Universitat Internacional de Catalunya - Barcelona

Physiotherapy and Miofascial Pain

• code 10236
• course 4
• term Semester 1
• type op
• credits 3

Module: Physiotherapy in clinical specialties

Matter: Optativas de especialización

Main language of instruction: Spanish

Head instructor

Dp. Miguel Ángel PÉREZ - maperez@uic.es

Currently muscle pain is one of the main reasons for medical consultation. According to the International Anatomical Nomenclature Committee (IANC - CINA in Spanish), the muscular system constitutes as the largest organ in the human body (~ 400 muscles) and represents almost 40% or more of the body weight of an individual. That is why any individual may suffer, and consequently suffers, from episodes of musculoskeletal pain in the course of their life, where myofascial pain (MP - DM in Spanish) is shown as a significant demonstration of this functional disability.

Acute MP is associated with a myofascial trigger point (mtP - Pgm in Spanish), located in an evident tense band of muscle tissue, and whose most significant symptom is local pain and / or referred to distance, called Referred Pain Pattern (RPP - PDR in Spanish).

Doctors Travell and Simons, described the myofascial pain syndromes (MPS - SMP in Spanish) in the middle of the last century and showed a new path for understanding their neurophysiological mechanisms and possible therapeutic interventions.

Diagnosis and / or delayed treatment of acute MP, caused by mtP, tends to become chronic MP. The process which, although not a direct threat to the patient's life, can generate a disabling situation not only from a physical point of view but also from a psychological point of view.

There can be multiple etiology and clinical manifestations of chronic MP. Their study is viewed from a multidimensional model, where different areas are involved: Neurophysiological, Biochemical and Psychological.

In chronic MP, paying attention to the deep Neuroplastic functional and structural changes of the Central Nervous System (CNS - SNC in Spanish). Therefore, it is necessary to have a focus on a multifactorial therapeutic approach based on the theoretical and practical contribution of different research and scientific evidence.

For all these reasons, in general, professionals in the health sciences and, in particular, the Physiotherapy, must acquire the necessary knowledge, both diagnosis and analysis in various therapeutic approaches in the field of MP. This way students can address those myofascial syndromes and dysfunctions in a profound and correct manner.

Not specified.

General objective:

• Provide to the Physiotherapist the knowledge that will allow for a differential diagnosis of MP relative to other pathological conditions. This requires learning the signs and symptoms, diagnostic techniques and examination characteristics and specific therapeutic approaches of this discipline.

Specific objectives:

• Know and understand the myofascial influence on main clinical conditions according to the anatomical region (rotator cuff pathology, back pain, ...).
• Know anatomy and muscular topography.
• Understand the nature and the characteristics of the mtP and MP.
• Understand the neurobiological and neurochemical mechanisms of modulation of MP.
• Address the hypothesis that goes into the understanding of Physiopatholgy of MP.
• Recognize referred pain patterns (RPP) described by Travell and Simons, from the muscles that have been studied
• Examine and palpate the mtP in a tense muscular band. with different palpation models depending on the characteristics of each muscle.
• Know how to identify the local spasm response (LSR - REL in Spanish) using different types of palpation in those muscles studied.
• Description and application of the various conservative myofascial techniques.
• Know the principles of the application of the cryo-spray technique.
• Describe models of chronic myofascial pain and treatment options - articular dysfunction myofascial (AD--MP - DA--MP in Spanish) - Segmental Spinal Sensitization (SSS - SES in Spanish) - Intramuscular Stimulation (IMS).
• Comprehend the role of the fascial system as an integrator of the different causes of the myofascial pain dysfunction syndromes.

• 01 - The ability to analysis and synthesis.
• 02 - The ability to organise and synthesize
• 09 - Demonstrate critical thinking skills.
• 15 - Demonstrate a concern for quality.
• 37.4 - Adhere to professional competencies and standards in health care
• 43 - Knowledge of physiotherapeutic procedures based on techniques and methods specific to physiotherapy interventions applied to the various disorders of all systems and medical and surgical specialisations, as well as health promotion and disease prevention.
• 47 - Ability to assess the patient's/client's functional status, taking into account his/her physical, psychological and social aspects.
• 49 - Ability to design a physiotherapy treatment plan.
• 51 - Ability to assess the outcomes of the physiotherapy treatment against the initial goals set and the established outcome criteria.

• Acquire the theoretical knowledge necessary to be able to develop proper physical examinations and carry out the characteristic therapeutic approaches of MP.

• Know how to recognize and identify specific pathogenetic features of MP.

• Differentiate the processes of myofascial origin of other classifications (compression of peripheral nerves, root processes, "joint" pains or other pathologies).

The contents are distributed in different teaching blocks which develop the general and specific objectives.

 Theoretical block:

 - Historical Review and introduction to MP.

 - Myofascial Morphophysiology.

 - Neurophysiology of myofascial pain.

 - Nature and characteristics of mtP and MP.

 - Classification of mtP.

- Signs, symptoms and physical findings of mtP.

 - Examination of mtP.

 - Methodology, indications and contraindications of the different types of treatment techniques:

• Spray and stretch.
• Myofascial techniques.

 - Invasive Approach.

• Legal situation with regard to invasive approach of MP.
• Definition.
• Advantages and disadvantages.
• Mechanisms of action.
• Indications, contraindications, complications and advice.

