Sensory Receptors Supply CNS input on stimuli such as pain, touch, sound, light, heat and cold. Sound. They also initiate aberrant feedback loops and muscle imbalance patterns due to injured injured articular articular structures. Structures.
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Erik Dalton - Myoskeletal Alignment Techniques.pdf
Sensory Receptors Supply CNS input on stimuli such as pain, touch, sound, light, heat and cold. Sound. They also initiate aberrant feedback loops and muscle imbalance patterns due to injured injured articular articular structures. Structures.
Sensory Receptors Supply CNS input on stimuli such as pain, touch, sound, light, heat and cold. Sound. They also initiate aberrant feedback loops and muscle imbalance patterns due to injured injured articular articular structures. Structures.
Freedom from Pain Institute Myoskeletal Myoskeletal Alignment Alignment Techniques Techniques For Pain Management For Pain Management Sensory Receptors Sensory Receptors Rebels Without a Pause? Rebels Without a Pause? Research conclusions from ongoing studies: Research conclusions from ongoing studies: Soft tissues (previously viewed as purely mechanical Soft tissues (previously viewed as purely mechanical structures) are innervated and participate in active structures) are innervated and participate in active balancing of the spine. balancing of the spine. Specialized mechanoreceptors play major roles in Specialized mechanoreceptors play major roles in myofascial unwinding AND also initiate aberrant myofascial unwinding AND also initiate aberrant feedback loops and muscle imbalance patterns due to feedback loops and muscle imbalance patterns due to injured injured articular articular structures. structures. SENSORY RECEPTORS SENSORY RECEPTORS Supply CNS input on stimuli such as pain, touch, Supply CNS input on stimuli such as pain, touch, sound, light, heat and cold sound, light, heat and cold Categorized by specific physiological duties such as Categorized by specific physiological duties such as nociceptors nociceptors, mechano, chemo, thermo and , mechano, chemo, thermo and electromagnetic receptors electromagnetic receptors Transmit Transmit proprioceptive proprioceptive and and nociceptive nociceptive information information Change sensory stimuli into action potentials so the Change sensory stimuli into action potentials so the CNS continually receives data on the overall body CNS continually receives data on the overall body environment. environment. Muscle Joint Muscle Joint Reflexogenic Reflexogenic Relationships Relationships Is impaired muscle function the primary cause of Is impaired muscle function the primary cause of joint dysfunction, or is the reverse true? joint dysfunction, or is the reverse true? McLain 1994: McLain 1994: -- --Receptors monitor capsular tension Receptors monitor capsular tension -- --Receptors may initiate protective reflexes important in preventi Receptors may initiate protective reflexes important in preventing ng joint degeneration. joint degeneration. Grieve: Grieve: -- --Postural asymmetry joint blockage enhances fibroblastic activity Postural asymmetry joint blockage enhances fibroblastic activity resulting in resulting in periarticular periarticular tissue fibrosis. tissue fibrosis. Catch 22 Pain/Spasm/Pain Cycle Catch 22 Pain/Spasm/Pain Cycle Murphy: Murphy: -- -- Added that changes in spinal joint soft tissue fibrosis Added that changes in spinal joint soft tissue fibrosis alters the normal instantaneous axis of rotation alters the normal instantaneous axis of rotation How Joints Affect Muscles How Joints Affect Muscles Joints influence muscle tone and therefore Joints influence muscle tone and therefore muscle function. muscle function. The joints ability to alter muscle tone is The joints ability to alter muscle tone is mediated by mediated by articular articular receptors. receptors. In the joint capsule, the greatest number of In the joint capsule, the greatest number of receptors are found in regions subject to receptors are found in regions subject to variation of tension during movement. variation of tension during movement. Articular Articular receptors can inhibit or facilitate receptors can inhibit or facilitate muscle tone. muscle tone. 2 ARTICULAR RECEPTORS ARTICULAR RECEPTORS Freeman and Freeman and Wyke Wyke categorized categorized articular articular receptors into four types: Type I, II, III, and IV. receptors into four types: Type I, II, III, and IV. Each is