근막이완의 기초과학 The basic science of myofascial release - 정리해야

[문형철]

근막이완법

근막이 잘 이완되어야 근육이 잘 움직이고, 인체 관절은 잘 움직인다.

The "Myofascial release" is the soft tissue therapy for the treatment of skeletal muscle immobility and pain. First described by Andrew Taylor Still and his early students,^[1] the therapy relaxes contracted muscles, improves blood and lymphatic circulation and stimulates stretch reflex in muscles.

근막이완은  근골격계 immobility와 통증을 치료하는 연부조직치료법임. 

앤드류 테일러 스틸에 의해서 기술됨. 

수축된 근육을 이완하고, 혈액과 임파액의 순환을 촉진하고, 근육에서 스트레치반사를 자극함.

The term myofascial was first used in medical literature by Janet G. Travell in the 1940s in reference to musculoskeletal pain syndromes and trigger points.^{[citation needed]} In 1976, Travell began using the term "myofascial trigger point" and in 1983 published the reference Myofascial pain & dysfunction: the trigger point manual.^[3] There is no evidence she actually used what is now termed "myofascial release".^{[citation needed]} Some practitioners use the term "myofascial therapy" or "myofascial trigger point therapy" referring to the treatment of trigger points, usually in medical-clinical sense. 

The phrase has also been loosely used for different manual therapy techniques, including soft tissue manipulation work such as connective tissue massage, soft tissue mobilization, foam rolling, structural integration, and strain-counterstrain techniques. 

Myofascial techniques generally fall under the two main categories of passive (patient stays completely relaxed) or active (patient provides resistance as necessary), with direct and indirect techniques used in each.

근막이라는 용어를 의학교과서에 처음 사용한 의사는 자네트 트라벨의 1940년 musculoskeletal pain syndromes and trigger points에서 처음 사용

1976년 트라벨은 myofascial trigger point라는 용어를 사용하기 시작하고, Myofascial pain & dysfunction을 1983년 를 출간함. 

이 용어는 다양한 수기치료에서 느슨하게 사용됨. 결합조직 마사지, 연부조직 가동법, 폼롤링, 구조통합, strain-counterstrain 테크닉 등

근막이완법은 두개의 분류가 가능함

- 능동적, 수동적 근막이완법

- 직접적, 간접적 근막이완법

Direct myofascial release is an attempt to bring about changes in the myofascial structures by stretching or elongation of fascia, or mobilizing adhesive tissues.

The indirect method involves a gentle stretch, with only a few grams of pressure, which allows the fascia to 'unwind' itself. The dysfunctional tissues are guided along the path of least resistance until free movement is achieved.

Myofascial release의 기초과학.pdf

Introduction

It is imperative, as manual therapists, to seek and understand a comprehensive and cohesive model of what happens to the body's tissues following trauma, and how we facilitate health in our patients. This greater understanding can potentially lead to increased potency of treatment as well as encouraging a multidisciplinary approach. The conscientious bodyworker needs to ask, 'what am I trying to accomplish with my treatment, and what is happening beneath my hands to create these desired changes in tissue health and structural alignment?' The facilitation of the body's self correcting mechanisms, directing the tissues and systems toward metabolic and morphologic efficiency, and ultimately gaining functional, painfree movement, should be major goals of treatment. 

It is theorized that the alterations in tissue texture and tension resulting from myofascial release (see Sidebar over page) come from dynamic changes in the connective tissue and neuromuscular systems of the body. These two systems have been shown to be vitally interrelated in function and in their response to therapy (Pischinger 1975). This relationship is

cellular, systemic and somatic.

This theoretical and clinical approach asks the individual to reflect on their view of the body; how it is structured, functions and communicates. It involves a conceptual shift from a biological systems infrastructure model to a selforganizing cybernetic biological systems model. Ideally, practitioners of various bodywork approaches are

constantly updating their paradigm about bodily function, potentially leading them to a greater unified theory of somatic dysfunction and treatment. According to Foss (1987), health care is entering a second medical revolution. In the face of this revolution, this conceptual shift is necessary to advance the quality and efficiency of patient care. 

This article will discuss the connective tissue response to trauma and myofascial release, supported by a biocybernetic model of morphologic function.

The connective tissue response to trauma encompasses adaptive responses of the morphologic and neuromuscular systems, reflected clinically as dysfunction and pain. These concepts are the very foundation required for understanding 

the body's response to trauma, and treatment of subsequent dysfunction.

