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Science and Theory

Compressional Band Therapy

*your name here !2

OutlineThe Science

Treatment Considerations

All in One Application

Tissue Glide/Mobility

Functional Movement Enhancement

External Cueing - Movement

Case Study!3

Multi Modal Approach

TouchTeach Move

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The Intervention

Compressional Floss Bands!5

What is it?Compressional Band Therapy (aka Tack and Floss, Voodoo Floss, Blood Flow Restriction, etc) is a manual technique that has been shown to improve range of motion, fluid dynamics, pain mitigation, and improved recovery rates

CompressionShear

Fluid PumpNeurosensory Stimulation

Placebo?

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Properly performed procedures contribute to:

1. Improved range of motion2. Pain reduction3. Reduced fluid congestion4. Joint Centration - Improved Joint Relationships

Benefits of Flossing

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Why?Although patients have seen notable improvements after treatment using protocols and standards from various blogs and company websites, no medical journals or practices have any set protocols on tension of the band, wrapping techniques, or movement programs to dictate the proper use of floss bands.

The lack of protocols can lead to inaccurate results and varied effects. The scarcity of evidence on floss bands warrants further investigation

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Non Negotiable

COMFORTSAFETY

PRACTICAL

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Tissue Preparation ConsiderationsFloss is made out of latex rubber

How to decrease skin reactions:

1. Ask and Inform 2. Over clothing

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CleaningGenerally speaking, if flossing is performed on intact skin only, floss can be treated as noncritical reusable medical devices that need to be cleaned and then disinfected with an appropriate low-level disinfectant.

Alcohol Cavicide !11

Mechanical Theory

ShearingCompression Move

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Mechanical - Compression/Shear

Separating Layers Shear

Compression

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Its all Connected

Stecco, Guimberteau, Schleip, - Fascial Research Society !14

Fluid Effect - External Pump

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Squeeze Film Fluid Theory

The Journal of the American Osteopathic Association, August 2013, Vol. 113, 600-610Max Roman, PhD; Hans Chaudhry, PhD; Bruce Bukiet, PhD; Antonio Stecco, MD; Thomas W. Findley, MD, PhD

!16This is a footer, so use it when you need it.

Tangential Oscillation

The Journal of the American Osteopathic Association, August 2013, Vol. 113, 600-610Max Roman, PhD; Hans Chaudhry, PhD; Bruce Bukiet, PhD; Antonio Stecco, MD; Thomas W. Findley, MD, PhD

Lateral Stretch

H20

Edge of Floss Band

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New Organ - The Interstitium

Petros C. Benias, Rebecca G. Wells, Bridget Sackey-Aboagye, Heather Klavan, Jason Reidy, Darren Buonocore, Markus Miranda, Susan Kornacki, Michael Wayne, David L. Carr-Locke & Neil D. Theise. Structure and Distribution of an Unrecognized Interstitium in Human Tissues. Scientific Reports, Volume 8, Article number: 4947 (2018) !18

Neuro-Chemical Response

Neural Response Enzyme Response

+

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Precision Training

Improve Sensory Map Change Body Awareness

Decrease Pain Improve Motor Control

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Sensory-Motor Effects

Ruffini Endings (Corpuscles) - respond to sustained deep pressure and lateral (tangential) shear !21

Haptic Learning - Nerve Growth Factor

Studies have shown that just the feeling of touch promotes the release of NGF in the brain. The release of NGF in a learning environment will facilitate nerve net growth in response to the learned task in both the central and peripheral nervous system, resulting in improved proprioceptive feedback and motor patterning.

Tortora, Gerard J. and Nicholas P. Anagnostakos. Principles Of Anatomy And Physiology. Sixth Edition. NY Harper, 1990. pp 336-337.

!22This is a footer, so use it when you need it.

Heme Oxygenase-1 (H0-1)

A variety of stimuli induce heme oxygenase-1 expression, a wide array of hepatotoxic chemicals and conditions conferring an adaptive cytoprotective response. HO-1: Heme oxygenase-1

• Cupping • IASTM • Floss • Tape

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Skin Strain CascadeSkin Strain

Hemoproteins

Heme

Enhanced Tissue Injury

Wound Contraction and Fibrosis

Excessive Scar Formation

Oxidative Stress &

Inflammation

H0-1/H0-2

CO Biliverdin Bilirubin

Fe/Ferritin

H0 - Heme Oxygenase !24

1. Fluid/Pain Management (50/50)

2. Movement Assist

3. Tissue Glide

4. Movement Cueing

5. Case Study (time dependent)

Floss Apps

Treatment Considerations

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• Over areas of broken skin (open wounds) or rashes, severe edema

• Areas where there are large blood vessels, • High fever with convulsions. • Bleeding disorders• Pregnant women should never have flossing on the

abdominal/sacrum• Varicose Veins• Dermatitis • Severe health issues (CHF, Renal Failure)• Areas near large veins such as groin region• Infections• Systemic inflammatory conditions (RA)

Contraindications

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Step 1: Tack down Tissue Step 2: External Glide Step 3: Open Chain Movement Step 4: Closed Chain Movement (if able)

• Make it Meaningful

3 Step Process - All Apps

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Safety Considerations• Total Dosage = 2 mins

• Remove if:

