diagnosis is usually made between the ages of 20 to 50 years, but the incidence rises with age so that by age 80, approximately 8% of adults meet the American College of Rheumatology classification of fibromyalgia.<br /><br />Symptoms<br /><br />Chronic widespread body pain is the primary symptom of fibromyalgia. Most people with fibromyalgia also experience moderate to extreme fatigue, sleep disturbances, sensitivity to touch, light, and sound, and cognitive difficulties. Many individuals also experience a number of other symptoms and overlapping conditions, such as irritable bowel syndrome, lupus and arthritis.<br />• Pain<br />The pain of fibromyalgia is profound, chronic and widespread. It can migrate to all parts of the body and vary in intensity. FM pain has been described as stabbing and shooting pain and deep muscular aching, throbbing, and twitching. Neurological complaints such as numbness, tingling, and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors that affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.<br />• Fatigue<br />In today's world many people complain of fatigue; however, the fatigue of FM is much more than being tired after a particularly busy day or after a sleepless night. The fatigue of FM is an all-encompassing exhaustion that can interfere with occupational, personal, social or educational activities. Symptoms include profound exhaustion and poor stamina<br />• Sleep problems<br />Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep. Medical researchers have documented specific and distinctive abnormalities in the Stage 4 deep sleep of FM patients. During sleep, individuals with FM are constantly interrupted by bursts of awake-like brain activity, limiting the amount of time they spend in deep sleep.<br />• Other symptoms/overlapping conditions<br />Additional symptoms may include: irritable bowel and bladder, headaches and migraines, restless legs syndrome (periodic limb movement disorder), impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness, vision problems, Raynaud's Syndrome, neurological symptoms, and impaired coordination.<br />Causes<br /><br />While the underlying cause or causes of FM still remain a mystery, new research findings continue to bring us closer to understanding the basic mechanisms of fibromyalgia. Most researchers agree that FM is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation. The FM patient experiences pain amplification due to abnormal sensory processing in the central nervous system. An increasing number of scientific studies now show multiple physiological abnormalities in the FM patient, including: increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain, HPA axis hypofunction, low levels of serotonin and tryptophan and abnormalities in cytokine function.<br /><br />Recent studies show that genetic factors may predispose individuals to a genetic susceptibility to FM. For some, the onset of FM is slow; however, in a large percentage of patients the onset is triggered by an illness or injury that causes trauma to the body. These events may act to incite an undetected physiological problem already present.<br /><br />Exciting new research has also begun in the areas of brain imaging and neurosurgery. Ongoing research will test the hypothesis that FM is caused by an interpretative defect in the central nervous system that brings about abnormal pain perception. Medical researchers have just begun to untangle the truths about this life-altering disease.<br /><br />Prognosis<br /><br />While there is currently no cure for fibromyalgia, better ways to diagnose and treat the chronic pain disorder continue to be developed. Since June 2007, the U.S. Food and Drug Administration has approved three medications for the treatment of fibromyalgia and other FM medications are currently in development. Research efforts have expanded as well. In 1990 there were approximately 200 published research papers on fibromyalgia studies. Today there are more than 4,000 published reports.<br /><br />While many strides have been made in the last decade, fibromyalgia remains a challenging condition. However, clinical studies have demonstrated that fibromyalgia patients can reduce their symptoms through a variety of treatment options. Working in conjunction with knowledgeable healthcare professions, motivated and informed patients can experience significant improvement in their symptoms and quality of life. Developing an individualize self-management plan, from identifying effective treatments approaches to making necessary lifestyle changes, will further improve one’s health<br /><br />Treatment<br /><br />One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation. Most people are resistant to change because it implies adjustment, discomfort and effort. However, in the case of FM, change can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement.<br /><br />An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. It may be a family practitioner, an internist, or a specialist (rheumatologist or neurologist, for example). Conventional medical intervention may be only part of a potential treatment program. Alternative treatments, nutrition, relaxation techniques, and exercise play an important role in FM treatment as well. Each patient should, with the input of a healthcare practitioner, establish a multifaceted and individualized approach that works for them.<br />• Pain management<br />A number of pharmacological treatments for fibromyalgia are available for prescription. The first to be approved by the U.S. Food and Drug Administration to treat fibromyalgia was pregabalin (Lyrica®); the second was duloxetine (Cymbalta®); and the third was milnacipran (Savella®). Other FM medications are currently in development, and may soon receive FDA approval to treat fibromyalgia. Additionally, healthcare providers may treat patients' FM symptoms with non-narcotic pain relievers (e.g. tramadol) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines. Patients must remember that antidepressants are "serotonin builders" and can be prescribed at low levels to help improve sleep and relieve pain. If the patient is experiencing depression, higher levels of these or other medications may need to be prescribed. Lidocaine injections into the patient's tender points also work well on localized areas of pain. An important aspect of pain management is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness. <br />• Sleep management<br />Improved sleep can be obtained by implementing a healthy sleep