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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 - 2010 Taras V.
Kochno, M.D. All Rights Reserved
Board Certified in
Physical Medicine and Rehabilitation
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