Rapid Release Therapy- Technique Topic: Rapid Release Therapy Technique – 2 Hours Instructors: Stanley Stanbridge, DC Michael Griffo, DC Tom Hendrickx, MPT, OCS, CSCS Title: Rapid Release Therapy Technique Mastery

Basics of Scar Tissue The Physical Nature of Scar Tissue Causes Symptoms How scar tissue causes pain How scar tissue limits range of motion

Existing Therapies A.R.T. Graston Technique Low Speed Vibration Therapy Thumper Sonicur DMS/PMR Vibracussor High Speed Vibration Therapy RRT

Vibration Therapy The History… Shamanic chanting and drumming in Ancient Times “drumming enhances recovery through inducing relaxation and enhancing theta-wave production, brain-wave synchronization and release of emotional trauma” - American Journal of Public Health April 2003

Vibration Therapy The History… Aboriginal Digereedoo circa 40,000 years ago Still used today

Vibration Therapy The History… Tibetan Bowls were used in the Bronze Age 3000 years ago Still Used Today

Vibration Therapy The History… Pythagoras, the Greek mathematician, philosopher and father of Music Theory, used music to heal the body and emotions in the sixth century BC

High Speed Vibration Therapy The Science… Sound has organizing properties. Ernst Chladni a physicist and musician known as the father of acoustics, published his experiments in 1787 that illustrate the creative and organizing effect of vibration

High Speed Vibration Therapy The Science… These images, created by Dr. Hans Jenny, are of dynamic, harmonic patterns arising in vibrating water from pure audible tones.

High Speed Vibration Therapy The Science… Why is Mechanical Vibration so much more effective than Sound Therapy? There is 100% reflection of the sound waves at the air-skin interface. Direct Mechanical Vibration efficiently transfers compression waves through the skin barrier High Speed Vibration Therapy is right in the middle of the Human voice frequency This Frequency is independently reported to resonate with scar tissue (Nogier Frequencies)

High Speed Vibration Therapy The Science… Specific frequencies resonate with different types of body tissues. Findings include a frequency found to resonant directly with fibrotic yellow scar tissue without harmful effects to the surrounding tissues. Dr Paul Nogier neurologist Our results in using HSVT correlate his findings

High Speed Vibration Therapy The Science… The difference between High Speed and Low Speed vibrational therapies. Insert 35 seconds of High Speed 2000 fps video High Frequency and Short Stroke are Keys to comfort and effectiveness

High Speed Vibration Therapy The Science… Mechanical vibration (100-200 Hz) directly administered to tendons or muscles causes a reflex response (Hagbarth and Eklund, 1965) This particular reflex activity has been named the (TVR) "tonic vibration reflex“ (Latash 1998)

High Speed Vibration Therapy The Science… Muscle spindles are sensitive to vibration Echlin and Fessard (1938) Because the muscle spindle is sensitive to small changes in muscle length, the discharge rate of the muscle spindle is strongly modulated by muscle vibration, which induces repeated changes in muscle fiber length. The discharge rate of Ia afferents increases linearly with the frequency of vibration up to 500 Hz (Brown, 1967).

High Speed Vibration Therapy The Science… The fusimotor system, after integrating input from the afferent nerves of skin, muscles, and joints serves as a final common path for the regulation of muscle stiffness. Johansson (1990)

High Speed Vibration Therapy The Science… Acute Direct Vibration quickly relaxes muscles… Evidence from acute direct vibration studies suggest that an excitatory response of the muscle spindle occurs, which activates the Ia afferents. These afferents in turn, excite the alpha motor neurons of the surrounding muscles, which uncouples the co-contraction of agonists-antagonists -Eklund and Hagbarth, 1966

High Speed Vibration Therapy The Science… Cortical areas of the brain that receive and process proprioceptive information are stimulated when direct vibration is applied (Munte et al., 1996). Ia afferent input has the ability to excite the corticospinal pathways (Carson et al., 2004) and activate the cortical motor areas (Lewis et al, 2001).

