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Understanding The MSR Treatment Systems
The MSR Treatment System takes you through a logical and highly effective method of diagnosing, analysis, and treatment. The following illustration shows you the key steps that you will be using throughout the course:
1. Apply The MSR Diagnostic System
2. Develop A Personalized MSR Treatment Algorithm
3. Apply Basic MSR Protocols To Affected Myofasical Structures
4. Address Joint Dysfunction
5. Focus On Addressing Issues
6. Focus On Addressing Global
The Motion Specific Release Diagnostic Algorithm
Applying the MSR Diagnostic Algorithm is a critical component for reaching a full resolution of any condition. The first priority is always to make sure that you are dealing with a musculoskeletal condition and not some underlying pathological process. MSR is designed specifically for dealing with MSK conditions, so anything that does not fall within this category should be referred to the appropriate medical practitioner.
So, what exactly is the MSR™ Diagnostic Algorithm? As practitioners, some parts of this information will be familiar to you. But it is the way we use this diagnostic information that makes MSR™ powerful and successful for you! Let’s review the key components of this MSR algorithm.
1. Obtain A Comprehensive Patient History
2. Complete All Standard Examination Protocols
3. Palpate With Motion
4. Perform Muscle Testing
5. Access Joint Mobility
6. Obtain Appropriate Diagnostic Imagining
Step 1: Take a Comprehensive History
A comprehensive history not only helps you to rule out pathologies, but it may also give you a roadmap to your treatment strategy. Consider this, fascia/connective tissue thickens over time (Davis’s Law) resulting in lack of mobility, muscle imbalances, and nerve entrapments. By understanding the history, injuries and lifestyle of your patient, you will be better able to address their specific problem.
(Davis's Law is used in anatomy and physiology to explain how soft-tissue remodels itself along imposed demands. It is the equivalent to Wolff’s Law which applies to osseous structures).
Step 2: Follow Standard Examination Protocols
Always perform the appropriate standard orthopedic and neurological examination tests. In addition, determine if further diagnostic tests are needed (X-ray, Ultrasound, MRI etc.). These tests are essential in cases of trauma, to rule out pathologies, or when orthopedic or neurological tests are not providing sufficient information. Basically diagnostic imaging can help you to determine if a condition falls within your scope of practice as a musculoskeletal practitioner. If not, refer out to an appropriate medical practitioner immediately. MSR™ is only to be used to treat musculoskeletal conditions.
Step 3: Palpation with Motion
By combining palpation with motion, you can generate a significant and useful amount of clinical information, especially when compared to static palpation. With this step, you will be able to perform a functional assessment of both joints and soft-tissue structures, and begin to identify what refer to as dysfunctional fascial lines.
During palpation with motion:
Check for tissue tonicity, tissue fibrosis, quality of motion, range of motion, and end-feel. In addition, check for the relative density of fascial structures, and for variations in tissue quality, while always considering symmetry. Developing the tactile sensitivity to do this will take time, but it is well worth the effort.
Always visualize the anatomy of the area that you are palpating and consider what you should encounter as you move through a specific region. Focus on what you are feeling as you move through each layer of the patient’s body.
Use the tactile sensitivity of your hands to detect normal and abnormal tissue texture. Just as you would use your eyes to look for changes in body symmetry, use your hands from a tactile perspective, for the same purpose. The better your knowledge of functional anatomy, the more accurate your palpatory findings will become.
Do not add “noise” into the patient’s neuromuscular system. Always have the patient in a supported neutral position where their extremities are relaxed during “palpation with motion”. Also encourage the patient to breathe in slowly and deeply. “Noise” also applies to the practitioner. It is very common to see practitioners introducing their own tension into the patient’s body. This concept is often taught during Tai Chi “pushing hands”. During “pushing hands”, Tai Chi practitioners must allow their own bodies to relax so that they can feel the force and tension within their opponent’s body. Most practitioners do not realize how much tension they themselves can bring into the palpation equation.
Good patient communication is essential during the palpation process. Receiving patient feedback is critical. Be careful not to use medical jargon when asking questions. And be sure to explain the palpatory process and just what you are trying to achieve. Research has shown that good doctor-to- patient communication has a strong therapeutic effect. Unfortunately, busy practitioners often do not realize just how poor their communication is, or the negative effect that this is having on their patients.
Follow-up is a critical component of palpation. You must continually re-evaluate for changes in your palpatory findings. Is the patient’s tissue quality and mobility improving or is it getting worse? Be specific and always record your findings and changes.
