Myotherapy

Last updated

Myotherapy is a form of muscle therapy which focuses on the assessment, treatment and rehabilitation of musculoskeletal pain and associated pathologies. The term myotherapy was coined by Bonnie Prudden to describe a specific type of trigger point therapy which she developed in the 1970s based on the earlier work of Travell and Simons who researched the cause and treatment of pain arising from myofascial trigger points. While based on rational principles, there is little scientific research regarding the efficacy of this therapy, so it remains controversial within the medical and academic disciplines. [1]

Contents

Over the ensuing 40 years, myotherapy has evolved to become an allied health discipline which is practised in many countries across the world including the UK, Australia, [2] USA, Canada, Malaysia, and Thailand.

Myotherapy incorporates trigger point therapy and a wide range of soft tissue massage and manipulation including muscle energy technique, dry needling, and joint mobilization. Myotherapists also use stretching, nutritional advice, exercise prescription, postural advice and education, heat and cold therapy, ultrasound and TENS.

Definition

Myotherapy is a branch of manual medicine focused on the treatment and rehabilitation of musculoskeletal pain and associated conditions. It involves a physical evaluation and an integrated therapeutic approach to affected muscles, joints, nerves, and associated viscera (organs) and is used in the treatment of acute or chronic conditions and in preventative management. Myotherapy is a form of physical therapy treatment for most common musculoskeletal conditions that result from improper posture, poor biomechanics and injury.[ citation needed ] Myotherapy is defined as: "the comprehensive assessment, treatment, and management of neuromusculoskeletal disorders and conditions caused by improper biomechanical functioning." Myotherapists take into account all aspects of health and wellness to treat patients - this includes not only physical but psychological and occupational aspects of the individual.

Myotherapists are trained manual therapy professionals in the field of myofascial pain and dysfunction (pain that arises from the muscles and surrounding connective tissue). [3]

Myotherapists assess and treat the connective tissue (muscle, tendons, ligaments, joint capsules, tissue coverings) using mostly direct 'hands-on' techniques. Some myotherapists are also trained in the use of TENS machines, lasers, ultrasound, rehabilitation aids, taping, dry needling, and exercise prescriptions for rehabilitation.

Myotherapy treatments incorporate the following:

Myotherapy plays a role in manual medicine as a single mode of treatment, or is used in conjunction with treatment provided by both medical and other allied-health practitioners such as physiotherapy, podiatry, chiropractic, osteopathy, and acupuncture/TCM.

History

Myotherapy was developed by Bonnie Prudden, an American exercise and fitness expert and author of a number of books, including Pain Erasure. She created a new system of Manual Therapy based on the work of Janet Travell. Myotherapy is based on the research of Janet Travell and David Simons who established the neuro-physiological basis of myofascial pain and dysfunction, and has evolved to include the assessment techniques and treatment modalities.

Modalities

All modalities are used with the specific purpose of achieving a therapeutic outcome. None of these modalities were used by Bonnie Prudden, the developer of Myotherapy. She proposed only manual medicine based on trigger points and corrective exercise techniques. The use of muscle energy techniques, dry needling, joint mobilization, nutritional advice, heat and cold therapy, ultrasound and TENS are not a part of the practice of certified Bonnie Prudden myotherapists.

Soft Tissue Therapy is the use of the hands to target specific areas of dysfunction for the purpose of a therapeutic outcome. Techniques may include therapeutic massage, muscle energy techniques, neuromuscular techniques, positional release techniques, myofascial release techniques, trigger point therapy, lymphatic drainage techniques and joint mobilisation.

Temperature Therapies is the application of either heat (thermal therapy) or cold (cryotherapy). Techniques may include heat packs, cold packs, ice baths, whirlpools, heat lamps, and paraffin wax baths.

Electromechanical Stimulation is the application of electrical currents or soundwaves to produce a healing and/or analgesic (pain-modifying) outcome. Techniques include TENS therapy, interferential technique, therapeutic ultrasound and low level laser therapy.

Myofascial Dry-Needling (MDN) is the application of fine filiform needles (which are also used by but not exclusive to acupuncture) into specific points in the muscles known as trigger points, to produce a healing and analgesic (pain-modifying) outcome.

Myofascial Stretching is the application of a range of stretching techniques, used to elongate the muscle fibres, return functionally short muscles to their optimal length and increase the range of motion of a joint, leading to prevention of further injury. Techniques may include static stretching, dynamic stretching and proprioceptive neuromuscular facilitation stretching (PNF).

