Monday, October 6, 2008

Myofascial Release - An Introduction for the Patient

SCeB CAPT® & MFTRF®
Reg. No. A1.M9/08, S. 289/08
Chemmanampady, Medical College, Kottayam
Ph: 9846265331, 9846474873, 9048001452
www.scebcapt.blogspot.com. E mail: scebcaptmfr@gmail.com
Introduction
Myofascial Release is a relatively new addition to the armamentarium of the physical therapist. Because it is somewhat different from traditional physical therapy, many patients ask questions such as "What is it?" and "How does it work?" Myofascial Release is generally an extremely mild and gentle form of stretching that has a profound effect upon the body tissues. Because of its gentleness, many individuals wonder how it could possibly work. To help you understand, we are providing you with this article.
In SCeB CAPT ® our therapist are specialized in MFR and practicing most resent and proved Hands- On techniques through an approach called AJIMSHAW’s Approach ® & this is the identity and uniqueness of our clinic.
Our motto "SCeB CAPT® Care…….100% Cure……
Fascia
Fascia (also called connective tissue) is a tissue system of the body to which relatively little attention has been given in the past. Fascia is composed of two types of fibers: A) Collagenous fibers which are very tough and have little stretch ability. B) Elastic fibers which are stretchable. From the functional point of view, the body fascia may be regarded as a continuous laminated sheet of connective tissue that extends without interruption from the top of the head to the tip of the toes. It surrounds and invades every other tissue and organ of the body, including nerves, vessels, muscle and bone. Fascia is denser in some areas than others. Dense fascia is easily recognizable (for example, the tough white membrane that we often find surrounding butchered meat).
When Fascia is Injured
Because fascia permeates all regions of the body and is all interconnected, when it scars and hardens in one area (following injury, inflammation, disease, surgery, etc.) it can put tension on adjacent pain-sensitive structures as well as on structures in far-away areas. Some patients have bizarre pain symptoms that appear to be unrelated to the original or primary complaint. These bizarre symptoms can now often be understood in relationship to our understanding of the fascial system.

