__The_Manual_of_Trigger_Point_and_Myofascial_Therapy

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Chapter 13 hen patients suffer from one or more of the fol­ and outer membranes covering the brain. Symptoms usually develop within a short period of time after a Wlowing conditions, trigger point and myofascial head injury. Manual therapy is very intense for such a therapy may be contraindicated: condition. * Malignancy: When a mass of cancer cells may invade * Anticoagulant therapy: Patients who are taking Coumadin (DuPont Pharmaceuticals, Wilmington, surrounding tissues or spread to distant areas of the Del) or heparin may develop bruises with the appli­ body. In general, manual therapy may be contraindi­ cation of trigger point therapy. Clearance from the cated depending on the type and area of the tumor. treating physician and consent from the patient * Open wounds in the area of application of trigger should be obtained before application of this tech­ point therapy. Tissue may become more irritated with nique. the application of trigger point therapy and myofas­ * Advanced osteoporosis: Bone loses calcium and phos­ cial stretching exercises. phorus, the minerals that make it strong. The tissue * Severe arteriosclerosis: Commonly shows its effects becomes less dense and bones become thinner. With first in the legs and feet. The arteries may become narrowed and blood flow decreases, progressing in sparse tissue or fewer supporting I beams, bones are some cases to total closure (occlusion) of the vessel. The vessel walls become less elastic and cannot dilate fragile and fracture easily. It is often called the silent to allow greater blood flow when needed. Excessive disease because fractures can occur without warning compression and stretching may cause blood clot for­ and when they are least expected. If trigger point mation. therapy and stretching exercises are too forceful, frac­ * Aneurysm: Resembles a sack of blood attached to one tures may occur. side of a blood vessel by a narrow neck. All types of manual therapy are contraindicated. Communication with the patient's primary care physician, * Subdural hematoma: A brain disorder involving a other treating physicians, as well as other clinicians involved in collection of blood in the space between the inner the patient's care is strongly suggested before /Jroceeding with treatment.

68 Chapter I 3 REVIEW QUESTIONS I . In what ways may trigger point and myofascial therapy be harmful to patients with severe advanced osteoporosis? A. Local hematoma B. Ineffective treatment C. D anger of fracture D. None of the above 2. A 50-year-old male is suffering from low back pain. Myofascial evaluation reveals active myofascial trig­ ger points on the quadratus lumborum. The patient is on Coumadin. What is the proper inter­ vention? A. Trigger point therapy will not help and should not be applied in this case. B. Obtain clearance from the physician and con­ sent from the patient before proceeding with treatment. C. Obtain clearance from the physician, consent from the patient, and proceed with treatment. Adjust pressure to avoid possible fracture. D. Obtain clearance from the physician, consent from the patient, and proceed with treatment. Adjust pressure to avoid bruising.

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Chapter 14 CHAPTER 1 12. Motor unit 13. True I. False 14. False 2. True 15. True 3. Postisometric relaxation CHAPTER 4 CHAPTER 2 1. False I. False 2. True 2. True 3. False 3. 71 4. Repetitive movements, high-velocity movements, 4. True 5. True stress positions 6. True 5. True 7. False 6. B CHAPTER 3 CHAPTER 5 I. False 1. False 2. False 2. False 3. Accessory 3. True 4. True 4. False 5. True 5. False 6. Actin 6. True 7. True 7. True 8. False 8. False 9. Triad 9. Positive stretch sign 10. False 10. B II. Motor endplate 11. C

72 Chapter 14 CHAPTER 1 0 CHAPTER 6 1. True 2. False I. True 3. False 2. False 4. False 3. False 5. True 6. False CHAPTER 7 7. True 8. True I. True 9. A 2. False 10. C 3. False 4. True CHAPTER 11 5. True 6. Central I. True 2. True CHAPTER 8 3. False 4. B j. False 2. True CHAPTER 12 3. True 1. True CHAPTER 9 2. False 3. True I. Patient pain recognition 4. False 2. False 5. True 3. False 6. True 4. Active, latent 5. False CHAPTER 1 3 6. True 7. True I. C 2. D

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Part B