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2014/11/5

Course structure

Fascial manipulation
Oversea Training Sharing
Part II
Wong Ka Ho, Curtis
Physiotherapist II

Fascial manipulation

Level 1
Subacute MSK
pain
Chornic MSK
pain
Deep fascia

Level 2
Acute MSK
pain
Deep fascia

Level 3
Visceral
dysfunction
Superficial
fascia

Hyaluronic acid (HA)

Brief recap on theory (Part 1)

Overuse syndrome (Piehl-Aulin 1991)

Overuse syndrome (Piehl-Aulin 1991)

Hyaluronic acid = Non-newton fluid

Hyaluronic acid = Non-newton fluid

Lubricant vs. friction


Superficial fascia

Lubricant vs. friction


Superficial fascia

Deep fascia

Deep fascia

Muscle

Muscle

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Centre of coordination
Centre of perception

Analogue of CC and CP
MF
CC

CP

Examples of CC and CP

MUSCLE

Interaction of Agonist and Antagonist

MUSCLE
MUSCLE

Alteration in the fascia of agonist of mf unit can


effect the antagonist mf unit
Every segments stabilized by
agonist and antagonist

CC: an-ge

Hypertonicity of agonist

CC
CP

Segments and directions

Hypertonicity of antagonist

Body Segments

14 segments with 6 direction


Total: 84 myofascial unit
84 Centre of
coordination

>84 Centre of
perception

>84 Movement Verification

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Direction

Direction (Rt Lower Limb)

Myofascial sequence (Rt Lower Limb)

Clinical practice (Part 2)


Sagittal plane

Frontal plane

Horizontal plane

Assessment

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Centre of perception
Site of pain: anterior
knee
CC: AN-GE
Plane: Sagittal

Movement Verification
Plane: Sagittal
Segment: GE
Direction: AN
Test: Lunging

Principle of Selection of CC

Palpation/ Treatment Technique

Agonist
Antagonist
At least 1 level up and down
Distal along the sequence
No. of CC: 6
Knuckle

THUMB ?

Elbow

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Antemotion sequence

Antemotion sequence

AN-LU ()

AN-PV ()

CP:
Abdominal or back
pain

CP:
Heaviness in iliac
fossa
Anterior thigh or
sacrum region

MoVe:
Trunk Extension
(any deviation)
Full crunch

Antemotion sequence

MoVe:
Anterior pelvic tilt

Antemotion sequence

AN-CX ()

AN-GE ()

CP:
Anterior thigh pain,
agg. by lifting
leg/going up a step

CP:
Anterior knee pain,
agg. by descending
stairs

MoVe:
Leg kicking

MoVe:
Single half squat
Lunging

Antemotion sequence

Retromotion sequence

AN-TA ()

RE-LU ()

CP:
Anterior ankle pain
Achilles tendonitis
Chronic ankle sprain

CP:
Lumbosacral region

MoVe:
Walk on heel
(tension and range)

MoVe:
Trunk extension
Trunk flexion

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Retromotion sequence

Retromotion sequence

RE-PV ()

RE-CX ()

CP:
Sacral iliac region

CP:
Gluteal or hamstring
Cramp feeling

MoVe:
Push pelvis forward

Retromotion sequence

MoVe:
Backward kicking
Sit to stand

Retromotion sequence

RE-GE ()

RE-TA ()

CP:
Popliteal fossa

CP:
Heel, Plantar fascia,
Achilles tendinitis

MoVe:
Check strength of
hamstring
Fast knee flexion

MoVe:
Walk on tiptoe
Repeat PF x 10 times
Jump up and return

Finish 1 CC?
Patient:

Therapist:

Discussion in clinical practice

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Time to complete 1 CC (Borgini, 2009)

Time to complete 1 CC? (Borgini, 2009)

Temporal modification of pain (Mean: 3.24 mins)

Process

VAS
10

8
6
Pain

4
2
0
1 min

2 min

3 min

4 min

Pressure on CC? (Stem, 2006)

Post treatment

Effect of manipulation

Remind the patient about the post treatment


effect
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 appointment
Sub-acute/ Chronic case: 1-2 week
Acute case: 3-5 days
Should we recheck the CC that was treated in
last session?
Scenario:

+/- Subsequent treatment

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Contraindication

Opposite
CC

Work in
same
plane

Change
plane

FU in 1
month

Absolute

Relative

Fever

Lymphedema (> Stage III)

Severe immunodepression

Non-cooperative patient

Dermal lesion in the region of Cancer patient (not for


Rx
distant tumor)
Thrombophlebitis

Recent trauma w/o analysis

Thrombosis

Severe bleeding disorder


Corticosteroid therapy

Self clinical experience

Self clinical experience

Patient no: 12

Any cases were not responsive to the


treatment?

Immediate Improvement: 50-80%


Last for up to 1 month
Condition encountered:

Any cases got worse after treatment?


Time saving vs. Time consuming

Sciatica, LBP, neck pain, shoulder pain,


TMJ pain, Knee pain, buttock pain, ITB
syndrome, mid-thoracic pain

Conclusion

Questions

Safe
Effective outcome with long lasting effect
No protocol
Treat sequence/plane rather than segment