Fascial Manipulation (Practical)

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
2014/11/5
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
2014/11/5
RE-PV ()
RE-CX ()
CP:
Sacral iliac region
CP:
Gluteal or hamstring
Cramp feeling
MoVe:
Push pelvis forward
MoVe:
Backward kicking
Sit to stand
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
2014/11/5
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
2014/11/5
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

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2014/11/5

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

Lubricant vs. friction

Interaction of Agonist and Antagonist

Alteration in the fascia of agonist of mf unit can

Segments and directions

14 segments with 6 direction

>84 Movement Verification

Direction (Rt Lower Limb)

Myofascial sequence (Rt Lower Limb)

Clinical practice (Part 2)

Palpation/ Treatment Technique

Discussion in clinical practice

Time to complete 1 CC (Borgini, 2009)

Time to complete 1 CC? (Borgini, 2009)

Temporal modification of pain (Mean: 3.24 mins)

Pressure on CC? (Stem, 2006)

Remind the patient about the post treatment

Inflammatory reaction begins

Results of the treatment become apparent

+/- Subsequent treatment

Lymphedema (> Stage III)

Dermal lesion in the region of Cancer patient (not for

Recent trauma w/o analysis

Severe bleeding disorder

Self clinical experience

Self clinical experience

Any cases were not responsive to the

Immediate Improvement: 50-80%

Any cases got worse after treatment?

Sciatica, LBP, neck pain, shoulder pain,

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