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Active Isolated Stretching: The Mattes Method

 

Aaron Mattes MS, RKT, LMT, 33 years ago developed a myofascial release technique which he termed Active Isolated Stretching (AIS). Aaron Mattes has incorporated Active Isolated Stretching in his application to many musculoskeletal conditions as well as disease states. Incorporating Active Isolated Stretch in therapeutic use, he has termed this technique the Mattes Method.

The Mattes Method of Active Isolated Stretching is a myofascial release and therapeutic treatment for deep and superficial muscles, tendons and fascia. The Mattes Method is founded on kinesiologic laws of controlling the body’s stretch reflexes while performing a specific isolated manual release of individual muscles and their proper fascial plane.

The Mattes Method utilizes active movement and reciprocal inhibition to reduce co-contraction and optimize flexibility. The foundation of the technique is providing a 2.0 second rhythmic stretch that avoids activating the muscle sensors, muscle spindles and Golgi tendon bodies. The active movements initiated allow antagonistic muscle group relaxation and promotion of uninhibited flexibility.

In treating musculoskeletal injuries, a concise knowledge of human anatomy attachment points and actions need to be mastered.  Physical therapists study the musculoskeletal system in great detail; however, the application to myofascial dysfunction is not mentioned in most physical therapy curricula.

The term “myofascial” did not appear in medical literature until the late 1940’s when medical researchers Gorell, Steindler, Rinzler and others started describing myofascial trigger points of the lumbar spine that were the source of musculofascial pain. Janet G. Travell, M.D. coined the term “myofascial” after observing referred pain patterns of muscles during muscle biopsy in 1952.

Muscle has individual characteristics based on the person’s activity, age as well as the type of physical exertion. When a muscle becomes overstretched, over-shortened or is subject to direct trauma, the muscle fibers may tear or fray. The healing process, which results in scar tissue, creates an increased resting tension becoming more stiff and ischemic with the potential of increasing metabolic waste. There are visible changes that occur in the muscle at a histological level. This tightness in one muscle group will lead to a direct effect on the antagonist or opposite muscle function.

The Mattes Method of Active Isolated Stretching utilizes a facilitated stretch technique based on anatomical awareness of muscle tendon origin and insertion within its appropriate motion plane. Muscle fibers are laid in patterns that correspond to the attachment points. Utilizing this plane of myofascial tissue allows for optimal stretching without friction, cross-friction or activation of other muscle groups.

The Mattes Method of Active Isolated Stretching also incorporates the ability of controlling and minimizing the activation of the body’s defense stretch reflexes at the level of the muscle spindles and Golgi bodies. By having the patient initiate the movement, a reflexive relaxation of the antagonistic muscle ensues. The continuation of that movement in the proper plane at end range with a slight pressure of less than one pound within a two-second interval will allow the muscle tissue to continue stretching without any co-contraction. Utilizing this 2.0 second stretch technique reduces the pential of activation of these sensors and avoids the reflexive contraction of the antagonistic muscles.

 

The Mattes Method follows a simple six-step protocol:

1.  First, identify the muscle to be stretched, knowing its attachment site (i.e. biceps femoris-hamstrings).

2.  Secondly, isolate the muscle by positioning into its most relaxed state. This is done by knowing the attachment points, the muscle fascial matrix and its movement within a plane of motion.

3.  Have the patient initiate the contraction of that muscle, guiding it through its proper plane, monitoring for relaxation of the opposing antagonist muscle.

4.  As the patient contracts the muscle through its proper plane at the endpoint of voluntary contraction, provide a gentle stretch of no more than one pound of pressure within the same fascial plane to the next endpoint as well as providing a controlled movement back within that same fascial plane.

5.  The importance of optimizing full flexibility along proper myofascial is that at the end of voluntary muscle movement the gradual extension of the stretch by the therapist from that point towards endpoint and return should be no longer than 3.0 seconds, again with no greater pressure than one pound.

6.  Each motion should return back to the isolated muscles neutral or relaxed state position. The same technique is then repeated anywhere from eight but no more than ten times having each subsequent facilitated stretch achieve an incremental gain in degrees of range of motion.