Anatomy of Fascia
The majority of the fascia of the body is oriented vertically. There are, however, four major planes of fascia in the body that are oriented in more of a crosswise (or transverse) plane. These four transverse planes are extremely dense. They are called the pelvic diaphragm, respiratory diaphragm, thoracic inlet and cranial base. Frequently, all four of these transverse planes will become restricted when fascial adhesions occur in just about any part of the body. This is because this fascia of the body is all interconnected, and a restriction in one region can theoretically put a "drag" on the fascia in any other direction.
Treating Fascial Restrictions
The point of all the above information is to help you understand that, during myofascial release treatments, you may be treated in areas that you may not think are related to your condition. The trained therapist has a thorough understanding of the fascial system and will "release" the fascia in areas that he knows have a strong "drag" on your area of injury. This is, therefore, a whole body approach to treatment. A good example is the chronic low back pain patient; although the low back is primarily involved, the patient may also have significant discomfort in the neck. This is due to the gradual tightening of the muscles and especially of the fascia, as this tightness has crept its way up the back, eventually creating neck and head pain. Experience shows that optimal resolution of the low back pain requires release of the fascia of both the head and neck; if the neck tightness is not also released it will continue to apply a "drag" in the downward direction until fascial restriction and pain has again returned to the low back.
Muscle provides the-greatest bulk of our body’s soft tissue. Because all muscle is enveloped by and in grained with fascia, myofascial release is the term that has been given to the techniques that are used to relieve soft tissue from the abnormal grip of tight fascia. The type of myofascial release technique chosen by the therapist will depend upon where in your body the therapist finds the fascia restricted. If it is restricted in the back (more superficial than deep) he may apply a very gentle stretch on the skin across the back, with the use of two hands. If the thoracic inlet, deep transverse fascia is suspected of being restricted, the therapist may place one hand on the upper back and one over the collarbone area in front and apply extremely gentle pressure. Muscle tissue responds to a relatively firm stretch, but this is not the case with fascia. Remember the collagenous fibers of fascia are extremely tough and resistant to stretch. In fact, it is estimated that fascia has a tensile strength of as much as 2000 pounds per square inch. (No wonder when it tightens, it can cause pain). However, it has been shown that under a small amount of pressure (applied by a therapist’s hands) fascia will soften and begin to release when the pressure is sustained overtime. This can be likened to pulling on a piece of taffy with only a small, sustained pressure. Another important aspect of myofascial release techniques is holding the technique long enough. The therapeutic affect will begin to take place after holding a gentle stretch and following the tissue three-dimensionally with skilled, sensitive hands.
In general, acute cases will resolve with a few treatments. The longer the problem has been present, generally the longer it will take to resolve the problem. Many chronic conditions (that have developed over a period of years) may require three to four months of treatments to obtain optimal results.
Frequently there is increased pain for several hours to a day after treatment, followed by remarkable improvement. After, remarkable improvement is noted immediately during or after a treatment. Sometimes new pains in new areas will be experienced. There is sometimes a very light-headedness or a feeling of nausea. Sometimes a patient experiences a temporary emotion change. All of these are normal reactions of the body to the profound, but positive, changes that have occurred by releasing fascial restrictions. It is felt that release of tight issue is accompanied by release of trapped metabolic waste products into the surrounding tissue arid bloodstream. We highly recommend that you "flush your system" by drinking a lot of fluid during the course of your treatments, so that reactions like nausea and light headedness will remain minimal or nil. If patients have any questions or concerns that arise concerning myofascial release, they should be encouraged to discuss them with the therapist.
Some examples of our Successes
Case History—Chronic Low Back Pain
A 32-year-old construction worker was suffering from Chronic Low Back Pain with bilateral thigh pain. Five months after his continuous pain he was referred to physical therapy by his doctor for three weeks of treatment for chronic low back pain and bilateral thigh pain. He was treated with AJIMSHAW’s Approach for his condition. After just two treatments sessions itself there was no further leg pain and only mild low back pain with movement. After the completion of the course he no longer was having any pain and had returned to his job as a construction worker. Specific exercises and activity modifications were advised. Following up by telephone three months later, he reported having no problems with his back. He is very pleased with his ability to continue his strenuous job.
Case History- Fibromyalgia
A 18-year-old BDS student was suffering from chronic low back pain, neck pain, head ache, leg pain and arm pain, she was treated with AJIMSHAW’s Approach for one month. After the course he is totally pain free and energetic and doing well in her studies.
Case History- Cervical Spondylosis
A 48-year-old businessman was referred to our centre with a diagnosis of Cervical Spondylosis. He was having symptoms of radiating pain over both the arm, neck pain and head ache. He was given a 20 days program of AJIMSHAW’s Approach. Now he is spending a normal life without any discomfort on a 4 months follow up enquiry.