High Speed Vibration Therapy The Science… Mechanical vibrations enhanced muscle power and decreased the related EMG/P relationship in elite athletes. Analysis of EMG re-corded before the treatment and during the treatment itself showed an enormous increase in neural activity during vibration up to more than twice the baseline values. This indicates that this type of treatment stimulates the neuromuscular system more than other treatments used to improve neuromuscular properties. C. Bosch, 1999

High Speed Vibration Therapy The Science… Vibration treatment was effective for attenuation of delayed-onset muscle soreness and recovery of range of motion after strenuous eccentric exercise. Lau WY, Nosaka K. 2011. American Journal Physical Medicine and Rehabilitation. Aug. 2011

High Speed Vibration Therapy The Science… Acute Direct Vibration vs. Aspirin Study Vibratory stimulation is as effective and in some patients more efficient pain suppressive measure as compared to aspirin. It is suggested that on the basis of these findings that vibratory stimulation merits consideration in the choice of treatment of myofascial or musculoskeletal pain. The pain suppressive effect of vibratory simulation and (TENS) as compared to aspirin. - Lundeberg T. Brain Res. Mar. 1984 Pain Alleviation Study: 366 patients suffering acute or chronic musculoskeletal pain of different origin were given vibratory stimulation for the pain. Many patients had treatments of various kinds without satisfactory relief. The effects of vibratory stimulation was assessed during and after simulation using a graphic rating scale. 69% of the patients reported a reduction of pain during vibratory stimulation. Pain alleviation by vibratory stimulation. Lundeberg T. Brain. September 1984

High Speed Vibration Therapy The Science… Reduction of TMD pain Vibration delivered directly to the skin can reduce pain (vibratory analgesia). In this study, vibratory analgesia was examined in 17 participants with painful TMD. The results of 20 Hz and 100 Hz were compared with data from a no vibration control condition. The results documented for the first that vibratory analgesia occurs in TMD chronic pain conditions. VAS ratings and drawings both showed that pain is reduced by 100 Hz, but not by 20 Hz vibration. Pain. Roy EA, Hollins M, Maixner W. 2003 August. Vibration Stimulation for the reduction of pain This paper describes the effect of vibratory stimulation on pain of dental origin in 36 patients. Each patient has been experiencing pain for greater than 2 days. Vibration at 100 Hz was applied to various points in the fascial region and and/or the skull. 33 of the 36 patients experienced an effective reduction of the intensity of pain. Pain. Ottoson D, Ekblom A, Hansson P. 1981 February.

High Speed Vibration Therapy The Science… 267 patients with chronic neurogenic or musculoskeletal pain were given vibratory stimulation for the pain. 59% of the total number of patients reported > 50% pain relief, as scored on a visual analogue and an adjectival scale. 72% reported increased social activity and > 50% reduced intake of analgesic drugs The patients had suffered pain for a period of 6 months to 8 years. All of them had previously been subjected to various forms of therapy, including surgery, analgesic agents, anti-inflammatory agents, TENS and acupuncture. with little effect on their pain or with adverse side effects. T. Lundeberg Department of Physiology II, Karolinska Instirutet, Stockholm (Sweden) (Received 23 June 1983, accepted 27 February 1984)

High Speed Vibration Therapy The Science… Conclusions: Only frequencies between 100-200 Hz will activate the TVR. The elicitation of the TVR in the neuromuscular system is essential to maximize the benefits of vibration therapy. HSVT uses frequencies to specifically target scar tissue. Only the precise combination of frequency, amplitude and motor neuron excitation can uncouple the co-contraction of agonists-antagonists. Vibrational therapy enhances the excitement of corticospinal pathways to assist in the activation of cortical motor areas. HSVT is useful in assisting athletes in pre-workout power and post workout recovery HSVT is effective in pain relief HSVT is effective in nearly every stage of treatment (acute to chronic)

