What exactly is fascia?
In 2007, the first World Congress on Fascia Research was held at Harvard Medical School in Boston, the first dedicated research on fascia. International Congress of Composition and Function. At this conference, fascia was formally defined as fascia is the fibrous connective tissue that spreads throughout the body.
If you have eaten chicken thighs, you can probably imagine. Fascia, like the translucent milky-white film between the meat and the skin when we eat chicken and push the meat apart, is what the fascia looks like. .
But it not only covers the muscles, it also covers our stomach and heart and other organs, and some of its characteristics are very similar to muscles It is full of water, can store energy like a spring, and even has the ability to partially contract. However, some parts are not the same. Muscles simply allow two bones to move, and may affect one or two joints, depending on where the muscles are attached, while fascia is a layer of dense connective that runs through the body. Tissue that can affect multiple joints through tension. Therefore, it may happen that the fascia of the fingers affects the tightness of the shoulders or the strength of the diaphragm affects whether the soles of the feet are flat or the thumbs are everted, etc.
In addition, fascia has 10 times more sensory receptors than muscle, In other words, it is more sensitive and more prone to pain than muscles. So when you’re inflamed or in pain, in addition to thinking about the muscles, you can also deal with the fascia.
Myofascia is like a tight suit, And elastic, it fits over your entire body and supports your daily activities.
What should we do if the fascia is abnormal? Correct stretching becomes a good way of treatment. The difference between fascia and muscle leads to different stretching of fascia and muscle. Muscle can be quickly elongated, but fascia cannot, only slowly. Elongate too quickly and may cause tearing. Our stretching is not just to make it longer, but to use resistance stretching as much as possible to change the flexibility of the fascia, change the internal arrangement of the fascia, and make the Disorganized fascia rearranges in the direction of tension – “comb out fascia” to improve or repair adhesions and damaged scar tissue. Wewe can alsouse the hands of a physical therapist to groom the fascia , release our tension and adhesion of the fascia, which is often said -the release technology of the fascia.
Front table line
span>1. Manipulation site: extensor retinaculum
patient Posture: Supine position, calf exposed on the bed surface;
Procedure:< span>The therapist puts both hands on the back of the foot, straightens the elbow joint, uses the body weight, pushes the hands up, and the patient cooperates to slowly dorsiflexion and plantar flexion of the ankle joint.
2. Manipulation site: tibialis anterior muscle
Patient position: Supine position, calf exposed on the bed surface;
Operation procedure: The therapist makes half fists with both hands, and the two fists form the surface Triangle, on the dorsum of the foot, straighten the elbow joint, use the body weight to push up the hands along the tibialis anterior muscle, and push the hands to the tibial tuberosity.
Patient position: Supine with head turned to unaffected side ;
Procedures:The therapist immobilizes the patient’s head with one hand, and the other half makes a fist on the sternoclavicular joint straighten the elbow joint and push up along the sternocleidomastoid muscle to the scalp fascia above the mastoid.
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“Posterior surface line
1. Manipulation site: Achilles tendon
patient Posture: prone position, feet exposed on the bed surface; operation procedure: the therapist’s index finger and second phalanx surface are respectively placed on both sides of the Achilles tendon and squeeze the Achilles tendon to slide down.
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Patient assessment:Standing, observe whether the patient has flat feet and high arched feet;
Patient position: prone position, feet exposed on the bed surface; operation procedure: The therapist puts both hands and half fists on the gastrocnemius muscle, straightens the elbow joint, and presses down the body at the same time, the patient cooperates to do The therapist’s hands slide down the gastrocnemius muscle while plantar flexing and flexing the ankle.
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Patient position: prone, knee flexed 90°; procedure: therapist’s hand The fingertips of the four limbs are placed between the medial and lateral heads of the hamstrings. The patient cooperates with the external rotation of the knee joint while the fingertips of the therapist’s operating hand slide.
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Patient assessment:Sit, instruct the patient to bow the head first, then flex the neck, thoracic, and waist in sequence Sacral spine, observe whether the movement of each segment is restricted.
Patient position: seated, Behind the patient, as shown in the figure, the patient cooperates to flex the spine section by section, and the therapist slides both elbows from top to bottom at the same time; after the operation, the therapist’s operating hand reminds the patient from bottom to top Stretch your spine.
strong>5. Manipulation site: occipital spine
Patient position: Supine position; operating procedure: The therapist flexes the fingers, puts the hands together, and places the tips of the fingers on the lower edge of the occipital tuberosity, instructs the patient to relax the whole body and place the head naturally on the fingertips of the therapist; then the tips of the fingers run along the cervical spine Swipe from bottom to top.
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Lateral line (lateral line)
1. Manipulation site: peroneal muscle< /p>
Assessment:Assess medial and lateral arch balance;
Therapist: extends or spreads the tissue according to body interpretation;
patient position:Lie on your side, with your feet out of the edge of the bed, and do plantar flexion and dorsiflexion;
Notes:< /strong>Place a pillow under the treated leg; distinguish it from the soleus.
