MYOFASCIA RELEASE
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Myofascial
Release (MFR) uses specific hands on techniques which allow the collagen fibres
to re-align in a pattern which allows maximum strength and function. Fascia is a
thin tissue which covers all the organs of the body. As a result of trauma
the muscle fibres and fascia shortens and becomes tight. This trauma often
results in the fascia within other parts of the body becoming uneven twisting it
out of shape and restricting function. Myofascia Release as the name suggests,
releases the tightness of the fascia.
Dawn is a certified Myofascia release therapist trained by Ruth Mitchell-Golladay PT, EBW, CMT .Ruth began working with horses in 1990 and now specializes in the equine population. She is the owner of the Equine Therapeutic Center, Inc (now based at Smith Mountain Lake, Virginia), where she provides therapy for horse and rider. She uses her biomechanical knowledge to assist in determining a problem with the horse and then primarily use Myofascial Release techniques to decrease the symptoms and/or dysfunction.
Myofascia
Release for rehabilitation of the tendons and ligaments
Introduction
During
my externship and the case studies I have been the most interested in the
effects the Myofascia release (MFR) has had on the cural fascia and the tendons
of the limbs. In my essay I wish to explore the cause of tendon injuries in
sports horses and what happens at a cellular level, how (MFR) works at a
cellular level and where and at what stage MFR is best used as a tool in the
therapist’s box.
Background
and effect on ligament injuries sports horses
The
equine limb can absorb force and aid in movement at high speed. Tendon and
ligament strains and sprains are common injuries in the lower limbs of the
performance horse. The tendons and ligaments that run from the knee down to the
foot - the superficial digital flexor tendon, the deep digital flexor tendon,
the accessory ligaments and the suspensory ligament can range in injuries from
minor inflammation with no lameness, to complete rupture of the tendon strap.
Injuries usually result from excessive loading and overstretching, but also may
be due to a direct blow to the tendon area. Tendon and ligament injury can be
dependent on the type of activity carried out by the horse racehorses, show
jumpers, eventers and polo horses most commonly injure the superficial digital
flexor tendon (SDF) in the front limbs, while in trotters and driving horses the
suspensory ligaments of the hind limbs are most commonly affected. The
suspensory ligaments of dressage horses are prone to strain during extended
trot, particularly when working in deep sand arenas. Forelimb suspensory
ligament injuries are also common in polo horses that have to brake quickly from
high speeds and perform quick forehand turns. Any factor that increases the
stress imposed on a tendon or ligament can result in overstretching and strain.
Factors such as prolonged training, increasing age and overheating by bandages
may also weaken tendons, making them more susceptible to strain. This weakening
appears to affect the centre of the tendon rather than the edges, and this
central region is the area most likely to be affected by tendonitis.
Conformational weaknesses that transfer weight to the rear of the limb, such as
“back at the knee”, “cut in behind the knee”, long, sloping pasterns and
“under at the heels” increase the mechanical loading on tendons during
exercise. Horses that are heavy in the shoulders and neck or carry heavy riders
also load extra weight onto their tendons during fast exercise or turns.
Inadequate conditioning at slow speed in early training can predispose a horse
to tendon strain. Tendons stretch more without suffering strain when warmed up,
as their elastic limit is doubled when warm. Accumulative leg stress from long
term training, and in tired horses at the end of fast competition, particularly
on heavy surfaces, increases the risk of tendon strain.
Tendon
structure
Tendons
and ligaments are dense bands of fibrous tissue composed mainly of collagen.
Tendons connect muscle to bone, while ligaments connect bone to bone. The flexor
tendons run down the back of the leg from the knee to the foot and their role is
to flex the fetlock and the digit joints. The suspensory ligament lies at the
back of the cannon bone, deeper than the flexor tendons, and stretches from the
back of the knee to the sesamoid bones in the fetlock. The suspensory ligament
provides support for the fetlock, preventing extreme over-extension. The main
action of tendons is to transmit muscle power to the lower leg, and healthy
tendons are able to bear extreme stretching forces. Tendons also have elastic
properties, allowing them to store “energy” and absorb minor overloads
during exercise. However, any sudden overload exceeding the limits of their
ability to stretch can result in tearing of the tendon structure.
