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      Muscle Repositioning: Combining Subjective and Objective Feedbacks in the Teaching and Practice of a Reflex-Based Myofascial Release Technique

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          Abstract

          Muscle Repositioning (MR) is a new style of myofascial release that elicits involuntary motor reactions detectable by electromyography. This article * describes the principal theoretical and practical concepts of MR, and summarizes a workshop presented October 31, 2009, after the Second International Fascia Research Congress, held at Vrije Universitiet, Amsterdam.

          The manual mechanical input of MR integrates the client’s body segments into a block, which is evident as a result of the diagnostic manual oscillations the practitioner imparts to the client’s body. Segmental integration is achieved when the client’s body responds as a unit to the oscillatory assessment. It appears that manually sustaining the condition of segmental integration evokes involuntary muscle reactions, which reactions might correspond to mechanisms that maintain homeostasis, such as pandiculation. It might be that these reactions are part of the MR mechanism of action and underlie its clinically observed efficacy in the treatment of musculoskeletal disorders.

          For the practitioner and the client alike, segmental integration provides unique sensations. In teaching MR, these paired sensations can be used as kinesthetic feedback resources, because quality of touch can be guided by the client’s reported sensations, which should match the practitioner’s sensations. Another form of feedback with respect to quality of touch is the visually discernable degree of segmental integration. Finally, because the involuntary motor activity elicited by the MR touch can be objectively monitored through electromyography and possibly other instrumented measurements, the MR approach might yield objectivity, precision, and reproducibility—features seldom found in manual therapies.

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          Most cited references25

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          On yawning and its functions.

          The forms and behavioral correlates of yawning are described, and the phylogenetic and ontogenetic aspects of the act are examined with particular attention to its possible functions. Much evidence supports the view that yawning is an important mediator of behavioral arousal levels, a view that is further strengthened by a review of endocrine, neurotransmitter, and pharmacological mechanisms of yawning: A major function of yawning appears to involve maintenance or increase of arousal when environments provide relatively little stimulation.
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            The ligamento-muscular stabilizing system of the spine.

            Electrical and mechanical stimulation of the lumbar supraspinous ligament of three patients with L4-L5 spinal deficits and of the feline model, respectively, was applied while recording electromyography on the multifidus muscles. To determine if mechanoreceptors in the human spine can reflexively recruit muscle force to stabilize the lumbar spine, and to demonstrate, in the feline model, that such ligamento-muscular synergy is elicited by mechanical deformation of the lumbar supraspinous ligament (and possibly of other spinal ligaments), the facet joint capsule, and the disc. The literature repeatedly confirms that ligaments have only a minor mechanical role in maintaining spine stability, and that muscular co-contraction of anterior and posterior muscles is the major stabilizing mechanism of the spine. The literature also points out that various sensory receptors are present in spinal ligaments, and that the ligaments are innervated by spinal and autonomic nerves. Data that describe how ligaments and muscles interact to provide stability to the spine were not found. The supraspinous ligament at L2-L3 and L3-L4 was electrically stimulated in three patients undergoing surgery to correct deficits at L4-L5. Electromyography was performed from the multifidus muscles at L2-L3 and L3-L4, bilaterally. In 12 cats, the supraspinous ligaments from L1-L2 to L6-L7 were mechanically deformed, sequentially, while electromyography was performed from the multifidus muscles of the six levels. Loading of the ligament was applied before and after each of the two vertebrae were externally fixed to prevent motion. Electromyograms were recorded from the multifidus muscles, bilaterally, in the two of the three patients, demonstrating a direct relationship to receptors in the supraspinous ligament. Electromyograms were recorded from the feline multifidus muscle with mechanical loading of the supraspinal ligament at each of the L1-L2 to L6-L7 motion segments. In the free-spine condition the largest electromyographic discharge was present in the level of ligament deformation, and lower electromyographic discharge was recorded in two rostral and caudal segments. After immobilizing any two vertebrae, loading of the ligament resulted in electromyographic discharge in the muscles of the same level and at least one level above and/or below. Deformation or stress in the supraspinous ligament, and possibly in other spinal ligaments, recruits multifidus muscle force to stiffen one to three lumbar motion segments and prevent instability. Strong muscular activity is seen when loads that can cause permanent damage to the ligament are applied, indicating that spastic muscle activity and possibly pain can be caused by ligament overloading.
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              The neurobiology of pleasure, reward processes, addiction and their health implications.

              Modern science begins to understand pleasure as a potential component of salutogenesis. Thereby, pleasure is described as a state or feeling of happiness and satisfaction resulting from an experience that one enjoys. We examine the neurobiological factors underlying reward processes and pleasure phenomena. Further, health implications related to pleasurable activities are analyzed. With regard to possible negative effects of pleasure, we focus on addiction and motivational toxicity. Pleasure can serve cognition, productivity and health, but simultaneously promotes addiction and other negative behaviors, i.e., motivational toxicity. It is a complex neurobiological phenomenon, relying on reward circuitry or limbic activity. These processes involve dopaminergic signaling. Moreover, endorphin and endogenous morphinergic mechanisms may play a role. Natural rewarding activities are necessary for survival and appetitive motivation, usually governing beneficial biological behaviors like eating, sex and reproduction. Social contacts can further facilitate the positive effects exerted by pleasurable experiences. However, artificial stimulants can be detrimental, since flexibility and normal control of behavior are deteriorated. Additionally, addictive drugs are capable of directly acting on reward pathways. Thus, the concrete outcome of pleasant experiences may be a question of dose. Moderate pleasurable experiences are able to enhance biological flexibility and health. Hence, pleasure can be a resistance resource or may serve salutogenesis. Natural rewards are mediated by sensory organ stimulation, thereby exhibiting a potential association with complementary medical approaches. Trust and belief can be part of a self-healing potential connected with rewarding stimuli. Further, the placebo response physiologically resembles pleasure phenomena, since both involve brain's reward circuitry stimulation and subjective feelings of well-being. Pleasurable activities can stimulate personal growth and may help to induce healthy behavioral changes, including stress management. However, more research is needed to better understand the nature, neurobiology and maybe dangerous aspects of pleasure. Also, a possible involvement of endogenous morphinergic signaling has to be studied further.
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                Author and article information

                Journal
                Int J Ther Massage Bodywork
                International Journal of Therapeutic Massage and Bodywork
                International Journal of Therapeutic Massage & Bodywork
                Multimed Inc.
                1916-257X
                2010
                17 March 2010
                : 3
                : 1
                : 26-35
                Affiliations
                Associação Brasileira de Rolfing, São Paulo – SP, Brazil
                Author notes
                Corresponding author: Luiz Fernando Bertolucci, Avenida Dr. Arnaldo, 1644, Sumaré, 01255-000 São Paulo, SP – Brazil. bertolucci.lf@ 123456gmail.com
                Article
                ijtmb-3-1-26
                3091424
                21589699
                211ec020-37ab-4b24-9f0e-bf2ce7da49eb
                Copyright© The Author(s) 2010. Published by the Massage Therapy Foundation.

                Published under the CreativeCommons Attribution-NonCommercial-NoDerivs 3.0 License.

                History
                Categories
                Education

                Complementary & Alternative medicine
                myofascial pain syndromes,yawning,muscle stretching exercises,rehabilitation,musculoskeletal manipulations,fascia,sensory feedback,teaching,physical therapy (specialty),martial arts

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