AAO FDM Indroduction 1994 PDF
AAO FDM Indroduction 1994 PDF
AAO FDM Indroduction 1994 PDF
by Stephen Typaldos, DO
Clinical Assistant Professor
Department of General and Family Practice
University of North Texas Health Science Center
at Fort Worth/Texas College of Osteopathic Medicine
Introduction the muscle. This definition allows us of a whole host of commonly seen
The fascial distortion model is a to conceptualize the pathology and to dysfunctions from ankle sprains to
new anatomical model in which many speculate on how our treatment whiplash injuries. These distortions
musculoskeletal injuries are thought choices might affect the dysfunction. are presented and discussed over the
to be the result of specific alterations Another example is tendonitis. The next several pages. Some of the terms
of the body's fascia. It was developed traditional definition implies that it is used will be familiar to the reader, but
in an attempt to improve current the result of inflammation of an in the fascial distortion model they
treatments by basing them on a more involved tendon, but clinically this take on other meanings and have
anatomical approach. Many of the rarely occurs. In the fascial distortion implications that the reader may not
most commonly seen musculoskeletal model tendonitis is defined as a appreciate at first. This paper defines
injuries are vaguely defined and often triggerband or less commonly a terminology so assumptions are not
respond poorly to conventional continuum distortion present in an derived from other medical models.
treatments. One example of this is a involved tendon. The dysfunction now A glossary of fascial distortion model
pulled muscle. It is difficult to becomes tangible, and the treatment terminology is presented at the end of
visualize what a pulled muscle is, and modality can be specifically selected this paper. All of the drawings are
therefore most treatments are not for that particulardistortion type. This based on as much clinical and
specifically designed to correct the change in terminology perspective anatomical information as is currently
underlying dysfunction. In the fascial can often lead to significantly more available. In time as more data
distortion model a pulled muscle is effective treatment results. accumulates through surgical and
defined as a muscle that has a There am four principle distortion clinical investigations, more specific
triggerband wedged within its belly types and several subtypes which are representations of fascial distortions
at a perpendicular angle to the axis of considered to be the etiological cause can be made.
7
All fascial distortions currently Specific
Distorted pathways Triggerband
Fascia! Yes technique
known are of one of four types: Bands throughout the
body
triggerbands, triggerpoints, TRIGGERS ANDS,
continuum distortions or folding
Herniation
distortions. These are reviewed and of tissue
Abdomen. Jones technique
pelvic area,
compared in Table 1. Note that each through No or iriggerpoint
supraclavicular
fascia' therapy
principle type is differentiated by the .. fossa
plane
TRIGGERPOINT,S /
etiology of its distortion.
... Near joints at
B\ St1C, Alteration the origin and
Triggerbands 4.
qq
h of
transition
insertion of
Continuum
fi • No tendons or
zone figments and technique
Al,:oit:::,.. between
Triggerbands are clinically the tissue types costo-chondro
CONTINUUM DISTORTIONS junction
most commonly encountered fascial .
distortion and occur as fascial bands Three
dimen- Inside joints, Nlyofascial
become pathologically altered. An 4 sional No interosseous release
. b.; distortion
membranes technique
important difference between -I of fascia'
triggerbands and the other principle FOLDING DISTORTIONS planes
fascial distortion types is that during
treatment triggerbands move and the The triggerband subtypes are
others do not. In the fascial distortion compared in Table 2. An important
model movement is considered to point to realize is that regardless of
occur when the tender area of a fascial the specific subtype all am treated
band or its palpable distortion is able essentially the same way, that is by
to change its location du ring treatment. using triggerband technique. The
Therefore any fascial distortion that palpatory differentiation of the
can be induced to move is by definition subtypes is necessary so they are not
a triggerband and is best treated with confused with other distortions and
modalities that correct distorted fascial treated inappropriately. Their
bands. treatment is the subject of the
There are six clinically recognized accompanying paper Triggerband
subtypes of triggerbands: twists, Technique.
