After studying many soft tissue techniques, I’ve realized the importance of the most ubiquitous tissue in the body, the fascial system. It is a complex network of connective tissue that surrounds and provides framework for the soft tissues (muscles, tendons, ligaments, nerves). Without this very important structure, muscles would have no integrity in their structure to transmit forces necessary for movement. In other words, muscles would be “jelly like” or “ground beef” without the fascial system.

About a year ago, I discovered a manual technique developed by Luigi Stecco, a Physiotherapist from Italy. Over the last 35 years, he has developed a method of evaluation and treatment of the fascial system, called Fascial Manipulation, that has proven to be extremely successful in the treatment of a variety of musculoskeletal conditions.

BACKGROUND

“One tissue gaining increasing attention in manual therapy is the connective tissue known as fascia. An innovative 3D bio­mechanical model for the human fascial system called Fascial Manipulation takes into account movement limitation, weakness, and pain distribution during the analysis of musculoskeletal dys­functions. The model is the result of 35 years of study and clinical practice by Luigi Stecco, an Italian physiotherapist. Developed specifically for manual therapists working with movement dysfunction and pain, the chief focus of this model is the relationship between muscles, deep fascia, and its compo­nents (epimysium, perimysium, and endo­mysium). More recently, this work has been supported by a series of extensive anatomi­cal dissections of unembalmed cadavers. Histological, biomechanical, and functional studies have also been undertaken to verify some of the underlying hypotheses concern­ing the architecture of the fascia, its innerva­tion, its relationship with muscle fibers, and the possible mechanisms of action of the manual technique itself.” Julie Ann Day, PT, Padova Italy.

FASCIAL MANIPULATION TECHNIQUE

In summary, the technique is is broken down into 4 steps. First, a very thorough history is obtained regarding the present complaint as well as any concomitant or previous injuries in any part of the body.  Second, an accurate, codified evaluative process reveals which plane or planes of fascia is involved. Third, through palpation verification the exact fascial points in the soft tissue are identified that have been altered causing restriction of movement of the fascial system. Fourth, treatment consists of hands on manual therapy utilizing tension and movement to restore mobility and equilibrium to the fascial system resulting in reduction and/or elimination of pain complaints. It is not uncommon for these altered points to be located at a distance from where the pain is perceived.

The technique is extremely effective for the diagnosis and treatment of Muscle Strains, Ligament Sprains, Low Back Pain, Neck Pain, Headaches, Shoulder Pain, Rotator Cuff Tendinitis, Tennis Elbow, Golfer’s Elnow, Hip/Buttock Pain, Sciatica, Knee Pain, Chondromalacia Patella, Iliotibial Band Syndrome, Ankle Sprains, Achilles Tendinitis, Plantar Fasciitis, Shin Splints, Numbness and Tingling, and Carpal Tunnel Syndrome.

Please feel free to email me today if you have any questions about the technique and if it would be clinically indicated for your condition.

Dr. Hargreaves

For those of you that know me well and for those of you that may not, I am always in pursuit of new cutting edge clinical information or techniques that will help to satisfy my hunger to ” to resolve injuries faster than ever thought possible.” My wife Laura, who is my biggest fan, knows all to well about the amount of time I spend reading and researching when I should be doing other things. Recently, I was reconnected with a former classmate of mine from Chiropractic college, Dr. Anthony Lombardi who practices in Canada. It was through these conversations that I felt I stumbled upon a huge breakthrough in treatment approach.

Dr. Lombardi is a legend in his own right as he has studied alongside one of the top sports medicine specialists in North America, Alejandro Elorriaga, MD. Dr. Elorriaga, originally from Spain, is the director of the Contempory Medical Acupuncture program at McMasters University in Hamilton Ontario (Canada). Since 1995, Dr. Elorriaga has focused his efforts on the applications of electro-acupuncture for the treatment of pain and sports injuries, and on the development of a contemporary approach to the design of these treatments and their integration with manual techniques. Dr. Lombardi is also a course instructor at McMasters.

Through our  interactions, I realized both we both had a very similar approach for the assessment of injuries . Through years of tinkering on my end, I put together something that I called the Performax Exam. It is a very easy, thorough assessment tool utilizing various different, unconventional tests to arrive at an accurate diagnosis leading to successful treatment. My colleague Dr Lombardi was also busy as he had come up with an approach called Exstore (Examination and Restore). I had to learn more!!!!

With passport in hand, I traveled to Canada to learn more about this unique approach.  The weekend workshop revealed that Exstore is a very innovative, highly successful approach used to assess and manage musculoskeletal injuries. It is much like the Performax exam, however it included further detailed evalaution of two very important aspects of the body that can be the culprit of pain: nerves and fascia.

