Therapeutic methods

Fascial Manipulation was developed by Italian physiotherapist Luigi Stecco, who for 40 years of clinical practice and profound study of human anatomy and physiology developed an extremely effective and coherent therapeutic system. The author noted that certain places in the body show great tactile pain if the consistency of tissues in this region is altered and the restoration of proper slip between these tissues (manipulation) causes reactions in distant regions of the body. It took many years to develop a map of those points which (and there is nothing strange about that) mostly coincide with acupuncture points. He called these points the Coordination Centres (CC) and Merger Centres (CF). Stecco came to the conclusion that these special places lie on the tension line of the fascial system which is a “transmission band” for the propagation of mechanical compensation and pain radiation in our body. The method therefore takes into account a holistic approach to the body, treating its individual segments as individual links in the tissue chain whose continuity is provided by the fascia. The selection of points for manipulation is made according to specific rules – based on motor and palpation verification. A detailed history is an extremely important element that guarantees effective therapy. Another aspect that underlines the uniqueness of this concept is its extraordinary therapeutic effectiveness, which in just a few visits allows to solve many problems of patients, treated in a classical manner for years.

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The Muscle Chain Method was developed by Godelieve Denis-Struyf, a Belgian physiotherapist and osteopath. It is a therapeutic work method which forms a basis for an individualized approach to the patient. It combines rehabilitation, physiotherapy, health care, prevention of problems without neglecting the aspect related to the human psyche and behaviour. The concept of the Muscular Chains of Mrs. Godelieve Denys- Struyf is an approach to the psyche and body and, due to this fact, it has different faces. The method offers a manner of observation, measurements, tests, rigorous analyses and interpretation and a wide range of therapeutic tools. All parts of the body depend on each other and the muscles and their areolae form chains and connect the body parts between them. The muscles are also tools of psycho-bodily expression: our state of tension, our emotions, feelings and ways of being expressed through the myofascial system which affects posture, breathing and gestures. When the tensions or behaviours are repeated and prolonged, there is an excess of muscle tension which is located and progressively covers more and more specific regions until real stretches of myofascial tension are induced in the body. This mechanism gradually determines a series of joint movements, which we refer to as joint sequence. The method offers a wide range of techniques to fulfil the need to adapt to the situation of which the therapist is a part. Regardless of the technique used, this method is always based on an excellent knowledge of anatomy and physiology.

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Muscle Energy Technique – MET

It is a set of methods having their origin in orthopaedics, physiotherapy and chiropractic using the patient’s effort in various ways to eliminate disorders within soft tissues. Muscle Energy Techniques can be used when: we observe muscle hypertonia, muscle and connective tissue spasms, spasticity, muscle physiological weakness, local swelling, venous stasis, joint mobility restriction due to soft tissue dysfunction. These techniques can be used both in very sick patients with acute pain conditions and in chronic patients, e.g. in rheumatic diseases or osteoporosis.

Active Release Techniques

They belong to the methods of manual medicine that focus on eliminating abnormalities within soft tissue such as adhesions, excessive muscle tonus, muscle and connective tissue spasms. They are among the most effective methods in eliminating these abnormalities. They are an achievement of recent years in manual medicine. They are often combined with the Techniques of Myofascial Release or Muscle Energy Techniques and they are extremely effective. The technique involves maintaining constant pressure or blocking of tissues, while at the same time active tissue stretching is performed. There are three types of active release techniques: Passive: the therapist maintains pressure on the tissue and moves the part of the body to be released. This form is very relaxing and causes great release. Active: The therapist exerts pressure and the patient moves the body towards the performed stretching direction. It is more intense but sometimes better tolerated by the patient, especially in terms of pain (self-control of movement). It can be combined with resistance to movement or Muscle Energy Techniques. In the joint load position: it is very effective in restoring full tissue function, e.g. in athletes. It is often performed in eccentric work. It should be performed at the end of the treatment process.

Myofascial release

MR techniques are one of the latest therapeutic methods in manual medicine. They focus on working with the myofascial system. These techniques improve internal mobility of soft tissues, especially the fascia. Living tissue has an internal ability to move, resulting from rhythmic changes in muscle tone and internal body rhythms (spasms of blood vessels, bowel movements, breathing, muscle spasms, eyeball movements, etc.). The activation of forces in MR techniques takes place directly and indirectly. They are both internal and external. Internal forces are associated with the physiological movements of living tissue mentioned above. The external forces are related to the delivery of mechanical energy by the therapist through pressure, traction, twisting, stretching which adequately affect the soft tissue, changing its biomechanical properties and inducing reflex movement. They are linked by the main goal of manual medicine, which is to achieve a symmetrical, painless range of movement of the musculoskeletal system.