Step 4: Perform Muscle Testing
Muscle testing gives you an opportunity to consider the functional anatomy of a given region and identify which anatomical structures are affected. Muscle testing helps you to determine if the problem is being caused by the primary movers, synergists, or if there is an issue of reciprocal inhibition being caused by the antagonists.
Step 5: Assess Joint Mobility
It is extremely important that you do an analysis for, and then address identified joint mobility problems. Joint mobility issues can be addressed by either mobilization or manipulation (depending on your scope of practice).
You will find that your success rate is greatly reduced if do you not properly address joint mobility (spinal or peripheral joint) restrictions.
Step 6: Obtain Appropriate Diagnostic Imaging
In some cases, you may require additional diagnostic images to fully identify the cause of the injury that you are treating. We recommend diagnostic imaging be ordered in cases of trauma, to rule out pathological conditions, or in cases where a MSK diagnosis is in question. If imaging is not within your scope of practice, then you should refer out to an appropriate medical practitioner. Once you have collected your diagnostic data and determined that you are dealing with a musculoskeletal injury, and then you can begin treating your patient.
Understanding The Motion Specific Release Treatment Algorithm
The MSR Treatment Algorithm is a powerful tool or methodology that will help you to:
Optimize your treatment protocols to address each patient’s unique needs.
Evaluate your results.
Ensure that you are able to treat in a logical progression that addresses issues ranging
from regions of Local to Global Tensegrity.
Help you to identify and address any issues across the entire kinetic chain.
Execute Basic MSR Protocols for Identified Structures.
Stage 1 Results
Is the problem resolved?
Identify and Apply MSR Fascial Expansions for Regions of Local Tensegrity
Stage 2 Results
Is the problem resolved?
Identify and Apply MSR Fascial Expansions for Regions of Global Tensegrity
Stage 3 Results
Is the problem resolved?
The MSR Treatment Algorithm divides your treatment into several stages, with each phase being followed by an ‘evaluation’ stop.
Stage 1: Apply Basic MSR Procedures to the Affected Structures
This is the familiar process used by most treatment systems. You have identified the most likely source of injury, pain, or dysfunction, and are ready to treat that specific structure(s). This manual, and our concepts, provide a large number of MSR protocols to help you achieve this. Unlike many techniques, each MSR Basic protocol typically treats 6 to 10 anatomical structures.
Stage 2: Consider Using MSR Treatments to Address Issues of Local Tensegrity
We will be discussing this concept in more detail later, but basically, in Stage 2, you will be addressing issues within the local or immediate kinetic chain of the affected structures. These local kinetic chain elements may also have experienced injuries or restrictions that are affecting your primary structures and are thus preventing a full resolution.
Identify effected areas within the local sphere of involvement - Local Tensegrity
Select appropriate MSR Protocols for affected soft-tissue and joints
Treat affected areas with MSR Protocols and Joint Manipulation
Often, by addressing issues of Local Tensegrity, you will be able to fully resolve the injury. During this phase:
Identify affected areas in the local area.
Evaluate the primary muscles, antagonists, and synergists.
Apply additional MSR protocols to these additional structures.
Identify and treat joint dysfunction.
Stage 3: Consider Using MSR Techniques to Address Issues of Global Tensegrity
In many cases, especially with chronic or long-standing issues, you may find that the patient’s condition continues to re-occur, despite completion of Stages 1 and 2. In such cases, you will have to look for problems within the larger kinetic chain- at the Global Tensegrity of the body. This is one of the most powerful aspects of MSR. When considering Global Tensegrity, you will be working through the fascial expansions of the entire body. This is when you will:
Evaluate Local & Global Spheres of Tensegrity
Use the MSR Fasical Expansions to Identify Dysfunctional Fascial Planes
Treat Affected Areas with MSR Protocols
Address any additional Joint Dysfunctions
Evaluate how both local and global spheres of tensegrity may be influencing each other.
Take advantage of the Fascial Expansions provided with each MSR protocol to identify dysfunction lines that are preventing full resolution.
Apply additional MSR protocols to address issues in global dysfunctional lines.
Identify and address additional joint dysfunction.
By using and following this treatment algorithm, you will find that you are able to treat large numbers of structure within a short period, while providing optimal service to your patient.
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The Power of Motion Specific Release Fascial Expansions
Fascial expansions are one of the most powerful aspects of our MSR™ courses. Fascial expansions are included within each MSR™ protocol. You will find that by addressing restrictions related to fascial expansions, you can dramatically improve your clinical results.