stimulated in a distinctive way and responds to Each is stimulated in a distinctive way and responds to stimulation differently. stimulation differently. Type I and II mechanoreceptors act as physiological Type I and II mechanoreceptors act as physiological receptors/ active during normal movement. receptors/ active during normal movement. Type III and IV receptors normally inactive/ only Type III and IV receptors normally inactive/ only stimulated at extremes of movementmay function stimulated at extremes of movementmay function under pathological conditions. under pathological conditions. ARTICULAR RECEPTORS ARTICULAR RECEPTORS Ligament Ligament Innervation Innervation Jiang Jiang et al (1995) et al (1995) documented documented innervation innervation of human of human supraspinal supraspinal //interspinal interspinal ligaments from 10 spinal ligaments from 10 spinal decompression surgery patients. decompression surgery patients. Dense collagen bundles of Dense collagen bundles of Ruffini Ruffini corpuscles suggest corpuscles suggest active monitoring of mechanical joint loading and active monitoring of mechanical joint loading and provide static positional awareness for postural control. provide static positional awareness for postural control. Jaings Jaings findings support concept of ligaments as part of findings support concept of ligaments as part of neurologic neurologic feedback mechanisms for protection and feedback mechanisms for protection and stability of the spine. stability of the spine. Zygapophysial Zygapophysial Joint Joint Innervation Innervation Belief in Belief in zygapophysial zygapophysial joint pain dates back to joint pain dates back to 1933 when 1933 when Ghormley Ghormley coined the term facet coined the term facet syndrome. syndrome. Facet Facet innervation innervation is derived from the medial branch of is derived from the medial branch of the posterior primary division at the level of the joint the posterior primary division at the level of the joint and the levels above and below. and the levels above and below. Jeffries 1988 Jeffries 1988 suggested that this multilevel suggested that this multilevel innervation innervation is probably one reason why facet joint pain frequently is probably one reason why facet joint pain frequently has a broad referral pattern. has a broad referral pattern. McLains Facet Studies McLains Facet Studies McLain McLain dissected human cervical facet capsules from dissected human cervical facet capsules from three normal subjects to determine the type, density, three normal subjects to determine the type, density, and distribution of and distribution of mechanoreceptive mechanoreceptive nerve endings. nerve endings. Mechanoreceptors were found in 17 of 21 specimens Mechanoreceptors were found in 17 of 21 specimens McLain concluded the presence of McLain concluded the presence of mechanoreceptive mechanoreceptive and and nociceptive nociceptive nerve endings in cervical facet capsules nerve endings in cervical facet capsules proves that neural input from facets is important to proves that neural input from facets is important to proprioception proprioception and pain sensation in the cervical and pain sensation in the cervical spine. spine. 3 Whiplash and Facets Whiplash and Facets Barnsley Barnsley et al et al double double--blind, controlled diagnostic blind, controlled diagnostic blocks / Investigated cervical facets in 50 post blocks / Investigated cervical facets in 50 post--whiplash whiplash patients / Found facets were most common source of patients / Found facets were most common source of chronic neck pain. chronic neck pain. Bogduk Bogduk, Hirsch et al, and Yamashita et al , Hirsch et al, and Yamashita et al also also reported on rich reported on rich innervation innervation of facet joints. of facet joints. They concurred that altered They concurred that altered intersegmental intersegmental and and segmental joint motion and postural distortions create segmental joint motion and postural distortions create aberrant traffic in aberrant traffic in neuropathways neuropathways.. Cross Cross--talk perpetuates aberrant reflex alterations, talk perpetuates aberrant reflex alterations, muscular and muscular and ligamentous ligamentous alterations, inflammatory alterations, inflammatory responses and resultant pain syndromes. responses and resultant pain syndromes. Discogenic Discogenic Pain Pain Roofe Roofe (1940) (1940)--11 st st evidence of evidence of anulus anulus fibrosus