__Myofascial_Manipulation__Theory_and_Clinical_Application

and 83 tone. This muscle tone has historically been ex­ shown to demonstrate localized electrical activ­ plained as a postural low-level tonic ity in the confined area of the point]6 of motor neurons. As explained Walsh, this It appears that these taut bands of muscle are was begun by Waller and was the result of the same contracture mechanisms based on a inapplicable described by physiologists. reported Brondegeest in 1860. Waller, and Other forms of muscle contraction of later the Sherrington explained lar interest to clinicians fall into two muscle tone with the muscle stretch reflex. Such The f irst form we know as involuntary an explanation definition, an where there is unnecessary muscular contraction action potential to be generated in (X-motor neu­ that limits movcment. The second form could rons. Activation of (X-motor neurons would acti­ best be described as inefficient use. Most clini­ vate motor which would be perceptible cians are aware that because of EMG. All efforts to document resting muscJe and other causes, patients wi II move tone via EMG have failed.3234 This is not to in manners that are inefficient. These ineffi­ that some form of contracture is can have serious con­ in the muscle. Physiologists tend to define con­ sequences. for a marathon tracture as an of the mus­ runner who gets a blisler over the head of the cular contractile apparatus in the absence of fifth metatarsal at mile 3 of the race. Such a EMG activity initiated by anterior horn cells. minor ury has been known to have conse­ With this there are quences of a femoral head stress fracture by formed but they have not resulted from an action the end of the marathon. The same such ineffi­ from the myoneural junction. cient use can occur with The second level of muscle tone trigger Lack of relaxation is what Simons and Mense refer to as electro­ between contractions of th e upper trapezius has spasm. This particular of contraction been demonstrated Elert et and Ivanichev is an involuntary contraction that is demonstrated that muscles with points sociated with measurement EMG failed to relax during that muscle31 Voluntary muscular contraction movements as is the third and last level of muscle tone and An requires no muscle tone, which are associated with electri­ Before we move on to a more cal in the is certainly nation of recent findings regarding viscoelastic for the clinician. Also, an insight into the influ­ tone, it useful to discuss in a little more ences of various on (X-motor neuron ideas related to clinical muscle spasm. As we and y-motor neuron activity is useful for under­ have already a pain-spasm-pain cycle is however, this volume relates an insupportable hypothesis in the sense of an more specifically the manipulation of spasm. As anyone who has worked ciaI tissues. Consequently, the next section on on another human or even mammal will attest, IS very and will help and in compressibility of the reader to understand some of the very rapid muscular tissue are discernible by palpa­ results seen with myofascial tion. In this the f indings related to trig­ headache (T-TH) Viscoelastic Muscle Tone In T-TH it is easy taut bands of muscle. These The viscoelastic muscle tone, or tone, while often associated with trigger points, do is made up of an elastic component and a vis­ not demonstrate observable EMG activity. The coelastic component. The purely elastic compo­ points, have been nent, by requires a force to Copyrighted Material

84 MYOFASCIAL MANIPULATION produce a deformation of the substance, which tissues that prompt the stretching behavior and in this case is myofascial connective tissue. As account for maintenance of static balance, how­ we know, the collagen and other structural pro­ ever, have experienced an abundance of study teins of myofascial tissue are not the only com­ over the past 10 years and a new flurry of activ­ ponents of connective tissue. These tissues also ity during 1998 and 1999. This \"new\" property contain various other proteins in addition to their obvious structural systems. These other sub­ is known as thixotropy. stances are primarily in fluid form and have varying degrees of viscosity or \"fluid stiffness.