regimen. This includes going to bed and getting up at the same time every day; making sure that the sleeping environment is conducive to sleep (i.e. quiet, free from distractions, a comfortable room temperature, a supportive bed); avoiding caffeine, sugar, and alcohol before bed; doing some type of light exercise during the day; avoiding eating immediately before bedtime; and practicing relaxation exercises as you fall to sleep. When necessary, there are new sleep medications that can be prescribed, some of which can be especially helpful if the patient's sleep is disturbed by restless legs or periodic limb movement disorder. <br />• Psychological support<br />Learning to live with a chronic illness often challenges an individual emotionally. The FM patient needs to develop a program that provides emotional support and increases communication with family and friends. Many communities throughout the United States and abroad have organized fibromyalgia support groups. These groups often provide important information and have guest speakers who discuss subjects of particular interest to the FM patient. Counseling sessions with a trained professional may help improve communication and understanding about the illness and help to build healthier relationships within the patient's family. <br />• Other treatments<br />Complementary therapies can be very beneficial. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.<br /><br />Pain tracker<br /><br />What’s the benefit to keeping track of your pain? You can monitor it over a period of time and start to identify patterns, which can ultimately help you manage your pain. For example, one kind of activity may exacerbate pain while another may soothe it.<br /><br />Calendar<br /><br />Tracking your pain is simple: Use a calendar like format. Just write your pain details on it on a day in the calendar or add more details to a previous one. Forgot when your last entry was? The indicates existing entries. <br />Create a Report<br />View and print your pain history to discuss with your doctor.Dr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-20341011005763828412009-07-27T19:48:00.000-07:002009-07-27T19:52:25.523-07:00<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIv9BYKC34sWWAe-ANBvRtomHSWJOWM82zjP9P7OeyYIbxHp37G5KcV95IfAcHydb_wL0lX7X6Ml5_tr7_Zfrg0qcK4BJZKRftjW3IW4Ij5cWLGfwNuQMkCRi7cmhzfzYKbo0JXYwTAe0l/s1600-h/view_320200_1_1233737598.gif"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 250px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIv9BYKC34sWWAe-ANBvRtomHSWJOWM82zjP9P7OeyYIbxHp37G5KcV95IfAcHydb_wL0lX7X6Ml5_tr7_Zfrg0qcK4BJZKRftjW3IW4Ij5cWLGfwNuQMkCRi7cmhzfzYKbo0JXYwTAe0l/s320/view_320200_1_1233737598.gif" border="0" alt=""id="BLOGGER_PHOTO_ID_5363338070182923682" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigW-rnvWh41xLee_NIRXmwoYoFbhbvfWCswIDmO1-k6zeUNVMUnXspo-4msOraurUsET2M0HU1sbQVzKkdhLTAyBsSgVqtJ5pNHwBRE1NHWxuVl3y6GTXQ5RfHJ_J9luEi_ze2qzvd_7Ef/s1600-h/fibro_pts.gif"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 306px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigW-rnvWh41xLee_NIRXmwoYoFbhbvfWCswIDmO1-k6zeUNVMUnXspo-4msOraurUsET2M0HU1sbQVzKkdhLTAyBsSgVqtJ5pNHwBRE1NHWxuVl3y6GTXQ5RfHJ_J9luEi_ze2qzvd_7Ef/s320/fibro_pts.gif" border="0" alt=""id="BLOGGER_PHOTO_ID_5363338069586550978" /></a><br /><br /><br /><br /><br />In 1990 the American College of Rheumatology developed the tender point exam, which maps 18 specific points on the body that are extremely sensitive in people with fibromyalgia. In order for your doctor to diagnose you with fibromyalgia, you need to experience pain in at least 11 of these points and have constant, widespread pain for at least three months.<br />When mild pressure is applied to any of these soft-tissue tender point areas around the neck, shoulder, chest, hip, knee and elbow regions, a patient with fibromyalgia often experiences it as pain. Another symptom: applying pressure to these points may trigger pain in a larger region, such as down your leg.<br />If you have widespread, frequent pain, above and below the waist, on both sides of your body, and in the neck, chest, or back, ask your doctor to administer the tender point test for a definitive fibromyalgia diagnosis. Once you’ve gotten a diagnosis you can begin to create a treatment plan to help you manage your symptoms<br />Our approach<br /><br />• Myofascial Unwinding for balancing the body<br />• Diet and Exercise Can Calm Fibromyalgia Symptoms <br />• Alternatives Abound in Fibromyalgia Treatment <br />• Manage Stress, Manage Fibromyalgia <br />• Proper Sleep Is Crucial to Managing Fibromyalgia <br /><br />Put Together Your Fibromyalgia Treatment Plan <br /><br /> If you have the flu, spend a few days in bed, and you’ll likely feel better. Fibromyalgia is different. Symptoms are eased, never cured, and there is no one “remedy” that works for everyone. For these reasons, fibromyalgia patients should develop a personalized treatment plan to minimize flare-ups and the severity of symptoms.<br />Identify your symptoms<br />Widespread, chronic pain is a hallmark of fibromyalgia. It’s diagnosed by the presence of tenderness in 18 specific points of the body, with at least 11 of those 18 spots being abnormally tender, even when mildly touched. Fatigue, sleep, and memory and concentration problems (often called “fibro fog”) also are common symptoms of fibromyalgia. You might also experience restless legs syndrome, irritable bowel syndrome, painful menstruation, depression, dry eyes, anxiety or headaches. Make sure you work with your doctor to treat all of your ailments.<br />Find the right medications<br />To date, pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella) are the only medications approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia pain. Tricyclic antidepressants often have been found to be the most efficacious medications for fibromyalgia, especially since sleep and fatigue problems respond well to some antidepressants. But other painkillers, from over-the-counter ibuprofen to prescription-only narcotics, also are prescribed.<br />Talk to your doctor about what will give you the greatest relief with the fewest side effects. Because there are so many medications to choose from, you may need to use trial and error to help determine which is best for you. If antidepressants don’t work, you may need to incorporate sleep aids or muscle relaxants into your treatment plan.