Myofascial Release
By: Tim Juett, PT
Case History - Chronic Low Back Pain (Post Surgery)
A 32-year old choker-setter had a lumbar laminectomy in 1983, followed by decompression surgery at the same
level in October, 1985. Five months after his second surgery he was referred to physical therapy by his surgeon
for three weeks of treatment for chronic low back pain and bilateral anterior thigh pain. His treatment included
hot wet packs with concurrent interferential electrical stimulation, a home exercise program and myofascial
release to the low back area as well as to the surgical scar itself. After two treatments there was no futher leg
pain and only mild low back pain with movement.
After four treatments, the patient called and cancelled further appointments because he no longer was having
any pain and had returned to his job as a choker-setter. Following up by telephone three months later, he
reported having low back discomfort at times and never any leg pain. He is very pleased with his ability to
continue his strenuous job. This is the most dramatic improvement I have experienced with any patient having
similar symptoms after two or more low back surgeries. The only difference in treatment with this patient was
the addition of myofascial release.
Case History - Chronic Dislocating Patella
This 15-year old female had a history of a chronic dislocating right patella for three years. At age 11 she fell and
hit a curb on the lateral aspect of the right knee. Approximately one month later her patella began dislocating.
Dislocations gradually became more frequent. She stated that with "just normal walking" the patella would
dislocate and she would fall. She had been having constant pain at the lateral aspect of the knee for the past
two years. Originally, her patella dislocated about twice per week, and this progressed to daily for a year prior
to coming to us for therapy. The only treatment given her was quadriceps and hamstring "sets," and a trial of
two types of braces until she came to see us in June of 1987.
The physician's referral to us requested SLR quadriceps strengthening and iliotibial band stretching. We treated
her five times with ultrasound to the lateral retinacular area of the right patella, followed by myofascial release
of the iliotibial band and lateral retinaculum. She was also given straight-leg raises against theraband with some
external rotation of the hips, so as to emphasize strengthening of the VMO.
After the first treatment she had no further dislocations, even when running up and down stairs at home.
Follow-up with this patient nine months later, she reported having no further problems at all with her right
knee.
This patient was a possible candidate for surgical release of the lateral retinaculum of the right knee. Because
she had done exercises in the past without reduction of chronic dislocation of the patella, we feel that rapid
resolution of her problem was due primarily to the non-invasive release of the scarred and adhered lateral
retinaculum with manual myofascial release techniques.
Case History - Myofascial Syndrome, Status Post Open Heart Surgery
This 73-year old patient had open heart surgery on January, 1988. She came for physical therapy on March 29,
1988, complaining of excruciating pain at the sternal surgical scar region and spreading up the left
sternocleidomastoid and into the left upper extremity to the elbow. She also complained of paresthesis of the
left side of the face, episodes of dizziness, difficulty breathing when tilting the head back, and lack of pulse in
the left side of the neck.
A total of four treatments were given in a ten-day period. They included moist heat, myofascial release and
home program of stretching the neck and shoulders.
Myofascial release was performed over the surgical scar, left chest, left neck, cranial base and left side of the
face. A left "arm pull" was also performed. At the end of the fourth and final treatment, she reported feeling
"100% improved." She had no pain. She could feel a pulse again in the left side of her neck, breathing was
unrestricted with cervical extensions, there was normal sensation in her face and no further episodes of
dizziness. Her six standard cervical motions had improved a total of 40 degrees, including a gain of 15 degrees of
extension.
Upon follow-up by telephone exactly four weeks following her final treatment, she reported feeling as well as
after the last treatment. She only had "soreness" in the left neck and left axillary region when stretching while
doing her home exercises, which I had recommended that she continue daily.