Case History- Carpal tunnel syndrome
A 55-year-old retired nurse/ house wife was suffering from tingling, numbness, pain along both the wrists. All studies (EMG, NCV) confirmed the diagnosis of Carpal tunnel syndrome. She received treatment for her neck, upper back, upper arm, fore arm and wrists. There were 18 sessions after that she didn’t have any tingling episodes and reported complete recovery.
Case History- Heel pain
A 28-year-old female (House Wife) visited SCeB CAPT® for her debilitating pain on right heel. She cannot walk properly, not able to use her feet for any force producing activities. The pain was particularly worse in the morning when she is getting up from the bed. She has undergone five days treatment at our centre. According to her 90% of her pain had vanished immediately after the first session. After two months enquiry she is doing well and the pain has never returned.
Case History- Shoulder Stiffness
A 70-year-old retired businessman, known diabetic and hypertensive, was referred to our centre for his left shoulder stiffness, severe pain particularly at night which is radiating to his upper arm too. He was given a 20 day program. After 10 days itself he had a very good relief and his shoulder activities returned back to 100%. A follow up after five months reported that he is having no complaint with his left arm.
Case History- Lower leg pain.
A 45-year-old government employee, was referred to our clinic with the complaints of pain in his both lower legs. Pain intensity is worse in the right than left. He cannot walk for long, cannot squat or cannot climb steps. He was given a 15 day program of AJIMSHAW’s Approach. Now all his discomfort had disappeared and is doing well.
Case History- Tennis Elbow
A 27-year-old computer professional was referred to our centre with a history of pain and weakness on his right elbow and hand. He was given a five day program. Now he is happy because he is not having any such complaints when using the mouse of the computer.
Case History- Head Ache
A 29-year-old university employee had visited our centre with a complaint of severe head ache for which she had tried almost all treatments. Her duties include prolonged sitting and computer use. We had given a course of AJIMSHAW’s Approach with Craniosacral Therapy and given some advices regarding how to use the daily activities correctly without harming the neck. Now she back to work with no such complaints afterwords.
Other conditions for which we are having successful track records are :-
Post Chickun gunia pain
Persistent body pain after severe accidents
Stroke rehabilitation
Spinal cord injury rehabilitation
Parkinsonism rehabilitation
Cerebral Palsy
Different types of arthritis
Knee Joint Pain and so on…….

Sunday, August 31, 2008

Back Pain


Myofascial Release Training In INDIA

'Health is not only about feeling better but getting better at feeling'
-John F Barnes-

Myofascial Release (MFR) is a whole body, hands-on approach to healthcare. It is a mild and gentle form of stretching that has a profound effect upon the body. A slow gentle pressure allows the body's tissue to reorganize without force, release physical restrictions and release the body's unconscious holding and bracing patterns.
Myo means muscle and fascia means band, or connective tissue, is a 3D continuous web that extends without interruption throughout the body. It is composed of two main types of fibers, collagen and elastin, that promote strength and flexibility. It is dynamic in nature and changes and conforms to pressures applied to it. It meets resistance in order to protect and support the human frame. Fascia is prominently vertical in orientation and Surrounds, infuses and protects every other tissue and organ of the body. When healthy, the fascial system is relaxed, providing a supportive cushioning mechanism allowing us to move safely without restriction or pain.
Following all physical and emotional injury, and through poor posture, fascia scars and hardens in the affected site and along the tension lines imposed on it. As the fascial system is completely continuous then any injury will compromise the whole structure. Once injured, fascia twists and pulls, like the pull in a jumper, creating a spider web effect of tension throughout the system. This tension can exert a pressure of up to 2,000 pounds per square inch crushing and impinging important structures like the dural tube, organs, and the circulatory, nerve and lymphatic systems. The "fascial tension can also affect the alignment of the skeletal and muscular system all of which create on-going physical and emotional tension and pain.

