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Myofascial Techniques

Drags:  3-5 drags / strokes, for 2-3minutes

Releases / Traction:  5 minutes

Pulls:  15 minutes

Treatment plan considerations:

  • 38-40 minutes total

  • Remember releases can be done alone

  • A release must follow drags

  • You don’t want to start the massage with a release

 

  • Seated upper trap drag (*usually follow up with *)

  • Lateral stroke = 2-3 minutes

  • Anterior to posterior stroke = 2-3 minutes

  • 4-6 minutes per side = 8-12 minutes total

  • Pectoralis drag = 2-3 minutes per side = 4-6 minutes total

  • Occipital / suboccipital drag

  • Suboccipital stroke (lower half of ear) = 2-3 minutes

  • Occipital stroke (upper half of ear) = 2-3 minutes

  • 4-6 minutes per side = 8-12 minutes total

  • Occipital release = 5 minutes

  • Cervical traction = 5 minutes

  • Anterior cervical drag = 2-3 minutes per side = 4-6 minutes total

  • Cervical traction w / anterior cervical release = 5 minutes

  • Pectoral release (many variations-pin and stretch, cross hand, etc.) = 5 minutes

  • Arm pull (traction, release) = 9-15 minutes

  • Leg pull (traction, release) = 9-15 minutes

  • Quadriceps drag = 2-3 minutes per side (4-6 minutes total)

  • Erector Spinae Drag =2-3 minutes total

  • Scalene release = 5 minutes per side = 10 minutes total

 

 

  • Erector spinae drag 2 minutes per side = 4 minutes total

  • Torso spiraling =  5 minutes

  • Quadriceps spreading 2 minutes per side = 4 minutes total

  • Quad spiraling 5 minutes per side = 10 minutes

  • Quadriceps drag 3 minutes per side = 6 minutes total

  • Lumbosacral decompression = 5 minutes total

  • Psoas x-hand release or pin and stretch = 5 minutes

  • Leg pull (traction, release) = 15 minutes

Upper crossed syndrome

Postural muscles

  • Pectoralis major

  • Pectoralis minor(anterior)

  • Upper trapezius

  • Levator scapulae

  • Sub occipitals

 

Phasic muscles

  • lower trapezius

  • middle trapezius

  • serratus anterior

  • anterior throat muscles

  • teres major and minor

 

Postural signs UX syndrome

  1. the occiput and top three cervical vertebrae will hyperextend, with the head translated forward, often in a chin-poking posture.

  2. The lower cervical to the 4th thoracic vertebrae will be posturally stressed, often painful, and can lead to arthritic or disc problems(Collagen fibers buildup)

  3. Elevation, protraction, and internal (medial) rotation occur at the shoulder girdle, generating neck , upper back, and shoulder imbalance and strain.

​

 

Lower crossed syndrome

  • A predictable pattern of dysfunction in which form one arm of the cross and those that are typical weak from the other.

Postural muscles – tightened and shortened (hypertonic)

  • Lumbar erector spinae

  • Quadratus lumborum

  • Rectus femoris

  • Tensor fascia latae

Phasic muscles – weakened (hypotonic)

  • Rectus abdominis

  • Internal and external obliques

  • Gluteus maximus

Postural signs LXS

  • Increased lumbar lordosis (hyperlordosis)

  • ASIS to PSIS greater than ½ inch

  • Hyper-extended knees

  • Compensatory hyperkyphosis and forward head posture may be present

Postural analysis

 Anterior view

  • Levelness of shoulders

  • Clavicles should be even, with a slight incline from the s/c joint to the a/c joint

  • Clavicles should be visible (lateral edge)

  • Ears are level

  • Nose

  • Cubital space (crease of elbow)

  • Straight line between xiphoid and symphysis pubis

  • Shape/collapse of chest

  • Feet - rotation, arches (neutral, supinated, pronated)

  • Knees - level, medial /lateral rotation, Genu valgus (inward knees / knock knees) or Genu varus (outward knees / bow legged

  • ASIS - level

  • Check for arm length

  • Check for symmetry and levelness of the elbows

  • Check for rotation of hands (knuckles showing

  • Check for flexed Wrists

  • Check for flexed fingers

Lateral view

  • Auditory meatus over head of humerus

  • Flared appearance of scapula (inferior angle and or medial border)

  • Rounded shoulders

  • Lateral condyle of humerus

  • Greater tubercle of humerus

  • Shape of thoracic curve (kyphosis)

  • Lateral malleolus

  • Lateral condyle of knee

  • ASIS / PSIS (within 2 inches)

  • Check for medially rotated shoulder

  • Check for middle finger in line with seam of pants

  • Check for flexed elbow

Posterior view

  • Equidistant between scapulae

  • Levelness of the scapula

  • Flared appearance of scapula

  • Is the inferior angle of the scapula lifted or winging?

  • Is the anterior shoulder forward and pulled down? (pectoralis minor)

  • Is the medial border of the scapula lifted or winging?

  • Is the medial border protruding off the rib cage?(hypotonic rhomboids, middle trap, and serratus anterior hypertonic pectoralis major and upper trap)

  • Flatness in spine

  • Thickness of upper middle trapezius

  • Shape of thoracic curve (s-curve, c-curve).

  • Achilles tendon (straight or bowed)

  • Popliteal space

  • Ischial tuberosity

  • Greater trochanter

  • PSIS

Scoliosis (posterior view)

  • Look for lateral deviation of the spine

  • Scoliosis is either structural or functional

  • To test:

  • Have the patient put their hands together in front of their body, palm to palm, fingertip to fingertip, ask them to bend forward slowly, observe their spine during this movement

  • Structural scoliosis:

  • The spine does not straighten during forward bending

  • A rib hump is usually observed

  • Observe the hands, the fingertip and palm of one hand will slide downward

  • Functional scoliosis:

  • Normally the spine straightens during the forward bending test

Assessment protocol                 

  1. Client intake / health history

  2. Postural analysis / body reading

  3. Postural muscle assessment (PMA) / ROM (AROM and PROM)

  4. Special tests

  5. Tissue excursion / palpation

(reminder-way to remember PCPST)

 

Treatment protocol

  1. Myofascial drags and release – MFR

  • Releases - X-hands, pin and stretch, traction, pulls (arm/leg)

  2. Clinical progression – NMT

  • Initial contact

  • General warming

  • Decongestion (specific warming)

  • Specific treatment – TrP, TP, PR

  • Muscle lengthening – MET

  • Completion / transitioning

Reciprocal inhibition techniques:

    Biceps – Triceps
    Deltoids – Latissimus Dorsi
    Pectoralis Major – Trapezius/Rhomboids
    Iliopsoas – Gluteus Maximus
    Quadriceps – Hamstrings
    Hip Adductor – Gluteus Medius
    Tibialis Anterior – Gastrocnemius
    Anterior Deltiod – Levator Scapula
    Forearm Flexors – Forearm Extensors

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