Myofascial Manual Therapy of L/E - Principle & Treatment - Myofascial Manual Therapy of L/E Principles of Treatment 2012 KATA Kim, Ho-Sung (Ph D, PT Kim Ho Sung (Ph D, PT Myofascial Manual Therapy of L/E Principles of Treatment Myofascial Trigger Point - Pathogenesis - Trigger Point Pathogenesis "Trigger points are described as.. hyper-irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers palpable nodules are small contraction knots, common cause of pain. " Overstretching & Overload --> Microtrauma-->Muscle strain damage sarcolema--> damaged sarcoplasmic Reticulum-->Ca 2+ release sustained Contraction excessive Ca 2+ action with ATP consumption & depletion Vasocontriction, circulation, metabolism muscle pain -->muscle contraction shortened muscle fiber--> taut band in muscle--> trigger point Bradykinin destroyed phospolipid arachidonic acid----- ------- Prostaglandin destroyed platelete serotonin mast cell histamine sensitizing product active trigger point pain Repeated Microtrauma Macrotrauma 1
Referred Pain Pattern Myofascial Trigger Point - Clinical Symptoms & Myofascial Diagnosis- 연관통패턴 (Referred Pain Pattern Biomechanics of Injury Clinical Symptoms 가해진외력방향 손상받는동안신체의위치 환자의독특한자세 습관적이거나반복적인운동방향 골격 ( 척추와골반 의비대칭 국소통증 (Local Pain 연관통패턴 (Referred Pain Pattern 부종과셀루라이트 (Edema and Cellulite 피부분절탈모 (Dermatomal Hair Loss 입모 (Pilomotor 수면장애 (Sleep Disturbances 족부의부정렬 자율신경및고유수용감각의장애 (autonomic & Proprioceptive Disturbances Myofascial Diagnosis (I Myofascial Diagnosis (II 양성스트레칭징후 (Positive Stretch Sign : PSS 국소연축반응 (Local Twitch Response : Taut Band 를가로지르며타진 단단한띠 (Taut Band 의촉진 운동범위제한 (Limited ROM : ROM 마지막부위에서통증 압통및통증성소결절 (Tender & Painful Nodules 근력약화 (Muscle Weakness 2
Treatment Process Contraindication 양성스트레칭징후 (Positive Stretch Sign : PSS Relax position 진행성골다공증 (progressive osteoporosis 골절 (fractures Trigger Point 지압 (digital Compression Repetition Pain 감소 & ROM 증가 출혈성부위 (hemorrhage sites, 항응고치료 ( 헤파린 봉합부위 (suture sites 개방성상처 (open wound 통증이심한경우 (severe pain 근력강화 (Muscle Strengthening 악성종양 (malignance 대퇴 (Thigh Lower Extremity Iliopsoas ( 장요근 Hip Flexion Iliopsoas( 장요근 3
Iliopsoas ( 장요근 Hip Extension Gluteus Maximus( 대둔근 Gluteus Maximus ( 대둔근 Gluteus Maximus ( 대둔근 Gluteus Medius ( 중둔근 Hip Abduction Gluteus Medius( 중둔근 4
Gluteus Medius ( 중둔근 Hip Adduction Adductor Muscle( 내전근 Adductor Muscle ( 내전근 Adductor Muscle( 내전근 Piriformis ( 이상근 Hip External Rotation Piriformis( 이상근 5
Piriformis ( 이상근 Hip Internal Rotation Gluteus Minimus( 소둔근 Gluteus Minimus ( 소둔근 Gluteus Minimus ( 소둔근 Quariceps Femoris ( 대퇴사두근 Knee Extension Quadriceps Femoris( 대퇴사두근 6
Quariceps Femoris ( 대퇴사두근 Knee Flexion Biceps Femoris( 대퇴이두근 Biceps Femoris ( 대퇴이두근 Biceps Femoris ( 대퇴이두근 하퇴 (Lower Leg Ankle Dorsiflexion Tibialis Anterior( 전경골근 7
Tibialis Anterior ( 전경골근 Tibialis Anterior ( 전경골근 Gastrocnemius ( 비복근 Ankle Plantar Flexion Gastrocnemius( t i ( 비복근 Soleus( 가자미근 Gastrocnemius ( 비복근 Soleus ( 가지미근 8
Soleus ( 가지미근 Ankle Inversion Tibialis Posterior( 후경골근 Tibialis Posterior ( 후경골근 Tibialis Posterior ( 후경골근 Peroneus Longus & Brevis ( 장 & 단비골근 Ankle Eversion Peroneus Longus & Brevis( 장 & 단비골근 9
Peroneus Longus & Brevis ( 장 & 단비골근 Any Question 10