Persistent, recurrent back pain can cause or be the result of asymmetrical soft tissue tension that does not respond to active stretching by the patient. Active myofascial trigger points can be the stimuli for continued muscle spasm. The painĖspasm cycle further distorts the patientís posture and causes additional soft tissue injury. Using Focused Myofascial Stretching, the physical therapist can neutralize the trigger points and equalize the soft tissue tension, decreasing the postural asymmetries.
Anterior chest wall tightness, forward head posture and active myofascial trigger points can cause carpal tunnel symptoms. Myofascial Stretching of the anterior chest wall decreases the asymmetrical pull that causes protraction of the scapulae and contributes to the forward head posture. Myofascial Trigger Points in the pectoralis minor and the forearm can be neutralized at the same time. A home exercise program using Myofascial Release techniques is given as soon as the initial symptoms decrease by 50%. Focused Myofascial Stretching can also break the adhesions that form between irritated and inflamed tendons.
Persistent cervical pain can cause or be the result of asymmetrical soft tissue tension that does not respond to active stretching by the patient. Active myofascial trigger points can cause radiating pain into the face, jaw, skull, shoulders, upper back and down the arms. Chronic cervical strain and forward head posture can cause vertigo and balance dysfunction. All of these problems must be addressed in a comprehensive physical therapy treatment program.
When a patient does not completely recover from an initial injury, inefficient accommodation to the residual restriction of movement causes additional asymmetrical soft tissue stresses. Chronically irritated and inflamed tissues develop adhesions that further limit efficient movement. As this feedback loop continues, the patientís pain complaint becomes diffuse and global. Pain causes fatigue, depression and impaired sleep.
Myofascial Release can address all of these problems as part of a comprehensive physical therapy treatment program. As a direct, "hands-on" treatment, Myofascial Release reverses the physical withdrawal behavior of many patients who are in chronic pain. As the asymmetrical soft tissue stresses decrease, the feedback loop is interrupted. Sleep patterns improve and overall pain decreases. Gradually, the layers of injury are peeled away like an onion until only the sequelae from the original injury are present and can be treated.
A comprehensive physical therapy evaluation of impaired balance due to subjective dizziness and vertigo must include an evaluation of overall muscle strength and coordination, chronic muscle strain due to forward head posture and decreased neck range of motion, and Myofascial Trigger Points. Soft tissue trigger points in the sternocleidomastoid muscles can contribute to vertigo with and without labyrinthine dysfunction. Weakness and incoordination of the ocular muscles can also be a source of dizziness and the resulting balance dysfunction.
The possibility of overmedication, drug interactions and substance abuse must also be considered. Patients who see different physicians for a variety of problems do not always provide each physician a complete list of their medications. Therefore, I routinely ask my patients to list all medications that they take for any reason. I also ask if the patient uses more than one pharmacy. All of this information is given to the patientís primary care physician when appropriate.
Myofascial Release is used to treat the soft tissue trigger points and the muscular imbalance contributing to the forward head posture. Ocular coordination exercises and visual stabilization exercises teach the patient compensatory mechanisms for a decrease in innate balance sense. Lower extremity strengthening and coordination exercises improve proprioceptive feedback and ability to recover from mild to moderate balance disturbances.
Myofascial Release is one of the most effective treatments for patients with moderate to severe symptoms of fibromyalgia. Soft tissue adhesions and active Myofascial Trigger Points must be reduced before the patient can participate in an active exercise program successfully. Postural asymmetry is energy expensive and contributes to the extreme fatigue reported by patients who have fibromyalgia. The patient may initially feel worse when beginning treatment with Myofascial Release. As postural symmetry improves, the patient will feel less fatigued and have less morning stiffness.
Myofascial Release can decrease the chronic tightness of the posterior cervical musculature and the sensitivity of the Myofascial Trigger Points that cause muscle tension headaches. Myofascial Release can decrease the frequency and intensity of tension headaches. A tension headache can be totally eliminated during a treatment session. By decreasing the tension headache component, migraine headaches can also be decreased in intensity and frequency. Myofascial Release cannot be used to treat a migraine headache.
Myofascial Release can stretch the plantar fascia and decrease soft tissue adhesions that keep the plantar fascia in a chronically shortened position. The shortened fascia can cause an altered gait pattern resulting in knee or hip pain that does not respond to direct treatment. As the plantar fascia is stretched, the foot pain will decrease and normal foot motion will be restored. Only then will the knee and hip pain resolve.
Myofascial Release is the safest treatment method I have found for individuals experiencing Post-Polio symptoms. Since feedback guides all Myofascial Release treatments, over-stretching of weak muscles is avoided. Myofascial Release can decrease the asymmetrical stresses caused by shortened, weak muscles. Functional tightness is left undisturbed.
Scars that are not freely mobile can become a pain focus when the patientís postural adaptation to that tightness and restricted motion is disrupted. Active Myofascial Trigger Points can appear in the scar tissue at any time and cause a unique pain radiation pattern. Using Myofascial Release, the scar adhesions can be broken, restoring free motion of the previously restricted body segment. As the patient adjusts to this unfamiliar posture, new pain may appear. This pain is easily and quickly resolved. As scar adhesions are released, the visible scar may become less prominent and defined.
Pectoralis minor tightness can produce thoracic outlet symptoms. Focused Myofascial Stretching of the pectoralis minor and the trigger points in its proximal attachment can completely eliminate thoracic outlet signs. Midline sternal scars from open-heart surgery can also cause thoracic outlet symptoms. Focused Myofascial Stretching of the surgical scar and of the anterior chest wall can completely eliminate the thoracic outlet signs. A long-term home exercise program must be followed to maintain the new range of motion.
Asymmetry of the muscles of mastication, forward head posture, tightness of the posterior cervical musculature and multiple Myofascial Trigger Points can cause or are the result of TMJ problems. All of the soft tissue problems need to be addressed to achieve maximum effectiveness of the dental treatment. Myofascial Release is used to stretch the posterior cervical musculature and decrease the sensitivity of the Myofascial Trigger Points. A muscle re-education home exercise program is given to re-establish the cervical lordosis. As the forward head posture is decreased, better alignment of the temporomandibular joint is achieved, and the pain from the TMJ malalignment is decreased. Once more symmetrical jaw movement has been achieved using Focused Myofascial Stretching of the muscles of mastication, specific stretching and strengthening exercises are included in the home exercise program.
Myofascial Trigger Points can produce symptoms that mimic many other medical diagnoses. For example, hypersensitive Myofascial Trigger Points in the neck and shoulder muscles can cause headaches, tooth pain, jaw pain, difficulty swallowing, pain behind the eyes, pain in the eyes, vertigo, intrascapular pain, arm pain and hand pain. Myofascial Trigger Points can cause atypical angina, diarrhea, groin pain, sciatic distribution pain, chest and abdominal pain. For a complete description of the effects of Myofascial Trigger Points, please consult Myofascial Pain and Dysfunction: The Trigger Point Manual, volume I and II by J.G. Travell and D.G. Simons, William & Wilkins Publishers.
The multiple muscle strains that are the result of a whiplash injury can cause soft tissue adhesions, hypersensitive Myofascial Trigger Points and persistent headaches. A pain, muscle spasm, postural asymmetry feedback loop can be established as a result of the initial injury. Aggressive early medical and physical therapy treatment of the whiplash injury can prevent a feedback loop from being created. However, once a feedback loop is established, the same treatment approach described under COMPLEX PAIN COMPLAINTS is followed.