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Aponeurotic hooking technique: The Soft Hooks®




INTRODUCTION


    1.   Why hooking?




      The connective fibrous tissue represents up to 60% of the bodily
      mass.
      Of different structures, it mainly features a unique fascia1.


This fascial web must remain absolutely free.
Stress at any single point involves the participation of the entire fascia.


Either in case of a muscular contracture, tissue adhesions or fibrous
corpuscles, the release by means of a simple mechanical effect will
bring relief.


Soft hooks allow to painlessly remove those biomechanical troubles
and to re-establish the natural configuration.




    2.   With what tools?
1
    Léopold Busquet, Les chaînes musculaires tome 1,2000.


                                                                          1
Aponeurotic hooking technique: The Soft Hooks®




The fingertip approach of underlying skin and tissue structures is
limited by the thickness of the finger.



A simple and precise tool can put that right.


The soft hook: the real lengthening of the finger.


The soft hook is made of a stainless steel wire of a chosen diameter
which ensures the sharpness at tissue level.



First and foremost it is painless.




                                                                       2
Aponeurotic hooking technique: The Soft Hooks®

    3.   How?




A few precisions:

1. The hook does not replace the therapist’s hand but will be its
perfect auxiliary.
2. Any action starts distant from pain and then gets closer to it.
3. The palpating anatomy constantly guides the therapist.


The ideal way to hold the tool is summed up in three points:
- lay the tool in the commissure between thumb and forefinger
-fold the forefinger on the handle
- put the thumb in the opposite side




Simple exercise: go over an uneven surface to feel the vibration2.




2
    The flexion of the inox wire is limited by the resistance if the welding and by the handle


                                                                                                 3
Aponeurotic hooking technique: The Soft Hooks®

Look at the picture showing the best way to hold the tool as well as
the typical manoeuvre




Standard movement:

  1. The free hand palpates and judges the tissue wave which
     defines the curve of the hook to be used.
  2. The forefinger will identify the place to hook.
  3. The soft hook comes closer to that forefinger and receives
     the tissue wave for the patient’s maximum comfort.

 Palpating hand and soft hook both make some exploratory motions
 over the painful spot.

A brisk pulling of the soft hook will free (the tendon) from
adhesions or separate the fibrositis




                                                                       4
Aponeurotic hooking technique: The Soft Hooks®

 4.   When?




To free the adhesions resulting from shock during a sports practice or
from surgery or to remove inflammatory or neuralgic pains in the
locomotive system.



The obvious relaxation of the muscles due to the transverse
mobilisation of the fibres and the effect of the inhibition of reflex
points already represent a non-negligible treatment.



The main counter-indications are clearly related to the skin and
circulatory condition of the patient.


An excitable patient seems very sensitive to hooking.


Suggested indications for hooking (non restrictive):



Epicondylitis, medial epicondylitis, Achilles tendinitis, pubalgia,
periostitis, muscle contracture, strain, tenosynovitis, keloids,
Dupuytren postoperative, carpal tunnel, ulnar canal syndrome,
occipitalgy, sciatica, lumbago, torticollis, PSH, ganglion cysts,
algodystrophy




                                                                         5
Aponeurotic hooking technique: The Soft Hooks®

 5.   Origin of the method



This technique was developed by Kurt EKMAN, a Swede
kinesiotherapist contributor of CIRIAX in London.


He revealed the deficiencies and limits of palpation and manual
treatment of soft tissues.


The adhesions and small deposits are difficult to palpate on the deep
myo-aponevrotic levels.


He had the idea of creating tools which offered a better access to the
pathogenic structures.




                                                                         6
Aponeurotic hooking technique: The Soft Hooks®




                     PRACTICE




                                                 7
Aponeurotic hooking technique: The Soft Hooks®

A – INFERIOR LIMB

1.- TIGH


ANATOMIC REMINDER


The tigh consists of three areas


  • Anterior region
  • Posterior region
  • Lateral region



Each area is joined by muscle groups with similar actions and is
crossed by a vascular-nervous pedicle.