Minor muscles
Patient position: side decubitus, knee flexion, hip flexion; Location: Midpoint between iliac crest and greater trochanter;
Procedure: Therapist holds the upper side with one hand leg while doing hip abduction/adduction, with the patient’s upper leg fully relaxed on the therapist’s arm. The therapist puts the other elbow against the anchor point and presses down slowly.
3. Gluteus medius, gluteus maximus
Patient position: side decubitus; span>
Operation procedure: The therapist uses the elbow joint to press against the muscles of various parts, presses down slowly, and the patient straightens the knee joint. Do internal and external rotation of the hip at the same time.
4. Manipulation site: internal and external oblique muscles
Patient position : lateral position;
Procedure:Therapist’s hands With fingers together, insert deep from the upper edge of the iliac crest, and pull the fascia below the iliac crest to both ends.
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5. Manipulation site: Abdominal and external oblique muscles
Assessment: Does the lower rib on the thoracic side move closer to the back of the pelvis (emphasis on the internal oblique muscle); does the lower rib on the thoracic side move forward (focus on the external oblique muscle);< /p>
Patient Position: Lateral;
Procedure:Therapist’s hands Half make a fist, press the tissue at the position of the iliac crest, press the elbow down, and complete the downward pressing and upward arcing motion. When lifting up, the tissue should be brought up to the direction of the rib, paying attention to the position of the top of the floating rib. inside and outside As you move, your body swings.
6 Trapezius
Patient position: lateral decubitus, shoulder internal rotation ;
Procedures:The therapist presses the upper side of the trapezius with half-clenched fists, presses down and lifts up, Be careful not to compress the arteries and trachea.
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(the quadratus lumborum is part of the anterior deep line, but problems are often found on the lateral line, so it is introduced here); Method 1:
Patient position: side decubitus, with hips and knees flexed;< /span>
Procedures:The therapist first finds the patient’s midline, stabilizes the patient’s waist with one hand, and straightens the other palm. Insert the fingertips posteriorly from the junction of the iliac spine and the midline of the body, and ask the patient to sit in the pelvic sink-up motion in the hip flexion position.
Method 2: strong>Patient position: Lateral position, hips and knees flexed;
Procedure:The therapist sits behind the patient’s pelvis, stabilizes the pelvis, first palpates to find the 12th rib, and then straightens and overlaps the palms, inserting downward and upward from the lower edge of the 12th rib.
Method three: strong>Patient position: Sit upright, feet flat on the ground;
Procedure:The therapist inserts the quadratus lumborum muscle from the side with both palms straight, causing the patient to flex the trunk left and right.
1. Static Body Rotation Assessment
< strong>Patient position:Stand with heels together;
Therapist:The thumbs of both hands were placed on the posterior superior iliac spine of the patient, and the line connecting the two thumbs and the two heels was visually checked to see if they were parallel.
2. Dynamic body rotation assessment
Patient position:Stand with heels together;
Therapist:Place both thumbs on the patient’s posterior superior iliac spine and rotate the patient’s torso to the left/right, respectively.
Notes:Observe the flexibility of spine rotation when the patient rotates, and keep the patient’s pelvis and lower limbs stable.
>3. Manipulation site: large and small rhomboidsPatient position: Sitting, feet on the ground;
Procedure:The therapist places both elbows on the patient’s medial border of the scapula, uses body weight to push down along the medial border of the scapula, and accompanies the patient Adduct/abduct the shoulder joint.
4. Manipulation site: serratus anterior< /span>Patient position: Sit with feet on the ground;
Procedure: span>The therapist locates the serratus anterior according to the body surface landmarks, pushes the interphalangeal joints along the lower border of the scapula toward the spine, and accompanies the patient to lift the chest.
5, treatment site Sideline
Patient Assessment: Feet hip-width apart, parallel forward, do In squatting action, whether the descending trajectory of the knee joint of the joint patient is along the vertical line of the second toe.
Therapist: Internal rotation of the knee joint (as an example of the left knee in the figure), the therapist steps on the back of the patient’s foot to fix it, holds the patient’s knee joint (upper edge of the patella) with both hands, and corrects the movement trajectory of the knee joint when the patient squatting with bare hands. Notes: The patient should continue to exert force regardless of flexion/extension of the knee.
6. Treatment site: Helical line posterior lower extremity line (short head of biceps femoris); Patient position: side decubitus;
< span>Operation procedure:The therapist’s four fingers are placed on the short head of the biceps femoris, and the patient cooperates with the knee extension/flexion movement.
