Instrumental TenseActive Release of Median Nerve. Poland 2014. The professor David Lopez PT, DC teach how to release the median nerve and increases the affected circulation to recover the neural mobility and function using the KineticXer approach. The presentation expose the most common points where the median nerve suffer entrapment and during the workshop those techniques to produce the release according the anatomy and pathological attachments. In addition teach the traces to increaseand normalize the nerve irrigation affected by the compression and chronic dysfunction.

1. International Workshop
“Kineticxer ®
instrumental Neural
Release”
XX edition of International Disabled People’s Day.
International Scientifique Symposium
20-23 March 2014. Zgorzelec, Poland.
Prof. David López Sánchez
Kinesiologyst; Chiropractor D.C.
Director of Chiropractic Program
Central University of Chile
Director of Manual Therapy Diplomats
Saint Thomas University, Chile

2. What is KineticXer?
 KineticXer is an instrumental Tense
Active Release Concept to diagnostic
and treat or mobilize soft tissues.
 KineticXer apply ergonomically
designed stainlesss steel devices to act
over fascias, nerve, muscles and over
different conditions.
 Similar to other concepts as
crochetagem, Graston, Gua Sha, etc.
for the treatment of soft tissues,
KineticXer evoluted to diagnostic and
treat neural tissues, limphtatic drainage
and soft tissues repair in chronic lesions.
 With a variety of new applications
KineticXer improves the existent
methods

3. www.kineticxer.cl

4. KineticXer: Different Applications

5. Diagnosis
• The Instrument TenseActive
Release Concepts (ITARC) use
stainless steel instruments, which are
thought to be able to detect and treat
soft tissue lesions, by using a variety
of gliding multidirectional stroke
techniques over the involved soft
tissue structure.
(W. Hammer. Journal of Bodywork
and Movement Therapies, Volume 12,
Issue 3, Pages 246-256).

6. Diagnosis
• Carey-Loghmani (2003) likens the
stainless steel when contacting
fibrotic tissue, the instrument
reverberate, sending more precise
information to the clinician.
• Much as a stethoscope amplifies
what the human ear can hear, this
function hepls the clinician to detect
and treat soft tissue dysfunctions.

7. KineticXer
Technique
• Today several instrumental to soft
tissue mobilization techniques
employs the use of stainless or
plastics instruments, with the rationale
that this technique increases blood
flow and tissue healing to the area as
well as breaking up soft tissue
restrictions. (Carey-Loghmani,
2003:12) Crochetagem, Graston
Technique, Diacutaneous Fibrolisis ,
eg.
• These ITAR instruments are designed
able to penetrate the soft tissues to a
greater degree than the clinicians
digital pressure.

8. Muscle Action
Fascial
Tension
TenseActive
Changes in
fascia
perfomance
MotoActive
Changes in
muscle
perfomance
Passive muscle stiffness may be influenced by active contractility of
intramuscular connective tissue. Robert Schleip *, Ian L. Naylor, Daniel Ursu,
Werner Melzer, Adjo Zorn, Hans-Joachim Wilke, Frank Lehmann-Horn,
Werner Klingler

9. Tense Active Action of Fascias
The Fascia produces tension in the mechanical
tissues related the muscles and nerve movemente
Williams PE, Goldspink G. Connective tissue changes in immobilised muscle. J
Anat 1984;184(2):343–50.

10. Absolute Contraindications for ITARC Techniques
• Open Wound- Unhealed Suture Site/Sutures
• Unhealed Fractures
• Thrombophlebitis
• Uncontrolled Hypertension
• Kidney Dysfunction
• Patient Intolerance/Non-compliance/Hypersensitivity
• Hematoma
• Osteomyelitis
• Myositis Ossificans
• Anti-Coagulant Medications
• Cancer Varicose Veins
• Burn Scars
• Relative Contraindications for ITAR:
• Acute Inflammatory Conditions (e.g. Synovitis)
• Inflammatory Condition Secondary to Infection
• Rheumatoid Arthritis Pregnancy (consider inherent ligament laxity)
• Osteoporosis

11. Some Effects And Desirable Applications
• To produce va correct muscle fiber alignement
• To induce a controlled injury repair proccess
(inflamatory reaction and granutation-fibrin clot-
fibroblast profiferation- tissue remodeling)
• To induce the repair process in chronic lesions
• To increase blood flow
• To break up soft tissue restrictions due to
adhesions and fibroblasts
• To promote the soft tissue fibrosis
• To increase the mechanical tissue response to
load (stiffness)
• Kineticxer is reasonably able to act specifically over and treat soft
tissue lesions, by using a variety of multidirectional stroke
techniques over the involved soft tissue structure

12. Technique
• Palpation and soft tissue
evaluation: To detect tissue
restricctions.
• Instrumental tissue
assessment: serve to detect
fibrous corpuscles and
fibrous adhesions.

13. Median Nerve:
1.-Cervical Radiculopathy.
2.- Thoracic Outlet
Syndrom
3.-Síndrome del pronador
redondo y síndrome del
túnel carpiano.
More Frequent
Entrapments of Median
Nerve (doble Crush)
Osterman AL: The double crush syndrome.
Orthop Clin North Am 2011;19:147-55

14. Thoracic Outlet Syndrome
• Generalized Symptoms:
Pain in the upper extremity,
paraesthesia, numbness,
weakness, skin
discolorations, swelling,
Raynaud’s Phenomenon.

