Myofascial release (MFR) During an injury, myofascia tends to tighten and adhere to the adjacent muscle. This affects the functionality of the muscle, leading to joint restrictions. Also, myofascial restrictions trigger severe pain. Release of these restrictions is called myofascial release (MFR). Release of myofascia breaks down the scar tissue in between the muscle and the fascia and relaxes the underlying muscle. People suffering from back pain, headaches, fibromyalgia, muscle injuries, and sciatica can be successfully treated with MFR [29] . Joint manipulation The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) has defined joint manipulation as “a passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit with the intent to restore optimal motion, function, and/or to reduce pain [30] .” The definition implies that manipulation can increase the passive range of motion of the joint, and can simultaneously reduce the pain. Pilates Pilates is a technique introduced by Joseph H. Pilates in the beginning of the 20th century. Pilates controls muscle movement consciously to gain balance, strength, and correct posture. This technique primarily focuses on the core of human body, which is denoted by the abdominals, back musculature, and glutei . Maintaining a strong core helps preserve the normal curvatures of the spine. Deviation of the proper alignment of the vertebral column and the pelvis may result in poor posture, which can cause back pain. Thus, Pilates can be considered a gold standard in preventing back pain. Pilates techniques integrate both physical and psychological components. There are eight principles of Pilates, including [31] : 1. Concentration : Concentrating on the correct movement pattern is required in Pilates. Each muscle performing the technique has to be consciously moved. 2. Breathing : Pilates focuses on breathing in the movement pattern. During Pilates sessions, breathing flows into a slow and deep rhythm. The participant must maintain a relaxed neck and shoulder musculature to facilitate normal breathing. 3. Centering : The back muscles, as well as the abdominals, play a role in Pilates. The abdominals are considered the second spine because the strength of these muscles is as equally important as back muscles in maintaining a good posture. Proper management of this area not only leads to a good posture, but also helps the progress of well- coordinated movements. 4. Control : Every movement carried out in Pilates has to be controlled and slowly paced. This requires attentiveness, concentration, and control of the movements performed. Controlling the movement may condition all the muscles in that particular muscle group, which involves the specified movement. 5. Precision : The movement pattern should be precise. Mindful concentration of the movements helps to create a meticulous movement pattern. 6. Flowing movement : This principle involves a series of controlled movements. Similar to a single movement, transition of movements also must be well-coordinated. This requires strength and agility, developed through continuous practice. Pilates automatically corrects the tight, contracted, and overstretched muscles. 7. Isolation : When an individual participates in Pilates, he or she can distinctly identify the muscles that are performing a specific movement. 8. Routine : Pilates is not an over-night solution, it takes time to see and feel results. Therefore, executing the Pilates techniques on a regular basis and patiently awaiting the results is essential.
People who have acute rheumatoid arthritis, osteoporosis, malignancies, and healing fractures should not undergo MFR. It is possible to have MFR during pregnancy with special precautions to avoid the abdominal area. Self-MFR is quite common in the sports world. Affected myofascial can be self-treated with the aid of a foam roll or a ball placed under the particular area. With the pressure of bodyweight exerted over the foam roll, the adhesions are broken down. There are two types of joint manipulation: peripheral joint manipulation and spinal manipulation (chiropractic). Contraindications to this technique include healing fractures, dislocations, malignancies, spinal deformities, and spinal cord compressive disorders. Joint manipulation has to be done by an experienced chiropractor, physiotherapist, osteopath, or occupational therapist.
Image 1: Pilates Instructor Demonstrating the Correct Performance of Pilates Using a Reformer
Note. Image adapted from: http://en.wikipedia.org/wiki/ File:Pilates_Teacher.jpg In the past, Pilates techniques have been practiced using specialized apparatus, but it can now be done with self- performing mat exercises. The Reformer, Wunda chair, Cadillac (Trapeze table), and Ladder and Arc Barrel are some of the apparatus specially designed for Pilates procedures. Image 1 shows how the Reformer is used. Pilates has shown its effectiveness in many areas. It has been successfully shown to treat people with neurological and musculoskeletal conditions, enhance the performance of athletes, and preserve the functionality of the elderly. Evidence shows that musculoskeletal conditions such as back pain [32][33] and fibromyalgia [34] can be treated with Pilates. Pilates may not be a good option for patients having degenerative disc problems, disc herniations, or fractures of the vertebrae. Pilates exercises have been specified for certain medical conditions [34][35] . Pilates techniques for fibromyalgia Mat exercises: ● Theraband LE stretching and chest opening. ● Grounding. ● Bridging. ● Pelvic clocks.
● Heel slides. ● Chest lifts.
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