Download (MFR)?

A MANUAL THERAPY APPROACH
TO PREVENTING & TREATING
SHOULDER PAIN
Kevin Laudner, PhD, ATC, FACSM
Illinois State University
School of Kinesiology & Recreation
Presenter Conflict
No Conflict
• The views expressed in these slides and today’s
discussion are mine
• My views may not be the same as the views of my
company’s clients or my colleagues
• Participants must use discretion when using the
information contained in this presentation
Outline
• Myofascial release
– Concepts & theories
– Procedures
– Precautions/contraindications
• Muscle energy technique
– Concepts & theories
– Procedures
– Precautions/contraindications
• Case studies
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What is Myofascial Release (MFR)?
• Interactive stretching technique that uses
manual pressure to facilitate maximum
relaxation of tight or restricted tissues
– Direction
– Force
– Duration
(Manheim, 2001; Ferguson & Gerwin)
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“Fixes/Anchors”
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Forearm
Elbow
Fist
Palm
Grip
Reinforced thumbs
Finger(s)
Knuckle(s)
External devices
(Manheim, 2001)
Direction of Stretch
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Horizontal
Diagonal
Perpendicular
Vertical
Can be performed passively or actively
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Myofascial Trigger Points (TP)
• A hyperirritable spot located within a taut band
of skeletal muscle or its fascia
(Travell & Simons, 1983)
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Why not just use a gross stretch?
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Common Mistakes
• Too much pressure
• Too long of stretch
• Too many applications
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MFR Example: Subscapularis
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Muscle Energy Technique (MET)
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Muscle Energy Technique
• Voluntary muscle contractions exerted against a
precisely executed counterforce (ATC) to loosen
specifically localized joints for passive lengthening
during post-contraction relaxation
(Fred Mitchell, 1940)
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Basic Components of MET
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Specific joint position
Precise active muscle contraction
Appropriate counterforce
Allow for full relaxation
Apply stretch force to increase motion
(Chaitow, 2006)
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Common Mistakes
Patient
• Too strong contraction
• Starting and finishing contraction too quickly
• Does not relax completely
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Common Mistakes
ATC
• Improper control of joint at resistance barrier
• Inadequate counterforce against contraction or
direction of force
• Move too quickly to new barrier
• Don’t allow enough time for stretch
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MET Example: Subscapularis
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Case Studies
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Subacromial Impingement:
Forward Head
• Causes:
– Stretch of levator scapulae
• Decreases scapular:
– Posterior tilt
– Upward rotation
(Ludewig et al, 1996)
Levator Scapulae: Active MFR
(Johnson, 2009)
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Levator Scapulae: MET
(Chaitow. 2006)
Over-Activity of Upper Trapezius
• Increased scapular elevation
• Decreased scapular upward rotation
(Ludewig et al, AJSM 2004; Ludewig & Cook, Phys Ther 2000;
Lukasiewicz et al, JOSPT 1999)
Upper Trapezius: MET
Shoulder movement
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Subacromial Impingement:
Rounded Shoulders
• Causes:
– Tight serratus anterior & pectoralis
minor & major
(Kendall, 2005)
• Increases scapular:
– Protraction
Pectoralis Minor: MFR
Trigger Points
Pectoralis Minor Stretch
Glenohumeral Internal Rotation Deficit (GIRD)
Soft tissue tightness?
Associated pathologies?
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Posterior Capsule (Passive MFR)
Posterior Shoulder: MET
• IR with scapula stabilized
• Horizontal ADD
– With IR
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Infraspinatus (Passive MFR)
Teres Minor (Passive MFR)
Conclusions
MFR
• Direction, force, & duration
determined by feel
MET
• Be conscientious of direction & force
of patient’s counterforce
MFR and MET are additional tools to
use in your rehabilitation program
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THANK YOU
For more information:
[email protected]
ILLINOIS STATE
UNIVERSITY
www.kinrec.ilstu.edu
Practice Session
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Levator scapulae
Upper trapezius
Pectoralis minor
Posterior glenohumeral capsule
Infraspinatus/teres minor
Pick a muscle – perform both MFR & MET
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