MFR Techniques

Question 1

Cervical Traction

Answer 1

1) Cradle occiput and chin
2) Apply axial cephalad traction slowly and rhythmically, with gradual increasing amplitudes
3) Continue until desired soft tissue or disc response
4) recheck

Question 2

C-Spine: Bilateral Forearm Fulcrum Forward Bending

Answer 2

Arms are crossed under patient’s head and hands placed palm down on patient’s shoulders

Repetitively flex patients neck, giving a longitudinal stretch of the paravertebral muscles

Repeat for 203 minutes or until desired effect is achieved

Re-evaluate for TART

Question 3

C-Spine: Unilateral Forearm Fulcrum Forward Bending

Answer 3

Contract patient shoulder with one hand and use the same arm to cradle patients occiput

Repetitively flex the patients c-spine, stretching the desired muscle by moving the forearm anteriorly for 1-2 seconds

Repeat for 2-3 minutes or until desire defect is achieved

Re-evaluate for TART improvement

Question 4

C-Spine: Contralateral Traction, Supine

Answer 4

Caudad hand reached across with finger pads medial to the cervical paravertebral muscles on side opposite of where you are standing

Superior hand rests on patient’s forehead to stabilize head preventing rotation

Engage tissue with anterolateral force thru you finger pads creating a perpendicular stretch to the cervical paraspinal muscles

Question 5

C-Spine: Cradling with Traction, Supine

Answer 5

Fingers placed under patient’s neck bilaterally on paraspinal muscles, just lateral to the spinous process

Engage soft tissue with anterior and lateral force

Longitudinal traction exerted by moving cephalad along the soft tissues

Question 6

Head and C-Spine: Suboccipital Release

Answer 6

Finger pads are placed in the suboccipital region

Apply anterosuperior pressure

• kneading: pressure may be slowly and rhythmically applied until tissue texture changes occur of for 2 min
• Inhibition: apply a constant inhibitory pressure for 30 sec-1 min

Question 7

Thoracic: Prone Pressure

Answer 7

Place thumb pads medial to the side opposite to the one you are standing

Keeping you elbows straight-ish and using you own body weight, engage soft tissues with a ventrolateral force creating a perpendicular stretch

Question 8

Thoracic: Prone Pressure with Counterpressure

Answer 8

Place thenar eminence and thumb of caudad hand over the thoracic paravertebral muscles opposite the side you are standing

Place hypothenar eminence of cephalad hand on paravertebral muscles on the same side you are standing

Engage tissue with a ventral force and then move your hands in direction in which they are facing

Question 9

Thoracic: Subscapular Stretch

Answer 9

Take patient’s arm, on the side being treated, and placed it behind their back

Place fingers around medial border of scapula

Engage the tissue ventrally then give gentle and upward traction, pulling scapula away from rib cage

Question 10

Upper Thoracic w/Shoulder Block

Answer 10

Standing at side of table facing patient

Inferior hand passes under patients arm and contacts paravertebral muscles

Superior hand contacts anterior portion of shoulder to give counterforce. Drape patient’s arm over your arm

Question 11

Thoracic and Lumbar MFR

Answer 11

Finger pads placed on paravertebral muscles, lateral to the spinous processes

Engage muscle with ventrolateral force to induce a perpendicular stretch

Question 12

Lumbar: Prone Pressure

Answer 12

Place thenar and hypothenar eminence on paravertebral muscles opposite the side you are standing

Place other hand on top of hand contacting the muscles

Keeping your elbows straight and using own body weight, engaging soft tissues with a ventral force and move out laterally creating a perpendicular stretch

Question 13

Lumbar: Prone Pressure with Counterleverage

Answer 13

Using Inferior hand, grasp ASIS on other side of patient

Place thenar and hypothenar eminence of superior hand on the paraspinal muscles

Pull posteriorly on the ASIS and apply anterlateral pressure on lumbar paraspinal muscles in a repetitive rhythmic fashion holding the stretch for 1-2 seconds

Treat the tighter portions of the muscles and move after the muscle release

Question 14

Lumbar: Paraspinal Perpendicular Stretch

Answer 14

At side of table facing patient, reach over patient’s back and place finger pads on the paravertebral muscles

Engage tissues with a ventral force and mover out laterally to create a perpendicular stretch

Question 15

Hip Myofascial Release

Answer 15

Flex hip and the knee to 90 degrees, and test internal rotation and external rotation to determine direction or laxity and restriction

Indirect: Move the hip to its position of laxity, apply compression or traction along the femur to facilitate laity and follow any tissue release until tissue release is perceived

Direct: Move the hip into its restrictive barrier and apply compression or traction until tissue release is perceived

Question 16

Superior Popliteal Space/Hamstring MFR

Answer 16

Use your finger pad on either side of the superior aspect of the popliteal space and introduce a spreading force to load the fascia

Test directions

Engage the barriers stacking either indirectly or directly

Use REMs to induce a release

Follow the release until there is no more creep of the tissue

Question 17

Direct/Indirect Thoracolumbar MFR

Answer 17

Hands on either side of T/L junction

Introduce myofacial stress, clockwise rotation of right hand and counterclockwise rotation of left hand

Engage Barriers

Perform REM

Question 18

Prone Regional Thoracic Direct or Indirect MFR

Answer 18

Hands on bilateral sides of thoracic spine

Put area under myofascial stress, clockwise rotation of right hand and counterclockwise rotation of left hand

