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Fascial manipulationOversea Training Sharing
Part II
Wong Ka Ho, Curtis
Physiotherapist II
Course structure
Fascial manipulation
Level 1
Subacute MSKpain
Chornic MSKpain
Deep fascia
Level 2
Acute MSKpain
Deep fascia
Level 3
VisceraldysfunctionSuperficialfascia
Brief recap on theory (Part 1)
Hyaluronic acid (HA)
Overuse syndrome (Piehl-Aulin 1991)
Hyaluronic acid = Non-newton fluid
Lubricant vs. friction
Superficial fascia
Deep fascia
Muscle
Overuse syndrome (Piehl-Aulin 1991)
Hyaluronic acid = Non-newton fluid
Lubricant vs. friction
Superficial fascia
Deep fascia
Muscle
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Centre of coordination
Centre of perception MF
Analogue of CC and CP
CC
CP MUSCLE
Examples of CC and CP
CC: an-ge
MUSCLE
MUSCLE
CC
CP
Interaction of Agonist and Antagonist
Alteration in the fascia of agonist of mf unit caneffect the antagonist mf unit
Every segments stabilized by
agonist and antagonist
Hypertonicity ofagonist
Hypertonicity ofantagonist
Segments and directions
14 segments with 6 direction
Total: 84 myofascial unit
84 Centre ofcoordination
>84Movement Verification
>84Centre ofperception
Body Segments
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Direction Direction (Rt Lower Limb)
Myofascial sequence (Rt Lower Limb)
Sagittal plane Frontal plane Hor izontal p lane
Clinical practice (Part 2)
Assessment
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Centre of perception
Site of pain: anteriorknee
CC: AN-GE
Plane: Sagittal
Movement Verification
Plane: Sagittal
Segment: GE
Direction: AN
Test: Lunging
Principle of Selection of CC
Agonist
Antagonist
At least 1 level up and down
Distal along the sequence
No. of CC: 6
Palpation/ Treatment Technique
Knuckle ElbowTHUMB?
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Antemotion sequence
AN-LU ()
CP:Abdominal or back
pain
MoVe:
Trunk Extension(any deviation)Full crunch
Antemotion sequence
AN-PV ()
CP:Heaviness in iliac
fossaAnterior thigh orsacrum region
MoVe:Anterior pelvic tilt
Antemotion sequence
AN-CX ()
CP:
Anterior thigh pain,
agg. by liftingleg/going up a step
MoVe:
Leg kicking
Antemotion sequence
AN-GE ()
CP:
Anterior knee pain,
agg. by descendingstairs
MoVe:
Single half squatLunging
Antemotion sequence
AN-TA ()
CP:Anterior ankle pain
Achilles tendonitisChronic ankle sprain
MoVe:Walk on heel(tension and range)
Retromotion sequence
RE-LU ()
CP:Lumbosacral region
MoVe:Trunk extension
Trunk flexion
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Retromotion sequence
RE-PV ()
CP:Sacral iliac region
MoVe:
Push pelvis forward
Retromotion sequence
RE-CX ()
CP:Gluteal or hamstring
Cramp feeling
MoVe:
Backward kickingSit to stand
Retromotion sequence
RE-GE ()
CP:
Popliteal fossa
MoVe:Check strength ofhamstring
Fast knee flexion
Retromotion sequence
RE-TA ()
CP:
Heel, Plantar fascia,
Achilles tendinitis
MoVe:Walk on tiptoe
Repeat PF x 10 timesJump up and return
Discussion in clinical practice
Finish 1 CC?
Patient:
Therapist:
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Time to complete 1 CC (Borgini, 2009)
Temporal modification of pain (Mean: 3.24 mins)
0
2
4
6
8
10
1 min 2 min 3 min 4 min
VAS
Pain
Time to complete 1 CC? (Borgini, 2009)
Process
Pressure on CC? (Stem, 2006)
Effect of manipulation
Post treatment
Remind the patient about the post treatmenteffect
Medication (anti-inflammatory vs. analgesic)
Self stretching after treatment !!
Inflammatory reaction begins
Peak of the inflammatory reaction
Occasionally fever
Inflammatory reaction ends
Results of the treatment become apparent
+/- Subsequent treatment
Subsequent appointment
Sub-acute/ Chronic case: 1-2 week
Acute case: 3-5 days
Should we recheck the CC that was treated inlast session?
Scenario:
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OppositeCC
Work insameplane
Changeplane
FU in 1month
Contraindication
Absolute Relative
Fever Lymphedema (> Stage III)
Severe immunodepression Non-cooperative patient
Dermal lesion in the region ofRx
Cancer patient (not fordistant tumor)
Thrombophlebitis Recent trauma w/o analysis
Thrombosis Severe bleeding disorder
Corticosteroid therapy
Self clinical experience
Patient no: 12
Immediate Improvement: 50-80%
Last for up to 1 month
Condition encountered:
Sciatica, LBP, neck pain, shoulder pain,TMJ pain, Knee pain, buttock pain, ITBsyndrome, mid-thoracic pain
Self clinical experience
Any cases were not responsive to the
treatment?
Any cases got worse after treatment?
Time saving vs. Time consuming
Conclusion
Safe
Effective outcome with long lasting effect
No protocol
Treat sequence/plane rather than segment
Questions