\" Thixotropy The primary component of noncontractile fluid component is water, which is retained by the Defil1ed nonsulfated glycosaminoglycans ( GAGs) and makes up about 70% of the extracellular Thixotropy [8t1;w (touch) and \"po1ITl (turning matrix. The second component is the sulfated version of GAGs, which account for the or change)], as a term, is new to many people tissue cohesiveness. Another fluid component across the entire spectrum of clinicians who use of myofascial tissue is actin. Although actin manual therapeutics. It is not, however, new to certainly comprises a large complement of physiologists involved in the study of muscle muscle itself, it is also abundantly present in and tissue mechanics. Thixotropy describes a noncontractile fluid and serves cell motility and state of stiffness of a fluid that is dependent intracellular structure functions. This protein is on the past history of movement. There are actually fluid in its purified form and, much like a number of common substances that exhibit syrup, will form strings when picked up on a thixotropy. Tomato catsup is probably the most glass rod or other stirring device. common. After sitting in the bottle, catsup be­ comes very stiff and difficult to get out of the The GAGs, actin, and myosin all contribute to bottle. With just a little stirring, the stiffness the viscoelasticity of myofascial tissue. Unlike decreases substantially.59 elasticity, the stiffness of viscoelasticity is veloc­ ity dependent. Also, it is worthy of note that Thixotropy is a physical property of muscle unlike the velocity dependence of spasticity, the relationship between viscoelasticity and ve­ and other tissues and not a response to some neu­ locity of movement is purely mechanical. The rophysiologic event. The mere act of moving a mechanical viscoelasticity characteristic and substance with thixotropic properties will result the structural elasticity of the structural pro­ in a reduction of stiffness. The reverse is also teins combine to make up the specific tone of a true, if a thixotropic substance remains still muscle that is unrelated to contractile activity. for a given period of time (variable dependent upon the substance), the substance will become Viscoelasticity of muscle, or viscoelastic tone, stiffer. affects movement and postural control. The sensation(s) from the musculoskeletal system In order to measure thixotropy, physiologists that prompt mammals to stretch after remaining have used torque motors with very small torques still are relatively undefined concerning their of approximately 0 .1 Newton.meters (Nm). sensory mechanisms. Concerning posture, there Under conditions of a sinusoidal motion of the are mechanical properties of muscle (largely wrist, the amplitude of a motion of the wrist is unexplored until recently) that tend to support about 0.02 radians (1.14°). With a movement of a resting stiffness of muscles in posturally sup­ the wrist in an amplitude of approximately .075 ported humans that is unrelated to EMG activ­ radians for only three cycles, the amplitude of ity with the exception of occasional corrective the passive wrist movement with the same 0.1 bursts of activity. The properties of myofascial Nm of torque increases to about 0.06 radians (3.42°). These amplitudes are very small so as to avoid stirring the muscle; however, it is impor­ tant to note that a brief interruption of as little Copyrighted Material

and 85 as 2.5 seconds returned stiffness to its Ciinicailmplications ofThixotropy levels. Also of note is the fact that this Considering the ranges of motion used in which is restorable in as little as 2.5 IS i-lv.,;:\"'\",,, at most any length with the exception measurement of thixotropy, it is questionable position of extreme stretch. As one can tell, whether thixotropy has any the amount of and the amount of inter­ tion to clinical practice. This author proposes ruption of motion can be very smalL Now that that may offer an explanation for we understand the basic and the of palpable \"muscle spasms\" we delve the mechanisms 40 that are found on examination of with points. As previously highly lo­ Possible Mechanisms ofThix:otropy in calized electrical has been found in Muscle ger points. These same points have also have hypothesized that been identified by