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Erik Dalton - Myoskeletal Alignment Techniques.pdf

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1 Erik Dalton’s Erik Dalton’s Freedom from Pain Institute Myoskeletal Myoskeletal Alignment Alignment Techniques Techniques® ® For Pain Management For Pain Management Sensory Receptors… Sensory Receptors… Rebels Without a Pause? Rebels Without a Pause? Research conclusions from ongoing studies: Research conclusions from ongoing studies: ãã Soft tissues (previously viewed as purely mechanical Soft tissues (previously viewed as purely mechanical structures) are innervated and participate in a
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  1 Erik Dalton’s Erik Dalton’s Freedom from Pain Institute MyoskeletalMyoskeletal Alignment Alignment Techniques Techniques ®® For Pain ManagementFor Pain Management Sensory Receptors…Sensory Receptors…Rebels Without a Pause?Rebels Without a Pause? Research conclusions from ongoing studies:Research conclusions from ongoing studies: ããSoft tissues (previously viewed as purely mechanical Soft tissues (previously viewed as purely mechanical structures) are innervated and participate in active structures) are innervated and participate in active balancing of the spine.balancing of the spine.ããSpecialized mechanoreceptors play major roles in Specialized mechanoreceptors play major roles in myofascial unwinding AND also initiate aberrant myofascial unwinding AND also initiate aberrant feedback loops and muscle imbalance patterns due to feedback loops and muscle imbalance patterns due to injured injured articulararticularstructures.structures. SENSORY RECEPTORSSENSORY RECEPTORS ããSupply CNS input on stimuli such as pain, touch, Supply CNS input on stimuli such as pain, touch, sound, light, heat and coldsound, light, heat and coldããCategorized by specific physiological duties such as Categorized by specific physiological duties such as nociceptorsnociceptors, mechano, chemo, thermo and , mechano, chemo, thermo and electromagnetic receptorselectromagnetic receptorsãã Transmit  Transmit proprioceptiveproprioceptiveand and nociceptivenociceptiveinformationinformation ããChange sensory stimuli into action potentials so the Change sensory stimuli into action potentials so the CNS continually receives data on the overall body CNS continually receives data on the overall body environment. environment. Muscle Joint Muscle Joint ReflexogenicReflexogenicRelationshipsRelationships Is impaired muscle function the primary cause of Is impaired muscle function the primary cause of joint dysfunction, or is the reverse true?joint dysfunction, or is the reverse true? ãã McLain 1994:McLain 1994: ----Receptors monitor capsular tensionReceptors monitor capsular tension ----Receptors may initiate protective reflexes important in preventiReceptors may initiate protective reflexes important in preventing ng joint degeneration. joint degeneration. ãã Grieve: Grieve: ----Postural asymmetry joint blockage enhances fibroblastic activity Postural asymmetry joint blockage enhances fibroblastic activity  resulting in resulting in periarticularperiarticulartissue fibrosis.tissue fibrosis. Catch 22 Pain/Spasm/Pain Cycle Catch 22 Pain/Spasm/Pain Cycle ãã Murphy:Murphy: ---- Added that changes in spinal joint soft tissue fibrosis  Added that changes in spinal joint soft tissue fibrosis alters the normal instantaneous axis of rotation alters the normal instantaneous axis of rotation How Joints Affect MusclesHow Joints Affect Muscles ãã Joints influence muscle tone and therefore  Joints influence muscle tone and therefore muscle function.muscle function.ãã The joint’s ability to alter muscle tone is  The joint’s ability to alter muscle tone is mediated by mediated by articulararticularreceptors. receptors. ããIn the joint capsule, the greatest number of In the joint capsule, the greatest number of receptors are found in regions subject to receptors are found in regions subject to  variation of tension during movement. variation of tension during movement.ãã Articular Articularreceptors can inhibit or facilitate receptors can inhibit or facilitate muscle tone.muscle tone.  2  ARTICULAR RECEPTORS ARTICULAR RECEPTORS ãã Freeman and Freeman and  Wyke Wyke categorized categorized articulararticular receptors into four types: Type I, II, III, and IV.receptors into four types: Type I, II, III, and IV. ããEach is stimulated in a distinctive way and responds to Each is stimulated in a distinctive way and responds to stimulation differently.stimulation differently.ãã Type I and II mechanoreceptors act as physiological  Type I and II mechanoreceptors act as physiological receptors/ active during normal movement.receptors/ active during normal movement.ãã Type III and IV receptors normally inactive/ only  Type III and IV receptors normally inactive/ only stimulated at extremes of movement…may function stimulated at extremes of movement…may function under pathological conditions. under pathological conditions.  