<br />Explore alternative treatments<br />For many people, massage and acupuncture, as well as Pilates, tai chi, chiropractic treatment, and various dietary supplements, can provide relief. You also may find it helpful to work with a physician who incorporates complementary medicine into his or her practice.<br />Make healthy changes<br />Stress reduction, a healthy diet and regular exercise can reduce fibromyalgia flare-ups, so lifestyle changes should be a part of your treatment plan. Sleep also is crucial for managing symptoms. Devising a treatment plan will require coordinating with your primary care doctor and/or a rheumatologist, physical therapist, naturopathic physician (if you use one) and other health professionals. Make sure everyone on your health care team is aware of your plan, and consult your doctor before making adjustments.<br /><br />Myofascial Unwinding for balancing the body<br />Myofascial Unwinding is an advanced form of Myofascial Release technique, which is intended to reduce the increased body pressure or tension aroused due to myofascial dysfunction; which is the cause of the debilitating pain suffered by fibromyalgic patients.<br /> Here a myofascial practitioner applies well controlled forces and stretches to the body by using extremities as lever. It’s a slow procedure and need 2-3 months of treatment for its complete cure. In my experience MFU is the only effective technique in its management. If MFU can be combined with the below described procedures; the effects will be four fold.<br />Diet and Exercise Can Calm Fibromyalgia Symptoms<br /><br />A healthy diet and regular exercise are essential to anyone who wants to feel well. For someone with fibromyalgia, those two things play a critical role in helping to reduce pain, increase energy and improve quality of life.<br />Studies have shown that walking, strength training, stretching exercises and swimming in a heated pool can alleviate fibromyalgia symptoms. Regular exercise appears to enhance the body’s response to stress, which often triggers symptoms. It also improves endocrine function to help the body better process pain and regulate sleep patterns.<br />Here are the keys to an effective exercise program:<br />• Start slowly. Begin with gentle stretching, walking, bicycling or swimming. <br /> Create a routine. Exercise should be a regular part of your life. Schedule time for it on your weekly calendar and take advantage of small opportunities to exercise throughout your day, such as using the stairs instead of the elevator. <br /> <br />• Have fun with it. Yoga, Pilates, strength training, tai chi, bicycling, walking, jogging, low-impact aerobics or swimming all are recommended. Mix it up so you won’t get bored. <br />While exercise is one of the most proven ways to battle fibromyalgia, the jury is still out on the issue of nutrition. A balanced diet can help increase your energy level and reduce your risk of other health problems, but more research is needed before experts can identify if specific foods affect the risk of flare-ups. Many people with fibromyalgia, however, have reported a reduction in symptoms by avoiding certain things, such as caffeine and alcohol. Experiment by cutting foods from your diet that seem to intensify your symptoms. To maintain your health, though, make sure your diet remains well-balanced.<br />Improving your diet can make you healthier and may even reduce your pain and fatigue. Add that to a regular exercise regimen and you may be on the road to more pain-free days.<br /><br />Proper Sleep Is Crucial to Managing Fibromyalgia <br /><br />It’s a vicious cycle: A poor night’s sleep makes your fibromyalgia symptoms worse, and then the pain makes it hard to fall asleep at night. Restless legs syndrome, a problem for many people with fibromyalgia, also can keep you from getting the rest you need.<br />Sleep is a crucial piece of the fibromyalgia puzzle. In fact, some research shows that disruptions during the deepest levels of sleep can cause the onset of fibromyalgia symptoms.<br />Try these suggestions to get better sleep:<br />Adopt a daily routine<br />Try to go to bed and wake up at the same time each day. Avoid daytime napping and create a nighttime relaxation ritual. This could include a warm bath, reading or listening to music as a way to wind down.<br />Watch your diet<br />Avoid caffeine and alcohol in the late afternoon and evening. Caffeine can make it harder to fall asleep and alcohol can disrupt sleep. Also, avoid spicy or fried foods if they cause heartburn or indigestion. And so your bladder won’t wake you, try not to consume any liquids right before bed.<br />Time your workouts<br />Exercise can help you sleep better at night. Some experts advise finishing at least three hours before bedtime because the stimulation may make it difficult to fall asleep right away. Others, however, point out that exercise can relax you and help you fall asleep shortly after participating in it.<br />Medication can help<br />If lifestyle changes are not enough, medication is an option. Tricyclic antidepressants can help you achieve restorative sleep, but they may leave you drowsy during the day. If you have restless legs syndrome, your doctor may prescribe sedatives such as diazepam (Valium). On the downside, the extended use of benzodiazepines can lower your pain threshold and ultimately exacerbate pain. Plus, they can be extremely addictive. Sleep medications and muscle relaxants can also help, so talk to your doctor about your options.<br /><br />Manage Stress, Manage Fibromyalgia<br /><br />When you have fibromyalgia, stress has a powerful grip on your life. It can cause the disease to flare-up, resulting in shooting pains, extreme fatigue, and cognitive problems like confusion and memory loss—often called “fibro fog.” In fact, many people report that a traumatic event brought on their first symptoms of fibromyalgia, leading some researchers to speculate that stress can actually trigger the disease. The National Institute of Arthritis and Musculoskeletal and Skin Diseases currently is funding research into whether fibromyalgia is caused by a breakdown in the way the body responds to stress.<br />Stress is known to trigger flare-ups in people with fibromyalgia, so restoring calm to your everyday life can help reduce your symptoms. Here are some coping techniques that can help you have more pain-free days.