Case History - Status Post Right Mastectomy and Radiation Burn
This 73-year old woman came for her initial physical therapy treatment on July 14, 1987. She had a right
mastectomy in January, 1986. She received one year of chemotherapy following surgery, then six weeks (30
treatments) of radiation therapy. She had irregular shaped radiation burn with hypertrophic scarring over the
distal third of the sternum (of approximately 6-7 mm diameter). The right shoulder was drawn forward. The right
shoulder and chest were extremely hypersensitive to mild touch and minor movement of the right shoulder. The
radiation scar still ad a small area of scab. She was referred to us as soon as the physician felt that the burn was
sufficiently healed to begin physical therapy. Right shoulder external and internal rotation range of motions
were within normal limits. Active flexion and abduction (standing) were respectively 0-130 degrees and 0-97
degrees.
She was given a home program of cane exercises and treated of 15 times (ending August 21, 1987) with moist
heat and myofascial release to the chest, right upper extremity and neck. At the final treatment she had 160
degrees of motion of both right shoulder flexion and abduction (equivalent to the contralateral motions). She
had no further discomfort, except for mild tenderness when pushing her range of motion exercises to the end
of range.
On follow-up with this patient over seven months later, she had maintained her range of motion and reported
no limitations of function and no pain. She felt fully recovered in every way other than "some tightness at the
side of radiation." She expressed how thoroughly grateful she was for the remarkable increase of motion and
reduction of pain which occurred with such gentle and relatively painless techniques.
A 32-year old choker-setter had a lumbar laminectomy in 1983, followed by decompression surgery at the same
level in October, 1985. Five months after his second surgery he was referred to physical therapy by his surgeon
for three weeks of treatment for chronic low back pain and bilateral anterior thigh pain. His treatment included
hot wet packs with concurrent interferential electrical stimulation, a home exercise program and myofascial
release to the low back area as well as to the surgical scar itself. After two treatments there was no futher leg
pain and only mild low back pain with movement.
After four treatments, the patient called and cancelled further appointments because he no longer was having
any pain and had returned to his job as a choker-setter. Following up by telephone three months later, he
reported having low back discomfort at times and never any leg pain. He is very pleased with his ability to
continue his strenuous job. This is the most dramatic improvement I have experienced with any patient having
similar symptoms after two or more low back surgeries. The only difference in treatment with this patient was
the addition of myofascial release.
Case History - Chronic Dislocating Patella
This 15-year old female had a history of a chronic dislocating right patella for three years. At age 11 she fell and
hit a curb on the lateral aspect of the right knee. Approximately one month later her patella began dislocating.
Dislocations gradually became more frequent. She stated that with "just normal walking" the patella would
dislocate and she would fall. She had been having constant pain at the lateral aspect of the knee for the past
two years. Originally, her patella dislocated about twice per week, and this progressed to daily for a year prior
to coming to us for therapy. The only treatment given her was quadriceps and hamstring "sets," and a trial of
two types of braces until she came to see us in June of 1987.
The physician's referral to us requested SLR quadriceps strengthening and iliotibial band stretching. We treated
her five times with ultrasound to the lateral retinacular area of the right patella, followed by myofascial release
of the iliotibial band and lateral retinaculum. She was also given straight-leg raises against theraband with some
external rotation of the hips, so as to emphasize strengthening of the VMO.
After the first treatment she had no further dislocations, even when running up and down stairs at home.
Follow-up with this patient nine months later, she reported having no further problems at all with her right
knee.
This patient was a possible candidate for surgical release of the lateral retinaculum of the right knee. Because
she had done exercises in the past without reduction of chronic dislocation of the patella, we feel that rapid
resolution of her problem was due primarily to the non-invasive release of the scarred and adhered lateral
retinaculum with manual myofascial release techniques.
Case History - Myofascial Syndrome, Status Post Open Heart Surgery
This 73-year old patient had open heart surgery on January, 1988. She came for physical therapy on March 29,
1988, complaining of excruciating pain at the sternal surgical scar region and spreading up the left
sternocleidomastoid and into the left upper extremity to the elbow. She also complained of paresthesis of the
left side of the face, episodes of dizziness, difficulty breathing when tilting the head back, and lack of pulse in
the left side of the neck.