fibrosus nerve nerve fibers. fibers. Bogduk Bogduk (1983) (1983)--nerve fibers in outer 1/3 of lumbar nerve fibers in outer 1/3 of lumbar anulus anulus fibrosus fibrosus.. Farfan Farfan (1973) (1973)--type 4 nerve receptors penetrating type 4 nerve receptors penetrating nucleus, nucleus, anulus anulus and posterior longitudinal ligament. and posterior longitudinal ligament. Shinohara (1970) Shinohara (1970)--nerve fibers penetrating degenerated nerve fibers penetrating degenerated discs nuclei. discs nuclei. Garfin Garfin (1995) (1995) --disc compression of normal nerve leads disc compression of normal nerve leads to to paresthesias paresthesias, sensory deficits and motor losspain is , sensory deficits and motor losspain is absent. absent. Wilberger Wilberger and the and the Silent Nerve Compression Syndrome Silent Nerve Compression Syndrome Wilberger Wilberger et al 176 et al 176 --lumbar lumbar myelographic myelographic herniated herniated discs in 108 asymptomatic patients. discs in 108 asymptomatic patients. Within 3 years, 64% developed Within 3 years, 64% developed lumbosacral lumbosacral radiculopathy radiculopathy.. Wilberger Wilberger hypothesizes that time was required for hypothesizes that time was required for mechanical deformation to cause this silent nerve mechanical deformation to cause this silent nerve compression syndrome. compression syndrome. 29 yr. old male 40 yr. old male Radicular Radicular Pain Pain FASCIAL PLASTICITY FASCIAL PLASTICITY Therapist hands often palpate a myofascial unwinding Therapist hands often palpate a myofascial unwinding as sustained pressure is applied to superficial and deep as sustained pressure is applied to superficial and deep myofascial layers. myofascial layers. Juhan Juhan attributed alteration in connective tissue attributed alteration in connective tissue resilience to what is commonly called resilience to what is commonly called thixotropy thixotropy or the or the gel gel--to to--sol phenomenon. sol phenomenon. Currier and Nelson Currier and Nelson--significantly more force, time significantly more force, time and heat must be generated in order to establish and heat must be generated in order to establish permanent connective tissue deformation. permanent connective tissue deformation. Oshman Oshman added piezoelectricity as a possible added piezoelectricity as a possible explanation for explanation for fascial fascial creep. creep. 4 Robert Robert Schleips Schleips Observations on Observations on Fascial Fascial Plasticity Plasticity Schleip Schleip concurred: these mechanisms may be a viable concurred: these mechanisms may be a viable explanation for long explanation for long--term tissue changes term tissue changes but but questioned their effectiveness for short term tissue questioned their effectiveness for short term tissue release experienced in clinic. release experienced in clinic. Schleip Schleip studies with anesthetized patients studies with anesthetized patients --in the in the absence of neural connection, short absence of neural connection, short--term term fascial fascial plasticity is lost. plasticity is lost. Schleip Schleip, , Pacinian Pacinian receptors are likely to be stimulated receptors are likely to be stimulated by high by high--velocity thrust manipulations as well as in velocity thrust manipulations as well as in vibratory techniques, whereas the vibratory techniques, whereas the Ruffini Ruffini endings may endings may be activated by slow and deep melting quality soft be activated by slow and deep melting quality soft tissue techniques. tissue techniques. Golgi Golgi tendon organs tendon organs Golgi Golgi tendon organs (GTOs) arranged in a series tendon organs (GTOs) arranged in a series respond to slow stretch by resetting a muscles length, respond to slow stretch by resetting a muscles length, inhibiting its synergistic stabilizers and facilitating its inhibiting its synergistic stabilizers and facilitating its antagonist. antagonist. Jami Jami 1992 1992 --passive myofascial stretching does not passive myofascial stretching does not stimulate GTOs. stimulate GTOs. Golgi Golgi tendon organs tendon organs Lederman 1997 Lederman 1997 --GTOs GTOs able to reset their able to reset their muscles length during muscles length during dynamic forceful dynamic forceful contractions. contractions. GTOs may serve a GTOs may serve a protective function by protective function by reflexively inhibiting its reflexively inhibiting its agonist at the end range agonist at the end range of joint motion. of joint motion. Nociceptors Nociceptors as Pain as Pain- -Generators Generators Nociceptor Nociceptor mechanical, thermal and chemical stimuli. mechanical, thermal and chemical stimuli. Nociceptor Nociceptor and chemoreceptor activation: and chemoreceptor activation: 1. 