ActiveReleaseTechniques-ARTJanLasotaMT/D.AC.lasota@sfim.dkHvadermanuelmedicin/terapi?AdvancedsofttissuetechniqueswhereTPandPTactivelyworktogether,ActiveReleaseTechnique(ART).Typicallyincluded:MET=muscleenergytechnique/therapy(US)MWM=mobilisationwithmovementFPR=facilitatedpositionalreleaseINIT=integratedneuromuscularinhibitiontechniqueOMT=osteopathicmanipulativetherapyPIR=postisometricrelaxationPNF=proprioceptiveneuromuscularfacilitationPR=positionalreleasePRT=positionalreleasetechniqueART-when?Ifthesofttissuesaretight,hard,hypertonic,shortenedorcontracted.Ifnormaltherapytriggerspain,spasm,inflammationorifthereisarelativelynewtraumaortriggeredmalaise.ART-whatisit?Aclusterofdifferenttherapies,whereyouinvolveschangingthepatientpositionorapartofanarea.Thiscanprovidesignificantfysiokalskresponse,whichmayrendermuskuskelletaledysfunction.Thesefavorablechangeswhichareacombinationofneurologicalandcirculatorychangestakingplacebyplacingpt.inthemostpainfreeposition.Jones(1981)-research(PRT)Joneswasthefirstwhodiscoveredaneffectivetreatmenttoapt.withtensionthatdidnotrespondtotreatment.Pt.couldnotsleepforpain.Jonestriedtofindthebestpossiblecomfortablepositionwhenhewassleeping.After20min.bytrialanderror,foundfinallyapositionwherethepainwasdiminishing.Heleftpt.forashorttimeinthisposition,andwasthenamazedpt.'spainwassignificantlydecreasing,whenhecameoutoftheposition.Thereliefwassustainedandpt.wasconstantlyimprovingwithouttreatment.

DynamicneutralWhenthereisalimitedROM,whetheritisarticul?rtormuscularcondition,therewillbeanewcenter.Typically,thispointbetweenthenewrestrictionandtheotherphysiologicalbarrier.Thepointiscalleddynamicneutral.Leadtodysfunction(tight/loose)DifferentresponseofmusclesunderstressMostresearchersinmanualmedicine,haveshownthatmusclesreactdifferentlyunderstress.Posturalmuscles(Positionmuscles),respondsbyshortening,becomestrongandthick.Thephasic(movingmuscles)willnotbeshortbutratherweak(inhibited).Therapy:Postural=MT,stretch,relaxation.Phasic=Enabledstrengthened.posturalmusclesmuscleChains1986showedJandatomusclesinteractinarealsystem,calledmusclechains.Theyare6differentmusclechainsviaafasciasystemisrootedinlove.Thiswilldependonthemusclesisofposturalorphasicnature,affectawidevarietyofasymmetriesthroughtheentiremusculoskeletalsystem.Kilde:Janda1986,Artikel:SomeaspectsofextracranialcausesoffacialpainTheuppercrossedsyndromeJanda,1986ThelowercrossedsyndromJanda,1986The6majormusclechainsTherearsuperficialline.Thefrontline.ThelaterallineSpiralline.Reararmlinie.Frontarmlinie.Therearsup.lineTheplantarfascia,chainsplantarsurfacesofthetoeswiththecalcaneus.gastrocnemius,chainscalcaneustothefemurcondyles.hamstrings,chainsfemoralcondylesfortubesischiadicum.sacrotuberousligament,chaintubesischiadicum.tothesacrum.Fascialumbodorsalis,erectorspineandbody.nuchae,chainssacrumtotheocciput.Fasciascalpchainsocciputtothefrontaledge.Therearsup.lineThefrontlineThefrontcompartmentandtibia,chainsthedorsalsurfaceofthetoestotuberossitastibia.Rectusfemoris,chainstuberossitastibiatoanteriorinferioriliacspineandthepubicbone.Rectusabdominisandalsothepectoralisandsternalfascia,chainsiliacspineanteriorinferiorandthepubicbonetothemanubrium.Sternocleidomastoid,chainsmanubriumwiththemastoidprocess.ThefrontlinelaterallineMm.peroneus,chainschainsthefirstandfifthmetatarsaltothecaputfibula.Tractusiliotibialis,tensorfascialataeandgluteusmaximus,chainscaputfibulawithiliaccrest.Externalobliques,internalobliquesand(deeper)quadratuslumborum,chainsiliaccrestwiththelowerribs.Externalintercostalsandinternalintercostals,chainsthelowerribswiththerestofribbende.Spleniuscervicis,iliocostaliscervicis,sternocleidomastoidand(deeper)scalener,chainsribbendethemastoidprocess.laterallineSpirallineSpleniuscapitis,throughanothercrossingopposite,chainsoccipitaledge(eg.Right)withspinousprocessesofthelowercervicalandupperthoracicproc.spinousontheleftside.Continueinthisdirectionrhomboideus(left)chainsviathemedialborderofthescapulawithserratusanteriorandrib(stillleft),revolvedaroundthetrunkviatheexternalobliqueandtheabdominalaponeurosisontheleftsideandconnectedtotheinternalobliqueontherightside,andfurthertoastrongpointoftheanteriorsuperioriliacspine(rightside).SpirallineFromSIAS,tensorfascialataeandtractusiliotibialislinkedtothelateraltibiacondyl.Tibialisanteriorchainsthelateraltibiacondylwiththefirstmetatarsalandcuneiform.Fromthisendpointchainwhichtransmitsviatheperoneuslongustothecaputfibula.Bicepsfemorischainscaputfibulatothetuberischiadicum.Equalssacrotuberalechainstubesischiadicumtosacrum.