What is myofascial release?

Fascia is tough connective tissue which spreads throughout the body in a three-dimensional web from head to toe. The fascia is ubiquitous, surrounding every muscle, bone, nerve, blood vessel and organ all the way down to the cellular level.  Generally, the fasciai system provides support, stability and cushioning. It is also a system of locomotion and dynamic flexibility forming muscle. 

근막은 머리에서 발가락까지 3차원 그물망으로 인체 전체를 연결하는 질긴 결합조직.

근막은 인체 도처에 존재하고, 모든 근육, 뼈, 신경, 혈관, 장기를 둘러싸는데.. 세포레벨까지 둘러싸고 있음. 

일반적으로 근막시스템은 지지, 안정성, 쿠션 등을 제공하고 이동과 근육을 형성하는 동적 유연성의 시스템을 포함함. 

Tightening of the fascial system is a histologic, physiologic and biomechanic protective mechanism that is a response to trauma. The fascia loses its pliability, becomes restricted, and is a source of tension to the rest of the body. The ground substance solidifies, the collagen becomes dense and fibrous, and the elastin loses its resiliency. Over time this can lead to poor muscular biomechanics, altered structural alignment, and decreased strength, endurance and motor coordination. 

근막의 단단해짐은 외부충격에 조직학적, 생리학적, 생체역학적 방어기전임. 

근막이 유연함을 잃으면 제한되기 시작하고 쉬고 있는 인체에 장력이 걸리는 원인이 됨. 

젤과 같은 GAGs가 굳어지고, 콜라겐이 단단해지고 섬유화되고 탄력섬유는 탄성을 잃어버림. 

시간이 지나면 근육생체역학, 변형된 구조 배열, 근력, 근지구력, 협응력의 감소가 초래됨.

Subsequently, the patient is in pain and functional capacity is lost. Myofascial release is a hands-on soft tissue technique that facilitates a stretch into the restricted fascia. A sustained pressure is applied into the restricted tissue barrier; after 90-120 seconds the tissue will undergo histological length changes allowing the first release to be felt. 

연속적으로 환자는 통증이 발생하고, 기능능력을 잃어버림. 

근막이완은 수기치료 테크닉으로 제한된 근막을 스트레칭시켜 기능을 촉진함. 

지속적인 압박이 제한된 장벽조직에 적용되고 90~120초 후에 연부조직은 조직학적 길이변화를 초래할 수 있음. 

The therapist follows the release into a new tissue barrier and holds. After a few releases the tissue will become softer and more pliable. The restoration of length and health to the myofascial tissue will take the pressure off the pain sensitive

structures such as nerves and blood vessels, as well as restoring alignment and mobility to the joints.

치료사는 새로운 연부조직 장벽을 이완시키고 고정함. 조직이완후에 조직은 부드럽고 좀더 유연해짐. 

길이의 회복과 근막조직의 건강함은 신경 혈관조직 등 통증민감조직을 압력으로부터 제거할 뿐 아니라 관절의 움직임과 배열을 회복함. 

[박건용]

-Andrew Taylor Still은 osteopathic medicine을 만든 장본인입니다. 정골의학이라는 범주에 MFR(myofascial release), LAS(ligamentous articular strain), SCS(strain counterstrain), MET(muscle energy technique), VM(visceral manipulation), lymphatic drainage, cranial osteopathy(대중화된 CST(craniosacral therapy)), HVLA 등의 기법들이 나왔습니다.
-정골의학의 철학
1,인체는 하나의 단위이다. 2,인체는 스스로 조절, 치료, 건강을 유지하는 능력을 갖추고 있다. 3,인체의 구조와 기능은 서로 관련되어 있다. 4,합리적인 치료는 인체의 단일성, 자가조절기능, 그리고 구조와 기능의 상관 관계를 바탕으로 할 때에만 가능하다.

[ChulhwanKim]

+++ 에 BLT (balanced ligamentous tension), GOT (general osteopathic technique), SAT (specific adjustment technique), Still's technique, PNF 의 기본 원리가 된 "F"unctional technique VS "f"unctional technique, 경락의 위치와 비슷한 Chapman reflex points 와 release 가 첨가되죠, SCS 은 근육일때와 관절 혹은 인대에 따라 positional release라고 도 불리구요, MET도 concentric, isometric, ecentric, isokinetic 으로도 구분되어지구요