CURRENT TRENDS IN MANAGEMENT OF MUSCULOSKELETAL PAIN

A WORKSHOP WITH APPLICATION OF FASCIA APPROACH

Dr kannabiran Bhojan, PhD(P.T)

Orthopedic Manipulative Sports Physiotherapist

Professor RVS college of physiotherapy

Certified Spinal,Cranial,Visceral,Fascial,MOVE Kinetictaping,Dry needling Practioner

Coimbatore

WHY????????????????

• While everyone learns something about bones and muscles, the origin and disposition of the fascinating fascial net that unites them is less widely understood

Because its less widely understood

The heart of healing lies in our ability to listen,to perceive, more than in our application of

technique.

Holistic networks

• The neural net

• The fluid net

• The fibrous net

All three convey informationAll three convey informationAll three convey informationAll three convey informationEach of the major body communicating networks is made up of tubular subunits. The nerves are unicellular tubes, the capillaries are multicellular tubes, and the tubes of the collagenfibers are cell products, woven by the fibroblasts.

The formation of the fascial net

The fibrous net

connective tissue net extends

into the dorsal and ventral

cavities as well, to surround

and invest the organs.

FASCIAL DYSFUNCTION AND DISEASE

• ADAPTATION TO OVERUSE ,DISUSE ,MISUSE & TRAUMA

DENSIFICATION AND LOSS OF FASCIAL SLIDING FUNCTIONDENSIFICATION AND LOSS OF FASCIAL SLIDING FUNCTIONDENSIFICATION AND LOSS OF FASCIAL SLIDING FUNCTIONDENSIFICATION AND LOSS OF FASCIAL SLIDING FUNCTION

Fascial restrictions can apply excessive pressure to

tissues causing a variety of symptoms ; pain, headaches

or restriction of motion.

This restrictions affect our flexibility and joint stability,

and sporting/ballistic movements of the human body.

How far we can hurl a stone, how high we can jump,

and how long we can run depend not only on the

contraction of our muscle fibers, but also to a large

degree on how well the elastic recoil properties of our

fascial network are supporting these often complex

movements

GLOBAL POSTURE ASSESSMENT OVERVIEWGLOBAL POSTURE ASSESSMENT OVERVIEWGLOBAL POSTURE ASSESSMENT OVERVIEWGLOBAL POSTURE ASSESSMENT OVERVIEW

FASCIA A HOLISTIC COMMUNICATING SYSTEM FASCIA A HOLISTIC COMMUNICATING SYSTEM FASCIA A HOLISTIC COMMUNICATING SYSTEM FASCIA A HOLISTIC COMMUNICATING SYSTEM

ANATOMY TRAINS AND FASCIAL BASCISANATOMY TRAINS AND FASCIAL BASCISANATOMY TRAINS AND FASCIAL BASCISANATOMY TRAINS AND FASCIAL BASCIS

The Superficial Back LineThe Superficial Back LineThe Superficial Back LineThe Superficial Back Line

SUPERFICIAL FRONT LINESUPERFICIAL FRONT LINESUPERFICIAL FRONT LINESUPERFICIAL FRONT LINE

The Deep Front LineThe Deep Front LineThe Deep Front LineThe Deep Front Line

The Lateral LineThe Lateral LineThe Lateral LineThe Lateral Line

The Spiral LineThe Spiral LineThe Spiral LineThe Spiral Line

The Arm Lines

two Front Arm Lines.

two Back Arm Lines.

The Functional LinesThe Functional LinesThe Functional LinesThe Functional Lines

How do fascial problems start

• Densification and disturbed fascial sliding system

According to fascia

When body segments are pulled out of

place and muscles are required to maintain

static positions – either

stretched/contracted ('locked long') or

shortened/contracted (locked short') –

then we see increased fascial bonding and

thixotropy of the surrounding intercellular

matrix (ECM),

Essentially, these muscles or parts of musclesare being asked to act like straps

(A) The ECM is designed to allow the relatively free flow of metabolites from blood to cell and back again in the

flow of interstitial fluid and lymph. (B) Chronic mechanical stress through an area results in increased laying down

of collagen fiber and decreased hydration of the ECM's ground substance, both of which result in decreased

nourishment to certain cells in the 'back eddies‘ caused by the increased matrix.

