【原创】脑瘫治疗 其他方法大观系列之六：Myofascial Release介绍

Myofascial Release

“Myofascial release is a very effective hands-on technique that provides sustained pressure into myofascial restrictions to eliminate pain and restore motion”
John F Barnes, P.T.
Author and authority on myofascial release
MFR
 Manual energetic techniques designed to treat the fascia that surrounds every cell and tissue in the body1
 Involves massage and stretching techniques that are advocated to cause changes or “releases” in restricted or pathological fascial structures2

Fascial system
Fascia is a tough connective tissue composed of collagen, elastin and viscous gel that exists as a three dimensional web surrounding all our cells and organized along the lines of tension imposed on the body1,3
Three layers/types
 Superficial: lies directly below the dermis1,3
 Deep: surrounds and fuses with bone, muscle, nerve, blood vessels and organs1,3
 Dura: surrounds the CNS1,3
Related to each other. Techniques used for Dura?

Myofascial disorders
Theoretical Models:
 Contraction: manifests as muscle hypertonicity or spasm3
 Contracture: manifests as inert or non-contractile tissues that have undergone fibrotic changes3
 Cohesion-Congestion: manifests as fluid and chemical changes in neuro-vascular and lymphatic systems3

Intervention / Techniques
(According to Dutton, these are the most commonly used techniques)
 J Stoke: used to increase skin mobility. Counter pressure is applied with the heal of the hand, while a stroke in the shape of the letter J is applied in the direction of the restriction, with two or three fingers, which creates some torque at the end of the stroke3
 Vertical stroke: the purpose is to open up the length of vertically oriented superficial fascia superficial fascia. Counter pressure is applied with one hand, while the stroking is performed with the other hand3
 Transverse stroke: applied in a transverse direction to the body. Force is applied downward into the muscle with the fingertips of both hands, and the force is applied slowly and perpendicular to the muscle fibers3
 Cross-hands technique: used for the release of deep fascial tissues. The clinician places crossed hands over the site of restriction. The elastic component of the fascia is then stretched until the barrier is met. At this point, the clinician maintains consistent gentle pressure at the barrier for approximately 90 to 120 seconds, until release is felt3
 Leg and arm pulls: targets the dural fascia layer, but can reach all areas. Gentle is applied for approximately 3 to 5 minutes. Barnes suggests beginning proximally and working distally in the spastic child3,4
 Skin rolling: targets superficial fascia and is a good way to assess adhesions3
 Techniques video: http://video.google.com/videoplay?docid=-9032370867412739095&q=myofascial+release&total=70&start=0&num=10&so=0&type=search&plindex=1
 With all of the techniques, the patient should be assessed during intervention. The success of myofascial release can be dependent on how well the clinician “reads” the patient and adjusts treatment accordingly1,3,4,5,6

Evidence
 The majority of evidence for myofascial release is good but it is also anecdotal1,2,3
 Hanten & Chandler (1994): comparing isometric contract relax to MFR’s leg pull technique to increase hip flexion range of motion. Both techniques can significantly increase hip flexion ROM, contract-relax was more effective and efficient than leg pull2

References
1. Davis CM. Myofascial release (Barnes method). In Umphred DA. Neurological Rehabilitation. St. Louis, Missouri: Mosby; 2007:1165-166.
2. Hanten WP, Chandler SD. Effects of myofascial release leg pull and sagittal plane isometric contract-relax techniques on passive straight-leg raise angle. Journal of Orthopaedic and Sports Physical Therapy. 1994; 20(3):138-144.
3. Dutton M. Orthopaedic examination, evaluation and intervention. Pittsburgh, Pennsylvania: McGraw Hill; 2004.
4. Barnes JF. Myofascial release. 2008. Available at www.myofascialrelease.com. Accessed January 25, 2008.
5. Barnes JF. The John F. Barnes myofascial release approach: Part 1. PT Massage Magazine. December 2006.
6. Barnes JF. The John F. Barnes myofascial release approach: Part 2. PT Massage Magazine. June 2007.
7. Barnes JF. The John F Barnes myofascial release approach: Part 3. PT Massage Magazine. October 2007