 Practical block:

 - Theoretical development, examination, palpation and treatment of mtP of different muscles depending on the model of MP, classified by anatomic and topographical regions:

1. Shoulder girdle.
2. Upper extremity.
3. Pelvic girdle.
4. Lower extremity.
5. Trunk.
6. Head and neck.

- Theoretical and practical presentation of clinical pictures according anatomical region.Based on concepts of multidisciplinary treatment for each of them.

 - Demonstration, by a team of professors, with invasive techniques used on the symptoms of MP (dry needling).

The course will be presented through a theoretical and practical model:

- The theoretical model will be taught using multimedia resources.

- The practical model is performed on a real model, developing different techniques and therapeutic approaches among peers.

Students will receive theoretical information via the intranet, while the learning and theoretical material of practical models will be given during the presentation without written support.

The theoretical and practical material developed will be evaluated at the end of the course, through the completion of two final exams. One over the theoretical contents and another on practical content. Each of them will count 50% of the final mark and both will have to be passed separately.

Basic bibliography

I.- Myofascial Pain

• Travell y Simons. Dolor y disfunción miofascial. Edit. Panamericana. Volúmenes 1 y 2 (2002 / 2004).
• Dommerholt, J. - Fernández de las Peñas, C. Punción seca de los puntos gatillo. Una estrategia clínica basada en la evidencia. Edit. Elsevier (2013).

II- ANATOMY.

•  Gray H. Anatomía de Gray. Churchill Livingstone / Harcourt Brace (1998).
• Anatomía y movimiento humano. Estructura y funcionamiento. Palastanga Niguel-Field Derek-Soames Roger. 1ª edición. Barcelona, Editorial Paidotribo. 2007.
• Netter F. Atlas de anatomía humana. Masson S.A. (2003).
• Rohen, Yokochi. Atlas fotogréfico de Anatomía Humana. 3ª edición. Barcelona, Ed. Doyma Libros, 1994.
• Gran Atlas de anatomía humana (disección). Mcminn R.M.H.-Hutchings R.T. Tomo I y II. Nueva edición. Barcelona. Oceano grupo editorial S.A. 1993
• Tixa S. Atlas de Anatomía palpatoria del cuello, tronco y Extremidad Superior. Barcelona, Ed. Masson, 2002.
• Tixa S. Atlas de Anatomía palpatoria de la Extremidad Inferior. Barcelona, Ed. Masson, 2002.
• Kapandji A I. Fisiología articular, Volumen 1, 2 y 3. 5ª edición. Madrid, Editorial Médica Panamericana, 1998.
• Calais-Germain B. Anatomía para el movimiento. Edit. La liebre de Marzo (1994).

DIAGNOSTIC TESTS III.

• Daniels L. y Worthingham C. Pruebas Funcionales musculares. McGRAW-HILL, Interamericana (1988).
• Buckup K. Pruebas clínicas para patología ósea, articular y muscular. Edit. Masson (1997).
• CC GooMPan and Snyder TK Medical Pathology for physiotherapists. Edit. McGRAW-HILL, Interamericana (2002).
• Neurología para fisioterapeutas. Downi Patricia A. 4ª edición. Argentina. Editorial médica panamericana. 2001.

Additional Resources

• Peter E. Baldry. Acupuncture, Trigger Points and Muskuloskeletal Pain. Edit. Elsevier (2005).
• Gunn C. Chan. Treatment of Chronic Pain. Edit. Churchill Livingstone (2005).
• Mense S. y Simons D. Muscle Pain. Understanding its nature, Diagnosis, and Treatment. Edit. Lippincott Williams & Wilkins (2000).
• Valera, F. - Minaya, F. Fisioterapia invasiva. Edit. Elsevier (2013).
• Fernández de las Peñas, C. - Cleland, J. - Huijbregts, P. Síndromes dolorosos en el cuello y el miembro superior. Detección, diagnóstico y tratamiento informados por la evidencia. Edit. Elsevier (2013).
• Jones L H. Jones Strain –CounterStrain. Tyrell Lane, Ed. Jones Strain-CounterStrain, Inc., 1995.
• Mitchell Jr Fred. L., Mitchell P. Kai Galen. The muscle energy manual. 2ª edición. Michigan. MET Press. 2005. Vol. 1 y 2
• Thomas W. Myers. Anatomy Trains. Edit. Churchill Livingstone (2006).
• Acupuntura osteopática. Seem M. Mandala ediciones. (2005).
• Busquet L. Las cadenas musculares, Tomo I – II – III – IV, Editorial Paidotribo.
• Chaitow L. Técnica Neuromuscular. Edit. Bellaterra (1980).
• Chaitow L. Técnicas de energía muscular. Edit. Paidotribo (2000).
• Chaitow L. Técnicas de liberación posicional. Ed. Elsevier, 2009.
• Paoletti Serge. Las Fascias. El papel de los tejidos en la mecánica humana. 1ª edición. Barcelona, Ed. Paidotribo. 2004.
•  Smith-Agreda V. Ferres-Torres E. Fascias. Principios de Anatomo-Fisio-Patología. 1ª edición. Barcelona, Ed. Paidotribo. 2004.
• Kenneth L. Knight. CRIOTERAPIA. Rehabilitación de las lesiones en la práctica deportiva. Edit. Bellaterra (2000).

E: exam date | R: revision date | 1: first session | 2: second session:

• E2 27/06/2019 12:00h