Fascial dysfunction might involve Fascial dysfunction might involve Fascial dysfunction might involve Fascial dysfunction might involve

• Modified local and general ROM

• Reduced local tissue resilience /viscoelasticity

• Loss of sliding potential between tissue surfaces

• Impaired coordination /motor control

• Postural deviation/mal alignment

• Soft tissue pain on movement

• Myofascial pain

• Decreased proprioception & decreased equilibrium

• Autonomic imbalance

ZINK SEQUENCE

STAR

Fascial dysfunction and adaptation

• Fascia focused therapy and adaptation

• Restoring sliding function

• Fascia and ageing ,Retarding fascial ageing

• Fascial inflammation ,wound scars ,fibrosis

and adhesion

• Hypermobility syndromes

The Front Functional Line in a tennis serve. The stronger and more vertical the serve, the more the Superficial Front Line will also participate in driving the ball.

A tennis forehand connects the Superficial Front Arm Line to its partner directly on the opposite side - one of several angles that the arms can transmit force to the front of the torso.

Backhand shot could similarly join the Superficial Back Arm Line to its opposite partner as well as down the torso to the pelvis and beyond

The forces going through the hurdler's body hurdler's body hurdler's body hurdler's body cross the Front Functional Line only at one cross the Front Functional Line only at one cross the Front Functional Line only at one cross the Front Functional Line only at one moment during the leap,moment during the leap,moment during the leap,moment during the leap, but a connection between the forward leg and the opposite shoulder is maintained throughout the movement.

The cricket bowler uses the Front Functional Line Front Functional Line Front Functional Line Front Functional Line to add impetus to the power of the arm.

The kayaker uses the opposite hip to stabilize hispaddling - the lowered pulling arm via the BFLlowered pulling arm via the BFLlowered pulling arm via the BFLlowered pulling arm via the BFL, and the lifted pushing arm via the FFLlifted pushing arm via the FFLlifted pushing arm via the FFLlifted pushing arm via the FFL.

Structural analysis

The winding andunwinding of the torso in walking involves the Functional LinesFunctional LinesFunctional LinesFunctional Lines(pictured) in alternatingcontraction, and the Spiral Lines and Spiral Lines and Spiral Lines and Spiral Lines and Lateral LinesLateral LinesLateral LinesLateral Lines as well

Begin by lying comfortably on your back and lettingyour knees go to the right.

When you reach side-lying, you can continue by takingyour knees and elbows away from each other

After you reach the belly-lying position, you cancontinue on around the roll by taking your knees to the left and letting the rest of your body follow.

The right Spiral Line is the primary rotator of the trunk,assisted in this movement by the left Front Functional Line bringing the left arm toward the right hip.

Structural analysis

Structural analysis

The pre-classical Kouroi series of sculpturesshows close to ideal 'coordinated fascial tensegrity' -balance andproper placement for the Anatomy Trains lines.

Most martial or sportive actions involve connecting the arm to the opposite leg to increase leverage.

The great athletes involve all the lines,distributing the strain evenly across the body.

Superficial Front Line stretchesSuperficial Front Line stretchesSuperficial Front Line stretchesSuperficial Front Line stretches. In each of t he following illustrations, each pose may stretch or challenge multiple muscles or lines, or have other intentions than mere stretch. For a simplified understanding of how the continual fascia within a line continuity may be stretched, as well as the individual structures.

Primary Superficial Superficial Superficial Superficial BackLineBackLineBackLineBackLinestretches.

A Lateral Line A Lateral Line A Lateral Line A Lateral Line stretch, and a Lateral Linestrengthening exercise.

Spiral Line Spiral Line Spiral Line Spiral Line stretches.

Arm Line Arm Line Arm Line Arm Line stretches.