<br />Identify Your Stressors<br />Analyze your day and look for potential stress hot spots. For example, some people don’t mind sitting in traffic, but others fume as they creep along during rush hour. If you feel hurried to get out the door on time every morning, consider waking up earlier (and going to bed earlier to compensate). If talking on the phone to a certain family member is stressful, consider changing to an email-only relationship. Figure out which situations you can control and make the necessary adjustments to make your days easier.<br />Develop Coping Techniques<br />Much of life’s stress is unavoidable, but you can learn to react to it while keeping your calm:<br />• Schedule time to relax or meditate every day. The more you do it, the better you’ll get at relaxing. Then, when you experience a sudden stressful situation, such as a heated discussion with your boss, you’ll know how to take a few minutes afterward for deep breathing exercises or a short walk. <br />• <br />• Don’t dwell on the past. One component of stress involves regret over things we could have done differently. Live in the moment and focus on what you need to do now to control your illness. <br />• <br />• Request accommodations at work. If your fibromyalgia makes mornings difficult, ask to work from 10 a.m. to 6 p.m., for example, instead of from 9 a.m. to 5 p.m. If sitting at your desk all day leaves your body aching, ask for a better chair or for regular breaks so you can walk and stretch. <br />• <br />• Find support. Talk to others who have fibromyalgia to share coping strategies and encouragement during your bad days. <br />Managing stress will not cure your fibromyalgia, but it can help you gain some control over your symptoms. Allow yourself to relax and your body will thank you<br />Alternatives Abound in Fibromyalgia Treatment<br /><br />Odds are if you have fibromyalgia, you have heard about alternative treatments that may help you feel better. In fact, 90 percent of fibromyalgia patients have reported trying such alternative therapies as massage, acupuncture, dietary supplements or chiropractic treatment to ease their symptoms.<br />While research has yet to prove that all alternative therapies work in treating fibromyalgia, there is a lot of evidence that supports acupuncture as a successful treatment. Using super-thin needles, acupuncturists stimulate various pressure points to provide pain relief. Some studies show that electroacupuncture, in which an electric current is pulsed through a needle, is more effective than the traditional method.<br />Many people with fibromyalgia find different alternative methods effective. And like mainstream fibromyalgia treatments, what works for one person might have no effect on another. Bottom line: You have to shop around to see what is best for you.<br />Here are some other options:<br />Massage: Massage therapists work on the muscles and soft tissue of the body to alleviate pain, muscle spasms and stress. However, the National Center for Complementary and Alternative Medicine reviewed research about the effectiveness of treating fibromyalgia with massage and found that the benefits are only short-term.<br />Cognitive behavioral therapy: Often called CBT, cognitive behavioral therapy has been shown to be among the most effective non-medication treatments for fibromyalgia. CBT helps change the way you think about pain with the goal of changing the way your body responds to pain, thus making the pain less severe. It may also help improve sleep.<br />Though studies on the following methods have been deemed insufficient by some medical experts, they are still widely used by people with fibromyalgia, with varying degrees of success.<br />Dietary supplements magnesium and SAM-e are often used to treat fibromyalgia. SAM-e is a naturally occurring compound in our bodies that helps in the production of dopamine and serotonin, which regulate mood and control the pain response. Preliminary research has shown evidence that SAM-e supplements may work to keep symptoms in check, but further study is needed. Magnesium is helpful in hundreds of ways, like converting food into energy, strengthening the immune system, and maintaining normal nerve and muscle function. Some researchers believe that a deficiency of this mineral contributes to fibromyalgia symptoms, though research into its efficacy has been inconclusive.<br />Finding the alternative treatment that works for you will require some experimentation. Ask your doctor for recommendations and be sure to tell him or her which treatments you already are using. This is especially important with dietary and herbal supplements since they can interact with other medications and possibly cause side effects.<br /><br />For more details please contact Dr. Ajimshaw @ dr.ajimshaw@rediffmail.com or ajimsha@aimst.edu.myDr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0tag:blogger.com,1999:blog-9016364437066447337.post-67117747489422254802009-07-27T19:38:00.000-07:002009-07-27T19:40:52.395-07:00Fibromyalgia and its Sufferings<strong>Understanding Chronic Pain and Fibromyalgia: A Review of Recent Discoveries</strong><br /> <br /> <br />Fibromyalgia tends to be treated rather dismissively, sometimes with cynical overtones. When I trained in BPT some 10 years ago, this diagnosis was never mentioned. In the United States fibromyalgia has become a semi-respectable diagnosis within the last 10 years, but even so it has some critics. The problem for doctors is that fibromyalgia is not a problem that can be understood according to the classic medical model. This is the model that is used in all medical training. It is based on the correlation of specific tissue pathology with distinctive symptoms (e.g. tuberculosis of the lung causing a chronic cough). Elimination of the causative agent (e.g. the tubercule bacillus) cures the disease. This model has led to the most major advances in medicine that we benefit from today. <br /> <br />I have seen over 150 fibromyalgia patients over the past 5 years; most want to be reassured that their symptoms are the product of a "real disease" rather than figments of a fertile imagination--commonly ascribed to the psychological diagnosis such as somatization, hypochondriasis, or depression. The good news is that contemporary research is hot on the track of unraveling the changes that occur within the nervous system of fibromyalgia patients. The basic message is that fibromyalgia cannot be considered a primarily psychological disorder, but as in many chronic conditions, psychological factors may play a role in who becomes disabled and may even up-regulate the central nervous system changes that are the root cause of the problem. <br /> <br />What is the problem?