2. A Method of total body evaluation and treatment Utilizes 1)
tender points and 2) a position of comfort Indirect technique-
applies force away from resistance Resolves associated dysfunction
3. Normalization of muscle hypertonicity Normalization of fascial
tension Increased circulation Reduced swelling Reduction of joint
hypomobility Decreased pain Increased strength 4. Dysfunction
within the body Traditionally looked at with a StructuralModel
Associated with 1) anatomic, 2) posturaldeformations, 3)
degenerative changes Treated in order to reshape the structure to
anideal 5. Structural Model Has been met with limited success-
Often unable to restore normal ideal structure FunctionalModel-
Biomechanical disturbances are caused by intrinsic properties of
the affected tissues 1) Result of trauma & inflammation 2) Seen
as direct expression of the tissue process at structural &
biochemical levels 6. Expressed as: 1) Reduced joint play 2) Loss
of tissue reilience, tone, or elasticity 3) Temperature &
trophic changes 4) Loss of overt ROM & postural asymmetry 7.
Sees the body as an expression of its function: Posture-
Manifestation of the degree of balancewithin the tissues Emphasis
on interaction of all body parts duringphysiologic &
non-physiologic motion 8. Belief that musculoskeletal pain is from:
1) Myofascial elements 2) Proprioceptive & neuromuscular
responses 3)Trauma to fascial matrix 9. Muscle Response to injury
is protective muscle spasm Regulated by local proprioceptors &
monosynaptic reflexes FascialSystem- vast network that 1) contains,
2) supports, and 3) connects tissues throughout the body Stress on
this system from injury can result in fascial tension 10. Small,
palpable nodule, usually located in the subcutaneous, muscular, or
fascial tissues 1) Hyperirritable area 2) Found in mechanically
stressed tissues Fascialsystem- is a continuous network that
surrounds & penetrates all structures of the body Tender point
is viewed as a point of constriction within this network 11.
Characteristics: Tense, tender, edematous area Tension felt in
surrounding areas Up to 4x as tender as normal tissue Thought of as
an outward sign of an underlying lesion, not as the pathology or
dysfunction 12. Force that produces injury results in: 1)
Protective muscle spasm due to an increasedneural impulse 2)
Increased resting tone of the muscle 3) Imbalance between
agonist/antagonist 4) Creates a self-perpetuating cycle
ofproprioceptive dysfunction 13. Chemicalmediators present during
injury Kinins, histamines, etc. Produce muscle guarding reactions
& somatic dysfn.Segment overload of a segment Facilitated of
the spinal cord with excessive afferent impulse Impulses from
proprioceptors & nociceptorsoutnumber available pathways, may
spill over to otherpathways Misinterpreted by the CNS 14.
Indications: Any patient with distinct physical mechanism of injury
Insidious onset with a mechanical stress association(repetitive
stress) Contraindications: Open wounds Sutures Healing fractures
Hematomoa Skin hypersensitivity Systemic/ localized infection 15.
Palpationto find tender points 1) May be in area of overt pain 2)
May be in related areas Ex: Scapular stabilizers tender with
anterior shoulderpain Ex: Iliopsoas tender with low back pain
Thorough evaluation of tender points should be part of the eval.
Process 1st see how much pressure you can apply Practice &
clinical experience! 16. Scanning Evaluation (SE)- reveals most
clinically significant points Global vs. Local Tx: Global-
interrelated lesions 1-3 points/treatment 2-3x/wk Need the most
dominant TP as its the source ofdysfunction Local- 6-8points,
2-3x/wk 17. Document severity of tender points Severe- causes a
jump sign Very Tender- no jump sign Moderate- subjective to patient
No Tenderness Prioritize Severity- most to least severe Position-
proximal to distal, medial to lateral, byseverity In a row, the
point in the middle is first for treatment 18. Locate tender point
Maintain palpation & passively move patient into position of
comfort (POC) Point of the POC is to dec. irritability of the
tender point & to normalize the tissues associated w/ the
dysfn. Monitor patient response to tender point Reach position of
1) no tenderness2) Monitor with feedback 19. Movinginto the POC
Feel a relaxing of the tissues/softening of themuscle tone Patient
should note elimination of tenderness Should NOT be painful,
especially in other areas Correct POC within 5-10 degrees Once POC
is reached, fine tune it with small movements for within 2-3 deg.
20. Maintain POC for 90s