The “safe” working elastic stretch in a warmed up tendon is about 3%.
However, if strain is excessive the tendon fibres behave in a “plastic”
manner, and can be safely stretched up to 8% of their length until their
“elastic” limit is reached. If loading increases, the maximum “strain”
limit is exceeded and the tendon fibres and blood vessels will begin to rupture,
beginning within the central core of the tendon. The end result is the
inflammation, pain and swelling.
The
Tendon Ultrastructure.
The tendons and ligaments are made up of many different
structures that are all intrical to the development and strength of the tendon
tissue. Each is important firstly in the integral strength of the tendon and
also important for normal repair of the tendon tissue. To make a tendon fibre: Procollagen
molecules are formed by
the tenocytes extruded into the extracellular space. Peptidase enzymes act to
cross link the collagen chains to form tropocollagen, which is the basic subunit
of collagen structure. These tropocollagen units become aligned in staggered
rows to form microfibrils. Which are then further grouped to form sub-fibrils,
then fibrils and ultimately fibres.
These
fibres are then grouped into fascicles. Each fascicle is capable of independent
movement in healthy undamaged surrounding tissues. When the collagen units are
formed there is a natural wave structure produced which aids in the natural
elasticity of tendon tissue. Collagen
confers the strength to the tendon. When injury occurs and repair
happens there is the development of scar tissue forming adhesions between each
individual fascicle causing often a loss of this independent motion which
reduces the abilities of the tendon to withstand stresses and strains.
The
fascial system
The
fascia is the connective
tissue of the body of
the body that has an appearance similar to a spider’s web or a sweater.
Fascia is very densely woven, covering and interpenetrating every muscle,
bone, nerve, artery and vein as well as all of our internal organs including the
heart, lungs, brain and spinal cord. It is the environment in which every cell lives
.The functions of the fascia include surrounding,
supporting, separating and protecting the cells, as well as allowing
communication between cells, which allows for proper cell metabolism. The fascia
consists of three layers superficial which is just under the skin, the deep
which surrounds muscles blood vessels and organs and the deepest the dura which
surrounds the brain and spinal cord. The
most interesting aspect of the fascial system is that it is not just a system of
separate coverings. It is actually one structure that exists from head to foot
without interruption. In this way you can begin to see that each part of the
entire body is connected to every other part of the body by the fascia, like the
yarn in a sweater. It plays an important role in the support of the body, since
it surrounds and attaches to all structures. This
living matrix provides the body’s shape and determines the form of each cell,
tissue and organ. These structures would
not be able to provide the stability without the constant pull of the fascial
system to keep an adequate amount of tension to allow the body to remain upright
with proper equilibrium.
In
the normal healthy state, the fascia is relaxed and wavy in configuration.
It has the ability to stretch and move without restriction.
When the body experiences physical trauma or inflammation, however, the
fascia loses its pliability. It becomes tight, restricted and becomes a source
of tension to the rest of the body. Trauma, such as a tendon injury causes
changes in the fascial system and therefore influences the whole body of the
horse. The fascia can exert excessive pressure producing pain and or restriction
of motion. It effects flexibility and is a determining factor in the horse’s
body’s ability to withstand future stresses and strains. Tendon and ligament
injuries are common in the competitive equine world, because of the limitations
that fascial restrictions place on the contractile elements of muscle, muscle
strength is inhibited by approximately one third of its normal strength in the
presence of fascial restrictions. So fascial restrictions not only affect
flexibility, but also limit a horse's inherent strength and stability. Muscles
will fatigue more quickly because they will have to overcome the enormous
tensile strength of a fascial restriction. Muscle and tendon strain is then
likely to occur where there is fascial restriction.
Myofascia
on a cellular level.