crumples, knots, peas, grains of salt Twists (fig. 1) are the most common
and waves. Note that these subtypes of the triggerband subtypes and can
were named by my patients based on appear anywhere in the body along
Knots (fig. 3) are the largest of all
what these distortions felt like to them. specific, well-demarcated pathways.
the triggerband subtypes and are
To the physician they feel like the
caused by either a portion of a fascial
edge of a twisted ribbon. A crumple
band becoming irregularly folded on
(fig. 2) is a distorted fascial band that
itself or occur when a portion of the
is wedged between two muscle layers.
band that has been ripped off its
During treatment, patients describe
attachment becomes knotted on top
these as causing a burning type of
of itself. Knots tend to be found at
pain. Like all of the subtypes, twists
crossbands, which are fascial bands
and crumples are capable of travelling
that intersect the triggerband at an
through tissues or joints into other
angle. The crossbands seem to stop
fascial planes. Once a crumple is
the progression of the tearing between
pushed through the muscle, it then is
palpated as a twist.
Well-defined.
demarcated Anywhere
point of Suture to including
— Ribbon edge tenderness that pencil width No
through joints
moves with the
Twist treatment
Yes, biome
% .,:- Eleethcal Burning I/4" to I/2" twtst dunng Between
sensation wide treatment muscle layers
Crumple
AAO Journal/17
Spring 1994
waves being moved along connecting bands combined wave being moved along fascial
to form one large wave band to the conclusion of its pathway
fig.9 r/
Table 3
Subtype Etiology Palpatory Differentation Treatment
, Herniation of .
Correction is completed
tissue through ggerpoint
Tn therapy
at the end of
non- banded triggerpoint therapy or Jones technique
NON-BANDED HERNIATED fascial plane
TRIGGERPOINTS
Herniation of Triggerpoint
At completion of
tissue through a therapy or Jones
triggerpoint therapy a
-cc banded fascial technique followed
U is palpable
---4•--,-
... -r °,14. ., plane distorted by by triggerband
BANDED HERNIATED':"'; a triggerband technique
TRIGGERPOINTS i P.' !
fcb
4:A ig;
Tcl
ligament ligament
W
unmineralized
r
unmineralized4,;
fibrocartilage fibrocartilage
mineralized (1;
,:7t1 et; mineralized
fibrocartilage :
fibrocartilage
1,3
lamellar 00 c -t *
,;• H
rt
bone -■„:„...r.. • cl, A•7
4-.L---
lamellar
. "
, • i LI . ' • „ .,._ "Z.,. ,",- .i S•, ' -.`:k: '
bone
Moderately tender to
continuum distortion is like a button
Palpatory sensation to patient Moderate tenderness
excruciatingly painful slipping into a button hole, while the
Time of treatment until release
triggerpoint is a melting sensation.
Variable-- seconds to minutes Variable-- less than a minute The differences are clinically
begins
AP
To visualize this better, think of
the fascial plane as a piece of paper
se that is folded in fours. As forces are
applied to the edges of the paper, it
fig. 16 pulls apart. First it becomes a half,
then three-quarters and then a full
page. But if the paper is twisted during
unfolding it will be contorted. For
111
to gently unfold the distortion and
then untwist it before refolding occurs.
The shoulder itself does not need to
be dislocated to accomplish this,
although firm traction is often
necessary. A total correction of the
Once traction is stopped
folding distortion does not occur with the fascia refolds into a
this treatment alone. Stretching and configuration more
similar to its pre-injury
strengthening, triggerband technique
t
state
and normal everyday use of the fig. 18
shoulder may also be necessary for a
complete resolution of the distortion.
Figs. 17 and 18 show what may healed is to correct the distortion with hands are necessary to accomplish
happen to the fascial planes as a myofascial release. To be successful, this. Again, physical therapy,
fracture occurs. The fascia is unfolded, forces must be applied in several stretching, strengthening and
torqued and then refolded with directions at once to first unfold the triggerband technique may be helpful
distorted fascial planes resulting. The fascia and then untorque it before it once the folding distortion has been
best treatment after the fracture has refolds. Often two or more sets of successfully treated.