 

To summarize, the therapist has an anatomical understanding of proper fascial plane for the isolated muscle that he chooses to stretch.  The important components of the stretch is that once positioned in the proper position the patient initiates the movement toward voluntary end range then the therapist guides to another further endpoint with a gradual tension of no more than one pound of pressure and then returns it back to its neutral position in less than 3.0 seconds.  The eight to ten repetitions are adequate as more repetitions would lead to local ischemia and subsequent trauma.  Following these stretches, ice can be applied to minimize the secondary inflammatory components at the attachment sites.

The Mattes Method is a muscle release technique that places the muscle in the appropriate anatomical position and stretching it within that specific direction of movement.  The previous injury to the muscle in which scar tissue results and made the muscle inflexible is then lengthened.

This lengthening with a gentle pressure at end range will microscopically loosen the scar tissue and allow restoration of proper muscle length.  The result is return back of normal range of motion and alleviation of pain.  Once full flexibility is achieved, strengthening can proceed to protect the muscle from re-injury or return of the contracture.

The muscles are enveloped with protective, thicker tissue made of connective tissue called fascia. Trauma, poor posture or inflammation creates a binding down of this fascia that limits muscle movement, constricts organs as well as puts pressure on the sensitive nerves, blood vessels and lymphatic systems.  Standard tests such as x-rays, CAT scans and MRIs do not show this fascial restriction.  Unfortunately, this constriction results in a high percentage of the pain that people are experiencing due to restricted motion and tightness of muscles, joints and other internal structures.

In any therapeutic approach, one needs to identify the cause of the problem with the most specific diagnosis. In the case of musculoskeletal injuries, an accurate myofascial diagnosis needs to be established.

 

The following steps can be followed in myofascial diagnosis:

Taking a medical history, identify for an onset of trauma, overloading stress, repetitive motion or disease process that may lead to micro-injury to musculoskeletal structures.

From the description of the history, establish a biomechanical model to the cause of injury.

Correlate the areas of injury with their expected referred pain patterns to confirm the diagnosis.

Examine for limitations of range of motion and attribute them to the specific structures.

Identify from isolated or group muscle weakness of the involved structures.

Palpate for specific attachment sites and trigger points of the musculoskeletal structures.

With palpation, visualize any hyperemic areas which would correlate myofascial trigger points or attachment points adding confirmation to the diagnosis.

Proceed with other orthopedic, neurological examination techniques and tests to establish a differential diagnosis.

Confirm the diagnosis with information obtained above in the history and physical examination and apply them in myofascial terminology.

 

Physical therapists are trained in many techniques to correct for musculo skeletal problems and injuries.  It is critical to their knowledge to have a foundation of anatomy, kinesiology and biomechanics in correlating their evaluations with the biomechanics or mechanism of injury.

Once the musculoskeletal releases have been accomplished and full flexibility is obtained, the second phase of rehabilitation can proceed. This phase involves muscle strengthening exercises, proprioceptive training and establishing a very specific home exercise program.

Proper posture, proprioceptive training and specific home exercise program which include self-stretching and strengthening are critical in preventing recurrent skeletal asymmetries, poor postural positions as well as reaggravation within activities which would increase mechanical stress and tension causing reactivation of the myofascial pain syndrome.

The Mattes Method has been successful in restoring musculoskeletal dysfunction, eliminating pain and returning workers back to full duty. The technique has eliminated pain in individuals with multiple back surgeries including fusions, titanium cage stabilizations and other invasive techniques.

Additionally, success has been found in overuse syndromes such as carpal tunnel, rotator cuff tendinitis and tendinosis of individual muscle as well as muscle groups, restoring their functional endurances and reducing their pain. The Mattes Method when incorporated with a home exercise program has been successful in maintaining clinical outcome.

 

Should you have any further questions regarding this article, please direct your questions or comments to "Ask the Doctor" section.

 

Copyright © 2004 - 2012Taras V. Kochno, M.D.  All Rights Reserved
Board Certified in Physical Medicine and Rehabilitation

 

 

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