The whole member is covered by skin, a superficial and a deep fascia.

It surrounds the muscles forming the intramuscular septa.

Anterior region of the tigh

  • Quadriceps femoris muscle
  • Sartorius muscle

Femoris vessels
  • Artery
  • Vein
  • Nerve




                                                                    8
Aponeurotic hooking technique: The Soft Hooks®

Medial region of the tigh

(from inside to outside)

  •   Sartorius muscle
  •   Iliopsoas
  •   Pectineus muscle
  •   Adductor longus muscle
  •   Gracilis muscle

Deeper
  • Adductor brevis muscle (between ALM and GM)


Buttocks area
  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus

  • Tensor fasciæ latæ

Deeper
  • Piriformis muscle
  • Sacrospinous ligament


Posterior region of the tigh

Long rear muscles
  • Semimembranosus muscle
  • Semitendinosus muscle
  • Biceps femoris muscle

Nerves
  • Sciatic nerve


                                                  9
Aponeurotic hooking technique: The Soft Hooks®

  • Posterior cutaneous nerve

Popliteal fossa (Knee pit)


Boundaries
Inside
   • Semimembranosus muscle
   • Semitendinosus muscle



Outside
  • Biceps femoris muscle



Inferior (with the plantaris muscle)
   • Medial and lateral heads of the gastrocnemius muscle



Contents
  • Popliteal vein and artery
  • Tibial nerve



Floor
   • Popliteal muscle




                                                            10
Aponeurotic hooking technique: The Soft Hooks®

HOOKING




Separation of the anterior gracilis muscle
Internal: the Sartorius muscle
External: to the fasciæ latæ




Separation of the Sartorius muscle
Vastus medialis muscle (teardrop muscle)



Area of concentration
    Sartorius muscle – vastus medialis muscle – anterior gracilis
    muscle




                                                                    11
Aponeurotic hooking technique: The Soft Hooks®




Edge of the vastus lateralis muscle in contact with the anterior gracilis
muscle

Reminder
    The vastus lateralis (side and rear) is covered by the FLT




Separation of the vastus lateralis
  from the short head of the biceps femoris muscle down the tigh


Separation if the vastus lateralis
   from the long head of the biceps femoris muscle to the upper area
of the tigh




                                                                       12
Aponeurotic hooking technique: The Soft Hooks®




Key point
  Vastus lateralis – biceps femoris – gluteus maximus




Gluteus maximus, linked up with
  • long head of the biceps femoris muscle
  • semitendinous muscle



Afterwards, separation of semitendinous / semimembranous muscles




                                                                   13
Aponeurotic hooking technique: The Soft Hooks®




Separation of the gracilis muscle with
  • Semimembranous muscle (popliteal area)
  • Sartorius muscle (just ahead it)




Separation of the adductor magnus muscle (posterior side)
  • semitendinous, semimembranous
  • gracilis muscle (just ahead it)

Key point
    Adductor longus – semimembranous – gracilis muscle

Adductor longus
  • gracilis muscle
  • adductor brevis




                                                            14
Aponeurotic hooking technique: The Soft Hooks®

PATHOLOGIES

STRUCTURES TO BE TREATED

Patellar hyperpressure
  • Buttocks
  • Tensor
  • Adductor
  • Patte d’Oie

Pubalgia
  • Adductor longus
  • Adductor magnus
  • Gracilis
  • Gluteus maximus
  • Abdominal muscles (periosteum)
  • Hamstring
  • Piriformis
  • Psoas
  • Quadratus lumborum muscle

Muscular strain
Hooking the periphery of the injure relaxes the contracture
emphasizing this way the drainage with this defibrosing effect.




                                                                  15
Aponeurotic hooking technique: The Soft Hooks®

PATHOLOGIES

STRUCTURES TO BE TREATED

Patellar hyperpressure
  • Buttocks
  • Tensor
  • Adductor
  • Patte d’Oie

Pubalgia
  • Adductor longus
  • Adductor magnus
  • Gracilis
  • Gluteus maximus
  • Abdominal muscles (periosteum)
  • Hamstring
  • Piriformis
  • Psoas
  • Quadratus lumborum muscle

Muscular strain
Hooking the periphery of the injure relaxes the contracture
emphasizing this way the drainage with this defibrosing effect.




