Wednesday, July 15, 2009

A specific manual therapy technique called “Muscle Repositioning or neuro-myofascial release” mimic the action of pandiculation.




Pandiculation (whole body stretch)

We like to stretch our whole body after getting off the bed which usually comes with a yawning. This stretch is different form the regular stretching exercise we do. Noteworthy is the difference between the pandiculation-type stretch, which arises spontaneously, is pleasurable and increases joint stability, with the regular stretching, which is produced by a volitional action, may produce displeasure and joint instability (because of this, stretching has been contraindicated before physical activity).

Pandicular stretching activity is remarkably reduced after spine & proximal appendicular pathologies (Luiz Fernando Bertolucci).

Following is more on the description of Pandiculation form following site: http://www.baillement.com/stretching-fraser.html.

The symmetrical, coordinated stretching and stiffening actions of the body as one unit is true pandiculation. This action typically occurs in man and animals alike, as an exertion which sweeps wavelike through the subject's' main articular parts, extending them distally. In each pandiculation there is a chain of actions, notably of the head, neck and limbs which are coordinated in stretching; yawning is sometimes involved among these articular extensions. Pandiculation is, in fact, a very characteristic phenomenon with overall stretching as its core. Modern neuroethology has shed light on the physiological background.

Possible functions of pandiculation: Because pandiculation is seen animal kingdom & also in developing human fetus it is believed to have a role in the development and maintenance of the musculoskeletal system (Fraser & Walusinski). According to Luiz Fernando Bertolucci (a physiatrist, a rolfing specialist & a researcher) pandiculating helps maintain the integrative function of the fascial system by:

(a) Mechanical signaling the connective tissue metabolism (mechanotransduction) to reinforce the collagen links that unites the segments to one another, as when one pandiculates,
(b) Redistribution of free water (water that can flow) in the extracellular matrix.

This latter effect stabilizes the joints and thus also increases the degree of integration, among other hypothetical mechanisms.

Muscle repositioning or Neuro-myofascial release: (Conceptualized by Luiz Fernando Bertolucci)
See the following URL that is a demonstration of muscle repositioning.

http://www.youtube.com/watch?v=HLk_wMK0Ecg

Muscle Repositioning (MR) is a different form of myofascial release came out of work of physiatrist Bertolucci LF. The term Muscle Repositioning was also coined by him.

The techniques start by twisting of fascia around harder structures that result in unification of body segments into a single block, a phenomenon that is possible immediate visual surveillance during & after the treatment.

Salient points of Practice:
1. Generally the practitioner produces small shaking movements on the client’s body.

2. Linkage of body parts leads to a unique sense of firmness under the practitioner’s hands. Once connected to the sensation of firmness, the maneuvers then proceed, up to a point in which a release naturally takes place (Compare Bind versus Release).

Old explanations & new challenges:
The older explanation of release of the bind or firmness was thought to be a mechanical phenomenon. The mechanical explanation says twisting of fascias would produce its tensioning, which, by its turn, would compress the joints and unite the segments that lie between them.

Such interpretation may be accurate, but more than pure mechanics seems to be taking place. If the contact with the sense of firmness is accurate and long enough, another class of phenomena follows: the client often begins to show involuntary motor reactions such as following:

i. Progressive isometric activity of the cervical erectors (most outstanding observation as well as palpation finding present in the neck in all subjects). It can be felt by the practitioner as an involuntary pushing of the client’s head cephalad and backwards but when this reaction is strong enough then one can see and palpate the muscular activity.

ii. Other involuntary concurrences are also observed. They are horizontal eyes movements, clonic and tonic appendicular movements and tremors.

How Bertolucci explains it? (The Hypothesis)
1. This form of manual therapy may be stimulating neurological reactions. (EMG activity in the local & area away from the immediate recipient area shows reactions in the neck in all subjects tested, abdominal activity during a maneuver in the thoracic area).

2. Firmer the feel to the clinician’s hand, the higher the EMG signals i.e.: the degree of firmness is possibly related to the intensity of the tonic reaction.

3. It is also noted that firmer the feeling to the touch, the more effective the maneuver.

Hence it is supposed that clinical efficacy of the maneuvers is related to the tonic reactions (a sort of neural reflex) during the clinical practice is a desired clinical effect.

Patients feeling of the maneuver:
Muscle repositioning is not only a clinician’s feeling only. Rather there is a matching of sensations experienced in both client and practitioner.
Once the sense of firmness is achieved, a whole class of sensations simultaneously emerges in the clients such as:

i. a sense of connectedness among structural segments
ii. a sense of bipolar expansion in the body’s longitudinal axis, among other sensations.

Recommendations of Bertolucci:
1. To elicit proper responses approach the soft tissues in an oblique angle.
2. A force couple is formed by oblique force mentioned above & inertia of the bodily segments under treatment.
3. The resultant force of the above said force couple produces internal shear forces among musculoskeletal structures in very precise directions. Which further result in a clear sensation of relative movements among myofascial compartments.

According to Bertolucci the feeling of muscle repositioning resembles the surgical maneuver named blunt dissection. Sometimes it is even possible to pinpoint the cleavage lines between fascial planes engaged in a certain maneuver. This approach may possibly change the relative muscle positions, directly affecting the myofascial force transmission as described by Huijing and colleagues.

Reference:

1. J Bodyw Mov Ther. 2008 Jul;12(3):213-24. Epub 2008 Jul 7.


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