<br />The problem is: disordered sensory processing.<br />I will try to convey to you what we mean by "disordered sensory processing." Even a superficial understanding of this topic will change the way you think about the fibromyalgia problem. Furthermore, recent advances that have been made at the molecular level hold out the promise of more effective treatment for fibromyalgia pain. <br /> <br />What is Fibromyalgia?<br />Fibromyalgia is a chronic pain state in which the nerve stimuli causing pain originates mainly in the muscle. Hence the increased pain on movement and the aggravation of fibromyalgia by strenuous exertion. <br /> <br />Pain is a universal experience that serves the vital function of triggering avoidance. A few unfortunate individuals have a congenital absence of pain sensation; they do not fare well due to repeated bodily insults that go unnoticed. As a physician I see patients with an acquired deficiency in the pain sensation (e.g. diabetic neuropathy or neurosyphilis) who develop a severe destructive arthritis--a result of repeated minor joint injuries that are overlooked. Thus pain sensation is a necessary part of being human. Pain sensation is a fact of life. Even the primitive amoeba takes avoiding action in the face of adverse events. In such primitive life forms, pain avoidance is purely reflex action, as they do not have the complexity of a highly developed brain to feel pain in the sense that humans do: (1)The unconscious reflex avoidance reaction that is so rapid that it occurs before the actual awareness of the pain sensation (as in all life forms), (2) the actual experience of the pain sensation (that can only occur in highly complex organisms). This is an important point, as it implies that different parts of the brain are involved in these two consequences of the pain reaction. <br /> <br />Over the last few years a number of important research discoveries have started to clarify the enigma of chronic pain. Many of these new findings have a special relevance to the chronic pain of fibromyalgia. The cardinal symptom of FM is widespread body pain. The cardinal finding is the presence of focal areas of hyperalgesia, the tender points. Tender points imply that the patient has a local area of reduced pain threshold, suggesting a peripheral pathology. In general, tender points occur at muscle tendon junctions, a site where mechanical forces are most likely to cause micro-injuries. Many--but not all--FM patients have tender skin and an overall reduction in pain threshold. These latter observations suggest that some FM patients have a generalized pain amplification state. There has been a recent plethora of experimental studies apposite to the pathophysiological basis of both the peripheral and central aspects of pain. <br /> <br />The Pathophysiological Basis for Chronic Pain<br />The International Association For the Study of Pain (ASP) defines pain as follows: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." This definition explicitly affirms that pain has both a sensory and an affective-evaluative component, and furthermore acknowledges that it may occur in the absence of obvious visceral or peripheral pathology. To fully understand chronic pain, one must integrate the sensory and affective/evaluative elements of the pain experience. It is equally misguided to focus on the psychological aspects of pain, as it is to address only the sensory component and ignore the affective dimensions. However, for the sake of clarity, each of these two constitutive elements will be considered separately. <br /> <br />The Sensory Component<br />Pain is generally envisaged as a cascade of impulses that originates from nocioceptors in somatic or visceral tissues. The impulses travel in peripheral nerves with a first synapse in the dorsal horn and a second synapse in the thalamus, and end up in the cerebral cortex and other supraspinal structures. <br /> <br />This results in an experience of pain and the activation of reflex and later reflective behaviors. These reflex and reflective behaviors are aimed at eliminating further pain. The expectation is that this nocioceptor driven pain will be successfully abolished, allowing healing and a return to a pain-free state. The problem with chronic pain is that the linear relationship between nocioception and pain experience is inappropriate or even absent, and the expected recovery does not occur. <br /> <br />It is a common misconception to view the nervous system as being "hard-wired"; that is, stimulation of a nerve ending (say a needle prick) always produces the same behavioral and affective response. This concept implies that the same intensity of pain stimulus will always elicit the same degree of nerve stimulation and hence the same subjective experience of pain. It is now understood that the concept is wrong. Some 30 years ago, Melzeck and Wall proposed that pain is a complex integration of noxious stimuli, affective traits, and cognitive factors. In other words, the emotional aspects of having a chronic pain state and one's rationalization of the problem may both influence the final experience of pain. Mendell and Wall provided the first experimental evidence that the nervous system was not hard-wired in 1965. They noted that a repetitive stimulation of a peripheral nerve, at sufficient intensity to activate C-fibers, resulted a progressive build-up of the amplitude of the electrical response recorded in the second order dorsal horn neurons. If the system had been hard-wired, each stimulus would have elicited the same response in the second order neuron. They termed this phenomenon "wind-up." It is now appreciated that the phenomenon of wind-up is crucial to understanding the problem of chronic pain via the mechanism of "central sensitization." <br /> <br />Central sensitization refers to an increased activation of second order neurons in the spinal cord, resulting from injury or inflammation-induced activation of peripheral nocioceptors. Sensory input from muscle, as opposed to skin, is a much more potent effector of central sensitization. This may be the clue to the role of muscle pain in the total spectrum of fibromyalgia. A common example of central sensitization is post-herpetic neuralgia. Previous injury to a peripheral nerve leads to an amplification of both nocioceptive and non-nocioceptive impulses. The mechanism responsible for the abnormal perception of non-nocioceptive impulses in post-herpetic neuralgia is an increased excitation of second order nocioceptive neurons in the dorsal horn of the