Descripción del problema

Myofascial dysfunction is the problematic process that occurs within the ground substance, the fibers cells and other substances and energetic , ,

components of the connective tissue.

All of the soft tissues are affecred in anatomic areas where myofascial dysfunction is present. Since the substance of the connective tissue enve­ lops and infiltrates at the level of the sarcomere, it is more correct to use the term myo(ascial dys­ (unctioll rather than (ascial dysfunction, but the term "myofascial dysfunction" is not always cor­ rect terminology to reflect the disorder. The pri­ mary pathology is within the connective tissue (fascial) system; the muscle fiber tissue is affected as a secondary problem.

Connective tissue encompasses many tissues and structures including bone, fascial envelopes, nerves, blood cells, and other tissue. These tissues and structures all have the potential to be affected with myofascial dysfunction. That means, a bone may be determined to have myofascial dysfunc­ tion as may a circulatory vessel or a neuron.

Sharon (Weisel fish) Giammatteo discovered Myofascial Mapping. Myofascial Mapping (MFMapping) is the practice of differential diag­ nosis via evidence that the fascial motility has been affected. Motility is the inherent rhythmic cycle of the physiologic pressure affecting a tis­ sue, structure, system, or other aspect of the body's anatomy. Motility is a circadian rhythm, a universal presentation that manifests in a man­ ner unique to the physiologically characteristic traits of that anatomy.

The term Myofascial Mapping refers both to 1 S 1

a diagnostic task and physologic motility. As a motility, it is the biological rhythm of the con­ nective tissue. When a practitioner performs the task of Myofascial Mapping in a given area, he or she is palpating the rhythm of the fascia and looking for a distortion in that area. When per­ forming Myofascial Mapping, one documents the areas of distortion on a body diagram.

The task of Myofascial Mapping is a proce­ dure that discovers the motility of the ground sub­ stance in the connective tissue. The flagellae of the glycosaminoglycans (GAGs) are apparently responsible for the unique characteristic traits of MFMapping. Their inherent motion, which is rhythmic and cyclical, is dependent upon the physiologic and energetic conditions of the region. Occasionally, the roral body rhythm (MFMap­ ping) is affected because an organ of significance is extremely dysfunctional, affecting all the f1agellae of all the GAGs in the body. This posi­ tive, total body MFMapping phenomenon indi­ cates a need for medical investigation before there is a breakdown of an organ's function.

When assessing MFMapping, there are three possibilities: ( 1) Positive mapping: an asymmet­ ric motion of the fascial tissue; (2) negative map­ ping: a symmetric motions of the fascial tissue; and (3) still space: no evident motion of the fas­ cial tissue.

The three planes of mapping are transverse, sagittal, and coronal. Internal rotation and exter­ nal rotation are the motions of the fascial tissue on the transverse plane. Flexion and extension are the motions of the fascial tissue on the sagit­ tal plane. Abduction and adduction are the motions of the fascial tissue on the coronal plane. All of the motions on the transverse, sagittal, and coronal planes are reflected on the body. When

152 INTEGRATIVE MANUAl THEUIY FOR THE CONNECTIVE TISSUE HIlEM

the hands of the therapist are in body contact, these motions of internal rotation, external rota­ tion, flexions, extension, abduction, and adduc­ tion can be discerned.

Experimental clinical research has indicated evidence on three levels: Level One MFMapping reflects the body's neuromusculoskeletal function and dysfunction. This can be confirmed with MFMapping on the body's surface. Level Two MFMapping reflects emotional, energetic body function and dysfunction. Level Three MFMap­ ping reflects the cognitive/mental energetic func­ tion and dysfunction, as well as spiritual/other energetic function and dysfunction that may be affecting the body.