                                                                  15

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Manual soft hooks extracts

  • 1. Aponeurotic hooking technique: The Soft Hooks® INTRODUCTION 1. Why hooking? The connective fibrous tissue represents up to 60% of the bodily mass. Of different structures, it mainly features a unique fascia1. This fascial web must remain absolutely free. Stress at any single point involves the participation of the entire fascia. Either in case of a muscular contracture, tissue adhesions or fibrous corpuscles, the release by means of a simple mechanical effect will bring relief. Soft hooks allow to painlessly remove those biomechanical troubles and to re-establish the natural configuration. 2. With what tools? 1 Léopold Busquet, Les chaînes musculaires tome 1,2000. 1
  • 2. Aponeurotic hooking technique: The Soft Hooks® The fingertip approach of underlying skin and tissue structures is limited by the thickness of the finger. A simple and precise tool can put that right. The soft hook: the real lengthening of the finger. The soft hook is made of a stainless steel wire of a chosen diameter which ensures the sharpness at tissue level. First and foremost it is painless. 2
  • 3. Aponeurotic hooking technique: The Soft Hooks® 3. How? A few precisions: 1. The hook does not replace the therapist’s hand but will be its perfect auxiliary. 2. Any action starts distant from pain and then gets closer to it. 3. The palpating anatomy constantly guides the therapist. The ideal way to hold the tool is summed up in three points: - lay the tool in the commissure between thumb and forefinger -fold the forefinger on the handle - put the thumb in the opposite side Simple exercise: go over an uneven surface to feel the vibration2. 2 The flexion of the inox wire is limited by the resistance if the welding and by the handle 3
  • 4. Aponeurotic hooking technique: The Soft Hooks® Look at the picture showing the best way to hold the tool as well as the typical manoeuvre Standard movement: 1. The free hand palpates and judges the tissue wave which defines the curve of the hook to be used. 2. The forefinger will identify the place to hook. 3. The soft hook comes closer to that forefinger and receives the tissue wave for the patient’s maximum comfort. Palpating hand and soft hook both make some exploratory motions over the painful spot. A brisk pulling of the soft hook will free (the tendon) from adhesions or separate the fibrositis 4
  • 5. Aponeurotic hooking technique: The Soft Hooks® 4. When? To free the adhesions resulting from shock during a sports practice or from surgery or to remove inflammatory or neuralgic pains in the locomotive system. The obvious relaxation of the muscles due to the transverse mobilisation of the fibres and the effect of the inhibition of reflex points already represent a non-negligible treatment. The main counter-indications are clearly related to the skin and circulatory condition of the patient. An excitable patient seems very sensitive to hooking. Suggested indications for hooking (non restrictive): Epicondylitis, medial epicondylitis, Achilles tendinitis, pubalgia, periostitis, muscle contracture, strain, tenosynovitis, keloids, Dupuytren postoperative, carpal tunnel, ulnar canal syndrome, occipitalgy, sciatica, lumbago, torticollis, PSH, ganglion cysts, algodystrophy 5
  • 6. Aponeurotic hooking technique: The Soft Hooks® 5. Origin of the method This technique was developed by Kurt EKMAN, a Swede kinesiotherapist contributor of CIRIAX in London. He revealed the deficiencies and limits of palpation and manual treatment of soft tissues. The adhesions and small deposits are difficult to palpate on the deep myo-aponevrotic levels. He had the idea of creating tools which offered a better access to the pathogenic structures. 6