The
fascia is made up of three components the elastic portion provides flexibility
and resilience, the collagenous portion which consists of microtubules filled
with crystalline saline solution and provides shape support, strength and
stability and the extra cellular matrix or ground substance which can vary from
soild states to viscous gel like fluid that determines the functional
capeabilities of every cell in the body. The fascia has three distinct
properties. It is biological plastic a colloid . It is viscoelastic meaning it
has he ability to change its shape in resonse to activity and to change its
ability to go through different phases of existence from liquid
to plastic to dense it is also piezoelectric it has the ability to conduct electrical energy.
Every event in the body either positive or negative will produce vibrations
throughout the body through its three dimensional web. If the three dimensional
nature of facia tissue is disturbed restrictions will compromise the nerves and
blood vessels resulting in impaired nutrition, metabolism and oxygen exchange at
a cellular level and decreased function at the system level.
Restricted fascia becomes like taught bands embedded in a solidified, dehydrated gel matrix. Restricted fascia loses its ability to glide and therefore affects the ability of tendons to glide smoothly at their junctions. So, tendon injuries can result from the inherent weakness and limited tendon glide caused by fascial restrictions. Whenever there is inherent weakness in a limb, the ligamentous structures are also commonly affected. Muscles stabilize a joint; when strength and muscle endurance are limited because of fascial restriction, there is less stability in the joints of the affected limb. When less stability is present, the ligaments become overstretched or lax. This situation easily leads to ligament sprain or rupture, particularly as the fascial system tightens over time or is left untreated.
Injuries result in inflammation, inflammation
is directly linked to dehydration when dehydration occurs the cells in the body
cannot communicate. The cells go in to shock and the Central Nervous System
(CNS) kicks in which sends out fibroblasts to the damage site to build scar
tissue and build up the extra cellular matrix products protoglucons that have be
lost through the ruptured cell walls these are the carriers of the electrical
conductor water within the cell and act as sponges holding that water. When the
cell is rehydrated communication can occur again and the (CNS) can calm its
emergency treatment to the area. The fibroblasts building the scar tissue
however take time to slow down the action of fibrosis continuing to build
adhesions which cause decreased elasticity and decreased mobility and function
to the tissue affected.
Treatment
Of Tendon & Ligament Strains/Sprains
In
treating a recently injured tendon the aim is to control inflammation. The
tendon may be increased in diameter and feel warm and sensitive to the touch.
Prompt application of cold therapy and pressure bandaging is essential to
control inflammation. Application of ice or ice packs to the limb will constrict
ruptured blood vessels and slow hemorrhage and bruising within the area. Injured
tendons are bandaged in between ice treatments to provide counter-pressure
against tissue swelling due to hemorrhage and edema. Constant firm, uniform
pressure will reduce the quantity of tissue fluid and blood clots that can
accumulate, improving the long term prognosis for maximum tendon repair.
Pressure bandaging should be continued to counteract lower limb swelling and
accumulation of tissue fluids around the inflamed area. Bandages should be firm
but not too tight. The horse should have complete rest in a stable or small yard
for at least 48 hours after injury to eliminate the risk of worsening the
injury. Complete rest should be continued until the inflammatory process is
under control. Anti-inflammatories help to keep the inflammation process under
control, which helps to minimise damage to surrounding uninjured areas of the
tendon. nonsteroidal anti-inflammatory drugs
are
usually prescribed and should be continued based on vet’s
advice, to minimise any ongoing inflammatory damage. Warming liniments or rubs
are not applied at this stage, as these tend to increase blood flow to the area,
which may encourage hemorrhage and further swelling. However topical products,
which contain anti-inflammatory properties and help prevent fluid accumulation
produced by the inflammatory process can be applied. The aim of treatment in
this phase is to minimise the spread of inflammation to undamaged areas of the
tendon, to reverse the effects of acute inflammation to try to minimise
permanent damage to the tendon, and to assist the repair process.Soon
coagulation should have occurred in the damaged blood vessels and the risk of
internal tendon bleeding will have decreased. Inflammatory substances will still
cause tissue fluid to accumulate and the aim of treatment at this time is to
control and remove these inflammatory substances and the fluid that they
accumulate. The application of alternating hot and cold therapy will help to
dilate and then constrict the vessels in the area, pumping the inflammatory
fluid into the circulation and away from the injury. Following the alternating
temperatures warm therapies alone should be used to improve the circulation and
to speed repair. Stall rest should be continued until tissue fluid accumulation
and swelling is halted. Once this inflammatory process is under control,
controlled gentle exercise can be started. Mild, non-injuring exercise helps to
stimulate tissue fluid movement and improves circulation throughout the tendon.
