Treatment of Myofascial Trains in an Olympian

Current History: This 24 year old male sprinter presented with a multitude of problems dating back to gradual onset of low back pain (LBP) 4 years previously when training for the Beijing Olympics. More recently, the LBP has worsened, the neck pain commenced 3-4 months ago, inferolateral posterior thigh pain started 1.5 years ago and finally the achilles pain commenced 6 months ago. There was also a past history of patella tendonopathy.

Current treatment had involved core stability exercises, orthotics, hamstring and gluteal strengthening with a physiotherapist at NSWIS some months previously

Physical Examination: large scar on right lateral thigh where a skin cancer was removed 2 years ago. Neurological examination normal. Static core strength good, Straight Leg Raise (SLR) 90 Left , 75 right. Active SLR positive on right. ASLR improved with bilateral lower rib compression and/or diaphragmatic lateral expansion. Posterior right superior fibula. Otherwise good flexibility in the L/S and right hip. Some reduction in range of movement (ROM) in the left hip. Marked loss of rotation and lateral flexion in the T/S. More so in th lower T/S. Generalised 3/4 ROM C/S movements. Poor Gluteal medius left and right. Increased adductor tone left side. Positive One Leg Standing (OLS) on left. Poor Active leg extension (ALE) which improved with left posterior T/S erector spinae compression.

Postural examination: left shoulder dropped, right pelvic shift, left pelvic crest high, right arm in abduction and torso in some right rotation. 

See : Muscle energy techniques for explanation of assessment

Treatment : Muscle energy techniques to left latissimus dorsi and left Quadratus Lumborum. Relaxation with awareness to left adductor. Joint mobilisations in rotation to the mid and lower left and right ribs as well as low T/S. Dry needling left erector spinae T/S. Myofascial Releases - SFL, SBL, spiral and lateral lines.

Exercises : Summo for gluteal activation, Queen Mum and Hammer Head exercises, lateral and rotation stretches of the T/S, as well as lateral diaphragmatic breathing for reduction in erector spinae overactivity resulting in improved stability of ASLR and marked increase in strength and ROM of ALE. Relaxation with awareness for the aductor. Together with the Summo this improved OLS stability and muscle synergy. Dynamic core stability using the Swiss Ball as warm up exercises before and during track work. Soft sand running and wall planks. Whole Body Vibration and Pilates Reformer exercises.

Result :  400m sub 46 secs. Injury free after 5 hands on sessions.

Myofascial techniques use the assessment of posture and movement to guide the direction and layers of treatment. Commonly used layers are the superficial front and back, deep front and back, medial and laterial trains as well as the spiral one. Treatment is from head to toes and frequently begins at the feet. These techniques integrate well with more specifically localised joint mobilisations and dry needling. Home exercise and gym regimes can complement Myofascial Train Therapy as do yoga, swimming and foam rolling. 

Uploaded : 14 May 2013