Simons45 as {'()tTP''C' I of muscle at anatomically with the intramuscular mechanisms in muscle. Camp­ motor nerve terminals. It is bell and Lakie have that the thixotropic localized electrical is to sensi­ behavior of relaxed skeletal muscle may be ex- tize in the area of a trigger a for some of the cross- The agents released may also desta­ bridges to connect even in the absence of an bilize the T-tubules enough to result in a action potentiaL As described by Hill, the early calcium concentration within stage of the tension response to movement ap­ would result in a number of pears to be dependent on the duration of the formed between the rest (no and the ponin, which would increase the stiffness release tension, which occurs later in the move­ thixotropy). Such an increase in ment and is linked to the stretch velocity 41 would decrease the pliability of muscle in the Campbell and Lakie summarize their muscle tissue. This tion of thixotropy, which attribute to a is feasible to explain the model of undetached ence of deep massage beneficial to in­ saying, \"The molecular motors of muscle crease the pliability of the muscle around may be idling rather than switched off when the gel' points. to the \"pain-spasm-pain\" muscle is relaxed.\"42(p957) deep massage of a point should There is another that can increase the pain and, the spasm, with the thixotropy of muscle. This hypothesis put even more pain. This does not always occur in forward Mutungi and and other as many practitioners can that would attribute the viscoelastic massage can \"decrease the spasm.\" of relaxed skeletal muscle to titiD f ila­ Neurophysioiogicallmpiications of Thixotropy ments. Titin filaments are exceptionally structural III which link the thick filaments to the Z-lines of muscle. The mechanical of thixotropy have Titin filaments tend to a random-coil COl)­ been reviewed in the previolls sections. These when relaxed and that uncoils with obviollsly, apply to the com­ Consequently, titin does not offer a plement of the extrafusal fibers. Extra­ very viable for thixotropy of muscle fusal f ibers are only part of the however. but with its increase in tension at extremes of As Proske et al have thixotropy, as range, it may contribute to the resistance felt in a mechanical has a profound influ­ muscle when it is stretched to near its limits of ence on muscle and their afferent neu­ range of motion.\"'.4ci rons. These influences are too numerous to Copyrighted Material

86 MYOFASCIAL MANIPULATION review here, but the discharge some of the movement or holding spindle afferents and their sensitivity to muscle described by Janda and Feldenkrais. stretch are on the history We have reviewed the basic ,'pC'pntAr of movements and/or contraction. In several re­ and physiology for most of the somatU:5t: search it has been demonstrated that with the of the vestibular when a conditioning movement or contraction system. We have also reviewed some of the in­ is such as an isometric contraction teractions of the somatosensory system with the in the shortened Dosition. the afferent motor system with emphasis from muscle is increased. The reverse on that portion related to the myofascial system. is observed in an isometric contraction in the Now that we have f inished the neuromechani­ position. This is not a cal background for myofascial facilitation of the cord mechanisms but we move into some direct application of this rather a sensitization or the and biophysics. case may be, of the muscle spindle. Studies of this phenomenon a stimu­ APPLICATION TO SPECIFIC THERAPEUTIC TECHNIQUES lated muscle stretch reflex tendon tap) pro­ duce the similar studies with the Hoffman reflex an electrophysi­ The following sections are to outline analog of the tendon tap) have failed to examples of specific application of the science show the same results. heretofore presented. This takes the Another potential influence of can form I) a very brief discussion of the be Dostulated based on the bio­ lar technique to which is made; a physical, and neurophysiological properties of discussion of the pathology/pathomechanics ad­ and other connective tissues. dressed by the technique; a pro­ the biochemistry and biophysics of the sulfated posed theoretical mechanism, these GAGs have shown them