Positional release

This method was developed in the 1960s by Jones, the osteopath, who observed that placing the joint in the position of maximum release and maintaining this position for 20-120 seconds results in a radical improvement in the range of joint movement and reduction of its pain. Jones believes that placing the joint in the direction where muscle tension is reduced causes the release of hypertonic muscles as a result of reduced nociceptive stimulation and thus changes the activity of muscle spindle receptors and improves the blood supply of ischemic and hypertonic muscles. The therapist searches for the most sensitive point and, by controlling it with his finger, he puts the patient’s body in a position so that the point disappears or decreases to 2 points (in a subjective pain scale from 0 to 10) and maintains this position for 90 seconds.

Trigger Point Therapy

Trigger point therapy is a technique that uses different forms of pressure and movement in sensitive regions of muscle tissue. The aim of the therapy is to free oneself from pain and improve the disturbed movement patterns. The trigger points are sensitive areas in the muscles with increased tension, which are painful under pressure and cause radiating pain and other symptoms in regions of the body distant from the irritation site.

Deep Tissue Massage

It is a form of therapy focused on restoring proper tension to deep layers of muscle and connective tissue. By releasing, lengthening, eliminating adhesions and releasing persisting patterns of abnormal tension in tissue systems – it reduces pain, improves flexibility and fluidity of movement and restores the proper range in the most effective and least stressful way.

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During the physiotherapeutic examination an individual patient’s problem is assessed. Our therapists work on specific elements related to this problem later. But what can be done to make the effects of the therapy last very long? How to strengthen the results of the therapy? And finally, how to prevent the recurrence of problems? The answer to all these questions is self-therapy. Self-therapy is an individually tailored exercise that is easy to do at home and is mainly based on the method of post isometric relaxation (PIR) but it also involves various positions stretching individual muscles or entire anatomical bands. Self-therapy together with postural education forms an important factor supplementing the treatment process and ensuring its long-term results. Therefore, therapeutic success also depends to some extent on the level of patient motivation.

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PNF method  is a concept with its own philosophy and principles of working with the patient. Based on the anatomical structure of a human being, it proposes natural, three-plane movements, similar to everyday activities. The basic aim of the therapy is to work on the function the patient needs. This concept recommends to perceive the patient in a holistic manner, using strong and healthy body regions for therapy. The aim of the therapy is to restore movement patterns such as proper walking and sitting, using techniques that stabilize, release, relieve the pain and teach movement and coordination. The essence of the PNF method is to maximally stimulate the exteroreceptors and proprioreceptors located in the body and the various spheres of the cerebral cortex in order to facilitate (pave) movement in the damaged region. Muscle strength, range of movement – what is important in traditional therapeutic management forms only a mean to achieve the goal of function. This concept recommends to perceive the patient in a holistic manner using strong and healthy body regions for therapy. This enables the full use of the body  reserves.

It motivates to undertake further actions and, most importantly, ensures painless work without psychologically and physically traumatizing sensations. The patient should be a partner of the physiotherapist defining the scope and limits of action. He sets the goals of the therapy. The therapist has an advisory role in this case. Due to this approach, the patient, even with a severe dysfunction, retains good motivation and is positively inclined to cooperate with the therapist.

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Manual Therapy (OMT) deals with: diagnosis and treatment of structural disorders of the locomotor system (joints, muscles, nerves). Due to the extensive differential examination scheme, the physiotherapist is able to find the abnormal structures, confirm the degree of their damage and analyse the mechanisms of the appearance of ailments basing on a detailed history taken and performed examination. Thus, the therapist formulates a hypothesis of a structural disorder in the patient. The cause of the ailment often lies in the disproportion between the ability of the tissue to absorb the load and its actual load. The treatment consists in abolishing this disproportion and restoring physiological “symbiosis” between joints, muscles and nervous structures. The following techniques are used as treatment: joint mobilization, neuromobilization of nerve structures, treatment of soft tissues (i.e. muscles, ligaments, tendons), as well as medical functional training with training devices adapted to patients’ problems.

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The objective of sensorimotor training is the combined improvement of the exteroreceptors and proprioreceptors with the motor system and stimulation of their proper integration in the central nervous system. The therapy uses various sensorimotor tools such as: balls, hand strengthener, tapes.

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The overriding goal of the McKenzie method is to restore the full function of the disturbed structures and thus protect the patient from the next occurrence of the pain problem. After a proper education of the patient, this method allows to deal with the pain individually. The author of the method has developed a program of therapeutic management, in which, in addition to the techniques performed by the therapist, the patient’s own movement, exercises and self-therapy performed at home are important. The exercises mostly involve low and recumbent positions. Active movements are repeated many times in different planes but in a strictly defined direction that does not cause pain. Great importance is attached to recommendations that protect the spine against further injuries and overloading. McKenzie places great emphasis on prevention.

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Kinesiology Taping is a method that allows to achieve excellent therapeutic results through the sensory action of a special tape. The aim of this therapy is to use the body’s natural self-healing processes which start with the skin and muscles. By appropriate application of the tape, kinesiology taping reduces pathological muscle tension, facilitates their function, improves microcirculation, activates the lymphatic system and supports the function of joints. It works in accordance with the functioning of the body for 24 hours a day, and not only during a therapeutic session.

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