Problems and Treatments > MSK Treatments and Investigations > Manual Therapy
- Travell & Simons Trigger Point therapy
- Manipulation & Mobilization of joints
- Muscle energy & facilitated positional releases
- Jones’ Strain and Counterstrain
Travell & Simons Trigger Point therapy
- Myofascial trigger point is a small area in a muscle that is hypersensitive to pressure, and palpably different from the surrounding muscle. This spot tenderness is found in a palpably tense band of fibers within a shortened, weakened muscle, and produces a characteristic pattern of referred pain.
- The predisposing factors contributing to the development of trigger points are trauma, repetitive strain or overuse, muscle imbalance, inappropriate muscle loading, bad posture, inherited susceptibility and inappropriate body positioning to perform a given task.
- Trigger point therapy evolved from the work of Dr. Janet Travell in 1940’s. Her success led her to the post of White House physician for her successful treatment of John Kennedy. From Dr. Travell’s research along with the help of her colleague Dr. David Simons, they were later able to map where trigger points occur on most people and where the pain is referred by each trigger point. They then developed a treatment regimen for trigger points that required injecting each point with a painkiller, and the use of cooling spray followed by passive stretching.
Manipulation & Mobilization of joints
- Manipulation and mobilization are manual techniques that involve the moving of one body part relative to the other to achieve a therapeutic effect.
- Manipulation is also known as mobilization with impulse (thrust). It involves the mobilization of the restricted joint by applying a high velocity, low amplitude thrust after the restrictive barrier of the joint has been fully engaged.
- Mobilization is to apply repetitive small amplitude motions to joints and related soft tissues and in small increments to push the restrictive barrier back in steps to the normal range and so increase the range of movement.
Muscle energy & facilitated positional releases
- Muscle energy techniques (MET) are a class of soft tissue mobilization methods that involves the voluntary contraction of patient muscle in a precisely controlled position, either isometric and/or isotonic contractions, against a counterforce applied by the musculoskeletal physician. The techniques are designed to increase the mobility of a particular joint or body area to improve musculoskeletal function and reduce pain. Such technique is very gentle for both the musculoskeletal physician and the patient.
- The mechanisms that MET works depend on two important neuro-physiological principles established by Sir Charles Sherrington in the 1890’s. The first principle is that, after a muscle contracts, there follows for a short refractory period to further stimuli, i.e. the muscle will not contract in this short period even when stimulated. The second principle is that, in any joint movement, when the agonist muscles contract, the antagonist muscles relax.
- There are some examples of MET:
- Post-isometric relaxation (PIR): The patient uses isometric contraction to contract the restricted joint’s antagonist muscles away from the restrictive barrier by pushing against the musculoskeletal physician’s counterforce. During the refractory period when these antagonist muscles relax, the musculoskeletal physician stretches the antagonist muscles to mobilize the joint into the direction of motion.
- Reciprocal inhibition: The patient uses isometric contraction to contract the restricted joint’s agonist muscles towards the restrictive barrier by pushing against the musculoskeletal physician’s counterforce. In so doing the antagonist will be reflexly inhibited. In the immediate period following contraction, the musculoskeletal physician stretches these inhibited antagonist muscles and mobilize the joint into the direction of restriction. This technique is particularly useful when contraction of the antagonist musculature produces pain.
Jones’ Strain and Counterstrain
- A technique developed by Larry Jones, DO, in which the musculoskeletal physician finds an exquisitely sensitive tender point in the muscles that is associated with a particular dysfunction. The patient is positioned in a manner as to relieve tension and tenderness at the point. The position is held for 90 seconds, during which time the tissue releases, tenderness and dysfunction resolve.
- Travell & Simons的激痛點治療
- Jones' Strain-Counterstrain 手法
Travell & Simons的激痛點治療
- 肌筋膜激痛點 (Myofascial trigger point) 是肌肉中的一個小點，這些小點的觸感與周圍的肌肉質地不一樣，且對外來的壓痛有超敏感的反應。這些超敏感的壓痛點通常位於已收縮但弱化肌肉中的繃緊帶內，並會產生特徵性的轉移痛 (referred pain)。
- 激痛點的治療源於Janet Travell醫生於1940年開始對肌骼痛症治療的研究。她醫治以故美國總統約翰甘迺迪痛症的成功讓她躋身白宮顧問醫生一職。Travell醫生透過與同事David Simons醫生的合作，研究病人肌骼的激痛點，成功地譜出人體大多數激痛點的位置以及其轉移痛的範圍。後來他們更以此為基礎，透過注射激痛點或使用噴霧冷卻後以被動式拉伸放鬆帶激痛點的筋肌，制定了一系列醫治激痛點的治療方案。
- 手動關節舒整療法 (Manipulation) 和關節鬆動術 (Mobilization) 是一種涉及移動身體某部分以達到治療效果的手法治療技術。
- 肌肉能量治療（MET）是一種軟組織的鬆動術。病人根據指示自主地將肌肉等長收縮或等張收縮至受控的精確位置，然後與肌骼科醫生施出的反作用力 (counterforce) 抗衡，從而達放鬆效果。這技術是用來增加關節或身體部分的活動幅度，從而改善肌肉功能及減輕痛楚。肌肉能量治療對於病人及醫生來說都是一種非常溫和的治療手法。
- 肌肉能量治療的原理建基於Sir Charles Sherrington在1890年確立的兩個重要的神經生理學原則。第一項原則是，肌肉收縮後會對外來刺激產生一段短暫的不應期，即就算肌肉受到刺激，也不會在這短時間內收縮。第二項原則是，在任何關節的活動中，在主動肌收縮時，對抗肌便會放鬆。
- 等長收縮後之放鬆 (Post-isometric relaxation, PIR)：病人運用等長收縮的方法將活動受限關節的對抗肌向關節活動受限的反方向收縮，期間肌骼科醫生以反作用力制衡。在對抗肌在收縮後放鬆的不應期間，肌骼科醫生把病人的對抗肌往關節活動受限的方向牽拉，藉此鬆解受限關節。
- 交互抑制 (Reciprocal Inhibition, RI) : 病人運用等長收縮的方法將受限關節的主動肌向關節活動受限的方向收縮，期間肌骼科醫生以反作用力制衡。在這過程中關節的對抗肌會被反射性地抑制。緊接主動肌收縮停止後，肌骼科醫生隨即把病人受抑制的對抗肌往關節受限方向牽拉，藉此鬆解受限關節。這種技術對於對抗肌收縮時會產生痛楚的情況特別有用。
Jones' Strain-Counterstrain 手法
- 這手法是由Larry Jones, DO 發展出來的。肌骼科醫生會在病人的肌肉中找出一個導致某功能障礙的極敏感壓痛點，然後替病人擺位直至找到一個可以緩解這壓痛點的緊張和痛楚的姿勢。然後將病人定位在這姿勢維持90秒，在此期間，組織可以得到放鬆，從而消除功能障礙引致的痛症。
A case with acute wrist drop
HKIMM ASM 2018
HKIMM ASM 2018
Refresher Course Musculoskeletal Medicine
Date: 13 – 15 July 2018
Day 1: Ballroom, 2/F., Courtyard by Marriott, I On Ping Street, Shatin, Hong Kong
Day 2 & 3: Room 306,3/F., Choh-ming Li Basic Medical Sciences Building, The Chinese University of Hong Kong, Shatin, Hong Kong