to be responsible for the may influence the somatosensory cohesiveness of conncctive tissue. with and (4) proposed mechanisms for altera­ this increased cohesiveness comes an increased tions in motor control are engendered bv the initial resistance to active or oassive stretch. technique under consideration. one would ent discharge from Anterolateral Fascial Elongation has remained still for a few minutes. Walsh and demonstrated that thixotropy The anterolateral fascial elongation occurs at the human hip, with the amplitude 8-96 and useful to consider as of the resonant frequency of a sinusoidally and associated neuromechanical char­ abducting/adducting hip almost doubling in re­ to virtually all of the super- sponse to a motion of amplitude.46 , described in this book. The W hether this resistance to initial anterior lateral fascial as an increased affer­ described later in this primarily stretches ent very early in the time course of the fascial sheath in a diagonal pat­ the movement remains to be tested. Neverthe­ tern across the anterior surface of the body. In less, if the fluid mechanics of a joint capsule, doing so, the is musculotendinous junction, or direct muscular number of restrictions at attachment to bone were changed inflamma­ interface between the skin and the superficial tion byproducts, then the afferent output from fascia, there may be restrictions secondary to those receptors could certainly be either in­ blunt trauma and In the creased or decreased. Such an event may explain fascia itself and its interface with the Copyrighted Material

Neuromechanical Aspects ofJ'vJyofascial Pathology and Manipulation 87 major and the external oblique abdomina Is, the flexion would be perceived as a \"greater than sheath is continuous from the proximal hu­ resting or normal position\" burst of activity. In merus, clavicle, and anterior shoulder down to that case, the patient would return to a position the contralateral crest of the ilium, thoracolum­ that was more in line with resting position. If a bar fascia, anterior superior iliac spine, inguinal mechanical restriction resulted in an abnormal ligament, and the pubis. phasic stimulus or tonic stimulus, then the inter­ pretation by the system would be that the patient Restrictions of the superficial fascia of the was in a stretched position when, in fact, the anterior trunk have mechanical implications for position might be neutral. Consequently, the posture and virtually all movements of the trunk patient would tend to move into a position that and upper and lower extremities. Certainly, there decreases the firing activity of the phasic and/or are mechanical restrictions of mobility but given tonic receptors. This position is then perceived, that patients develop such faulty postural habits, via the skin receptive f ields, as normal and fur­ the pathomechanical implications for the body as ther shortening of the superficial fascia occurs. a whole are most likely seated in position sense. This faulty receptor activity and the position Restrictions in the superficial fascia would result sense activity it provides soon becomes the basis in a continuous and abnormal stimulus of the for postural perception. slowly adapting mechanoreceptors in the skin and all the succeeding layers of the superficial Historically, the theoretical basis for such be­ fascia. Because the mechanical restriction in the havior has been that of pain avoidance. Cer­ skin and superficial fascia is very similar to that tainly pain avoidance behavior is a reasonable found in the experiment performed by Cohen et and patent argument in the early stages but after ai, some direct postulates are in order. several weeks of healing, the pain disappears. What remains is the new position sense refer­ Cohen and colleagues found increased activ­ ence from skin and superficial fascia receptors. ity of somatosensory cortical cells representing skin receptive fields in the axilla and the skin Another hypothesis concerning the continued of the medial proximal arm associated with par­ behavior of avoiding elongation is that of altera­ allel skin stretching, passive movement, and tion in motor programs (motor memories) to fit active movement. They were able to demon­ the new and dysfunctional behavior. Considering