Thesacralfasciaanderektorspinachainssacrumtotheoccipitaledge.SpirallinereararmlineAbroadstrokeofthetrapeziuschainsoccipitaledgeandthecervicalspinous

processustothespine,scapulaandclavicle.Deltoid,togetherwiththelateralintermuscul?reseptumconnectingthescapulaandcaviculawiththelateralepicondyl.Thelateralepicondylassociatedwiththehandandfingersbytendoncommuneextensor.Anothertrackfromthereararmliniestartsrhomboideusthatlinksthethoracicprocessus

transversitothemedialborderofthescapula.reararmlineScapulaislinkedtotheolecranonthroughtheinfraspinatusandtriceps.Olecranonlinkedsmallfingersperiodstonefromtheulna.A"stabilizer"inthereararmlinieinvolvingthelatissimus

dorsiandthoracolumbarfascialumbodorsalisthatconnectsthearmwithprocessus

spinousandthroughfasciaenthegluteusmaximus,whichattachestotheshaftofthefemurVastus

lateralischainsshaftofthefemurtothetibiatuberossitas.reararmlinefrontarmlineLatissimus

dorsi,teresmajorandpectoralismajorattachestothehumerusnearthemedialintramuscul?reseptum,andthroughitconnectedtotherearofthetrunk.Themedialseptumintramuscul?reconnectsthehumerustothemedialepicondylwhichisconnectedinthepalmandfingerstendoncommuneflexor.frontarmlineAnalternativelinefromfrontarmlinieinvolvingpectoralisminor,ligamentcostocoracoideus,itneurovascul?rebrachialbundleandfasciaclavipectoralis,whichfastensinprocessuscoracoideus.Processuscoracoideusisalsosourceofbicepsbrachii(orbrachial)chainsradiusandthumbthroughflexorcompartmentet.A"stabilizing"lineonthefrontarmlinieinvolvingthepectoralismajorisInséreronribbende,andobliquesexternus,whichrunsdowntothepubis.Fromherearisestheadductorlongus,gracilis,topesanserinus,themedialtibiacondyl.frontarmlineTechniquescovered:directtechniqueFunctionalart.Proprioceptivetaping.Canbeusedforshortenedpostural,hypertoniseredemuscles,creatingchainasymmetryandcancreatecontextdysfunction.RequirementsforeffectivePRTThereshouldbenoextrapainregardlessoftheareatreated;"Treats"pointdecreasesintendernesswithatleast70%;Noneworadditionalpainoccursaftertreatment.directtechnique(MarshMorrison(1969))Youpalpatethetenderpoints(tenderpoints),notnecessarilytriggerpoints.Locatedalongthetipoftheproc.transversi.Withagentlepull,feltthataftertheskin"Soapbarafterhim"asakindofresistance.Normally,therewillagainbeanTenderPoint.Theremayalsobeused,skinfoldroll.methodTenderpointsare.Thereispresseduntilyoufeelsoreness,withonethumb.Secondhandthenar,pressproc.spinoustowardsTenderPoint.Achieveatleast70%reductioninsoreness.(ifnosorenessshallbedealtwithonthesection.).Thepressureismaintainedforabout20sec.Nextpointisavailable.

