Myotherapy

Myotherapy is a form of manual therapy which focuses on the assessment, treatment and rehabilitation of musculoskeletal pain and associated pathologies. The term myotherapy was originally coined by Bonnie Prudden to describe a specific type of trigger point therapy which she developed in the 1970s based on the earlier work of Drs Travell and Simons who conducted extensive research into the cause and treatment of pain arising from myofascial trigger points.

Over the ensuing 40 years, myotherapy has evolved to become an allied health discipline which is practiced in many countries across the world including Australia,^[1] UK,^{[2][3][4][5][6][7]} USA, Canada, Malaysia,^[8] Thailand^[9] and Hong Kong.^[10]

Myotherapy incorporates not only the trigger point therapy, but also a wide range of soft tissue massage and manipulation including among others: muscle energy technique, dry needling, joint mobilization etc. Myotherapists also utilitise therapeutic stretching, nutritional advice, exercise prescription, postural advice and education, and use of thermal (heat/cold) and electro-mechanical therapies, e.g. ultrasound, TENS, as necessary.

Definition

Myotherapy is a branch of manual medicine which focuses on the treatment and rehabilitation of musculoskeletal pain and associated conditions. This involves an extensive physical evaluation and an integrated therapeutic approach to affected muscles, joints, nerves, and associated viscera (organs) and is used in the treatment of acute or chronic conditions and in the area of preventative management. Myotherapy is a form of manual therapy treatment for most common musculoskeletal conditions that result from improper posture, poor biomechanics and injury.^{[citation needed]} Myotherapy is defined as: "the comprehensive assessment, treatment and management of neuromusculoskeletal disorders and conditions caused by improper biomechanical functioning." Myotherapists take into account all aspects of health and wellness to treat patients - this includes not only physical, but psychological and occupational aspects of the individual.

Myotherapists are trained manual therapy professionals in the field of myofascial pain and dysfunction (pain that arises from the muscles and surrounding connective tissue).^{[citation needed]}

Myotherapists assess and treat the connective tissue (muscle, tendons, ligaments, joint capsules, tissue coverings) using mostly direct 'hands-on' techniques. Some myotherapists are also trained in the use of TENS machines, lasers, ultrasound, rehabilitation aids, taping, dry needling and exercise prescription for rehabilitation.

Myotherapy treatments incorporate the following:

• a thorough patient history,
• observations of tissues, movement, and gait,
• postural assessment,
• palpation of spine, peripheral joints, musculature, connective tissue and associated viscera,
• clinical orthopaedic and neurological tests.

Myotherapy plays a role in manual medicine as a single mode of treatment, or is used in conjunction with treatment provided by both medical and other allied-health practitioners such as physiotherapy, podiatry, chiropractic, osteopathy, and acupuncture/TCM.

History

Myotherapy was developed by Bonnie Prudden, an American exercise and fitness expert and author of a number of books, most importantly the acclaimed Pain Erasure. She created a new system of Manual Therapy based on the groundbreaking work of Dr. Janet Travell. Myotherapy is based on the research of Drs Janet Travell and David Simons who established the neuro-physiological basis of myofascial pain and dysfunction, and has evolved to include the assessment techniques and treatment modalities.

Some Standard Effects of Myotherapy Treatment:

• Reduction in abnormal muscle contraction (AMC)
• De-activation of Myofascial Trigger Points (MTrP)
• Prevention of muscular and tendinous injury, and associated joint dysfunction
• Reduction of myofascial pain
• Reduction of muscular strain and discomfort
• Alleviation of emotional stress and psychological impacts of pain and dysfunction
• Increase in range of motion (ROM) and facilitation of movement
• Reflex stimulation and relaxation of central and peripheral nervous systems
• Hyperaemia – local or widespread (depending on treatment)
• Increased lymphatic drainage
• Increased metabolic rate
• Increased blood supply –
  • enhances waste removal
  • increases oxygen to tissues
  • reduces ischaemic pain^{[citation needed]}

Modalities

All modalities are used with the specific purpose of achieving a therapeutic outcome. None of these modalities were used by Bonnie Prudden, the developer of Myotherapy. She proposed only manual medicine.

Soft Tissue Therapy STT is the use of the hands to target specific areas of dysfunction for the purpose of a therapeutic outcome. Techniques may include:

Therapeutic massage, muscle energy techniques, neuromuscular techniques, positional release techniques, myofascial release techniques, trigger point therapy, lymphatic drainage techniques and joint mobilisation.

Temperature Therapies Temperature Therapy is the application of either heat (thermal therapy) or cold (cryotherapy). Techniques may include:

Heat packs, cold packs, ice baths, whirlpools, heat lamps, and paraffin wax baths

Electromechanical Stimulation ES is the application of electrical currents or soundwaves to produce a healing and/or analgesic (pain-modifying) outcome. Techniques include:

TENS therapy, interferential technique, therapeutic ultrasound and low level laser therapy

Myofascial Dry-Needling (MDN) MDN is the application of fine filiform needles (which are also used by but not exclusive to acupuncture)into specific points in the muscles known as trigger points, to produce a healing and analgesic (pain-modifying) outcome. MDN is a highly effective and painless technique.^{[citation needed]}

Myofascial Stretching Myofascial Stretching is the application of a range of stretching techniques, used to elongate the muscle fibres, return functionally short muscles to their optimal length and increase the range of motion of a joint, leading to prevention of further injury. Techniques may include:

Static stretching, dynamic stretching and proprioceptive neuromuscular facilitation stretching (PNF)

Rehabilitative Exercise and Corrective Actions Rehabilitative exercise and corrective actions are an imperative part of any myotherapy treatment. It enables the client to make take responsibility for their own health, acts to permanently change dysfunctional patterns, and is a vital injury prevention mechanism. Techniques may include:

Core Stability and swissball, hydrotherapy neuromusculoskeletal rehabilitative programs, biomechanical retraining, nutrition, injury prevention, lifestyle education

Myotherapy is suitable for everybody and in varying stages of health and disease.^{[citation needed]} Notable examples include:

• General population
• Athletes (Amateur and Professional)
• The Elderly
• Children and Adolescents
• Pregnancy
• Neurological Conditions (e.g. post-stroke)
• Connective Tissue Dysfunction (e.g. fibromyalgia)
• Post Surgery and Rehabilitation
• Pain and Discomfort
• Movement Disorders
• Postural Problems
• Core Stability

What can a Myotherapist treat?

Common Conditions Treated and Managed with Myotherapy:

Head and Neck Region:

• Headaches; tension, referred, migraine, cluster
• TMJ Dysfunction; jaw pain
• Cervical (neck) sprains and strains
• Acute and chronic muscular conditions
• Pain locally or pain that refers to the chest, arms or hands
• Impingement conditions; thoracic outlet syndrome, facet joint dysfunction
• Degenerative joint conditions

Upper Limb Conditions:

• Joint capsule and ligament sprains, muscular and tendon strains
• Acute and chronic muscular conditions
• Referred pain from other sources
• Impingement conditions; thoracic outlet syndrome, carpal tunnel syndrome
• Rotator cuff injury, instability and adhesive capsulitis (frozen shoulder)
• Bursitis, tendonitis and tenosynovitis; bicipital tendonitis, olecranon bursitis, DeQuervains tensynovitis
• Degenerative joint conditions
• Overuse and occupational injury; medial and lateral epicondylitis (golfers and tennis elbow)
• Finger injuries

Thorax, Chest and Abdomen Conditions:

• Joint capsule and ligament sprains; thoracic spine, rib injury
• Muscular and tendon strains
• Acute and chronic muscular conditions
• Referred pain from other sources
• Impingement conditions; thoracic outlet syndrome
• Degenerative joint conditions

Lumbar Spine, Buttock and Pelvic Conditions:

• Lumbar (lower back) sprains and strains
• Acute and chronic muscular conditions
• Pain locally or pain that refers to the buttocks, legs or feet
• Bursitis and tendonitis; trochanteric bursitis
• Impingement conditions; lumbar disc injury, facet joint dysfunction, piriformis syndrome
• Degenerative joint conditions
• Sacroiliac dysfunction, sciatic pain
• Core stability weakness
• Pelvic pain, coccydynia and intrapelvic pain

Lower Limb Conditions:

• Joint capsule and ligament sprains; ACL, PCL, MCL and LCL injury, meniscus injury, ankle
• Muscular and tendon strains; quadriceps, hamstrings and calf, Achilles tendon
• Acute and chronic muscular conditions; plantarfasciitis, hamstring complaints, shin splints
• Referred pain from other sources
• Impingement conditions; hip impingement, compartment syndrome
• Patellar instability and patellofemoral dysfunction
• Bursitis and tendonitis; patellar tendonitis, ITB friction syndrome
• Degenerative joint conditions
• Toe injuries
• Balance and coordination

Other Conditions

• Arthritis and inflammatory conditions
• Fibromyalgia and myofascial pain syndrome
• Postural dysfunction – structural or functional
• Female specific and pregnancy related musculoskeletal complaints
• Stress related musculoskeletal complaints
• Occupational related musculoskeletal complaints
• Paediatric and Geriatric specific musculoskeletal complaints
• Athlete specific musculoskeletal complaints
• Disability related musculoskeletal complaints

References

Further reading

• Gunn C.C.; 2007, The Gunn Approach to the Treatment of Chronic Pain – Intramuscular Stimulation for Myofascial Pain of Radiculopathic Origin, 2nd edn., Churchill Livingstone, CN
• Jamison J.R.; 2006, Differential Diagnosis for Primary Care – a handbook for health care practitioners, 2nd edn., Elsevier, LON
• Kendall, F.P. et. al 2005, Muscles Testing and Function with Posture and Pain, 5th edn., Lippincott Williams & Wilkins, USA
• Magee D.J.; 2006, Orthopedic Physical Assessment, 4th edn., Saunders Elsevier, USA
• Petty N.J. & Moore A.P.; 2002, Neuromusculoskeletal Examination and Assessment – A Handbook for Therapists, 2nd edn., Churchill Livingstone/Elsevier Science Ltd., CN
• Travell J.G. & Simons D.G.; 1999, Myofascial Pain and Dysfunction – The Trigger Point Manual: Volume 1. Upper Half of Body, 2nd edn., Lippincott Williams & Wilkins, USA
• Travell J.G. & Simons D.G.; 1993, Myofascial Pain and Dysfunction – The Trigger Point Manual: Volume 2. The Lower Extremities, Lippincott Williams & Wilkins, USA
• Tritton, B.; 1996, Massage and Myotherapy, 2nd edn., RMIT Publishing, AUS