This was the breakthrough I have been searching for!!! It has allowed to expand and improve on my current exam. The Exstore System has given me a more advanced, complete, systematic way to find the true source of injury and fix it quickly in the least amount of time. It has also given me a deeper understanding of the movement systems of the body and the relationship between muscles, fascia and nerves in the role of pain. I thought patients were happy before….now they are raving about the results. Check out a testimonial given to me just this week.

I have had lower back and sciatic nerve pain for about seven years now.  I had been seeing a very good Chiropractor in Raleigh and had great results.  Six months ago I moved to Charlotte, NC and was looking and hoping for the same type of care. I FOUND IT!  You Dr. Matthew Hargreaves at “Carolina Spine & Sports” have done wonders for me!

About 2 months ago, my back again started causing me a severe pain where I could not walk, stand or sit comfortably. Not to mention, running was no longer an option as a form of exercise. These symptoms continued for over a period of 3-4 weeks.

Through church I was referred to you. On my first visit, I immediately noticed that it was a calm, informative and relaxing place. During my treatment session, you showed me that I had an imbalance and also explained how it could be corrected. I found the procedure to be intense, but overall painless. From the little that you did, I had immediate relief from the pain, which, amazingly, was greater relief than I had anticipated or experienced before. You then re-tested the area at the end of the visit and none of the tests were problematic as they were earlier. I felt so good that day, that I ended up going for a run for the first time in over 2 months. I was shocked that I ran pain free and have had no symptoms since, other than minor tightness which you have been helping me with over the past week.

“Now I can’t stop talking about Carolina Spine & Sports.”

Ever since my first visit, I have been telling everyone about Carolina Spine & Sports, and that the chiropractic techniques you use are effective, non-painful, and powerful! I trust your recommendations, because my life has been changed in the time I’ve been seeing you. In addition to finally getting relief from the pain, I also received additional benefits. I had not realized that my body had been using so much energy to keep me functioning – and that is why I had been so fatigued all the time. I am still amazed at how much better I now sleep … how much more energy I now have.

Thank you once again

R.T      

What is stopping you from getting the relief you only imagined? Dr Hargreaves

What is Iliotibial Band Syndrome (ITBS)?
The ITB is essentially an enlarged tendon that connects from the Gluteus and Tensa Fascia Latea (TFL) muscles of the hip and runs down the outer thigh and attaches to outer (lateral) portion of the knee. ITBS presents as a unilateral burning pain on the outside of the knee. It can also cause pain to radiate up the side of thigh and/or the hip. Early on in the injury cycle, pain occurs most often at the end of the run (i.e. >45 minutes into a run). As the injury progresses, the symptoms become more pronounced in severity, occur at earlier frequencies (i.e. 10 minutes into a run) and can begin to affect both knees. Changes in your running program (either increases in total distance, or speed) are most often the mechanism of injury. Other factors can also contribute to the process including: running on hard surfaces, running on the crowned surfaces of paved roads, hill running (both up and downhill), asymmetric arches of the feet (over pronation or supination), leg length inequality (both structural and functional) and muscle imbalances of the hip/thigh. The ITB is long, strong, and prone to tightening. Recently it has been discovered that, like many conditions, it is a multi-factor injury that occurs as a sequence of events.

Stage 1 – Deconditioning
Deconditioning is another way of saying “out of shape” or “weak”. Two major events can arise as a predictor of ITB Syndrome: ITB tightening and Gluteus Medius weakness. In ITB tightening, faulty running biomechanics can place increased strain on the ITB causing it to tighten, and thicken. Tightness or uncoordinated movements in a single muscle can change the way the body moves. Altered running patterns create a less elastic ITB that is more prone to be injured. For this reason, a proper treatment plan always begins with an analysis of your running gait.

With Gluteus Medius weakness, faulty running mechanics are once again to blame. The Gluteus Medius is a small muscle designed to stabilize the hip while the leg is in contact with the ground. As it weakens, the body begins to recruit larger muscles to stabilize the hip. Surprisingly, this weakness leads to a chronic low-grade spasm of this muscle. The end result is an unstable hip which then transfers more strain onto the ITB itself. Gluteus Medius strengthening must be a part of any rehabilitation program.

Stage 2 – Secondary Effects
As the body’s usage of the ITB changes, increased “friction” arises between the structures surrounding the ITB. These alterations are the ultimate cause of the pain associated with ITB Syndrome. However, a true fix always goes beyond what causes the symptoms and addresses the root of the problems as well (the deconditioning).