  • 7. Aponeurotic hooking technique: The Soft Hooks® PRACTICE 7
  • 8. Aponeurotic hooking technique: The Soft Hooks® A – INFERIOR LIMB 1.- TIGH ANATOMIC REMINDER The tigh consists of three areas • Anterior region • Posterior region • Lateral region Each area is joined by muscle groups with similar actions and is crossed by a vascular-nervous pedicle. The whole member is covered by skin, a superficial and a deep fascia. It surrounds the muscles forming the intramuscular septa. Anterior region of the tigh • Quadriceps femoris muscle • Sartorius muscle Femoris vessels • Artery • Vein • Nerve 8
  • 9. Aponeurotic hooking technique: The Soft Hooks® Medial region of the tigh (from inside to outside) • Sartorius muscle • Iliopsoas • Pectineus muscle • Adductor longus muscle • Gracilis muscle Deeper • Adductor brevis muscle (between ALM and GM) Buttocks area • Gluteus maximus • Gluteus medius • Gluteus minimus • Tensor fasciæ latæ Deeper • Piriformis muscle • Sacrospinous ligament Posterior region of the tigh Long rear muscles • Semimembranosus muscle • Semitendinosus muscle • Biceps femoris muscle Nerves • Sciatic nerve 9
  • 10. Aponeurotic hooking technique: The Soft Hooks® • Posterior cutaneous nerve Popliteal fossa (Knee pit) Boundaries Inside • Semimembranosus muscle • Semitendinosus muscle Outside • Biceps femoris muscle Inferior (with the plantaris muscle) • Medial and lateral heads of the gastrocnemius muscle Contents • Popliteal vein and artery • Tibial nerve Floor • Popliteal muscle 10
  • 11. Aponeurotic hooking technique: The Soft Hooks® HOOKING Separation of the anterior gracilis muscle Internal: the Sartorius muscle External: to the fasciæ latæ Separation of the Sartorius muscle Vastus medialis muscle (teardrop muscle) Area of concentration Sartorius muscle – vastus medialis muscle – anterior gracilis muscle 11
  • 12. Aponeurotic hooking technique: The Soft Hooks® Edge of the vastus lateralis muscle in contact with the anterior gracilis muscle Reminder The vastus lateralis (side and rear) is covered by the FLT Separation of the vastus lateralis from the short head of the biceps femoris muscle down the tigh Separation if the vastus lateralis from the long head of the biceps femoris muscle to the upper area of the tigh 12
  • 13. Aponeurotic hooking technique: The Soft Hooks® Key point Vastus lateralis – biceps femoris – gluteus maximus Gluteus maximus, linked up with • long head of the biceps femoris muscle • semitendinous muscle Afterwards, separation of semitendinous / semimembranous muscles 13
  • 14. Aponeurotic hooking technique: The Soft Hooks® Separation of the gracilis muscle with • Semimembranous muscle (popliteal area) • Sartorius muscle (just ahead it) Separation of the adductor magnus muscle (posterior side) • semitendinous, semimembranous • gracilis muscle (just ahead it) Key point Adductor longus – semimembranous – gracilis muscle Adductor longus • gracilis muscle • adductor brevis 14
  • 15. Aponeurotic hooking technique: The Soft Hooks® PATHOLOGIES STRUCTURES TO BE TREATED Patellar hyperpressure • Buttocks • Tensor • Adductor • Patte d’Oie Pubalgia • Adductor longus • Adductor magnus • Gracilis • Gluteus maximus • Abdominal muscles (periosteum) • Hamstring • Piriformis • Psoas • Quadratus lumborum muscle Muscular strain Hooking the periphery of the injure relaxes the contracture emphasizing this way the drainage with this defibrosing effect. 15
  • 16. Aponeurotic hooking technique: The Soft Hooks® PATHOLOGIES STRUCTURES TO BE TREATED Patellar hyperpressure • Buttocks • Tensor • Adductor • Patte d’Oie Pubalgia • Adductor longus • Adductor magnus • Gracilis • Gluteus maximus • Abdominal muscles (periosteum) • Hamstring • Piriformis • Psoas • Quadratus lumborum muscle Muscular strain Hooking the periphery of the injure relaxes the contracture emphasizing this way the drainage with this defibrosing effect. 15