Chiropractic Perspectives On Myofascial Therapy
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This is Chapter 15 from RC’s best-selling book:
“Applied Physiotherapy in Chiropractic”
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Chapter 15: Chiropractic Perspectives On Myofascial Therapy
The purpose of this chapter is to improve the doctor of chiropractic’s understanding of the significance of myofascial pain and dysfunction, and to improve the chiropractor’s level of competence in diagnosing the myofascial component of the subluxation complex.
The myofascial orientation in the chiropractic setting directs the doctor to look first for a myofascial source of the patient’s pain, and when found, to use numerous techniques and procedures to offer rapid relief. Lowe recommends broad spectrum therapeutics to be employed after the performance of myofascial therapy to assure maximum flexibility. [1]
Definition
Myofascial therapy may be defined in several ways. Basically, it is the treatment of the myopathophysiologic component of the vertebral subluxation complex. It is also the treatment of trigger points, areas of increased neurologic activity in muscle tissue, causing the secondary referral of pain with subsequent associated autonomic changes. [2]
The pain attributed to myofascial dysfunction is usually restricted to a certain region such as the cervical or upper thoracic area, lumbar and buttock area, or the cranial/TMJ area. A trigger point, often the cause of such pain, is always tender and palpably taut. This prevents full lengthening of the muscle and produces muscle weakening, altered proprioception, predictable referred pain patterns, and an objectively verifiable local twitch response during palpation. [3]
Historic Background
Several key figures have contributed to our understanding of the widespread cause of muscular pain syndromes, among them Travell, Rolf, and, in our own profession, Nimmo. Another chiropractor who added greatly to our understanding of the role of muscles in various pain syndromes was Gillet of Belgium. Gillet wrote, “Concerning the subluxation or misalignment, we prefer the term fixation, which describes far more accurately the actual status of the [peri]articular soft tissues, where we will find that it is the state of these tissues that actually keeps the two surfaces from moving. The osteopaths, very early on, stated that the soft tissues can vary from the simplest muscular contracture to a complete degenerative fibrosis of the muscles. The previous facts are not new ….unfortunately, x-rays, introduced early in chiropractic history, have done much to propagate the idea of the spine as a string of bones. Even today, many practitioners act as if they still believe the childish propaganda they so nimbly offer to the public, that it’s a bone out of place in the back.” [4]
Gillet continues, “It is true that sporadic mention of the existence of spinal muscles and ligaments is made, often by such words as, ‘Yes, I put the vertebrae back, but the muscles pulled them out again.’ “At best, certain chiropractic teachers did accept that there are taut muscles related to the subluxation complex and that these muscles were part of a vicious cycle in which the displaced vertebra produced pressure on a spinal nerve that caused a muscle spasm that, in turn, stopped the vertebra from being replaced. To us [Gillet’s group of Belgian researchers], abnormality in the spinal muscles, ligaments, and [peri]articular soft tissues is the real factor responsible for subluxations.”
Raymond Nimmo, DC, a 1926 Palmer College of Chiropractic graduate, was another early chiropractor skeptical of the logic and scientific validity of the spinal misalignment model of vertebral subluxation. After several years of practice, Nimmo became curious why some patients with severely distorted spines had little or no pain while others with excellent alignment had terrible pain. He became even more disillusioned with the misalignment theory when he saw patients get well with chiropractic treatment, but posttreatment radiographs showed no change in vertebral alignment. [5]
Nimmo began to reason that the bones of the body are passive structures whose alignment and movements are controlled by muscle contractions and tonus. He hypothesized that imbalanced muscle tension is the probable cause of spinal misalignment and that chiropractors might be inadvertently treating muscles while manipulating spinal and extraspinal joints. He also postulated that if muscles are capable of causing primary pain and dysfunctional biomechanics, treatment might be more effective if applied directly to the involved muscles. [6] For the remainder of his career, Nimmo researched the role of muscle in pain syndromes and created a chiropractic-oriented type of myofascial therapy that he called receptor-tonus technique, so named because he felt that noxious input from sensory nerve receptors into the central nervous system (CNS) could be modulated by decreasing muscle hypertonicity. His normal methods of locating and treating myofascial trigger points will be explained in this chapter.
The Myofascia and Its Role in Pain Syndromes
Skeletal muscle is the largest system in the body, comprising nearly half of body weight. Skeletal muscles are the motors of the body, working with and against the ubiquitous pull of gravity. The connective tissue between muscles, called fascia, comprises 16% of a person’s body weight, and it stores 23% of total water content. [7] Fascia forms the base of the skin and surrounds muscle sheaths, nerve sheaths, tendons, ligaments, joint capsules, periosteum, and blood vessel walls, and serves as the bed and framework of viscera. [8] Importantly, fascia can harbor trigger points as readily as skeletal muscle.
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Another good share. I’ve always felt that the adjustment provides a quick and efficient way to modulate the nervous system by augmenting muscle tone and feedback. Dr. Carricks approach also shows that multiple sensory modalities can be used to achieve a similar outcome.