1. Nerve fibers depolarized by joint capsule mechanical stresses Nerve fibers depolarized by joint capsule mechanical stresses 2. 2. Thermal extremes Thermal extremes 3. 3. Inflammatory chemical agents such as histamines, Inflammatory chemical agents such as histamines, prostaglandins, prostaglandins, bradykinins bradykinins, potassium ions, and lactic acid. , potassium ions, and lactic acid. Nociceptors Nociceptors can quickly become major generators of can quickly become major generators of both myofascial and spinal both myofascial and spinal--pain syndromes. pain syndromes. Postural Control Postural Control Soft tissues within and Soft tissues within and surrounding spinal articulations surrounding spinal articulations are densely populated with are densely populated with sensory receptors. sensory receptors. Macro or Macro or microtrauma microtrauma may create may create joint misalignment and postural joint misalignment and postural distortions. distortions. Injured Injured articular articular structures initiate structures initiate and facilitate spinal reflex and facilitate spinal reflex pathways which increase pathways which increase contractibility in contractibility in paraspinal paraspinal musculature. musculature. 5 Nociceptors Nociceptors and Posture and Posture Long Long--term CNS agitation by irritated term CNS agitation by irritated nociceptors nociceptors causes the causes the brain to twist and torque the body in an effort to avoid pain. brain to twist and torque the body in an effort to avoid pain. Regrettably, the brain has the ability to memorize these aberran Regrettably, the brain has the ability to memorize these aberrant t postural patterns. postural patterns. Nociceptors Nociceptors and Posture and Posture Dysfunctional Dysfunctional patterns that persist patterns that persist long after the painful long after the painful stimulus has been stimulus has been removed are referred removed are referred to as to as neuroplasticity neuroplasticity reflex entrainment reflex entrainment or spinal learning. or spinal learning. Transversospinalis Transversospinalis Muscles are the body's primary movers and must Muscles are the body's primary movers and must respond quickly to changes from neural structures. respond quickly to changes from neural structures. When tight muscles pull unevenly on the bodys bony When tight muscles pull unevenly on the bodys bony framework, the joints axis of rotation and center of framework, the joints axis of rotation and center of gravity changes. gravity changes. Prolonged joint misalignment (loss of joint play) Prolonged joint misalignment (loss of joint play) agitates sensory receptors in spinal joint capsules, agitates sensory receptors in spinal joint capsules, ligaments, discs, and ligaments, discs, and transversospinalis transversospinalis muscles. muscles. Transversospinalis Transversospinalis Almost always pulls Almost always pulls insertion points toward origins when at work. As the TP insertion points toward origins when at work. As the TP are pulled toward the SP, localized rotation and are pulled toward the SP, localized rotation and sidebending sidebending occur. occur. Transversospinalis Transversospinalis Particularly stressed are mechanoreceptors embedded Particularly stressed are mechanoreceptors embedded in overstretched capsules and the part of the joint in overstretched capsules and the part of the joint bearing excessive weight. bearing excessive weight. GATING GATING Joint dysfunction results in muscle dysfunction by Joint dysfunction results in muscle dysfunction by changing gamma bias of spindle cells. changing gamma bias of spindle cells. Joint injury, degeneration, inflammation, or muscle Joint injury, degeneration, inflammation, or muscle guarding causes fewer guarding causes fewer mechanoreceptive mechanoreceptive fibers. fibers. As we age we lose mechanoreceptors = cant gate. As we age we lose mechanoreceptors = cant gate. Because Because nociceptors nociceptors are free nerve endings they are not are free nerve endings they are not as affected. as affected. This explains why a minor trauma can cause much This explains why a minor trauma can cause much pain or