Rehabilitative Exercise and Corrective Actions are seen as central components of any myotherapy treatment. Proponents claim they enable the client to take responsibility for their own health, act to permanently change dysfunctional patterns, and prevent injury. Techniques may include core stability and Swiss Ball, hydrotherapy neuromusculoskeletal rehabilitative programs, biomechanical retraining, nutrition, injury prevention, and lifestyle education.

Effectiveness

In 2015 the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; "Massage therapy or myotherapy" was one of 17 therapies evaluated for which no clear evidence of effectiveness was found. [4] The report found that the overall quality of the trial was poor, although highlighted that there was moderate quality evidence of success with certain patients. The report concluded that "the effectiveness of massage therapy within this population remains uncertain. No studies were identified that assessed the effect of myotherapy in people with a clinical condition, and the effectiveness of this therapy is therefore unknown." [4]

Related Research Articles

<span class="mw-page-title-main">Temporomandibular joint dysfunction</span> Medical condition

Temporomandibular joint dysfunction is an umbrella term covering pain and dysfunction of the muscles of mastication and the temporomandibular joints. The most important feature is pain, followed by restricted mandibular movement, and noises from the temporomandibular joints (TMJ) during jaw movement. Although TMD is not life-threatening, it can be detrimental to quality of life; this is because the symptoms can become chronic and difficult to manage.

<span class="mw-page-title-main">Massage</span> Manipulation of the body through stretching and pressure

Massage is the rubbing or kneading of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In European countries, a person professionally trained to give massages is traditionally known as a masseur (male) or masseuse (female). In the United States, these individuals are often referred to as "massage therapists;" In some provinces of Canada, they are called "registered massage therapists."

<span class="mw-page-title-main">Osteopathy</span> Alternative medicine emphasizing muscle and bone manipulation

Osteopathy is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteopaths.

Rolfing is a form of alternative medicine originally developed by Ida Rolf (1896–1979) as Structural Integration. Rolfing is marketed with unproven claims of various health benefits. It is based on Rolf's ideas about how the human body's "energy field" can benefit when aligned with the Earth's gravitational field.

<span class="mw-page-title-main">Janet G. Travell</span> American physician

Janet Graham Travell was an American physician and medical researcher.

Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, massage therapists, athletic trainers, osteopaths, and physicians.

<span class="mw-page-title-main">Myofascial trigger point</span> Medical condition

Myofascial trigger points (MTrPs), also known as trigger points, are described as hyperirritable spots in the skeletal muscle. They are associated with palpable nodules in taut bands of muscle fibers. They are a topic of ongoing controversy, as there is limited data to inform a scientific understanding of the phenomenon. Accordingly, a formal acceptance of myofascial "knots" as an identifiable source of pain is more common among bodyworkers, physical therapists, chiropractors, and osteopathic practitioners. Nonetheless, the concept of trigger points provides a framework which may be used to help address certain musculoskeletal pain.

Myofascial release is an alternative medicine therapy claimed to be useful for treating skeletal muscle immobility and pain by relaxing contracted muscles, improving blood and lymphatic circulation and stimulating the stretch reflex in muscles.

Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain in multiple myofascial trigger points ("knots") and fascial constrictions. It can appear in any body part. Symptoms of a myofascial trigger point include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure.

Counterstrain is a technique used in osteopathic medicine, osteopathy, physical therapy, massage therapy, and chiropractic to treat somatic dysfunction. It is a system of diagnosis and treatment that uses tender points, which are produced by trauma, inflammation, postural strain, or disease, to identify structures to manipulate. The manipulation uses light pressure to decompress the local nociceptors and mechanoreceptors responsible for the sensation of pain, returning central sensitization to its normal state. This technique extends Strain-counterstrain, a technique inhibits the reflexes by putting the tissues in a position of ease directly opposite to that of the reflex. Strain-counterstrain is also known as the Jones technique,, and spontaneous release by position. Counterstrain was developed by Lawrence Jones in 1955 and was originally called “Spontaneous Release by Positioning,” before being termed “strain-counterstrain.”

Dry needling, also known as trigger point dry needling and intramuscular stimulation, is a treatment technique used by various healthcare practitioners, including physical therapists, physicians, and chiropractors, among others. Acupuncturists usually maintain that dry needling is adapted from acupuncture, but others consider dry needling as a variation of trigger point injections. It involves the use of either solid filiform needles or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome. Dry needling is mainly used to treat myofascial trigger points, but it is also used to target connective tissue, neural ailments, and muscular ailments. The American Physical Therapy Association defines dry needling as a technique used to treat dysfunction of skeletal muscle and connective tissue, minimize pain, and improve or regulate structural or functional damage.