There are three components to ITB Syndrome: ITB Bursitis, ITB Tendonosis, and Soft-Tissue Adhesions.

ITB Bursitis: Because of the tightening of the ITB, a compressive force is applied to the ITB bursa causing bursitis. ITB Bursa are small fluid filled sacs located just beneath the IT Band and are designed to lubricate areas of high friction between tendons and bones. They are highly prone to inflammation, and when irritated, cause pain and limitation of movement. This condition is especially resistant to therapy and the traditional approach of management is rest from running. However, new research highlights the importance of resolving the true cause by releasing the excessive tension of the ITB through effective soft tissue therapies.

ITB Tendonosis: The tightening of the ITB also causes it to rub on the bone of the lateral knee. This friction causes an irritation and breakdown of the tendon’s tissue at the cellular level. The body lays down adhesions within the tendon to compensate making it less elastic and thicker. As the tension increases, it deteriorates faster than the body can repair it. Over time, the adhesions cause more pain due to the inability to stretch. Gradually the symptoms increase and your runs become less and less enjoyable. In some cases, this can last for years and/or become episodic.

Soft-tissue Adhesions: This is quite often overlooked by many healthcare providers treating ITBS. Adhesions develop between the ITB and the Quads/Hamstrings. Essentially the IT Band sticks to the surrounding muscles causing further complications in regards to ITB function. Without releasing the soft-tissue adhesions in the surrounding muscles, resolution is incomplete and the condition is more likely to recur.

With all the possible factors, and involved structures, a thorough evaluation is the foundation upon which your recovery is built. To prevent a temporary solution, decreased performance or even a premature retirement from running, it is impertative that all these factors be considered when adressing this type of injury. An experienced profesional will be able to identify and correct these structural issues leading to a more enjoyable, even an enhanced, running career.

H1N1 – SWINE FLU PREVERNTION TIPS…

Dr. Vinay Goyal is an MBBS,DRM,DNB (Intensivist and Thyroid specialist) having clinical experience of over 20 years. He has worked in institutions like Hinduja Hospital, Bombay Hospital, Saifee Hospital, Tata Memorial etc. Presently, he is heading our Nuclear Medicine Department and Thyroid clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W). The following message given by him, is important for all of you to know the only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it’s almost impossible not coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. “Hands-off-the-face” approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).

3. Gargle twice a day with warm salt water (use Listerine if you don’t trust salt). H1N1 takes 2-3 days after initial infection in the throat/nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don’t underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, clean your nostrils at least once every day with warm salt water. Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.

5. Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6. Drink as much of warm liquids as you can. Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

A particularly interesting study compared six weeks of drug therapy using the antidepressant Amitriptyline with six weeks of chiropractic manipulation. The patients selected for this study had a history of at least one headache per week over a period of three months or more.

Chiropractic therapy was just slightly more effective at reducing headache pain. However, drug therapy relief was accompanied by side-effects in more than 82 percent of the patients. These side-effects included dry mouth, drowsiness and weight gain. Previous studies indicated that glaucoma and cardiac problems could be further side-effects of this drug. By contrast, less than 5 percent of the patients receiving chiropractic manipulation reported the minor side-effect of slight neck stiffness most liketly attributed to the physical hands on nature of the treatment.

A further chiropractic advantage became apparent during a follow-up period, four weeks after the interventions were stopped. Headache relief continued for the chiropractic group, while members of the drug therapy group returned to their previous levels of headache suffering. The chiropractic group also reported higher levels of energy and vitality than the drug therapy group during this follow-up period.

The advantage of the chiropractic approach over drug therapy has become even more apparent with the widespread recognition of “rebound headache,” sometimes called “medication headache” or “analgesic headache.” Long-term use of headache medicines more than twice per week can interfere with the body’s natural pain-control circuitry. After a while, the medication gives transient, partial relief, but the headache returns (rebounds) as the medication wears off. Sometimes, the rebound headache is more severe than the original symptoms, and the patient requires higher and higher dosages of medication. Even relatively innocuous over-the-counter headache remedies can have serious side-effects, especially when used for six months or more at dosages higher than recommended.

References
1. Curl DD. Chiropractic Aspects of Headache as a Somatovisceral Problem. In Masarsky CS, Todres-Masarsky M (eds). Somatovisceral Aspects of Chiropractic: An Evidence-Based Approach. Churchill Livingstone, New York, 2001.
2. Boline PD, et al. Spinal manipulation vs. Amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther 1995;18:148-154.