functionaltechniquePt.`Sdynamicneutralexist.Theasymmetryisdetected.HypertonusfoundandTenderPointsorTriggerPointlocated.Ismovedtothemostpainlessbarrier,whichisalwaysoninhypertonus.Positionisheldin20-90seconds.Thereismovedbacktothenewdynamicneutral.PubodysfunctionandtherapyThepointlocated(approximately1cmfromthesymphysis

symphysis)andpainlevelrecordedunderpressure.Withyourotherhandmade??ondiseasedside,kneesandhoftefleksion,hipcompressionandsmalladduction.Positionisheldin20-90sec.PubodysfunctionandtherapyGluteusmediustherapyPt.liesonherback.Tenderpointsare;locatedatSIPS,slightlylaterallyandpainlevelrecordedunderpressure.Withyourotherhandgrippedtothekneeandtp.Makeanextension,abductionandslightlateralrotation.Positionisheldin20-90sec.GluteusmediustherapySubscapularisterapiPt.erliggendep?ryggen.Tenderpointfindes;liggervedanteriorlateralegr?nsep?scapula,ogsmerteniveauregistreresundertryk.Armenbev?gesiforskelligeretningerogderefterimedialrotation.Positionenholdesi20-90sek.SubscapularisterapiPectoralismajorterapiPt.erliggendep?ryggen.Tenderpointfindes;liggerveddenanterioraxillinieudforbrystet,ogsmerteniveauregistreresundertryk.Armenroteresmedialtogadduceresunderforskelligeniveauer,indtilsmerterneerreduceret.Positionenholdesi20-90sek.Pectoralismajorterapi?vretrapeziusterapiPt.erliggendep?ryggen.Tenderpointfindes;liggeranteriortellerposteriortvedparsdecendesvinklen,ogsmerteniveauregistreresundertryk.Pt.`shoveddrejestilsammeside.Overarmenl?ftesopogforkorterdervedmusklen.Derkanevt.trykkesindvedextremitasproximalehumerus.Positionenholdesi20-90sek.?vretrapeziusterapiSacraldysfunktionterapiDensacralebaseogmargofindes(tegn).Tenderpointfindesogm?rkes.Huskatmarkererforskellenmellemforamenogknoglepunkter,dadebehandlesforskelligt.Knoglepunkter:smerteniveauregistreresundertryk.Dertrykkesp?modsattehj?rneafsacralebasis,ogvinklen?ndresindtilsmerteniveaueteracceptabelt.Positionenholdesi20-90sek.Sacraldysfunktionterapi,foramenpunkterSmerteniveauregistreresundertryk.Sammesidesbenflekteresogfemurlateralroteres.Dertrykkesinferiorforcristailiaca,ogtrykketskalbev?gesienmedialogsuperiorretning.Positionenholdesi20-90sek.Costovertebraldysfunktion