spinal cord. A special example of central pain occurs when there is pathology within the central nervous system. This occurs in a thalamic stroke--severe unilateral pain, often accompanied by strong emotions, that occurs in the absence of any nocioceptive input. <br /> <br />There are two forms of second order spinal neurons involved in central sensitization. (1) Nocioceptive--specific neurons--respond only to nocioceptive stimuli, and (2) Wide dynamic range neurons--respond to both nocioceptive and non-nocioceptive afferent stimuli. Both may be sensitized by nocioceptive stimuli leading to central senitization but wide-dynamic range neurons are generally more intensely sensitized than nocioceptive-specific neurons. Nocioceptive and non-nocioceptive peripheral nerves often converge onto the same wide dynamic range neuron (see figure). Once sensitized by ongoing nocioceptive impulses from peripheral nerves, wide-dynamic range neurons will respond to non-nocioceptive stimuli just as intensely as they did prior to sensitization. This results in sensitizations like a light touch to be experienced as pain (i.e. allodynia). Sensitization of wide-dynamic range neurons by prior pain stimuli provides the pathophysiological foundation for nonnocioceptive pain. <br /> <br />There is emerging evidence that afferent activity from Golgi tendon organs and muscle spindles can be converted into pain signals under the influence of central sensitization. For instance, some patients with strokes and spinal cord injuries develop severe pain on movement. Benc has proposed the term "proprioceptive allodynia" to describe this phenomenon. He describes such individuals as "while not experiencing pain at rest, they develop excruciating burning and tingling, often difficult to describe, that appear only when trying to hold an object, move a limb, stand or walk." Thus everyday muscle activity may cause pain and impair function in some individuals with central sensitization. At a physiological level, pain on movement implies that proprioceptive afferents are projecting onto second order wide-dynamic-range spinal neurons that have been sensitized by previous nocioceptive activity. Thus the central nervous system of subjects who have ongoing pain (e.g. arthritis) or have had previous pain experiences (e.g. post injury pain) may be permanently altered due to changes that can now be understood at the physiological molecular and structural levels. At a clinical level this is seen as persistent pain in survivors of serious illness who experienced high levels of pain during hospitalization, persistent pain after breast surgery, or the occurrence of fibromyalgia after automobile accidents. The reason why the phenomenon of central sensitization only occurs in a minority of individuals is not currently known. At a molecular level, there are many studies demonstrating the important role of excitatory amino acids such as glutamate and neuropeptides such as substance P in the generation of central sensitization. Substance P and CRGP are important neurotransmitters in lowering the threshold of synaptic excitability, which permits the unmasking of normally silent interspinal synapses and the sensitization of second order spinal neurons. Substance P, unlike the excitatory amino acids, can diffuse long distances in the spinal cord and sensitize dorsal horn neurons in spinal segments both above and below the input segment--with resulting pain signal generation from non-nocioceptive afferent activity. Clinically this will lead to an expansion of receptive fields; e.g. the spread of pain from to uninjured areas after an automobile accident. <br /> <br />The Psychological Component<br />It was seen in the preceding section that chronic pain could occur in the absence of ongoing tissue damage--this is an example of the sensory component of pain. It was also noted that one component of pain is a reflex avoidance behavior that can occur before the conscious appreciation of pain. In terms of brain physiology this implies that more primitive parts of the brain contain several discrete nuclei (e.g. the thalamus, cingulate gyrus, hippocampus, amygdyala, and locus ceruleus) that interact to form a functional unit called the limbic system. This is the part of the brain that subserves many reflex phenomena, including the association of sensory input with specific mood states (e.g. pleasure, fear, aversion etc.). These facts form the physiological basis for considering the emotional aspect of pain. Interestingly, the electrical stimulation of the brain during neurosurgical procedure does not induce pain sensations in pain-free subjects. However, in past pain patients it often reawakens previous pain experiences. It is surmised that such stimulation re-activates cortical and subcortical pain circuits that were previously dormant. It is not known whether there is a single cortical structure that subserves pain memory. Currently it appears that different cortical and subcortical structures are involved in the pain experience. For instance, removal of the somatosensory cortex does not abolish chronic pain, but excision of lesions of the anterior cingulated cortex reduces the unpleasantness of pain. The anterior cingulated cortex is involved in the integration of affect cognition and motor response aspects of pain and exhibit increased activity on PET studies of pain patients. Other structures involved in cortical pain processing include the prefrontal cortex (activation of avoidance strategies, diversion of attention and motor inhibition); the amygdala (emotional significance and activation of hypervigilance); and the locus ceruleus (activation of the "fight or flight" response). <br /> <br />All these structures are linked to the medial thalamus, whereas the lateral thalamus is linked to the somatosensory cortex (pain localization). One example of limbic system activation is the hypervigilance that accompanies many chronic pain states, including fibromyalgia. <br /> <br />The emotional component of pain is multifactorial and includes past experiences, genetic factors, generals state of health, the presence of depression and other psychological diagnosis, coping mechanisms, and beliefs and fears surrounding the pain diagnosis. Importantly, thoughts as well as other sensations can influence the sensory pain input to consciousness as well as the emotional coloring of the pain sensation. The term given for this modulation of pain impulses is the "gate control theory of pain." Thus thoughts (beliefs, fears, depression, anxiety, anger, helplessness, etc.), as well as peripherally generated sensations, can both dampen or amplify pain. Indeed, in many chronic pain conditions (that lack any effective therapy for the sensory/pain component), a reduction of pain and the resulting suffering can only be affected by modulating the psychological aspects of pain. As the psychological contribution to pain varies enormously from patient to patient, this approach has to be individualized. However, there are some general principles that are worth noting. There are important consequences of having pain that will not go away (as is the expected experience for most pain in most people). The unsettling realization that the problem may well be life-long generates a varied mix of emotions and behaviors that are often counterproductive to coping with a chronic problem. Many of these changes (which are partly reflex in origin) would be appropriate for dealing with acute self-healing pain events, but become a liability when dealing with chronic pain. The end result of chronic pain is often depressive illness, marital discord, vocational difficulties, chemical dependency, social withdrawal, sleep disorders, increasing fatigue, inappropriate beliefs, and a radical alteration in their previous personality. Varying degrees of functional disability are a common accompaniment of chronic pain states. The reasons for dysfunction are multiple and vary from individual to individual. Pain often monopolizes attention (causing lack of focus on the task at hand). It is usually associated with poor sleep (causing emotional fatigue). Movements may aggravate pain (causing a reluctance to engage in activity). Fear of activity often leads to deconditioning (which predisposes to muscle and tendon injuries and reduced stamina). Pain causes stress, which may result in anxiety, depression, and inappropriate behavior (causing disability due to secondary psychological distress). The modern era of psychological imaging is providing an important new framework for understanding these "emotional" responses<br /><br />Newly Diagnosed Patient<br /> <br />Fibromyalgia (fi-bro-my-AL-ja) is a very common condition of widespread muscular pain and fatigue. Seven to ten million Americans suffer from fibromyalgia (FM). It affects women much more than men in an approximate ratio of 20:1. It is seen in all age groups from young children through old age, although in most patients the problem begins in their 20s or 30s. Recent studies have shown that fibromyalgia occurs worldwide and has no specific ethnic predisposition. <br /> <br />The Symptoms of Fibromyalgia<br /> <br />Fibromyalgia patients have widespread body pain which often seems to arise in the muscles. Some FM patients feel their pain originates in their joints. Pain that emanates from the joints is called arthritis; extensive studies have shown FM patients do not have arthritis. Although many fibromyalgia patients are aware of pain when they are resting, it is most noticeable when they use their muscles, particularly during repetitive activities. Their discomfort can be so severe it may significantly limit their ability to lead a full life. Patients can find themselves unable to work in their chosen professions and may have difficulty performing everyday tasks. As a consequence of muscle pain, many FM patients severely limit their activities including exercise routines. This results in their becoming physically unfit, which eventually makes their fibromyalgia symptoms worse.<br /> <br />In addition to widespread pain, other common symptoms include a decreased sense of energy, disturbances of sleep, and varying degrees of anxiety and depression related to patients' changed physical status. Furthermore, certain other medical conditions are commonly associated with fibromyalgia, such as: tension headaches, migraine, irritable bowel syndrome, irritable bladder syndrome, premenstrual tension syndrome, cold intolerance, and restless leg syndrome. Patients with estalished rheumatoid arthritis, lupus (SLE), and Sjogren's syndrome often develop FM during the course of their disease. The combination of pain and multiple other symptoms often leads doctors to pursue an extensive course of investigations, which are nearly always normal.<br /> <br />Diagnosing Fibromyalgia<br /> <br />There are no blood tests or X-rays that show abnormalities diagnostic of FM. This initially led many doctors to believe that the problems suffered by FM patients were "all in their heads," or that fibromyalgia patients had a form of masked depression or hypochondriasis. Extensive psychological tests have shown these impressions were unfounded. A physician's diagnosis of FM is based on taking a careful history and the finding of tender areas in specific areas of muscle. These locations are called "tender points." They are tender to palpation and often feel somewhat hardened if the muscle is stroked.<br /> <br />The Long-Term Outcome for Fibromyalgia<br /> <br />The musculoskeletal pain and fatigue experienced by fibromyalgia patients are chronic problems that tend to have a waxing and waning intensity. There is currently no generally accepted cure for this condition. According to recent research, most patients can expect to have this problem lifelong. However, worthwhile improvement may be obtained with appropriate treatment. There is often concern on the part of patients, and sometimes physicians, that FM is the early phase of some more severe disease, such as multiple sclerosis, lupus , etc. Long-term follow-up of fibromyalgia patients has shown that it is very unusual for them to develop another rheumatic disease or neurological condition. <br /> <br />However, it is quite common for patients with "well-established" rheumatic diseases, such as rheumatoid arthritis, systemic lupus, and Sjogren's syndrome, to have fibromyalgia also. It is important for these patients' doctors to realize they have such a combination of problems, as specific therapy for rheumatoid arthritis and lupus, etc. does not have any effect on FM symptoms. Patients with fibromyalgia do not become crippled with the condition, nor is there any evidence it affects their lifespan. Nevertheless, due to varying levels of pain and fatigue, there is an inevitable contraction of social, vocational, and avocational activities that leads to a reduced quality of life. As with many chronic diseases, the extent to which patients succumb to the various effects of pain and fatigue are dependent upon numerous factors, in particular their psycho-social support, financial status, childhood experiences, sense of humor, and determination to push on. <br /> <br />The Treatment of Fibromyalgia<br /> <br />The treatment of FM is frustrating for both patients and their physicians. In general, drugs used to treat musculoskeletal pain, such as aspirin, non-steroidals (e.g. ibuprofen), and cortisone, are not particularly helpful in this situation. As in any chronic pain condition, education is an essential component that helps patients understand what can or can't be done as well as teaching them to help themselves.