a major trauma can cause only minor pain. pain or a major trauma can cause only minor pain. 6 Co Co- -activating activating Nociceptors Nociceptors Warmerdam Warmerdam1999 1999 -- nociceptive nociceptive gating best gating best achieved by stimulation of low achieved by stimulation of low--threshold threshold mechanoreceptors near mechanoreceptors near nociception nociception origination. origination. Nociception Nociception originating from muscle = passive originating from muscle = passive massage, joint = dynamic stimulation produces massage, joint = dynamic stimulation produces more sensory gating. more sensory gating. Co Co- -activating activating Nociceptors Nociceptors Lederman (1997) Lederman (1997) found found that successful that successful nociceptive nociceptive gating gating requires that the stimulus requires that the stimulus be pain free or that the be pain free or that the gating movements take gating movements take place within a pain free place within a pain free range. range. Joint Techniques to Lower Pain Joint Techniques to Lower Pain- - Generating Stimuli Generating Stimuli Spinal soft tissue Spinal soft tissue manipulations that manipulations that initiate passive joint initiate passive joint movements result in movements result in mechanoreceptive mechanoreceptive stimulation. stimulation. Joint Techniques to Lower Pain Joint Techniques to Lower Pain- - Generating Stimuli Generating Stimuli This technique creates This technique creates presynaptic presynaptic inhibition of inhibition of the the nociceptive nociceptive afferent to afferent to diminish or abolish the diminish or abolish the perception of pain. perception of pain. Sandoz Sandoz restoring normal restoring normal joint structure /function joint structure /function helps normalize helps normalize mechanoreceptive mechanoreceptive and and nociceptive nociceptive input. input. Cutaneous Cutaneous vs. vs. Articular Articular Receptors Receptors Massage primarily stimulates Massage primarily stimulates cutaneous cutaneous receptors. Active or passive movements receptors. Active or passive movements primarily stimulate primarily stimulate articular articular receptors = less receptors = less joint pain. joint pain. Active client participation better gates Active client participation better gates articular articular nociceptors nociceptors.. Active (rather than passive) positioning Active (rather than passive) positioning improves improves proprioception proprioception since muscles are since muscles are allowed to play a larger role. allowed to play a larger role. Passive Passive Cutaneous Cutaneous Massage Release Massage Release 7 Active Active Articular Articular Release Release MUSCLE INHIBITION OR MUSCLE INHIBITION OR ATROPHY? ATROPHY? Janda Janda 1988 1988 Although muscle weakness has usually Although muscle weakness has usually been considered a result of decreased activity, been considered a result of decreased activity, inhibition may be an integral part of many, if not all, inhibition may be an integral part of many, if not all, forms of weakness. forms of weakness. Hurley (1997) Hurley (1997)-- muscle weakness muscle weakness-- two factors: two factors: 1. 1. Decreased number of Decreased number of extrafusal extrafusal muscle fibers muscle fibers 2. 2. A failure to activate all muscle fibers A failure to activate all muscle fibers A decreased number or size of A decreased number or size of extrafusal extrafusal fibers may fibers may be termed be termed atrophy atrophy, whereas failure to activate all , whereas failure to activate all muscle fibers may be termed muscle fibers may be termed inhibition inhibition.. MUSCLE IMBALANCE MUSCLE IMBALANCE PATTERNS PATTERNS Jandas Jandas Upper and Lower Crossed Syndromes Upper and Lower Crossed Syndromes --2 of 2 of most common aberrant postural patterns. most common aberrant postural patterns. Exposed to same stressors certain muscles become tight Exposed to same stressors certain muscles become tight and facilitated/ others weak and inhibited. and facilitated/ others weak and inhibited. Abnormal afferent information: Abnormal afferent information: painful or noxious stimuli painful or noxious stimuli CNS CNS malregulation malregulation psychological psychological (emotional) stressors (emotional) stressors poor posture poor posture excessive physical excessive physical demands demands joint blockage joint blockage habitual movement habitual movement patterns patterns Upper Crossed Syndrome Upper Crossed