A total of four treatments were given in a ten-day period. They included moist heat, myofascial release and
home program of stretching the neck and shoulders.
Myofascial release was performed over the surgical scar, left chest, left neck, cranial base and left side of the
face. A left "arm pull" was also performed. At the end of the fourth and final treatment, she reported feeling
"100% improved." She had no pain. She could feel a pulse again in the left side of her neck, breathing was
unrestricted with cervical extensions, there was normal sensation in her face and no further episodes of
dizziness. Her six standard cervical motions had improved a total of 40 degrees, including a gain of 15 degrees of
extension.
Upon follow-up by telephone exactly four weeks following her final treatment, she reported feeling as well as
after the last treatment. She only had "soreness" in the left neck and left axillary region when stretching while
doing her home exercises, which I had recommended that she continue daily.
Case History - Status Post Right Mastectomy and Radiation Burn
This 73-year old woman came for her initial physical therapy treatment on July 14, 1987. She had a right
mastectomy in January, 1986. She received one year of chemotherapy following surgery, then six weeks (30
treatments) of radiation therapy. She had irregular shaped radiation burn with hypertrophic scarring over the
distal third of the sternum (of approximately 6-7 mm diameter). The right shoulder was drawn forward. The right
shoulder and chest were extremely hypersensitive to mild touch and minor movement of the right shoulder. The
radiation scar still ad a small area of scab. She was referred to us as soon as the physician felt that the burn was
sufficiently healed to begin physical therapy. Right shoulder external and internal rotation range of motions
were within normal limits. Active flexion and abduction (standing) were respectively 0-130 degrees and 0-97
degrees.
She was given a home program of cane exercises and treated of 15 times (ending August 21, 1987) with moist
heat and myofascial release to the chest, right upper extremity and neck. At the final treatment she had 160
degrees of motion of both right shoulder flexion and abduction (equivalent to the contralateral motions). She
had no further discomfort, except for mild tenderness when pushing her range of motion exercises to the end
of range.
On follow-up with this patient over seven months later, she had maintained her range of motion and reported
no limitations of function and no pain. She felt fully recovered in every way other than "some tightness at the
side of radiation." She expressed how thoroughly grateful she was for the remarkable increase of motion and
reduction of pain which occurred with such gentle and relatively painless techniques.
MYOFASCIAL RELEASE - AN INTRODUCTION FOR THE PATIENT - CON'T
| Author: Jarmila Svoboda Copyright @ 2007 All rights reserved. Revised: 5/3/2011 |
Gary D. Keown, PT and Tim Juett, PT of South Umpqua Physical Therapy Services in Winston, Oregon, have
extensive experience in Physical Therapy and Myofascial Release. The integration of the Myofascial Release
approach into their Physical Therapy practice has greatly enhanced their success. Their reputation for
excellence and resolving difficult cases has led to the growth of four very successful Physical Therapy facilities in
Oregon.
extensive experience in Physical Therapy and Myofascial Release. The integration of the Myofascial Release
approach into their Physical Therapy practice has greatly enhanced their success. Their reputation for
excellence and resolving difficult cases has led to the growth of four very successful Physical Therapy facilities in
Oregon.
Tim Juett, PT
Roseburg, Oregon
Roseburg, Oregon
John F. Barnes, PT
Tim is a very caring and highly intelligent health professional who believes in a multi-faceted approach treating
the whole person.
I would like to thank Tim and request anyone else interested in sharing anything of this nature, case histories
or their experiences to feel welcome to write me. I look forward to hearing form you.
the whole person.
I would like to thank Tim and request anyone else interested in sharing anything of this nature, case histories
or their experiences to feel welcome to write me. I look forward to hearing form you.
 |
 | |  | |  | |  | |  | |  | |  | |  | |  | |  | |  |