<br /> <br />It is important for a patient's physician to discover whether there is a cause for sleep disturbances. Such sleep problems include sleep apnea, restless legs syndrome, and teeth grinding. If the cause for a patient's sleep disturbance cannot be determined, low doses of an anti-depressive group of drugs, called tricyclic anti-depressants or short acting sleeping medications such as zolpidem (Ambien) may be beneficial. Patients need to understand these medications are not addictive when used in low dosages (eg., amitriptyline 10 mg at night) and have very few side effects. In general, routine use of sleeping pills such as Halcion, Restoril, Valium, etc., should be avoided as they impair the quality of deep sleep. It is claimed that Ambien (zolpidem) avoids this problem.<br /> <br />There is increasing evidence that a regular exercise routine is essential for all fibromyalgia patients. The increased pain and fatigue caused by repetitive exertion makes regular exercise quite difficult. However, those patients who do develop an exercise regimen experience worthwhile improvement and are reluctant to give up. In general, FM patients must avoid impact loading exertion such as jogging, basketball, aerobics, etc. Regular walking, the use of a stationary bicycle, and pool therapy utilizing an Aqua Jogger (a floatation device that allows the user to walk or run in the swimming pool while remaining upright) seem to be the most suitable activities for FM patients. Supervision by a physical therapist or exercise physiologist is of benefit wherever possible. In general, 20 minutes of physical activity three times a week at 70% of maximum heart rate (220 minus your age) is sufficient to maintain a reasonable level of aerobic fitness.<br /> <br />Drugs such as aspirin and Advil are not particularly effective and seldom do more than take the edge off FM pain. Opioid analgesics (propoxyphene, codeine, morphine, oxycodone, methadone) may provide a worthwhile pain relief in a subgroup of severely afflicted patients, but fibromyalgia patients seem especially sensitive to opioid side effects (nausea, constipation, itching, and mental blurring) and often decide against the long-term use of these drugs. The use of opioid analgesics (narcotics) in the management of non-malignant pain has been a controversial issue for many doctors, with the usual reasons for concern: addiction, oversight by state medical boards, and criminal diversion of drugs. However, recent research has shown that addiction seldom occurs when these medications are use in chronic pain states. It is important to understand the difference between addiction and dependence (which occurs with all these drugs in the majority of patients (see Addiction/Dependence). Two particularly useful weak opioids in the management of FM pain are tramadol (Ultram) and the combination of tramadol with acetaminophen (Ultracet). Neither of these two medications is a FDA scheduled drug (i.e. they have minimal addiction potential).<br /> <br />Particularly painful areas often may be helped for a short time (2-3 months) by trigger point injections. This involves injecting a trigger point with a local anesthetic (usually 1% Procaine) and then stretching the involved muscle with a technique called spray and stretch. It should be noted the injection of a tender point is quite painful (indeed, if it is not painful the injection is seldom successful). After the injection, there is typically a lag of two to four days before any beneficial effects are noted. Other techniques that directly help the tender areas on a transient basis are heat, massage, gentle stretching, and acupuncture.<br /> <br />About 20 percent of FM patients have a co-existing depression or anxiety state that needs to be appropriately treated with therapeutic doses of anti-depressants or anti-anxiety drugs often in conjunction with the help of a clinical psychologist or psychiatrist. Basically, patients who have a concomitant psychiatric problem have a double burden to bear. They will find it easier to cope with their FM if the psychiatric condition is appropriately treated. It is important to understand that fibromyalgia itself is not a psychogenic pain problem, and that treatment of any underlying psychological problems does not cure FM.<br /> <br />Most FM patients quickly learn there are certain things they do on a daily basis that seem to make their pain problem worse. These actions usually involve the repetitive use of muscles or prolonged tensing of a muscle, such as the muscles of the upper back while looking at a computer screen. Careful detective work is required by the patient to note these associations and, where possible, to modify or eliminate them. Pacing of activities is important; we have recommended that patients use a stopwatch that beeps every 20 minutes. Whatever they are doing at that time should be stopped and a minute should be taken to do something else. For instance, if they are sitting down, they should get up and walk around--or vice versa.<br /> <br />Patients who are involved in fairly vigorous manual occupations often need to have their work environment modified and may need to be retrained in a completely different job. Certain people are so severely affected that consideration must be given to some form of monetary disability assistance. This decision requires careful consideration, as disability usually causes adverse financial consequences as well as a loss of self esteem. In general, doctors are reluctant to declare fibromyalgia patients disabled and most FM applicants are initially turned down by the Social Security Administration at the first review. However, each patient needs to be evaluated on an individual basis before any recommendations for or against disability are made.<br /><br />For more details please contact Dr. Ajimshaw @ dr.ajimshaw@rediffmail.com or ajimsha@aimst.edu.myDr. Shawhttp://www.blogger.com/profile/12384370310310156599noreply@blogger.com0