Over time these twists and pulls create a devastating effect on the body. It is not uncommon for patients to complain of a symptom in one area of the body that may have originated elsewhere. As the body tries to compensate for the restrictions, further imbalance and tension occurs. This is one of the main reasons we experience on-going
physical and emotional discomfort when the whole body remains un-treated. Many people don't recognize that their body is being compromised by fascial pulls as these pulls happen so gradually. However there is usually 'the last straw that breaks the camel's back' and the body is no longer able to support the structure without pain'. It is therefore important for the Myofascial Practitioner to treat not just the injury but to treat the body as a whole and the whole fascial history.
Fascial restrictions do not show up on any X- Ray, MRl or CAT scan and patients may complain of bizarre pain and discomfort that can remain undiagnosed and subsequently, and unfortunately, may remain untreated within traditional healthcare systems.
The body remembers
The body and mind are one and the same and have the subconscious ability to associate postural positions, actions and emotions to a memory. It also subconsciously constructs and memorizes habit and bracing patterns in order to protect itself from physical and emotional pain and discomfort. This creates further fascial restrictions inhibiting the free flow of the subconscious mind throughout the body. Therefore the experiences we are compensating for become locked within the fascial system, without our awareness, maintaining body/mind dysfunction and increasing pain and discomfort. Without awareness there is no choice.
With the help of MFR, the physical and emotional content of any injury, literal or
symbolic, can be addressed in a safe and gentle way. MFR releases the restrictions within the fascial network, allowing valuable subconscious information to be released into awareness where it can be resolved in order to restore health.
A sense of art
MFR is an art form. The MFR Practitioner not only takes into consideration what they see in the patient's postural assessment but works directly with what they feel and sense from palpating and treating the body. They feel for the fascial restrictions and follow them to source, treating the cause and not merely the symptom. One of the important jobs of the fascial system is to meet resistance. When a force is applied to the system the fascial network meets that resistance in order to protect. The fascial network responds and releases to the Piezoelectric effect, a low load pressure over a sustained length of time. Therefore MFR should never force the fascial network but instead work slowly through the layers of restriction. It takes approximately 90 seconds for the fascial network to respond to the slow gentle pressure applied to it and a fascial release can take anywhere between 3 to 5 minutes, sometimes longer.
The fascial system is 3D, therefore we treat in a 3D manner. No patient ever injured themselves lying flat, motionless, on a massage table. Every patient's fascial restrictions are unique; therefore we treat each patient in a unique, 3D, way. MFR is not bound by protocols or structured techniques. It is rather an exploratory journey feeling, sensing, palpating and ultimately facilitating the release of restricted tissues that may have been tight and which have possibly been creating pain and dysfunction for years.
MFR is so gentle it allows the body/mind to reorganize itself and unwind its own tractions or twists. Some patients feel their body becoming lighter, twitch or feel their body move during treatment. This is a natural process and is our body's own inherent self-correcting mechanism which unravels the tension and restriction in a natural way.
Patients are encouraged to allow this to happen and to become more aware of what they are feeling during treatment to assist the process and ultimately take control of their health.

How to access the Fascial Network using the arms and legs as levers
If the fascial system is completely connected then we can work the whole system using the body as a lever.
Treating the body with an arm or leg pull is an effective tool for assessing the body's fascial pulls and restrictions. It is also a way to introduce MFR to a patient, particularly those who are in pain or who are anxious about treatment.
As the therapist it is important at all times to maintain a high level of softness and flow in your own body as resistance will diminish sensitivity in picking up the subtlety of the patient's fascial voice.
Completing arm and leg pull techniques may take anywhere from 5 to 10 minutes and sometimes longer depend on the fascial restrictions. Always treat within painless range of motion and treat each patient in a unique fascial way.

Arm pull technique

An arm pull can assist in the treatment of not only the arm, finger, wrist and shoulder but also the fascial restrictions and fascial pull throughout the entire body.
Hold the wrist /lower arm or elbow gently and slowly externally rotate the arm until you feel the smoothness of the movement change to a more sluggish movement. This is the first level of restriction. Hold at this barrier.
Next slowly abduct the arm until you feel the smooth movement change. Hold at this barrier.
Next, gently and slowly traction the arm until you meet restriction and also hold at this barrier. We are now treating the body 3D. Feel into the body and maintain your gentle 3D traction. We must always meet the resistance and never force the barrier. Gradually you will feel the arm soften and you will be able to take up a little more slack, in any or all of the 3D tractions.
This may take anywhere between 3-5 minutes. Follow the releases, slowly and gently into full circumduction, or within painless range of motion.
With the arm above the patient's head you can access into the chest area, back and pelvis and further on down into the legs. By placing the arm down next to the body you can release up into the neck, shoulder, face and TMJ.
As you traction the arm over the patient's head move into adduction and flexion with trunk rotation and grasp the medial border of the scapula and apply a lateral pull while continuing the arm traction. This position allows a release through the upper back, shoulder and neck area. Always return the arm back through its entire range slowly.
Leg pull technique
Patient lies supine with the therapist at the foot of the table. The leg pull uses the same concepts as the arm pull techniques
Gentle pick up the leg at the foot/ankle or lower leg and slowly externally rotate to the first barrier whilst dorsiflexing the foot. Gently abduct the leg to the barrier and hold. Next, gently give traction the leg to meet resistance.
Slowly and gently feel for the fascia! releases and follow them through abduction then adding in leg flexion while maintaining dorsiflexion, all of which must be within a painless range of motion. Return the leg back through its full range maintaining traction and dorsiflexion.
Next internally rotate the leg and gently adduct to the first fascial barrier. This position will pull into the hip and the patient will move into trunk rotation. This position will gently release the low back, sacroiliac joint areas and hip. Slowly return the leg back through its range to neutral whilst maintaining traction and dorsiflexion.
Contraindications
Contraindications such as malignancy, aneurysm and acute Rheumatoid arthritis may be considered absolute, while others such as Haematoma,. open wounds, healing fractures, etc. may be regional.
Malignancy
Open wounds
Cellulitis
Sutures
Febrile State
Haematoma
Systemic or localised infection
Healing fracture
Acute citculatory condition
Osteomyelitis
Degenerative Changes
Aneursym
Anticoagulant Therapy
Obstructive Oedema
Advanced Diabetes
Acute Rheumatoid arthritis
Skin hypersensitivity
Always perform a thorough patient history and always refer the patient back to their GP/Doctor if you are in any doubt as to contraindications for MFR treatment and also if their condition persists. Please refer to your own code of practice.