Syndrome Are the weak lower Are the weak lower shoulder stabilizers shoulder stabilizers solely responsible solely responsible for the aberrant for the aberrant forward head forward head posture seen in the posture seen in the upper crossed upper crossed syndrome? syndrome? Upper /Lower Crossed Syndromes Upper /Lower Crossed Syndromes Porterfield and Porterfield and DeRosal DeRosal -- forward posture factors forward posture factors other than scapular retractors stretch weakness. other than scapular retractors stretch weakness. weakness and lengthening of abdominal muscles allows the weakness and lengthening of abdominal muscles allows the chest to fall causing an anterior upper trunk weight shift. chest to fall causing an anterior upper trunk weight shift. As gravitation exposure pulls upper trunk forward on the rib As gravitation exposure pulls upper trunk forward on the rib cage, the scapulae externally rotate and protract cage, the scapulae externally rotate and protract forcing forcing clavicle to drop on the first rib. clavicle to drop on the first rib. The The clavicular clavicular head of head of pectoralis pectoralis major and hypertonic major and hypertonic latissimus latissimus dorsi dorsi internally rotate the internally rotate the humerus humerus forcing forcing the neck and head to follow. the neck and head to follow. Nociceptive Nociceptive Reflexes and Reflexes and Somatic Dysfunction Somatic Dysfunction Somatic Dysfunction Model Somatic Dysfunction Model-- restriction in mobility, autonomic, restriction in mobility, autonomic, visceral, and immunologic changes produced by pain visceral, and immunologic changes produced by pain--related related sensory neurons and their reflexes. sensory neurons and their reflexes. Nociceptor Nociceptor muscular guarding reactions and autonomic muscular guarding reactions and autonomic activation from stressed/damaged activation from stressed/damaged myoskeletal myoskeletal or visceral tissue. or visceral tissue. Guarding Guarding -- abnormal abnormal myoskeletal myoskeletal position and decreased ROM. position and decreased ROM. Local inflammatory responses and autonomic reflexes reinforce Local inflammatory responses and autonomic reflexes reinforce nociceptor nociceptor activity, maintaining restriction. activity, maintaining restriction. Nociceptive Nociceptive autonomic reflexes= visceral/immunologic changes. autonomic reflexes= visceral/immunologic changes. Abnormal guarding in muscles, joints, related tissues =changes i Abnormal guarding in muscles, joints, related tissues =changes in n connective tissues, solidifying the abnormal position. connective tissues, solidifying the abnormal position. Stretching tissues into normal range of motion may Stretching tissues into normal range of motion may restimulate restimulate nociceptors nociceptors, reinforcing the somatic dysfunction. , reinforcing the somatic dysfunction. 8 CONCLUSION CONCLUSION Patients benefit by restoring balance/function to all soft tissu Patients benefit by restoring balance/function to all soft tissue e structures. structures. A model for using receptor techniques to correct aberrant postur A model for using receptor techniques to correct aberrant postural al patterns is helpful in the clinical setting. patterns is helpful in the clinical setting. Impaired Neuromyoskeletal functions can cause stress, pain and Impaired Neuromyoskeletal functions can cause stress, pain and altered performance of internal organs, hormonal systems and altered performance of internal organs, hormonal systems and psycho psycho--immunological functions. immunological functions. Working with the sensory receptor system, trained therapists can Working with the sensory receptor system, trained therapists can determine if problems are primarily within muscles, fasciae or j determine if problems are primarily within muscles, fasciae or joint oint-- related tissues or if the problem exists elsewhere. related tissues or if the problem exists elsewhere. With assessment and treatment training, a therapist can more With assessment and treatment training, a therapist can more efficiently determine dysfunction sites and improve structure. efficiently determine dysfunction sites and improve structure. This leads to higher functioning in the self This leads to higher functioning in the self--regulating and self regulating and self-- protecting mechanisms of the body. protecting mechanisms of the body.
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