References Brown MC, Engberg I, Matthews PB. The relative sensitivity to vibration of muscle receptors of the cat. J. Physiology. 192, 773-800. 1967 Carson RG, Rick S, Mackey DC, Meichenbaum DP, Willms K, Forner M, Byblow WD. Excitability changes in human forearm corticospinal projections and spinal reflex pathways during rhythmic voluntary movement of the opposite limb. Journal of Physiology-London 560, 929-940. 2004. Cochrane DJ. The potential neural mechanisms of acute indirect vibration. Journal of Sports Science and Medicine 10, 19-30. 2011. Echlin F, Fassard A. Synchonized impulse discharge from receptors in the deep tissue in response to a vibrating stimulus. J. Physiology. 161, 282-297. 1938 Ekland G, Hagbarth KE. Motor effects of vibratori stimuli in man. Electroencephalography and Clinical Neurophysiology 19, 619. 1965. Ekland G, Hagbarth KE. Normal Variability of of tonic reflexes in man. Experimental Neurology. 16:80-92, 1966. Johansson H, Sjolander P, and Soja P. Activity in receptor afferents from the anterior cruciate ligament evokes reflex effects on fusimotor neurones. Neuroscience Res., 8:54-59, 1990. Latash ML. Neurophysiological basis of movement. Human Kinetics, Champaign. IL Lewis GN, Byblow WD, Carson RG. Phasic modulation of corticomotor excitibility during passive movement of the upper limb: Effects of movement frequency and muscle specificity. Brain Research. 900, 282-294. 2001. Mundt TF, Jobges EM, Wieringa BM, Kklein S, Schubert M, Johannes S, Dengler R. Human evoked potentials to long duration vibratory stimuli: Role of afferents. Neuroscience Letters. 216, 163-166. 1996. Dr. Charles McGee, MD, Healing Energies of Heat and Light, MediPress, 2000, p. 117 Dr. Nogier, French Neurologist in Healing Energies of Heat and Light, by Charles McGee, M.D.

HSVT Indications Carpal tunnel syndrome Tendonosis Muscle spasms Trapped nerves Range of motion Contractures Cramps Neuromas Adhesions Back pain Shoulder pain Ankle pain Headaches Knee problems Tennis elbow TMJ

Basic HSVT Protocol 1. Perform pre and post session tests for example, check flexibility, strength, areas of sensitivity etc. 2. Introduce the RR action to the client by lightly applying to the hand, palm up. 3. After gaining consent, gently apply RRT to the target area and work outward so as to cover all structures that act on the target area with the flat area of the device.  For example, if you are targeting the knee, cover the full length of all muscles ligaments and tendons that cause movement in that joint including hip abductors and adductors. 4. After 3 or 4 minutes, have the patient use the affected joint and report any residual discomfort and in what position the pain can be elicited.  Now apply RRT to these remaining areas while the patient puts the joint in the pain eliciting position.

Fine tuning the treatment RR may be used in a linear or circular motion Any treatment surface of the RR can be applied flat or angled No pressure is required, the weight of the machine is sufficient Use the Actuator treatment head on small areas, acupressure or trigger points Use the side of the Trumpet Head over tender or bony areas for a side to side motion Treatment times are proportional to the mass.  Fingers take much less time than a hip There is no observed benefit to sessions lasting longer than 5 minutes Use common sense When in doubt, limit treatment time Always error on the side of caution.

Contra-Indications for HSVT Use caution over joint replacements, plates or screws. Do not apply forcefully on patients with Osteoporosis. Do not apply the trumpet or actuator heads to bone. Do not leave stationary for more than 5 seconds. Do not use on DVT or areas with blood clots. Do not use over 10 minutes or when hot. Do not apply directly to plantar fasciitis. Do not apply to client with pacemaker. Do not apply during pregnancy. Do not use in shower :)

Specific Techniques for using RRT Recent injuries vs. Chronic Loosening the Para spinal muscles in preparation for adjustment Restoring Range of Motion to the Neck Thoracic and Lumbar Spine pain and ROM Treatments Techniques for using RRT on Knees Techniques for using RRT on Shoulders Techniques for using RRT to alleviate headaches Hand and Wrist Techniques Carpal Tunnel Trigger Finger Hips and Ankles

Treating other conditions with RRT Rapid Release has also had results with… Multiple Sclerosis Cerebral Palsy Numbness Sinusitus Loss of Strength

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