ARTICULAR RECEPTORS ARTICULAR RECEPTORSLigament Ligament InnervationInnervation ãã  Jiang Jianget al (1995)et al (1995) documented documented innervationinnervationof human of human supraspinalsupraspinal//interspinalinterspinalligaments from 10 spinal ligaments from 10 spinal decompression surgery patients. decompression surgery patients. ããDense collagen bundles of Dense collagen bundles of RuffiniRuffinicorpuscles suggest corpuscles suggest active monitoring of mechanical joint loading and active monitoring of mechanical joint loading and provide static positional awareness for postural control.provide static positional awareness for postural control.ãã Jaing’s Jaing’sfindings support concept of ligaments as part of findings support concept of ligaments as part of neurologicneurologicfeedback mechanisms for protection and feedback mechanisms for protection and stability of the spine.stability of the spine. ZygapophysialZygapophysial Joint  Joint InnervationInnervation ãã Belief in Belief in zygapophysialzygapophysialjoint pain dates back to joint pain dates back to 1933 when 1933 when GhormleyGhormleycoined the term “facet coined the term “facet syndrome”.syndrome”. ããFacet Facet innervationinnervationis derived from the medial branch of is derived from the medial branch of the posterior primary division at the level of the joint the posterior primary division at the level of the joint and the levels above and below. and the levels above and below. ãã  Jeffries 1988  Jeffries 1988 suggested that this multilevel suggested that this multilevel innervationinnervation is probably one reason why facet joint pain frequently is probably one reason why facet joint pain frequently has a broad referral pattern.has a broad referral pattern. McLain’s Facet StudiesMcLain’s Facet Studies ãã McLainMcLain dissected human cervical facet capsules from dissected human cervical facet capsules from three normal subjects to determine the type, density, three normal subjects to determine the type, density, and distribution of and distribution of mechanoreceptivemechanoreceptivenerve endings. nerve endings. ããMechanoreceptors were found in 17 of 21 specimens Mechanoreceptors were found in 17 of 21 specimens ããMcLain concluded “the presence of McLain concluded “the presence of mechanoreceptivemechanoreceptive and and nociceptivenociceptivenerve endings in cervical facet capsules nerve endings in cervical facet capsules proves that neural input from facets is important to proves that neural input from facets is important to proprioceptionproprioceptionand pain sensation in the cervical and pain sensation in the cervical spine.”spine.”  3  Whiplash and Facets Whiplash and Facets ãã BarnsleyBarnsleyet alet al doubledouble--blind, controlled diagnostic blind, controlled diagnostic blocks / Investigated cervical facets in 50 postblocks / Investigated cervical facets in 50 post-- whiplash  whiplash patients / Found facets were most common source of patients / Found facets were most common source of chronic neck pain.chronic neck pain.ãã Bogduk Bogduk , Hirsch et al, and Yamashita et al, Hirsch et al, and Yamashita et al also also reported on rich reported on rich innervationinnervationof facet joints. of facet joints. ãã They concurred that altered  They concurred that altered intersegmentalintersegmentaland and segmental joint motion and postural distortions create segmental joint motion and postural distortions create aberrant traffic in aberrant traffic in neuropathwaysneuropathways.. ãã“Cross“Cross--talk” perpetuates aberrant reflex alterations, talk” perpetuates aberrant reflex alterations, muscular and muscular and ligamentousligamentousalterations, inflammatory alterations, inflammatory responses and resultant pain syndromes.responses and resultant pain syndromes. DiscogenicDiscogenicPainPain ãã RoofeRoofe(1940)(1940) --11 stst evidence of evidence of anulusanulusfibrosusfibrosusnerve nerve fibers.fibers.ãã Bogduk Bogduk (1983)(1983) --nerve fibers in outer 1/3 of lumbar nerve fibers in outer 1/3 of lumbar anulusanulusfibrosusfibrosus.. ãã FarfanFarfan(1973)(1973) --type 4 nerve receptors penetrating type 4 nerve receptors penetrating nucleus, nucleus, anulusanulusand posterior longitudinal ligament.and posterior longitudinal ligament. ãã Shinohara (1970)Shinohara (1970) --nerve fibers penetrating degenerated nerve fibers penetrating degenerated discs nuclei.discs nuclei.ãã GarfinGarfin(1995) (1995) --disc compression of normal nerve leads disc compression of normal nerve leads to to paresthesiasparesthesias, sensory deficits and motor loss…pain is , sensory deficits and motor loss…pain is absent.absent.  Wilberger Wilbergerand the and the Silent Nerve Compression SyndromeSilent Nerve Compression Syndrome ãã  Wilberger Wilbergeret al 176et al 176 --lumbar lumbar myelographicmyelographicherniated herniated discs in 108 asymptomatic patients.discs in 108 asymptomatic patients.