strate this same highly correlated activity in a va­ the amount of practice required to change a very riety of tasks including reaction time tasks, hold­ well learned motor program, this is not likely. ing tasks, and active movement of the arm. The Consider, for example, attempting to change shortened range of skin produced very little ac­ one's signature. It is possible, but on a practical tivity in tactile receptors of the axilla and upper level, it is not probable secondary to the huge arm. This is in contrast to movements into shoul­ volume (millions of repetitions) of practice re­ der tlexion or shoulder flexion with abduction, quired. It is very likely that this new position which increased the activity46 Furthermore, the sense stimulus from the skin rapidly adapting greater the stretch in either amplitude or move­ and slowly adapting receptors function in an ment, the greater the firing rate of phasic (rap­ inhibitory fashion just like their Golgi tendon idly adapting) receptors (e.g., Pacinian corpus­ organ and Golgi-Mazzoni type joint receptors, cles). by inhibiting muscles which would further stretch these receptors. These findings are completely logical and intuitive when one considers human postural Such a postulate is based on the findings of phenomena observed by clinicians. Consider a numerous investigators of the inhibitory influ­ patient who is 3 to 4 weeks post cholecystectomy ences of GTOs and joint receptors on motor via a left upper quadrant incision rather than a output. It is also in agreement with Janda's laproscopic procedure. A phasic stimulus of skin model of altered muscle function and motor per­ receptors during erect sitting or right shoulder formance resu Iting from \"inadequate proprio­ Copyrighted Material

88 MYOFASCIAL MANIPULATION ceptive \" which is probably more cor of the thoracolumbar fascia from which stated as or mismatched surgery. Yahia et al found proprioceptive stimuli,30 One exception is and Vata-Pacini corpuscles (a and that is that the logic described cannot form of Pacinian These validly be to the Bindegwebsmassage were also taken from surgical type of strokc or the skin rolling. This is because Yahia's were prepared with im­ their goals and physiology are not con­ munohistochemical staining techniques that tar- nected to the evidcnce suoolied by Cohen et aL neural filament protein.49 With the documented presence of Ruffini Iliac Crest Release and Pacinian-like in the tho­ racolumbar fascia. it is I This technique is useful to as it is the thoracolumbar fascia would oroduce an ab­ a moderately technique 8-20A, normal afferent stimulus. This abnormal stimll and 8-21). As described, it is executed by Ius from normal motions or would applying an anterior directed force through the result in an abnormally excited or inhibited level from the border of the iliac crest of activity for the motor units of the abdominal, on to the thoracolum­ and auadratus lumborum muscula bar fascia and the insertion of the erector restrictions with the and quadratus lumborum, This particular iliac crest release would to cor­ tcchnique addresses restriction of the thoraco­ rect this abnormal afferent outflow, Such a cor­ lumbar fascia and the muscular and ligamentous rection would allow the relative levels of excita­ attachments. Bogduk and Macintosh discussed tion and inhibitions to return to levels dictated the anatomy of the thoracolumbar fascia with its the normal motor programs as onnosed to two to the crest of the ilium. proprioceptive signals. This anatomy makes its mechanics somewhat complicated and allows it to contribute to stabi­ Diaphragmatic Techniques lization of the spine in all movements, for restrictions in the diaphragm and inferior border of the rib cage are with the of side bending to diffi­ the same sideY the bar fascia. An assumption that the connective progress from a tissue in this structure is no different from that found in the shoulder, knee. and ankle would the superficial to middle restrictions lead one to conclude that the inferior to the anterior rib cage to those that involve the inferior portion of the rib cage, in a seated and endings, and others as­ and anteriorly while asking the structure. In a study and inhale (Figures however, failed to f ind a and 