Fascial manipulation (practical)

8/10/2019 Fascial manipulation (practical)

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Fascial manipulationOversea Training Sharing

Part II

Wong Ka Ho, Curtis

Physiotherapist II

Course structure

Fascial manipulation

Level 1

Subacute MSKpain

Chornic MSKpain

Deep fascia

Level 2

Acute MSKpain

Deep fascia

Level 3

VisceraldysfunctionSuperficialfascia

Brief recap on theory (Part 1)

Hyaluronic acid (HA)

Overuse syndrome (Piehl-Aulin 1991)

Hyaluronic acid = Non-newton fluid

Lubricant vs. friction

Superficial fascia

Deep fascia

Muscle

Overuse syndrome (Piehl-Aulin 1991)

Hyaluronic acid = Non-newton fluid

Lubricant vs. friction

Superficial fascia

Deep fascia

Muscle


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Centre of coordination

Centre of perception MF

Analogue of CC and CP

CC

CP MUSCLE

Examples of CC and CP

CC: an-ge

MUSCLE

MUSCLE

CC

CP

Interaction of Agonist and Antagonist

Alteration in the fascia of agonist of mf unit caneffect the antagonist mf unit

Every segments stabilized by

agonist and antagonist

Hypertonicity ofagonist

Hypertonicity ofantagonist

Segments and directions

14 segments with 6 direction

Total: 84 myofascial unit

84 Centre ofcoordination

>84Movement Verification

>84Centre ofperception

Body Segments


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Direction Direction (Rt Lower Limb)

Myofascial sequence (Rt Lower Limb)

Sagittal plane Frontal plane Hor izontal p lane

Clinical practice (Part 2)

Assessment


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Centre of perception

Site of pain: anteriorknee

CC: AN-GE

Plane: Sagittal

Movement Verification

Plane: Sagittal

Segment: GE

Direction: AN

Test: Lunging

Principle of Selection of CC

Agonist

Antagonist

At least 1 level up and down

Distal along the sequence

No. of CC: 6

Palpation/ Treatment Technique

Knuckle ElbowTHUMB?


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Antemotion sequence

AN-LU ()

CP:Abdominal or back

pain

MoVe:

Trunk Extension(any deviation)Full crunch

Antemotion sequence

AN-PV ()

CP:Heaviness in iliac

fossaAnterior thigh orsacrum region

MoVe:Anterior pelvic tilt

Antemotion sequence

AN-CX ()

CP:

Anterior thigh pain,

agg. by liftingleg/going up a step

MoVe:

Leg kicking

Antemotion sequence

AN-GE ()

CP:

Anterior knee pain,

agg. by descendingstairs

MoVe:

Single half squatLunging

Antemotion sequence

AN-TA ()

CP:Anterior ankle pain

Achilles tendonitisChronic ankle sprain

MoVe:Walk on heel(tension and range)

Retromotion sequence

RE-LU ()

CP:Lumbosacral region

MoVe:Trunk extension

Trunk flexion


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RE-PV ()

CP:Sacral iliac region

MoVe:

Push pelvis forward


RE-CX ()

CP:Gluteal or hamstring

Cramp feeling

MoVe:

Backward kickingSit to stand


RE-GE ()

CP:

Popliteal fossa

MoVe:Check strength ofhamstring

Fast knee flexion


RE-TA ()

CP:

Heel, Plantar fascia,

Achilles tendinitis

MoVe:Walk on tiptoe

Repeat PF x 10 timesJump up and return

Discussion in clinical practice

Finish 1 CC?

Patient:

Therapist:


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Time to complete 1 CC (Borgini, 2009)

Temporal modification of pain (Mean: 3.24 mins)

0

2

4

6

8

10

1 min 2 min 3 min 4 min

VAS

Pain

Time to complete 1 CC? (Borgini, 2009)

Process

Pressure on CC? (Stem, 2006)

Effect of manipulation

Post treatment

Remind the patient about the post treatmenteffect

Medication (anti-inflammatory vs. analgesic)

Self stretching after treatment !!

Inflammatory reaction begins

Peak of the inflammatory reaction

Occasionally fever

Inflammatory reaction ends

Results of the treatment become apparent

+/- Subsequent treatment

Subsequent appointment

Sub-acute/ Chronic case: 1-2 week

Acute case: 3-5 days

Should we recheck the CC that was treated inlast session?

Scenario:


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OppositeCC

Work insameplane

Changeplane

FU in 1month

Contraindication

Absolute Relative

Fever Lymphedema (> Stage III)

Severe immunodepression Non-cooperative patient

Dermal lesion in the region ofRx

Cancer patient (not fordistant tumor)

Thrombophlebitis Recent trauma w/o analysis

Thrombosis Severe bleeding disorder

Corticosteroid therapy

Self clinical experience

Patient no: 12

Immediate Improvement: 50-80%

Last for up to 1 month

Condition encountered:

Sciatica, LBP, neck pain, shoulder pain,TMJ pain, Knee pain, buttock pain, ITBsyndrome, mid-thoracic pain

Self clinical experience

Any cases were not responsive to the

treatment?

Any cases got worse after treatment?

Time saving vs. Time consuming

Conclusion

Safe

Effective outcome with long lasting effect

No protocol

Treat sequence/plane rather than segment

Questions

Documents

Fascial manipulation (practical)