Myofascial Release Training In INDIA
Advanced Diploma In Myofascial Therapy© (ADMFT)

There is only one foundation which ic conducting course on MFR which is Myofscial Therapy and Research Foundation, India. with its main centre at Kottayam, Kerala (SCeB CAPT). Advanced Diploma In myofascial Thewrapy© (ADMFT) is available as 3 months course, with Certificate, Transcript and life time membership in MFTRF for those who are joining early. The ADMFT provides advanced fascial release techniques that can be easily and immediately integrated into your existing practice. ADMFT is presented by Dr. Ajimshaw. M.S, an Osteomyofascial Manipulator, Advanced MFR Practitioner and Neuro Physical Therapist at MFTRF, SCeB CAPT, Medical College, Kottayam, Kerala.

At SCeB CAPT you can learn “AJIMSHAWs approach” which is a unique method of Hands-On release invented by Dr. AJIMSHAW. M.S, by combining recent advances in Physical Therapy with Hands-On techniques. AJIMSHAWs approach is very different from traditional MFR or soft tissue mobilization. By adding these valuable fascial release techniques to your treatments you will change the way you view, feel and assess your patients and you will create structural change that is both measurable and functional.
For further information and to contact your local MFT therapist visit http//:scebcapt.blogspot.com, or e-mail at scebcapt@gmail.com or call 09495300913.

Advanced Diploma In Myofascial Therapy© (ADMFT)

There is only one foundation which ic conducting course on MFR which is Myofscial Therapy and Research Foundation, India. with its main centre at Kottayam, Kerala (SCeB CAPT). Advanced Diploma In myofascial Thewrapy© (ADMFT) is available as 3 months course, with Certificate, Transcript and life time membership in MFTRF for those who are joining early. The ADMFT provides advanced fascial release techniques that can be easily and immediately integrated into your existing practice. ADMFT is presented by Dr. Ajimshaw. M.S, an Osteomyofascial Manipulator, Advanced MFR Practitioner and Neuro Physical Therapist at MFTRF, SCeB CAPT, Medical College, Kottayam, Kerala.

At SCeB CAPT you can learn “AJIMSHAWs approach” which is a unique method of Hands-On release invented by Dr. AJIMSHAW. M.S, by combining recent advances in Physical Therapy with Hands-On techniques. AJIMSHAWs approach is very different from traditional MFR or soft tissue mobilization. By adding these valuable fascial release techniques to your treatments you will change the way you view, feel and assess your patients and you will create structural change that is both measurable and functional.
For further information and to contact your local MFT therapist visit http//:scebcapt.blogspot.com, or e-mail at scebcapt@gmail.com or call 09495300913.