Let’s take a few minutes to understand why fascia is so important, and why we need to consider fascia’s critical role in communication, how it contains a memory of our body’s history, and acts as both a tensional network.
Your body’s fascial network contains ten times the number of sensory nerve receptors as those in muscle. This includes many different types of sensory receptors including both myelinated proprioceptive endings (Golgi, Paccini, and Ruffini), as well as un-myelinated free nerve endings. Fascia is the body’s most important perceptual organ.
Our Fascia Contains Our History:
Our fascial network is like a written history of our life! Every injury or physical force we experience transmits mechanical forces throughout the body. These forces eventually produce transcriptional changes in the body that produce changes in our fascial architecture. These changes can cause imbalances, adhesion formation, thickening, or lack of mobility. We are literally talking about how mechanical forces initiate transcription – the process of making an RNA copy of a gene sequence.
The Tensional Network:
We can define fascia as “one interconnected tensional network that adapts its fiber arrangement and density according to local tensional demands.” [i] When fascial tension is in balance, fascia acts to distribute force throughout the body, and allows us to store and release energy for propulsion. When fascial tension is out-of-balance, hypertensive, or restricted, fascia can then be the source of various dysfunctions. In reality, your fascial network is the ultimate physical manifestation of a kinetic chain.
[i] Findley T, and Schleip R. (2009). Introduction. In: Huijing PA, Hollander P, Findley TW, and Schleip R, eds. Fascia research II. Basic science and implications for conventional and complementary health care. München: Urban and Fischer.
Dysfunctional Myofascial Lines
When the fascial web and its tensional network is out-of-balance, the body often compensates by developing ‘dysfunctional myofascial lines’. This is when you have remodeling (thickening) of fascial tissue due to early injuries, muscle imbalances, loading compensations, and stress.
To get a better idea of how these dysfunctional lines function, let us first consider some of the key aspects of fascia. To do this we must consider the cells that form our cartilaginous web, how they can transform different cells, and what role our nervous system plays in the body’s tensional network.
Fascia is a Living Matrix
Fascia is far from a simple arrangement of packing material surrounding our internal organs. Instead, fascia is a living matrix that surrounds, supports, and penetrates every muscle, tendon, ligaments, and bone, joint, cardiovascular, and neurological structure in the body. Fascia is a dynamic web that maintains tension for force transmission, shock absorption, and communication. These functions are intimately related to the special cells contained within the fascia.
Though these cells form just a small portion of the entire volume of fascial material, they play very important roles in the architectural design, repair, and even in setting fascial tension. These dynamic cells are called fibroblasts.
Schleip R, Findley TW, Leon Chaitow L, and Huijing PA. (2012). Fascia: The Tensional Network of the Human Body - E-Book: The science and clinical applications in manual and movement therapy. Canada: Elsevier
Fibroblasts are Important
Fibroblasts are important because they form the foundation of the fascial system. Fibroblasts are dynamic cells that can change in length (within moments) when fascial tissue lengthens under compressive loads. What is amazing about fibroblasts is that they don’t just change in structure, but they also have the ability to turn into other types of cells known as myofibroblasts. Myofibroblasts have the ability to contract, and can have a direct influence on fascial tension, which in turn influences force transmission, energy storage, and communication. The contractibility of myofibroblasts is four-times stronger than that of regular fibroblasts.
How Myofibroblasts are Formed
Myofibroblasts are formed when mechanical strain increases in the body. This could be as a result of injury, repetitive stress, muscle imbalances, or even a lack of physical activity. Myofibroblasts play both positive and negative roles. For example, myofibroblasts serve an important role in wound healing, but they also are involved in fascial contractures and scar-tissue formation in conditions such as Frozen Shoulder or Dupuytren’s contracture. 7
This is where it gets interesting! Research has demonstrated that there is a link between myofibroblasts, the sympathetic nervous system, and small proteins known as cytokines. Researchers have long speculated about an association between increased myofascial tension systemically (on palpation) and chronic states of anxiety (increased sympathetic nervous system activity). However, researchers initially did not understand the relationship that myofibroblasts have on increasing fascial tension and dysfunction.
The Correlation Between the Sympathetic Nervous System and Myofibroblasts
The correlation between the sympathetic nervous system and myofibroblasts is an interesting one. Initially, researchers hypothesized that increased levels of myofibroblast contraction was related to sympathetic neurotransmitters (epinephrine, adrenaline, and acetylcholine) but later this was found not to be true.
