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CHAPTER OBJECTIVES

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Chapter Objectives

At the conclusion of this chapter, the reader will be able to:

  • Delineate the history and the major contributors to present-day soft tissue approaches in orthopaedic manual physical therapy (OMPT).

  • Describe the structure and function of connective tissue, including both the cellular and fibrillar components that establish the primary characteristics of connective tissue.

  • Describe the effects of immobilization on connective tissue.

  • Understand the differences between direct and indirect OMPT approaches to mobilization.

  • Define the theory of tensegrity and the integrated systems approach to myofascial release (MFR).

  • Perform a basic triplanar examination of connective tissue mobility.

  • Define the primary indications and differences between soft tissue MFR and articular MFR.

  • Identify and maintain a triplanar fulcrum.

  • Perform several basic MFR techniques for soft tissue and articulations.

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HISTORICAL PERSPECTIVES

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Attempts to mobilize the myriad of connective tissues of the body have led to the development of a variety of approaches that are considered to be "fascial" in nature (Box 14-1). This chapter is devoted to the description of one such approach, known as myofascial release (MFR). The philosophical underpinnings of one form of MFR and its clinical application are provided.

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Box 14-1 APPROACHES TO SOFT TISSUE DYSFUNCTION AND THEIR PRIMARY METHOD TO ENACT CHANGE

  • Bindegewebsmasssage: autonomic/reflexive approach to fascial manipulation

  • Hoffa Massage: use of minimal force that is designed to elicit as little pain as possible

  • Rolfing: improve the body's balance in relation to gravity through the integration of body and mind

  • Trager: combination of tissue relaxation and neuromuscular reeducation, which focuses on the subconscious mind

  • Hellerwork: incorporates movement reeducation through exercises that mimic everyday movement, reinforce stressfree methods of performance, and connect mental patterns to the patient's own somatic expression

  • Alexander Techniques: supplemented by mechanical approaches that prepares a person for movement reeducation by superimposing normal movement patterns to eliminate poor postural habits

  • Feldenkrais Awareness Through Movement: focuses on changing old habits and patterns using a hands-on approach to slowly change inadequate movement into efficient movement

  • Aston-Patterning: negotiating a balance of the body's tissue through touching, sensing, and hearing. Each body maintains and expresses patterns that can help or hurt an individual.

  • Functional Orthopedics Approach: incorporates proprioceptive neuromuscular facilitation (PNF) patterns of movement with direct connective tissue manipulation

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As already delineated in Chapter 13 of this text, approaches designed to address soft tissue dysfunction may be classified in accordance with the methods used or the structures targeted.1 Bindegewebsmasssage is considered to be an autonomic/reflexive approach to fascial manipulation that was developed in the 1920s by a German physiotherapist, Elizabeth Dicke. This approach relies on reflexive pathways mediated through the autonomic nervous system to facilitate a therapeutic effect. Bindegewebsmasssage is performed in a very systematic fashion. Dicke's purely "mechanical" approach was one of the first to articulate specific clinical parameters.

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