ãã Within 3 years, 64% developed  Within 3 years, 64% developed lumbosacrallumbosacral radiculopathy radiculopathy .. ãã Wilberger Wilbergerhypothesizes that time was required for hypothesizes that time was required for mechanical deformation to cause this “silent nerve mechanical deformation to cause this “silent nerve compression syndrome”. compression syndrome”. 29 yr. old male40 yr. old male RadicularRadicularPainPain FASCIAL PLASTICITY FASCIAL PLASTICITY  ãã Therapist hands often palpate a myofascial unwinding  Therapist hands often palpate a myofascial unwinding as sustained pressure is applied to superficial and deep as sustained pressure is applied to superficial and deep myofascial layers. myofascial layers. ãã  Juhan Juhan attributed alteration in connective tissue attributed alteration in connective tissue resilience to what is commonly called resilience to what is commonly called thixotropy thixotropy or the or the “gel“gel--toto--sol” phenomenon.sol” phenomenon. ãã Currier and NelsonCurrier and Nelson --significantly more force, time significantly more force, time and heat must be generated in order to establish and heat must be generated in order to establish permanent connective tissue deformation. permanent connective tissue deformation. ãã OshmanOshman added piezoelectricity as a possible added piezoelectricity as a possible explanation for explanation for fascialfascialcreep.creep.  4 Robert Robert Schleip’s Schleip’s Observations on Observations on FascialFascialPlasticityPlasticity ãã SchleipSchleip concurred: these mechanisms may be a viable concurred: these mechanisms may be a viable explanation for long explanation for long --term tissue changes term tissue changes but but questioned their effectiveness for short term tissue questioned their effectiveness for short term tissue release experienced in clinic.release experienced in clinic.ããSchleipSchleipstudies with anesthetized patients studies with anesthetized patients --in the in the absence of neural connection, shortabsence of neural connection, short--term term fascialfascial plasticity is lost.plasticity is lost.ããSchleipSchleip, “, “PacinianPacinianreceptors are likely to be stimulated receptors are likely to be stimulated by highby high-- velocity thrust manipulations as well as in  velocity thrust manipulations as well as in  vibratory techniques, whereas the  vibratory techniques, whereas the RuffiniRuffiniendings may endings may be activated by slow and deep ‘melting quality’ soft be activated by slow and deep ‘melting quality’ soft tissue techniques.”tissue techniques.” GolgiGolgitendon organstendon organs ããGolgiGolgitendon organs (GTO’s) arranged in a series tendon organs (GTO’s) arranged in a series respond to slow stretch by resetting a muscles’ length, respond to slow stretch by resetting a muscles’ length, inhibiting its synergistic stabilizers and facilitating its inhibiting its synergistic stabilizers and facilitating its antagonist.antagonist.ãã  Jami Jami19921992 --passive myofascial stretching does not passive myofascial stretching does not stimulate GTO’s.stimulate GTO’s. GolgiGolgitendon organs tendon organs ãã Lederman 1997Lederman 1997 --GTO’s GTO’s able to reset their able to reset their muscles’ length during muscles’ length during dynamic forceful dynamic forceful contractions. contractions. ããGTO’s may serve a GTO’s may serve a protective function by protective function by reflexively inhibiting its reflexively inhibiting its agonist at the end range agonist at the end range of joint motion. of joint motion. NociceptorsNociceptorsas Painas Pain--GeneratorsGenerators ããNociceptorNociceptormechanical, thermal and chemical stimuli.mechanical, thermal and chemical stimuli. ããNociceptorNociceptorand chemoreceptor activation:and chemoreceptor activation: 1.1.Nerve fibers depolarized by joint capsule mechanical stressesNerve fibers depolarized by joint capsule mechanical stresses 2.2. Thermal extremes Thermal extremes 3.3.Inflammatory chemical agents such as histamines, Inflammatory chemical agents such as histamines, prostaglandins, prostaglandins, bradykininsbradykinins, potassium ions, and lactic acid., potassium ions, and lactic acid. ããNociceptorsNociceptorscan quickly become major generators of can quickly become major generators of both myofascial and spinalboth myofascial and spinal--pain syndromes. pain syndromes.   Postural ControlPostural Control ããSoft tissues within and Soft tissues within and surrounding spinal articulations surrounding spinal articulations are densely populated with are densely populated with sensory receptors. sensory receptors. ããMacro or Macro or microtraumamicrotraumamay create may create joint misalignment and postural joint misalignment and postural distortions.distortions.ããInjured Injured articulararticularstructures initiate structures initiate and facilitate spinal reflex and facilitate spinal reflex pathways which increase pathways which increase contractibility in contractibility in paraspinalparaspinal musculature. musculature.

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