15. 15
Neurogenic Symptoms of TOS:
Pain, paraesthesia, weakness, coldness of the
arm
after prolonged hyperabduction:
– For exampe in Hair dressing, painting…
{this pain is similar to claudication pain}
 C8-T1 “Ulnar nerve”: (more common)
• Back of neck, medial side of arm to ring & little finger
 C5-7: Lateral neck, shoulder tip, outside upper arm back of
thumb & index finger
{Compression of C8-T1 (ulnar nerve) is more common.}
{Although cervical rib is congenital, Symptoms rarely develop
before adulthood because a person suddenly gets taller in
puberty and then symptoms appear.}

16. Causes of TOS
 Elongated C7 TVP
 Cervical Rib (or fibrous band)
 Trauma, exostosis
 Posture induced (Forward
head/rounded shoulders)
 Pancoast Tumor
 Scalene Muscles (spastic, flaccid, or
anomalous)
 Costoclavicular area
 Subcoracoid area (Pec minor/Coracoid
Pr.)

17. Cervical Ribs
 A congenital overdevelopment, bony
or fibrous, of the C7 costal process.
Can be unilateral or bilateral
 Usually asymptomatic.
 Occurs in 1% of the population and
only 10% of those are symptomatic.
 Pain and paresthesias in the medial
forearm and hand, usually relieved
by changing position. Can have
weakness and difficulty with fine
motor control.

18. Interscalene Triangle
• Anterior Scalene
• Middle Scalene
• T1 Rib
• Subclavian Artery
• Brachial Plexus
• Subclavian Vein passes anterior

19. Foraminal Space
Median Nerve: Entrapment
Zones

20. Escalene Muscles
Median Nerve: Entrapment
Zones

21. Subescapular muscle
1. Axilar Nerve
2. Subescapular Muscle
Median Nerve: Entrapment
Zones

22. Minor Pectoralis
Median Nerve: Entrapment
Zones

23. Subescapular, Pectoral mayor y menor:
posición ITARC: Liberación TensoActiva
• Colocar el hombro de lanzar en la pared
o la puerta de la creación de un ángulo
recto Desde esta posición, haga que el
paciente mueva suavemente su cuerpo
hacia adelante hasta que sienta un
estiramiento suave.
• Sobre la piel desnuda aplicar tranversal
y longitudinalmente el kineticer® ;
mientras se elonga el pectoral menor y
mayor. En la misma posición, con
mayor elevación de hombros y
extensión de codo, contra resistencia
es posible trabajar el subescapular

24. Pectoral-Deltoid Fascia
Median Nerve: Entrapment
Zones

25. Strüthers Ligament
Median Nerve: Entrapment
Zones

26. Lacertus Fibrosus
Median Nerve: Entrapment
Zones

27. Teres Pronator
Median Nerve: Entrapment
Zones

28. Median Nerve: Pronator Teres
Entrapment
• Entrapment at the level of the elbow or the
proximal forearm gives rise to the pronator
teres syndrome.
Causes
• A fibrous band at the site at which the nerve
passes between the heads of the pronator
teres muscle
• Hypertrophy of the pronator teres muscle
• The aponeurotic bridge of the flexor
digitorum superficialis muscle (superficialis
arch)
• Thickening of the bicipital aponeurosis

29. Median Nerve: Pronator Teres
Entrapment Anatomy

30. • (a) Axial T1-weighted SE MR image at a middle level in the
forearm shows normal volume and normal signal intensity of
the proximal forearm muscles 1pronator teres, 2 flexor carpi
radialis, 3 palmaris longus, 4 flexor digitorum superficialis, 5
flexor pollicis longus, 6a radial part of the flexor digitorum
profundus, 6b ulnar part of the flexor digitorum profundus)
and normal signal intensity of the radius (R) and ulna (U).
• (b) Corresponding T2-weighted fat-suppressed fast SE MR
image demonstrates increased signal intensity indicative of
edema in all of the muscles that are innervated by the
median nerve.

31. Clinical Symptoms
• Pain and burning of the skin supplied by
median nerve branches
• Loss of thumb opposition, with loss of
flexion of the three radial fingers on
prolonged compression
• Painful pronation
Thenar tenderness and characteristic
distribution of pain on compression of
the pronator teres
• Muscle and thenar atrophy
• Weakness of the flexor pollicis
• Longus and abductor pollicis brevis
muscles

32. Jean-Pierre Barral, Alain Croiber, Manipulaciones de los Nervios
Periféricos, Osteopatía, The Barral Institute, editorial Elsevier-
Masson, 2009
Palmaris Longus
Median Nerve: Entrapment
Zones

33. Jean-Pierre Barral, Alain Croiber, Manipulaciones de los
Nervios Periféricos, Osteopatía, The Barral Institute,
editorial Elsevier-Masson, 2009
Ligamento Transverso del Carpo
Median Nerve: Entrapment
Zones

34. l. Axial T1-weighted images of the median nerve MR s:
scaphoid bone, c: capitate bone, h: hamate bone, t: triquetrum
bone, p: pisiform bone, fcr: tendon of flexor carpi radialis
muscle, fpl: tendon of flexor pollicis longus, fdp: tendons of
flexor digitorum profundus muscle, fds: tendons of flexor
digitorum superficialis muscle, mn: median nerve, fr: flexor
retinaculum.
Normal anatomic
localization of the
median nerve in
the carpal tunnel

35. Neural structure traces
 Use KineticXer Manthis ®.
 The pressures over the nerve
not much of 40 mmHG. Follows
the instructcions of the teacher.
 The trace under the tension not
much of 20 mm HG.
 A nerve is safe elongated
between 6-8% without
manifest functional changes.
 Start the release from the
central points to peripheric
points.

36. Set of Techniques for today
Treatment: Scalene Group
Treatment: Deltoid Fascia & Pectoral Fascia
Treatment: Subescapular Muscle
Treatment: Teres Pronator
Treatment: Radialis Longus
Treatment: Carpal Tunnel entrapment
PD: “Please Follows strictly the instructions of Prof. David Lopez”
www.kineticxer.cl
Median Nerve exclusively