1. Fascial release at the posterior tibialis muscle
patient Posture: Supine;
Assessment:Foot in and out
Treatment: the middle and lower 1/2 of the calf, with the four fingers of both hands facing each other, and the inner hand along the back of the tibia The edge is inserted, the lateral hand is inserted between the soleus and peroneus muscles to penetrate each other, and the patient is instructed to dorsiflexion/plantar flexion of the ankle, and the hands slide up and down to separate. If the foot is inversion, the inner hand slides down, the outer hand is staggered upward, and the foot is everted, the inner side is up and the outer side is down.
strong<600>2. Release of iliopsoas confluence
Patient position: Supine flexion with hip flexion and knee flexion ;
Assessment:Pelvic tilt;
Treatment:The fingers enter from the anterior superior iliac spine along the pelvic curve until the fingertips touch the iliacus muscle, and pass inward through the fascia between the iliac muscle and the psoas muscle , instruct the patient to flex the hip to feel the contraction of the psoas major muscle, and touch the inner side of the psoas muscle inward (to deal with the forward tilt of the pelvis, if the pelvis is backward, stay on the outside); the patient can use the heel to perform the backward tilt of the pelvis, repeat 3 times; Also allow the patient to exhale, straighten the ipsilateral leg along the bed surface, inhale and flex, repeat 3 times.
3, diaphragm release, promote respiratory function
Patient position: Supine; Assessment: Inspiratory and expiratory diaphragm activity; p>
Treatment:(1) With the palm facing upwards, insert the fingers under the rib arch to hold, and at the end of the exhalation, place the ribs parallel with the other hand downward Push, hold when inhaling, add force to the upper hand when exhaling, repeat 3 times;
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(2) The therapist places the hypothenar on the coracoid with one hand and the other hand at T5-6 on the side of the body. When exhaling, the upper hand pushes the foot side first—the lower hand pushes the thorax toward the center – Rotate the bottom of the palm to the side of the foot; return in turn when inhaling.
4, long head muscle, long neck muscle release
Patient position:Supine with hips and knees flexed;
Assessment: Presence or absence of head extension;
Treatment:Treatment The teacher is located on the patient’s head, and the fingertips are placed on the posterior border of the sternocleidomastoid muscle, which is the cervical triangle between the anterior border of the scalene muscle and the posterior border of the sternocleidomastoid muscle. touch to motor The fascia of the cylinder slides forward along the fascia of the scalene muscle until it touches the transverse process of the cervical spine. Remember not to apply pressure, it must be done slowly, stop if there are symptoms of brachial plexus irritation and changes in facial expression; instruct the patient to gently lift the head to straighten the cervical spine, and then lay it flat to feel the change in finger tension; The cervical vertebra is down, keeping the position, the patient’s heel presses the head slightly upward, and repeats 3 times.
Assessment and practice of anterior and posterior functional lines
Patient Position:Prone;
Assessment:The therapist places one hand on the distal humerus and the other hand on the distal femur of the opposite lower extremity, instructs the patient to extend the upper and lower extremities at the same time, and observes whether the upper and lower extremities of the patient are at the same time.
Exercise: The starting position is the same as the assessment position, and the patient is guided by hand to simultaneously release Force or first stimulate the limb that lags behind the force, pay attention to observe the quality of the action, and gradually increase the resistance.
1. Pectoralis minor fascia release
Patient position: Supine position;
Assessment:Patient with rounded shoulders and Inconsistent scapula height;
Treatment: The patient was placed on the bed in an external rotation and abduction position on the treatment side. The therapist touches the pectoralis minor muscle along the chest wall with the cephalic hand, and presses the touched muscle with the other hand, and the patient cooperates with the scapula adduction.
2, subclavian fascia
Patient position:Supine;
< strong>Assessment:Observe whether the movement of the sternoclavicular joint is limited when the patient performs shoulder level abduction;
Treatment:The therapist holds the patient’s upper arm on the treatment side with one hand, and the other hand touches the subclavian muscle along the lower edge of the clavicle with four fingers.
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Teres Major/Latissimus Dorsi Fascial Release
Patient position: lateral decubitus;< /span>
Assessment:Patient with limited shoulder abduction;
< strong>Treatment:The therapist uses crossed hands, one hand presses the teres major muscle with the metacarpophalangeal joint, the other hand supports the shoulder joint, and the patient cooperates with the shoulder joint abduction.
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>2. Teres minor fascial release
Patient position: prone
Location of teres minor:The midpoint of the line connecting the acromion and the posterior axillary border, touching the cord ;
Treatment: First, locate the teres minor muscle, hold it down with the thumb, and the patient cooperates with the shoulder joint abduction and medial Spin (similar to arm swimming motion).
3. Subscapularis/glenoid capsular release
Patient position: sitting;
Treatment:The patient’s arm is abducted 90 degrees on the affected side, and the four fingers of the therapist’s hand touch the axilla. The arm is lowered and relaxed, the other hand of the therapist presses over the shoulder joint, and the arm of the armpit touches the humeral head, and then gradually exerts upward, outward and downward force;
Notes:Shoulder joint Always pressurize the upper hand, do not use too much force on the treatment hand.