• Feeling of claustrophobia

• Feeling of numbness or pins-and-needles

• Pain perception greater than 7/10 in intensity

Depth Gauge

Pain Pain Relief7/10 - Max Depth Recommended

Avoid: Numbness, Pins/Needles, Excessive Blood Flow Restriction

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1-3: Very light

4-6: Moderate

7-8: Firm

9-10: Deep

Pressure Gauge ScalePatient/Client Perception

Pressure Gauge

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All in One Application

1

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Application Instructions

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Goals of Application

Pain Mitigation

Range of Motion

Swelling Management

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Graded Exposure

1

2

3

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Treatment Methods

External Glide• Treatment Vectors (Optimal)

• Position Progressions (Relaxed, Lengthened, Loaded)

• Graded Mobilizations (Maitland, Mulligan, etc)

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Mobilization GradesGrade I - Small amplitude rhythmic oscillating mobilization in early range of movement

Grade II - Large amplitude rhythmic oscillating mobilization in midrange of movement

Grade III - Large amplitude rhythmic oscillating mobilization to point of limitation in range of movement

Grade IV - Small amplitude rhythmic oscillating mobilization at endrange of movement

Grade V (Thrust Manipulation) - Small amplitude, quick thrust at end-range of movement

Ref: Maitland

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Therapist-Assisted Manipulation

Augmented External Glide !38

Treatment MethodsInternal Glide

• Open Chain

• Closed Chain

• Functional Patterns (Tri-Planar)

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Make It Meaningful

Nothing happens until something moves

Albert Einstein

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Floss + Movement (Open Chain)

Dosage = 1 min!41

Floss + Movement (Closed Chain)

Dosage = 1 min !42

Treatment Considerations

1. Comfortable - Depth Gauge2. External Glide - Mobilization Vectors/Grades3. Internal Glide - Meaningful Patterns (pain free) 4. Patient Position - Progressions/Regressions5. Dosage: 1.5 - 3 mins (Zein-Hammoud, Standley)

6. Education/Encourage - Psycho/Social

Manal Zein-Hammoud, PhD , Paul R. Standley, PhD. Modeled Osteopathic Manipulative Treatments: A Review of Their in Vitro Effects on Fibroblast Tissue Preparations J Am Osteopath Assoc. 2015;115(8):490-502

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All in One 1.Screen 2.IDENTIFY areas of focus = TARGET AREA3.Wrap over the area for 90 - 180 seconds = FLOSS

• 50/50 All In - 50% Overlap + 50% Tension• Distal to Proximal Bias

4.ADDRESS regions up/down stream to target tissue (30 seconds each) = RIPPLE

5.Total DOSAGE per Region = 90secs-5mins Seconds

SCREEN + IDENTIFY + FLOSS + RIPPLE!44

Movement Assist Application

2

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Application # 2: Movement Assist

Dorsi-Flexion

Toe-Off

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Goals of Application

Mechanical Advantage Spring Effect

Influence Human Movement

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Functional Flossing1.Screen 2.IDENTIFY areas of focus = TARGET AREA3.Wrap over the area for 90-180 seconds = FLOSS

• 20-70% All In • Distal to Proximal Bias• Directional Preference

4.ADDRESS regions up/down stream to target tissue (30 seconds each) = RIPPLE

5.Total DOSAGE per Region = 90secs-5mins Seconds

SCREEN + IDENTIFY + FLOSS + RIPPLE!48

Move Assist - Calf

Up to 70%

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Functional Technique - Calf

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Move Assist - Spring Effect

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Move Assist - Tib Ant

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Move Assist - Finish

Assist in Foot Drop

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Tissue Glide Application

3

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Application # 3: Tissue Glide

May

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Goals of Application

Interlayer Gliding Mobility

ROM

Directional PreferenceTissue Glide Vectors

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Glide Technique - Tissue Shear

Drag Tissue in Preferential Direction

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Tissue Glide - External/Internal

SCREEN + IDENTIFY + FLOSS + RIPPLE

1. Screen 2. IDENTIFY areas of focus = TARGET AREA3. Wrap over the area for 90-180 seconds = FLOSS

• 20-70% All In • Distal to Proximal Bias• Directional Preference

4. ADDRESS regions up/down stream to target tissue (30 seconds each) = RIPPLE

5. Total DOSAGE per Region = 90secs-5mins Seconds

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Movement Cue Application

4

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Application # 5: Movement Cue

Dynamic R.N.T. Tool

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External Cueing - Corrective Strategy

1.Screen 2.IDENTIFY areas of focus = TARGET AREA3.Wrap over the area for 90-180 seconds = FLOSS

• 20-50% Along Fascial Sling• Distal to Proximal Bias• Directional Preference

4.Move - Tri-planar Movement Patterns 5.Total DOSAGE per Region = 90secs-5mins

Seconds

SCREEN + IDENTIFY + FLOSS + MOVE!62

Goals of Application

Coaching Cue Movement Re-Education Tool

Dynamic RNT !63

Helical Patterns - Upper Extremity

Stecco - Arm Helical Fascia Chain

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Helical Pattern - Lower Extremity

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Helical Pattern App

Fascial Tracing !66

Helical Patterns - Finished App

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Helical Pattern - Dynamic Control

Assisted RNT!68

Trunk

1

2

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Diaphragm Case Study

www.rehabps.com.

Open Scissors

centrated Rib/Pelvis Complex

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Bring Attention to Smudged Area

• Sensori-Motor Retraining

• Connection of the brain with trunk is poor

• Sensory Integration via peripheral activation and touch

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Soft Tissue/Joint/Brain

Soft Tissue Restrictions

Joint Restrictions

RockFloss Techniques RockFloss Manual Techniques

Sensory Cue