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Manual Therapy

Many of the following manual therapy techniques treat the fascia and are used regularly within our practice.


Why treat the fascia?

3D render of a male medical figure running with partial muscle map

The fascia is a network of connective tissue that holds the body together. It provides support for the joints, muscles, blood vessels and nerves and is continuous from head to toe. Fascia provides stability without it we would collapse. It creates the lubrication to allow frictionless motion and provides the substances that contribute to the immune system. Research has also shown that fascia is embedded with nerve endings, smooth muscle cells and specialised “myofibroblasts” to allow it to contract. When fascia holds this contraction in a protective reflex, dysfunction and pain often result.

Commonly used fascial techniques


Counterstrain (SCS)
cranisosactralCounterstrain is a manual therapy technique directed at the neuro-muscular and neuro-fascial elements in the body. It’s thought to relieve pain by switching off protective reflexes created within the nervous system during trauma. Dysfunction is identified by locating tender points in the muscular and fascial tissues. Having located a tender point, the practitioner takes the tissue into the direction that allows it to release its tension and the tender point is felt only as pressure rather than exquisite pain. This position of maximum ease is held for 90 seconds and then returned slowly to a neutral position to not “switch back on” the protective reflex. If the technique has been successful, the tender point will be markedly less painful, the tissue will hold less tension and the barrier to motion will be significantly reduced.
Visceral Manipulation (VM)
Visceral-ManipulationIs a manual therapy technique similar to MFR which focuses specifically on the fascia associated with the internal organs (viscera). When the body is healthy, viscera move in a synchronous manner. If there’s abnormal fascial tone or scarring, a source of chronic irritation may be established which creates a point the body distorts around during diaphragmatic and voluntary movement. Irritation produced by this abnormal motion may feed back to the spinal cord along the visceras nerve and muscles receiving the same nerve supply will also become irritated creating pain and spasm (viscerosomatic reflexes). The visceral related tissue tension abnormalities can be felt with light hand palpation as a pull into the restricted area. Treatment is applied by using very specifically directed light forces (similar to direct MFR) to encourage normal movement patterns.
Myofascial Release (MFR)
pro-065 (1280x813)Myofascial Release (MFR) is a manual therapy which focuses on the fascia of the musculoskeletal system. Where acute injury or recurrent microtrauma occurs, the fascia responds by inflammation which can lead to the formation of scar tissue. The surrounding fascial tissues may distort to unload this irritated region creating patterns of imbalance in related muscle groups. Some muscles may get progressively tighter and stronger while the opposite muscles become longer and weaker further perpetuating the fascial distortion pattern. Direct MFR techniques loads the myofascial tissues with a constant tension while indirect MFR techniques guide the tissues into the direction of ease. If successful, a neuro-reflexive release occurs producing greater motion and less pain in the tissues.
Craniosacral Therapy (CST)
Craniosacral-TherapyCraniosacral Therapy (CST) is a manual therapy which focuses on the craniosacral system which regulates the creation and outflow of cerebrospinal fluid (CSF). Research has shown that the skull joints (cranial sutures) maintain slight mobility throughout life. A slight expansion of the cranium occurs as the brain tissues produce CSF and the cranium narrows to its original size as this CSF exits the cranium to provide nutrition to the rest of the nervous system. This subtle rhythm can be palpated as motion of the cranial bones and sacrum. Motion restriction can result from distortion in the cranial fascia (dura mater) and can be corrected by applying light forces to balance the fascial restrictions. As the dura mater is continuous with the fascial and neuroendocrine systems of the body, CST can have a significant effect throughout the whole body.


Other manual therapy techniques used


Muscle Energy Technique (MET)

Muscle Energy Technique (MET) Is a manual therapy technique directed at the neuro-muscular element of the musculoskeletal system. It’s thought that one group of muscles surrounding a joint holds a spasm as a result of trauma. This results in increased tension on one side of a joint causing mal-tracking and a restrictive barrier in the direction that stretches the spasmed muscles. With MET, the practitioner puts slight tension on the spasmed muscles and asks the patient to exert a gentle isometric muscle contraction. After ceasing the muscle contraction, the practitioner moves the joint further into its restricted range to the new restrictive barrier, repeating this procedure several times to remove the barrier and allow normal joint motion.

Articulatory and Manipulative techniques

Articulatory and Manipulative techniques are manual therapies directed at the joints within the musculoskeletal system. Articulatory techniques are repetitive oscillations applied to a joint into the direction of the restrictive barrier. Its purpose is to increase range of motion and stretch the connective tissue surrounding the restricted joint. Manipulative techniques are similar except instead of oscillating the joint, a gentle thrust is applied. It’s thought that this creates a period of electrical silence in all muscles surrounding the joint allowing the central nervous system to correct tone imbalances within these muscles resulting in increased joint range and reduction of pain.

Soft tissue techniques

Soft tissue techniques are manual techniques which focus on the muscular and fascia of the musculoskeletal system. Incorporating massage, stretching and ischaemic pressures, the therapeutic goal is to reduce muscle spasm, fluid congestion and tissue immobility.