The horse should be hand-walked. Horses should be housed in stables or small
yards and not turned out into larger paddocks, as the risk of further injury is
high if the horse over-exerts the tendon. Although lameness may disappear in a
few weeks the tendon fibres will take at least 6 months to heal .In all cases
tendon “overloading” must be avoided until the tendon has healed and
regained its strength and elasticity, as the risk of re-injury is high. Specific
nutrients may improve the elasticity of tendons, which not only helps to reduce
the incidence of tendon problems, but also encourages the repair of damaged
tendon tissue.
So
where and how myofacia release fits in the tool kit.
It is recommended that following three months after a ligament injury MFR can commence. In MFR a therapist is utilizing gentle, sustained pressure through compression, stretching, or twisting of the myofascial system, to generate a flow of bioenergy (information) throughout the mind/body complex by the piezoelectric phenomenon. This facilitates the extracellular matrix to transform as it undergoes its reorganization during MFR. Fascia is behaving as an electrically conductive medium which allows this visco-elastic tissue to rehydrate under the sustained pressure of the therapist's hands.
This rehydration also allows for
an elongation of the myofascial system.It
has an impact at the cellular level and throughout the whole. This hands
on techniques allow the collagen fibres to realign in a pattern which allows
strength and function, the element of time sustained in the compression of the
deep fascia is so that true histological change in the tissue does occur, the
tissue is literally hydrating under the therapists hands, The electrical
potential of the area is changing and the information regarding this change is
being transmitted throughout the whole body by the extracellular matrix, water
is drawn to the dehydrated area, this impacts on the CNS that relaxes its
activity in that area due to increased hydration and the other metabolic
changes. The stretch elongates the myofacial system and there is a reduction in
muscular spasm. Providing pain relief, reduced edema and increased function, as
one area is hydrated the hands glide to the next restricted region.
‘Following injury the form and function of the tendon are not repaired
to normal. The new tissue is a different type of collagen weaker and less
elastic than the original. To minimise this we must modify cell permeability to
allow the cells to talk chemically. By doing this the disposition of the
collagen fibres can take place in a more appropriate pattern with Myofacial
release we are doing just that’ Mary Dyson Bsc LHD(Hon) PhD (biologist)
The energy effects the horse’s body’s energy and magnetic fields we energise the body to elicit change on a cellular level this electric change effects the big picture as is it effects the whole body, the fascia web unravels to create space for the horses body’s systems to work efficiently and effectively once more. It is not a localised therapy just for focal restriction; it affects the whole the global picture of the horse’s body and is somatic in its rehabilitation possibilities for future injury prevention. MFR is the power tool in the therapist’s kit for maintained health and well being of not just the cural facia and whole facial equilibrium of the horse.
Dawn
Clow August 2008.
Reading
References
1) FASCIA: THE BODY'S SHOCK ABSORBER by John F. Barnes, PT
Special to PT Today
3) Myofascial
Release the Search for Excellence, John F.
Barnes MFR Seminars,
5)
TENDON & LIGAMENT STRAINS & SPRAINS By
Ruth Davis BVSc
6)
MYOFASCIAL RELEASE AND THE EQUINE ATHLETE by Mark F. Barnes, MPT
Reprinted with permission from the
Healing through Myofascia Release Putting the pieces together for Horse
and Rider Ruth Mitchell-Golladay PT,MT, NCTMB Second Edition 2005.