8-46), significant of mechanoreceptors in the address restrictions that are thoracolumbar fascia of w ith chronic very deep in the thoracic and abdominal cavi­ back 48 They concluded that there were dif­ ties. Although directly addressing restrictions ferences in the of receptors between in the thoracic is not possible, it is pos­ normal subjects and persons with back pain. sible to affect restrictions in the mediastinum One major caveat concerning this study is that it the diaphragm and fascia of the was nerformed with standard histologic abdomen and diaphragm, Such restrictions can were noted concerning the area lead to or be the result of multiple postural Copyrighted Material

andVfJ/'nnlflU1J 89 protracted shoulders, other muscle fascicles. If a restriction occurs posture in between two fascicles or two then the The pathomechanics of slumped and altered mechanics produces a sensory forward-head are fairly well understood. With mismatch and inappropriate proprioception from an increasingly forward-head posture comes a the muscle. Such a case has been described pre- rpnnPf'I'H for the ribs and sternum to move infe­ in the section on of muscle riorly and posteriorly. This leads to a spindles and GTOs. of the connective tissue in the abdomen and WhiIe the influence of intermuscular and/or in the thorax. With length comes a interfascicular adhesions on afferent and effer­ tendency for increased afferent activity from the are fairly common Rufinni endings, among there are other An increase in tension problems related to such adhesions and benefits on these more especially the GTOs, related to a transverse muscle technique. of the central tendon of the diaphragm has been The pathology of such adhesions more shown to elicit a inhibitory effect on the in intramuscular pres­ the external intercostals and the diaphragm. sure caused them relates to influences of All of this activity results in a reduc­ thixotropy and the Group III and I V afferents. tion in lung volume. Over time, as lung capac­ Adhesions of such a nature can lead to a local ity is diminished by these inhibitory processes, irritation of the musc.le and a destabilization of the connective tissue would remodel to its new the cell membrane to cause a release resulting in a new \"set\" for the normal of calcium into the This release of tension on the tendon. The manipulation tech­ calcium will result in the formation of cross- niques described herein allow for a lengthening without benefit of an action potential of the along its anterior borders with and increased resistance to stretch. a resultant, postulated reduction in the inhibitory Second, increases in intramuscular pressure have activity of the GTOs. been directly associated with increased afferent action of the III and IV af­ Transverse Muscle Bend of the Erector ferents and Spinae connective tissue in proximity to these struc­ tures. Such afferent results in cardiovas­ This is relatively simple to perform cular and pulmonary changes on a systemic level and depending upon the vigor with which it is and an autonomic response of increased blood done can have ef­ flow at a local level. fects or, more can have The treatment themselves also mechanical effects. The technique is basically have direct effects on the thixotropy of the one of bending the muscle as if a system and the III and IV afferents. The hose 8-15 and 8-1 muscle motion of the muscle would provide can also be modified as in the quadriceps a mechanical stimulus to aid in the and hamstring technique to include and thixotropic resistance to motion. Next, the tech­ some muscle rolling and lifting actions. No nique would have direct etTects on the Group III matter what technique is used, the with resultant in local blood result a multidirectional mechanical stress flow and cardiovascular and with the least emphasis on longitudinal stretch- nary effects. The in engen­ dered by the techniques most likely also extend The to the outflow from the muscle the dies themselves with all the cascade of effects muscle and of individual muscle fascicles on from them. Copyrighted Material