Unique qualities of MFMapping are associ­ ated with Levels One, Two, and Three. Level One will reflect the physical body's dysfunction man­ ifesting through transverse plane internal rotation and external rotation. Other planes of MFMap­ ping, including coronal plane (abduction and adduction), and sagittal plane (flexion and exten­ sion) are not discovered on Level One. Level Two will reflect the emotional energy dysfunction with transverse plane motion (internal rotation and external rotation). Level Two will not provide any indication of coronal plane and sagittal plane motions. On Level Three, there is a reflection of: (1) mental!cognitive energies discovered on a coro­ nal plane as abduction and adduction; and (2) spiritual/other energies discerned on a sagittal plane as flexion and extension. Transverse plane motions of internal rotation and external rota­ tion are not evident on Level Three.

The motions possible with MFMapping are: (1) symmetric; (2) asymmetric; (3) no motion. Symmetric motions indicate healthy and function­ al fascial motilities. Asymmetric motions indicate unhealthy and dysfunctional fascial motilities. Still space (no motion), which can only be palpated on a transverse plane, indicates the pathologic pressures of other energies (emotional! mental/cognitive, spiritual/other) affecting the fascial motilities.

The motions are palpated in the following manner. Place hands next to each other (smaller areas can be palpated with just the fingers). Then rest hands lightly (like a feather) on the body's surface (and off the body for palpation of the three levels). Let the body's tissues move the hands. Both hands may be moved in the same direction (symmetric motion), or in opposite directions (asymmetric motion). The hands may remain still (no movement).

When the motion is symmetric, the MFMap­ ping is termed Negative Mapping. When the motion is asymmetric, the MFMapping is termed Positive Mapping. Where there is no motion, the MFMapping term is Still Space. (Still spaces are only palpated on a transverse plane, as we men­ tioned before.)

The inherent motility of the f1agellae of the glycosaminoglycans is peculiar to the metabolic cycle. Metabolism has many characteristics, one of which is an inhalation and exhalation cycle ((Weiselfish) Giammatteo) of the metabolic trans­ porr of nutrients and waste products into and out of the cells. During the inhalation phase the nutri­ ents enter the cell and waste products are excreted from it. During the exhalation phase there is a reorganization of the flagellae in preparation for the next inhalation phase. The inhalation phase is the more active, opening phase of the metabolic cycle. The exhalation phase is the more passive, closed phase of the cycle. Because the MFMap­ ping reflects the metabolic cycle of inhalation phase and exhalation phase, there are character­ istic motions for each. The motions of fascial motility of the inhalation phase include flexion, adduction, and internal rotation. The motions of the exhalation phase are extension, adduction, and external rotation.

There is no single or unique frequency of fas­ cial motility reflected with MFMapping. The orga­ nized, healthy, and functional motility will vary from 5 to 15 cycles per minute. This means, one cycle includes the flexion, adduction, internal rota­ tion of the inhalation phase plus the extension,

MYOFASCIAl MAPPING 1 53

abduction, external rotation of the exhalation phase. A rhythm of lower frequency may reflect sluggish metabolism. A rhythm of higher fre­ quency may reflect hyperactive metabolism. There is a wide range for normal fascial motility and there are several hypothetical explanations for the variability. In Eastern medicine, the rhythmic rate can indicate which "element" (wood, fire, earth, metal, or water) is most powerful in that person. [n Western medicine, it can indicate whether a person possesses an endomorphic, ectomorphic, or mesomorphic structure.

MFMapping will reflect whatever tissue or structure is in dysfunction and therefore is affect­ ing fascial motility. If a bone is fractured, for example, the frequency is quick (greater than 15 cycles per minute) and there will be a sharp inter­ phase (between inhalation phase and exhalation phase). When a muscle is ruptured or hurt, the frequency is slow (less than 5 cycles per minute) with a sluggish interphase. When an organ is com­ promised (whether or not anatomic dysfunction is already reflected by physiologic changes), the frequency will be normal (within 5 to 15 cycles per minutes), but a very wide amplitude of fascia motility will be evident, and the interphase will be acute. When the nervous tissues are compro­ mised, whether there is neural tension, brain or spinal cord fibrosis, nerve root impingement, or other problems of the central and peripheral ner­ vous tissue, the M FMapping will have small amplitude, high frequency, and a mild interphase. It is anticipated that future research will provide further clarity regarding these rhythms to assist in differential diagnosis.

An Overview of the Clinical Practice