Massage & Bodywork

MAY | JUNE 2015

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chronic tissue features are altered via exercise and/or therapeutic interventions. Thomas Myers has expressed this progressive adaptive phenomenon as involving a process in which chronic tissue loading leads to "global soft-tissue holding patterns," where clear postural and functional imbalance and distress are both visible, as well as being palpable. 4 A shorthand summary of such processes may describe them as being the result of: • Overuse—e.g., repetitive actions. • Misuse—e.g., postural or ergonomic insults. • Disuse—e.g., lack of exercise. • Abuse—e.g., trauma. • Any combination of these. Whatever the single or multiple contributing features may be, the end result is of structural and functional modifi cations that prevent normal activity, result in discomfort or pain, and which, themselves, make further adaptive demands as the individual attempts to compensate for restrictions and altered use patterns. ASSESSMENT OBJECTIVES When evaluating possible interventions, whether therapeutic or exercise related, it is important to ascertain which tissues, structures, patterns, and mechanisms may be involved. For example, is there any evidence of soft- tissue change involving hypertonicity or fi brosis? Is there joint or neurological involvement? Are the tissues infl amed? In other words: why is this happening? What causative or maintaining features are identifi able? What actions might usefully be taken to modify, improve, and correct the situation? As a starting point, in order to encourage rehabilitation, areas of restriction need to be identifi ed and assessed so that they can be encouraged toward normality. The question of how best to identify such pathophysiological changes is, therefore, one of the key challenges that face practitioners, before manual and/or movement Therapeutic Options When the sliding/gliding motion potential of fascia is reduced, is painful, or has been lost, restoration of normal function requires attention to the causative, as well as the maintaining, factors associated with the dysfunctional fascial layers. The intent of using such fi ndings is to decide on the best ways of encouraging more normal function. There are, of course, multiple strategies that aim to improve, correct, or rehabilitate such dysfunction, but their underlying ambitions can briefl y be summarized as follows: • To reduce adaptive load—e.g., to modify overuse, or misuse, or other features that are contributing to the problem. • To enhance functionality—e.g., to improve posture, breathing function, nutrition, sleep, and exercise patterns, as well as the local mobility and stability of tissues. • To focus on symptom reduction—this might be a poor, potentially short-term choice unless and until adaptive demands are reduced and/or function is improved. therapies or modalities can be safely applied. Fortunately, a range of palpation and assessment tools is available to help achieve the identifi cation and localization of dysfunction, as will be described later in this article. GATHERING EVIDENCE Clinical decision-making needs to be based on a combination of the unique history and characteristics of the individual, combined with objective and subjective information gathered from assessment, observation, palpation, and examination. The fi ndings of such information-gathering endeavors need to be correlated with whatever evidence exists, research studies, experience, etc., that offer guidance regarding different therapeutic choices. The objectives of palpation and assessment are, therefore, the gathering of evidence regarding function and dysfunction so that informed clinical decisions can be made, rather than being based on guesswork. What's too tight? What's too loose? What functions are impaired? Which kinetic and structural chains are involved? What are the causes? What can be done to remedy or improve the situation? There are many functional assessment methods and protocols, as well as a variety of palpation methods that can assist in this search for information and answers. Some of these have been tested for reliability; others are used extensively without any clear evidence that they are reliable. This leads to a key recommendation: no single piece of "evidence" gained from observation, or from the results of functional tests and assessment, or from palpation, should be used alone as evidence to guide clinical choices. It is far safer to rely on combinations of evidence that support each other and that point toward rehabilitation and/or treatment options. F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 65

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