90 MYOFASCIAL MANIPULATION CONCLUSION position sense and myofascial tone. Later, in an effort to elucidate some of the more recent Much of the material presented in the early literature, we discussed concepts of thixotropy sections of this chapter may appear to be and their importance in muscle tone. Finally, we weighted heavily toward basic science. It is have attempted to connect the science directly to highly probable, however, that a significant part the techniques in this volume proceeding from of benefit derived from the techniques is neuro­ the superficial to the deeper techniques. physiological in origin due to the rapidity of their effects and the relatively longer period of The practitioner is encouraged to apply the time required for remodeling. A number of these science and neurophysiology where valid but techniques can be viewed as methods to prepare to be cautious in extending their explanation the patient to be able to function in a manner too far afield from the intent of the science. that will lead to more functional remodeling of Furthermore, the practitioner should remember collagen. that many manual techniques appear to have no rational explanation but appear to consistently We have endeavored to explain and expound, benefit the patient. Consequently, the practi­ for the clinician, the relevant issues of mechano­ tioner should use the science for explanation, receptor anatomy and physiology. Moreover, we when they can, while continuing to use the art of have summarized some of the recent f indings manual therapy to heal and always continue to of the influence of skin and joint receptors on investigate the explanations for the effects seen. REFERENCES 10. Wyke B. The neurology of joints. Ann ROI·ul Coli Surg Eng. 1967;41 :25-50. I. Walsh EG. Muscles, Masses and Malian. The Physiol­ II. Zimny ML. Mechanoreceptors in articular tissues. Am J ogyo[Normalily, Hypolonicily, Spaslicily and Rigidily. Anal. 1988;182:16-32. New York: Cambridge University Press; 1992. 12. Stacey MJ Free nerve endings in skeletal muscle of the 2. Gardner EP, Mart in JH, JesselJ TM. in: ER Kandel, JH cat.JAllal.1969;105:231-254. Schwartz, TM Jessell, eds. Principles ofNeural Science, 13. Von During M, Andres KH. Topography and ultrastruc­ 4th ed. New York: McGraw-Hili; 2000:430-449. ture of group III and IV nerve terminals of cat gas­ 3. Hagen-Torn O. Entwicklung und Bau del' Sy noviamem­ trocnemius-soleus muscle. In: W Zenker, WL Neuhu­ branen.Arch Mikros Anol.1882; 21 :591-663. ber, cds. The Prill/Oly A/jerelll Neuron: A Survey of Recenl Morpho-Funclional Aspecls. New York: Plenum; 4. Gardner E. N erve terminals associated with the knee 1990:35-41. joint of the mouse. Anal Rec. 1942;83:401-419. 14. Kaufman MP. Afferents from limb skelctalmuscle. in: JA Dempsey, AI P ack , cds. Regulalion otBrealhillg, 2n d 5. Zimny ML, Schutte M, Dabezies E. Mechanoreceptors in the human anterio r cruci ate li gament . Anal Rec. 1986: ed. New York: Marcel Dekker; 1995:583-617. 2 I 4;204-209. 15. Kumazawa TN, Mizumura K. Thin-fibre receptors re­ 6. Zimny ML.Mechanoreceptors in articular tissues. Am J spondin g to mechanical, chemical and thermal stim­ ulation in the skeletal muscle of the dog. J Pilysiol. Anal. 1988;182:16-32. 1977;273:179-194. 7. Basbaum AI, Jessell TM. The perception of pain. In: 16. Haouzi P, Hill JM. Lcwis BK, Kaufman MP. Responses of group III and IV muscle afferents to distensio n of ER Kandel, JH Schwartz, TM Jessell, eds. PJ'lncljJles the peripheral vascular bed. J Appl Physiol. 1999;87: at Neural Science, 4th ed. New York: McGraw-Hili; 545-553. 2000:472-491 17. Mense S. Nervous outnow from skeletal muscle follow­ ing chemical noxious stimulation. J Pilysio! 1977;267: 8. Pearson K,Gordon 1. Spinal renexes. In: ER Kandel, 11-1 Sc hwartz, TM Jessell, eds. Principles ofNeural Science, 75-88. 4th ed. New York: McGraw-Hill; 2000:7 I 3-736. 9. Ho uk J, Henneman E. R esponses ofGolgi tendon organs to active contractions of the soleus muscle of the cat. J Neurophysiol. 1967;30:466-481. Copyrighted Material