Engage barriers

Question 19

Lower Thoracic Under the Shoulder (Lateral Recumbent)

Answer 19

Forearms contacting the axilla and the iliac crest, fingers contact medial aspect of the erector spinae

Elbows spread apart, elongating distance between the shoulder and the hip

Traction the paraspinal muscles laterally

The patient breaths deeply as the activating force

Question 20

Seated Paraspinal Lumbar Soft Tissue

Answer 20

Palm on medial aspect of erector spinae muscles, other hand grasps ipsilateral shoulder

In repetitive, fluid motion, apply force anteriorly and laterally while depressing and translating the erector spinae laterally until tissue response

Question 21

MFR: Lumbosacral Region

Answer 21

Place one hand over the inferior lumbar segment and the other hand over the superior lumbar segment

Monitor inferior and superior glide, left and right motion and clockwise and counterclockwise motion. noting the direction of ease of motion or restriction of motion

Question 22

Direct /Indirect Lumbosacral MFR

Answer 22

One hand at the L/S junction

Other hand over the superior lumbar vertebrae

Engage the barriers

Question 23

Fascial Release Technique: Prone-sacral release

Answer 23

Hand placed on top each other covering the sacrum

Engage Barriers

Activating Force

Question 24

Hamstring Hypertonicity SD and MFR

Answer 24

Patient supine. Stabilize at contralateral ASIS with one hand. Other hand grasps leg above ankle and flexes at hip until a fascial barrier is reached

Patient is instructed to push leg downward toward floor against resistance

Question 25

ITB Syndrome (Prone)

Answer 25

Use caudad hand to grab foot or ankle, flex knee to 90n Cephalad hand will contact lateral thigh Push the foot and lower leg out laterally while simultaneously engaging the IT band by compressing cephalad hand into patients IT band and pulling posteromedially

Question 26

ITB Syndrome (Lateral Recumbent)

Answer 26

Stand facing the front of the patient stabilize patient by placing cephalad hand on the posterolateral aspect of iliac crest Engage tissue giving a slight downward pressure into IT band and slide fist proximally towards the greater trochanter region. Then move proximal to distal

Question 27

Knee MFR/INR

Answer 27

With your move superior hand, grasp distal femur and stabilize it With your more inferior hand grasp the proximal tibia/fibula and use it as a lever to examine the knee for 3D tightness and looseness Passively twist th edistal LE in Ir/ER to treat with direct/indirect MFR

Question 28

Knee Myofascial Release

Answer 28

Grasp the proximal leg with your thumbs on the tibial plateau an dhold th efoot between you rknees Move the tibia into anterior-posterior glide, medial-lateral glide, and internal-external rotation to determine directions of laxity and restriction; Indirect: slowly move the tibia to its positions of laxity and follow any tissue release until completed Direct: Slowly move the tibia into its restrictions and maintain constant force until tissue give is completed Retest tibial or knee motion is successful and tolerated, consider prescribing hamstring position of ease or hamstring stretch

Question 29

Indirect Myofascial Release of the Sprained Ankle

Answer 29

Use your finger pads of your most superior hand to monitor fascial milieu of either individual ligaments or any kind of combination that you can palpate Use your inferior/distal hand on the forefoot to introduce the engage as many indirect barriers as possible and use inherent mechanisms to release the fascia Follow the release until there is no more creep of the tissue

Question 30

Plantar Fascia, Longitudinal Stretch

Answer 30

Stabilize foot by placing hand over dorsum of foot Make a closed fist with your other hand and contact sole of Patients foot just proximal to metatarsal heads Exert moderate pressure and move fist distal to proximal rolling the fist as you move the fist

Question 31

Plantar Fascia MFR

Answer 31

The patient lies supine, and the physician sits at the foot of the table The physician's thumbs are crossed, making an X, with the thumb pads over the area of concern (Tarsal to distal metatarsal) at the plantar fascia The thumbs impart an inward force that is vectored distal and lateral. This pressure is continued until the restrictive barrier is met The pressure is held until a release is palpated This is repeated with the foot alternately attempting plantar flexion and dosiflextion

Question 32

Upper Limb and Shoulder MFR

Answer 32

Grasp the humeral head of the prone patient whose arm is dangling from the table Monitor the tissues for tissue texture response to the following motions introduced thru the humeral head Choose to engage either for direct or indirect MFR-REMS used Follow the release until there is no more creep of the tissue

Question 33

Thoracics: Lateral Stretch, Rhomboid Region

Answer 33

Inferior hand loops beneath axilla and grasps inferior portion of medial scapular border Superior hand grasps superior border of medial scapula Apply lateral traction to scapula for 1-2 sec. in repetitive rhythmic manner

Question 34

Elbow MFR

Answer 34

Hold the patients hand with one hand and the proximal radius and ulna with you other hand Test elbow flexion-extension and forearm supination-pronation to determine directions of laxity and restriction Indirect: gently and slowly move the elbow to its position laxity, apply compression or traction between your hand to facilitate laxity, and follow tissue release until it is complete Direct: Slowly move the elbow into its restriction and apply steady force until tissue give is compeleted

Question 35

Still's Wrist MFR

Answer 35

Grasp carpal bones with thenar eminences Test the following motions: Flexion/extension, ulnar/radial deviation Stack restrictive barriers Instruct patient to make a fist and/or spread fingers widely for 5 sec and then relax hand Engage next restrictive barrier and repeat steps 2-4 until no new restrictive barriers are encountered