What researchers did find was that a cytokine call TGF-B1 (produced during increased sympathetic activity- stress) was the connecting factor. TGF-B1 results in a very high level of myofibroblastic contraction, which leads to increased myofascial tension and related dysfunctions. 7 [i]
This is really important from a practitioner's perspective. It means that by bringing the fascial system into balance, we could have systemic effect on myofibroblast activity - which in turn could decrease overall myofascial tension. [ii]
For example, by performing procedures such as the MSR™ Diaphragmatic Release (combined with supporting breathing exercises) our patients could quickly see a decrease in overall sympathetic nervous system activity. This could possibly provide considerable relief for many patients who suffer from chronic pain and a host of stress-related conditions.
[i] Stefano GB, and Esch T. (2005). Integrative medical therapy: examination of meditation’s therapeutic and global medicinal outcomes via nitric oxide (review). Int J Mol Med, 16(4), pp. 621-630.
[ii] Yahia LH, Pigeon P, and DesRosiers EA. (1993). Viscoelastic properties of the human lumbodorsal fascia. J Biomed Eng, 15(5), pp. 425-429.
Using Acupuncture Points in the MSR™ Fascial Expansions
One of the reasons we have added acupuncture points to the Fascial Expansions is its effectiveness in pain relief. In cases where there are myofascial restrictions, the fascia can become thicker and fibrotic, reducing overall mobility.
Thickening of the fascia directly affects the function of sensory nerves. The sustained stretching of connective tissue can also affect sensory nerve function. Releasing this tension over specific acupuncture points can achieve dramatic effects, not just locally, but systemically.
To research this theory, functional MRI studies were conducted on specific acupuncture points, and correlated with brain activity. In one study, a functional MRI of the brain was performed while stimulating the Large Intestine 4 (L4) acupuncture point (located on the web of the hand).
In this study, the data from the functional MRI demonstrated a deactivation of the brain's limbic system. Researchers concluded that acupuncture points, such as L4, can decrease the activity of the brain regions that respond to pain. On a clinical basis, I have personally seen dramatic changes in patients when I combine usage of specific acupuncture points with myofascial release techniques and appropriate osseous mobility procedures.
There is also some very interesting research coming out of Harvard University. Dr. Helen M. Langevin (a professor of Medicine and Director of the Osher Center for Integrative Medicine at Brigham and Women’s Hospital, Harvard Medical School, and a professor of neurological sciences at the University of Vermont) has found that more than 80% of standard acupuncture points in the arm are located along connective-tissue planes (fascial planes). [iii] [iv] There is still a great deal of research that needs to be done in acupuncture. But in my own clinical experience, using select points has made a huge difference in effectively treating a wide array of musculoskeletal conditions.
[i] Shen YF, and Goddard G. (2009). Functional MRI and Acupuncture (Large Intestine 4 Acupoint) in Patients with Myofascial Pain of the Jaw Muscles: A Pilot Randomized Trial. J Orofac Pain, 23(4), pp. 353-359.
[ii] Liu H, et al. (2013). fMRI Evidence of Acupoints Specificity in Two Adjacent Acupoints. Evidence-Based Complementary and Alternative Medicine, Volume 2013 (2013), Article ID 932581.
[iii] Langevin HM, and Yandow JA. (2002). Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec, 269(6), pp. 257-265.
[iv] Langevin HM, Churchill DL, Wu J, et al. (2002). Evidence of connective tissue involvement in acupuncture. FASEB J, 16(8), pp. 872-874.
Motion Specific Release Protocols Always Take Joint Mobility into Account
Joint mobility is a critical aspect that must be considered and used when resolving a musculoskeletal condition. Depending on your scope of practice, this would involve either mobilization or manipulation procedures. Addressing joint mobility is critical if you are to achieve the full positive effects of MSR™ protocols.
Impact of Injuries on Joint Function
TISSUE FAILURE & INJURIES
INJURY OR OSTEOARTHRITIS
In Joint Fluid
Adhesion Formation in the Synovial Folds of the Joint
Joints that become immobile are subject to several physiological changes. These include decreases in fluid content which in turn can cause a decrease in joint-fiber distance. This in turn causes increased fiber cross linkages, which can cause adhesion formation in the synovial folds of the joints. These adhesions cause a decrease in the strength of collagenous tissue, which can then cascade into tissue failure, even with diminished tissue loading.