(eleveretcostae).Pt.ersiddendep?lejet,ogterapeutenpalpererdetdysfungerendecostavertebralled.Pt.liggersignedmedbeggehofterogkn?flekteret,ogsmerteniveauregistreresundertryk.Pt.vipperbeggekn?f?rstdenenevejogderefterdenanden,ogholdesidenmestsmertefrieposition.Hovedetroteresf?rstdenenevejogderefterdenanden,ogholdesidenmestsmertefrieposition.Armenl?ftesidensygesideopoverhovedet,ogholdesidenmestsmertefrieposition.Positionenholdesi20-90sek.Nakkeproblemerdererfor?rsagetaf?ndedr?tsdysfunktion.Pt.?ndedr?tsfunktionregistreres.Etnormalt?ndedr?tskaludvidethoraxogikkemarkantl?ftesig.Vednogle,kandersesenmarkantkl?ftmellemclaviculaogtrapezius,somfor?gesunderinhalation.Dettetyderp?diagphramainhibition,somdervedoverbelastermm.splenius.Dissevilkompensatoriskindg?som?ndedr?tsmuskler.Behandlingaf?ndedr?tsdysfunktion(MET).Pt.sidderp?lejekanten,ogTp.st?rbagved.Tp.l?ggersinmedialfladeafh?ndkantenundernederstecostaebilateralt.Ogdrejerh?ndenindiabdomen,indtilTenderpointfindes,ogsmerteniveauregistreresundertryk.Pt.thoraxskubbesifleksionogabdomenvippesnedad.Positionenholdesi20-90sek.Lavtcervicalogh?jtthoracalekstensionssp?ndingerPt.errygliggende,ogTp.siddendeforendenaflejet.Tenderpointfindes;liggervedlangsspidsenafproc.transversus,ogsmerteniveauregistreresundertryk.Pt.bringestilekstension,ogdereftersideb?jning,rotationogkompressionindtildenmestsmertefripositionfindes.

Positionenholdesi20-90sek.Thoracalekstensionssp?ndinger.Pt.errygliggende,ogTp.siddendeforendenaflejet.Tenderpointfindes;liggervedlangsspidsenafproc.transversus,ogsmerteniveauregistreresundertryk.Pt.drejerhovedetmodsatognakkenb?jesovermodpunktet,derkanlavesenletkompression,indtildenmestsmertefripositionfindes.Positionenholdesi20-90sek.Lumbaloglavthoracalekstensionssp?ndinger.Pt.erliggendep?maven,ogTenderpointfindes;liggervedlangsspidsenafproc.transversus,ogsmerteniveauregistreresundertryk.Pt.′sbenl?ftes(kn?eterb?jet)ogbringestilabduktionindtildenmestsmertefriepositionfindes.Positionenholdesi20-90sek.Medialhamstringterapi Pt.liggerp?ryggenogTp.siddendevedsidenaflejet.Tenderpointfindesogsmerteniveauregistreresundertryk.

Benetflyttesudoverlejekanten,ogerdermedflekteret,ogensmuleabduceret.Derlavesenmedialrotationogsupinationifoden.Positionenholdesi20-90sek.MedialhamstringterapiLateralhamstringterapiPt.liggerp?ryggenogTp.siddendevedsidenaflejet.Tenderpointfindesogsmerteniveauregistreresundertryk.Benetflyttesudoverlejekanten,ogerdermedflekteret,ogensmuleabduceret.Derlavesenlateralrotationogpronationifoden.Positionenholdesi20-90sek.LateralhamstringterapiProprioceptivtapeningSammenmedbehandlingformm.asymmetriafis?rcolumnadysfunktioner,hardetvistsig,atbehandlingmedtapehenoverdenhypertoniseredemuskelers?rdeleseffektiv.