Myoskeletal Application

Physician Referral Form

Who Uses Myoskeletal Alignment Techniques® (MAT) and What Is It?

Erik Dalton

Erik Dalton, PhD

These massage techniques were developed by Erik Dalton, PhD, an American bodyworker whose background in structural integration, Western massage, and clinical study of manipulative osteopathy, helped form the basis for and recognize the niche for MAT. Any bodyworker can adopt the techniques and apply them in their practice as tools in their everyday work. The techniques are not a modality unto itself.

MAT attempts to tie together practices of manipulation of the human bony framework and soft tissue manipulation to become musculoskeletal or “myoskeletal manipulation” as a more complete and lasting treatment. Dalton acknowledges the techniques are not an end-all, but are best associated with an integrative health partnership in restoring proper alignment and function to movement of the human body. Such a referral base could include orthopedists, neurologists, other manual therapists such as chiropractors and manipulative osteopaths, other soft tissue therapists such as Rolfers, myofascial release practitioners, and others, and physical therapists for rehabilitative exercise, form, and muscle retraining.

The Science

The foundation of MAT is built upon and techniques derive from studies and work in orthopaedics, osteopathy, chiropractic, physical therapy, structural integration, and massage therapy, along with theories developed in these fields, the conventional medical field, and biomechanical field. Such authors include Drs. Janda, Cyriax, Greenman, Conti, Johansson, Issacs, and Rolf. The strain patterns and theoretical study of them evolve from existing and newly founded international studies by doctors, clinicians, researchers, biomedical, and biomechanical experts over the past 100 or so years.

myoskeletal influencesMuscular patterns of imbalance have become clinically predictable in how they affect the neuromuscular system. And striated muscle tends to develop predictable imbalance patterning before the appearance of pain. Ideally, MAT are applied to what are referred to as “common compensatory muscle strain patterns” in order to improve postural alignment or reduce the effects of dysfunctional posture before pain sets in. MAT assessment and the techniques themselves are not considered specific in nature, but is rather applied to gross anatomical dysfunction. Pain is not chased. Rather, patient history is considered and function is assessed and restored to the entire body in the assumption that its own innate wisdom will incorporate the manipulated change and strain and/or pain will resolve on its own with muscle, neural, and postural re-education and rehabilitative exercise.

A prospective MAT patient will be assessed, evaluated, and a treatment plan or protocol will be developed to apply over a non-specified number of sessions, depending upon how the body effects or integrates changes from treatment. In some cases, a body may not integrate change using these and other techniques, and the patient may be referred out.

The ideal patient will be referred to an MAT practitioner with a diagnosis and clearance for treatment in order to avoid contraindications and to assist the practitioner with designing a treatment plan for the individual patient. Sometimes, a diagnosis may not be included in the referral. However, specific complaints or observations may be reported. Or, perhaps, orthopedic testing will have taken place, but insufficient results may be found to make an official diagnosis. Regardless, an in-depth medical history and intake will be done and a MAT assessment will be made by the practitioner prior to beginning treatment. Assessment, evaluation, treatment plan, progress and/or results are forwarded to referring physician when released to do so by the patient.

Indications

Some common compensatory strain patterns indicated for use of MAT are as follows:

  • Upper crossed syndrome – a pattern of forward head posture, exaggerated (pathologic) kyphotic cervical curve, protracted shoulders at the glenohumoral joint and protracted scapulae due to muscular imbalance.
  • Lower crossed syndrome – a pattern of exaggerated (pathologic) lumbar lordosis, significant anterior pelvic tilt, bulging abdomen, exaggeratedly protruding gluteals, all due to muscular dysfunction.
  • Scoliotic curves along AP and/or coronal planes – functional aspects of scoliotic curves due to fourth-layer, short-lever transversospinalis muscular strain on transverse and spinal processes.short rotators
  • Functional short leg – in hemi-pelvic tilt due to muscular imbalances.
  • Lumbopelvic torsion and/or rotation and/or sidebending.
  • Iliosacral torsion and/or rotation
  • Sacroiliac and/or sciatic pain
  • Functional kinetic muscular chain and/or spring system breakdown – that the lumbopelvic region “locks-up” in a Type I group dysfunction, locking up the L4/5 rotation and sidebending to opposite sides during cross-patterned gait.
  • Spinal facet and rib dysfunction – and the use of short- and long-lever muscles to open or close stuck facets, and the use of transverse processes to affect short-lever muscles which cannot be reached directly.
  • Range of motion limitation to upper and lower extremities and cervical column.

Other working theories incorporated into MAT:

  • Theory of the spinal engine for functional movement, which infers that the lumbopelvic interaction drives locomotion and that leg movement is the expression of that interaction.
  • Anatomy trains for affecting movement and assessing dysfunction, which regards several sets of muscle pattern chains throughout the body tie together.
  • Theory that tight facilitated muscles create and weak inhibited muscles permit asymmetry in the musculoskeletal system.
  • Breaking the pain-spasm-pain cycle, which theorizes that pain creates spasm, which results in more or continued pain, which results in more or continued spasm, and that breaking the cycle at any point in the cycle will reduce all aspects of it.
  • Muscle energy techniques, in that active movement of a patient and resistance by the practitioner during treatment results in a higher success rate than for a passive patient.
  • Theory of muscle-firing order, where muscles firing out of time or out of order will result in dysfunction at one or more joints and in tonus of muscle or muscle groups.
  • Theory of the tensegrity system of the lumbopelvic/tensional connective tissue network, in that connective tissue displaces forces generated at the hip and distributes them throughout the pelvic bones and soft tissue instead of solely at the acetabulum.

MAT emphasizes:

  • Prevention: Early recognition of common strain patterns before they become pain patterns.mobilize fibula
  • How facilitated muscles create and inhibited muscles permit asymmetry in the skeletal system.
  • Assessment of structural facet dysfunction using fourth-layer muscle fibrosis as a tool.
  • “Whole body” alignment; myofascial, ligamentous, and skeletal.
  • Golgi tendon organ work.
  • Viewing bone also as soft tissue.

Physician Referral Form