Therapeutic ultrasound refers generally to any type of ultrasonic procedure that uses ultrasound for therapeutic benefit. Physiotherapeutic ultrasound was introduced into clinical practice in the 1950s, with lithotripsy introduced in the 1980s. Others are at various stages in transitioning from research to clinical use: HIFU, targeted ultrasound drug delivery, trans-dermal ultrasound drug delivery, ultrasound hemostasis, cancer therapy, and ultrasound assisted thrombolysis It may use focused ultrasound (FUS) or unfocused ultrasound.

Canine massage is a branch of massage therapy that promotes health in dogs. Specifically, canine massage therapy is a form of alternative therapy the benefits of which may include relaxation, increased oxygenation, relief from pain, improved joint flexibility, as well as miscellaneous benefits to the immune system. It uses touch to maintain or improve both physical and emotional well-being. However, be careful and make sure to consult with your vet before attempting to massage your dog yourself.

Dentomandibular sensorimotor dysfunction (DMSD) is a medical condition involving the mandible, upper three cervical (neck) vertebrae, and the surrounding muscle and nerve areas.

Fu's Subcutaneous Needle (FSN), invented by Dr. Zhonghua Fu in 1996, is an innovation for the treatment of myofascial pain and trigger points based on the research and clinical findings of Dr. D. Simons and Dr. Janet G. Travell.

The Bad Ragaz Ring Method (BRRM) is a type of aquatic therapy used for physical rehabilitation based on proprioceptive neuromuscular facilitation (PNF). BRRM is a water-based technique in which therapist-assisted strengthening and mobilizing exercises are performed while the patient lies horizontally in the water, with support provided by rings or floats around the neck, arms, pelvis, and legs.

Fascia training describes sports activities and movement exercises that attempt to improve the functional properties of the muscular connective tissues in the human body, such as tendons, ligaments, joint capsules and muscular envelopes. Also called fascia, these tissues take part in a body-wide tensional force transmission network and are responsive to training stimulation.

<span class="mw-page-title-main">Forward head posture</span> Spinal condition

Forward head posture (FHP) is an excessively kyphotic (hunched) thoracic spine. It is clinically recognized as a form of repetitive strain injury. The posture can occur in dentists, surgeons, and hairdressers, or people who spend time on electronic devices. It is one of the most common postural issues. There is a correlation between forward head posture and neck pain in adults, but not adolescents.

Fascial Manipulation is a manual therapy technique developed by Italian physiotherapist Luigi Stecco in the 1980s, aimed at evaluating and treating global fascial dysfunction by restoring normal motion/gliding to the system.

Rounded shoulder posture (RSP), also known as “mom posture”, is a common postural problem in which the resting position of the shoulders leans forward from the body’s ideal alignment. Patients usually feel slouched and hunched, with the situation deteriorating if left untreated. A 2022 study concluded that 73% of workers aged 20 to 50 years have a right rounded shoulder, and 66% of them have a left rounded shoulder. It is commonly believed that digitalisation combined with the improper use of digital devices have resulted in the prevalence of sedentary lifestyles, which contribute to bad posture. Symptoms of RSP will lead to upper back stiffness, neck stiffness and shoulder stiffness. It can be diagnosed by several tests, including physical tests and imaging tests. To prevent RSP from worsening, maintaining a proper posture, doing regular exercise, and undergoing therapeutic treatments could be effective. If the situation worsens, patients should seek help from medical practitioners for treatments. If RSP is left untreated, chronic pain, reduction in lung capacity and worsened psychosocial health are likely to be resulted.

References

  1. Vagg, Michael (October 3, 2012). "Myotherapy: panacea or placebo?". The Conversation. Archived from the original on 2 June 2017. Retrieved 23 July 2017.
  2. "Myotherapy". State Government of Victoria. Archived from the original on 14 December 2012. Retrieved 25 August 2012.
  3. "Myotherapy Melbourne". Motion Myotherapy. Archived from the original on 28 May 2019. Retrieved 28 May 2019.
  4. 1 2 Baggoley, Chris (2015). "Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance" (PDF). Australian Government Department of Health. Archived from the original (PDF) on 2019-12-02. Retrieved 2019-12-31.

Further reading