Nellromechanicct/ and Manipulation 91 Rotto DM, Schultz HD, Longhurst JC, Kaufman MP DiMauro S, TSlijino S Non-lysosomal Sensitlzarion of group III muscle afferents to static In: AG Engel, C Franzini-Armstrong, cds. ,tfyO/ogl\" 2nd contraction by products of arachidonic acid metabolislR cd., vol. 2. McGraw-Hili; 1994: I 1576. J App/ Physio/. 1990;68 861-867. 36. Simons DG, Hong CZ, Simons LS. Prevalence of spon­ 19. L1, Hill JM, Pickar .lG, Kaufman MP Effects taneOllS electrical activity at spots i1l1d control of contraction and lactic acid on discharge of group sites in rabbit muscle. J Muscu/oske/ci Pain. 1995;3: III muscle afferents in cats. J Ncurophysiol. 1993 ;69: 35--48 10531059. 37. Elert J, Dahlqvist SR, Altnay B, Eisemann M. Muscle 20 ROllo DM, Hill JM, Schultz HD, Kaufman MP Cyclo­ endurance, tension and personality traits in pa- oxygenase blockade attenuates the of group with muscle or jOlllt pain: A pilot study. J Rheu muscle afrerents to slatic contraction. Am Physioi. malo/. 1993;20: 155CH 556. 1990;259H745-H750. 21. Fields HL. Pain. New York: McGraw-Hili; 1987. Ivanichev GA. Pain/ullvlusde Hyperlonlls (in Russian). Kazan: Kazan University Press; 1990. Ghcz The control of movement. In: ER Kandel, JH 39. Proske U, Morgan DL, Gregory JE. Thixotropy in skel­ Schwartz, TM cds. Prillciples o/Neura/ Science, ctal muscle muscle spindles: A review. Prog 3rd cd. New York: Appleton & Lange, 1991:533-547. Neurobio/ 1993:41. 23 Houk J, Crago PE, Rymer WZ. Functional properties of the Goigi tendon organs. In: Spmal ami Supraspinal 40. Walsh EG. Muscles, Masses alld Molion. The Physio/ ojlVormalily, Hyp% niciIV, SpaslieilV and RigidUy. Mechanisflls or /lo/unl ar}' MaIOI' Conlrol alld Loco· New York: Cambridge University Press; I mo/iolls. Vol. 8, in Clinica/ Nellrophvsi% gy. Basel: Karger; 1980:33--43. 41. Hill DK. Tension due to interaction between the sliding Kennedy JC Aiexancler I J, Hayes KC. Nerve supply of filaments in resting striated muscle. etTect of stimu­ the human knee and its functional importance. Am J lation. J Physio/. 1968;199:637--684. Alec! 19R2;IO:329-335. 42. Campbell KS, Lakie M. A cross-bndge mechanism explain the thixotropIc short-range el astic component 25. Bcrkioblit M8, Feldman AG, 01. Adaptability of relaxed frog skeletal muscle. J Phvsiol 1998;510: of innate motor patterns and motor control mechanisms. 941·962. Belwv Brain Sci. 1986;9:585-<'>38. 26. Hagbarth KE. Excitatory and inhibitory skin areas for Murungi G, Ranarunga KW. The VJSCOUS, viscoelastic lld nexor and extensor notoneurones. Physiol Scali. elastic characteristics of resting fast and slow mamma­ lian (rat) muscle fibres. J Physiol. 1996;496:827··836. I-58. 27. Burgess PR, Wei JY, Clark FJ, Simon J Signaling of 44. Linke WA, Bartoo ML, Ivemeyer M, Bollack Gil. Limits of (ilin extenSJon in single cardiac myofibrils. J kinesthetic information by peripheral sensory reccptors. ,41use Res Cell MOli/. 1996;17:425--438. Allnl ReI' Neurosci. 1982;5: 17 87. 28. Matthews PB. Proprioceptors and their contrrburion Simons DG. Clinical and etiological update on l1lyofas­ to somatosensory mapping: complex messages require cial pain due 10 trigger points. J Musculoskel Pain. complex processing. Can J Phvsiol Ph armacol. 1988;66: 1996;4 93-121. 430-438. 29. Collins OF, Cameron T, Gillard DM, ProchazkaA. Mus­ 46. Walsh EG, W right GW Postural thixotropy at the human cular sense is attenuated when humans Physiol. hip. QJ Exp Phvsio/. 1988;73:369-377. 1998: 508:635-643. 47. Jull GA, Janda V Muscles and motor eontrol 111 low back 30. Cohen DAD, Prud'homme MJL, Kalaska JF. Tacttie pam: and l1lilnagemcnl In LT Twomey, JR activity in primate cortex during active arm movements' Taylor, cds. Physical Therapy of Ihe Back. New Correlation with receptive field properties. J Neuro­ York: Churchill Livingstone; 1987. pi,ys/O/.1994;71: 161-172. 48. Bogduk Macintosh JE. The apphcd anatomy Ihe thoracolumbar fascia. Spine. 1984;9(2):164-170. 31. Simons DG, Mense S. Understanding and measurement 49. Bednar DA, Orr FW, GT Observations o n the of muscle tone as related to clinical mu scle pain. Pain. I I-I pathomorphology of the thoracolumbar filscia in chronic 32. C1emmesen Some studics on muscle tone. PlVe R Soc mechanical back pain. A rnicroscoP1c study. Spine. 1995; Med.1951;44:637-646. 20(10):116 H164. 33. Ra lston I-IJ, Libet B. The question of tonus in skeletal 50. Y3hia L, Rhalmi S, Newman N, 1\\1 Sensory muscle. Am J Phy,- Med. I innervation of human thoracolumbar faSCia. An im­ 34. BasmaJian JV New views on Illuscular tone and relax- mUlJohistochemical study. ACla Orlho p Scat/d. 1992; Can !l4ed,issoc J 203-205. 63(2):195-197. Copyrighted Material