Care Plan 6:   Chronic Myofibrositis

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

ETIOLOGY: This results from irritation, trauma, or immobilization of interplanar fascia within and surrounding the muscles. It is often painful and prone to flare-up from acute injury. It is a complicating factor to other diagnoses and is a common residual from significant soft tissue injury. It can be minimized with early treatment. It may be associated with sleep disturbance.

APPROPRIATE CARE: Once established, myofascitis is hard to treat. It is easily aggravated by overuse, yet passive and active tissue movement provide the best long term outcome. Care includes aggressive deep myofascial work, long term stretching exercise, heating modalities and conditioning if response is poor.

EXPECTED FREQUENCY AND DURATION OF CARE: 2 to 3 sessions per week initially, reducing to weekly sessions if beneficial response is seen within the first 2-4 weeks. The patient must be self-dependent. Care beyond 6-8 weeks is appropriate PRN only if the patient complies with active stretching and ROM home exercise.

TOTAL: 10-14 VISITS OVER 8-12 WEEKS.

WEEK	CARE	PROGRESS	M	T	W	T	F	S
1-4	Aggressive myofascial work Heat Stretching	Great subjective pain reduction initially with gradual improvement 2-3 /week	X		X		X
5-8	Deep myofascial work Home stretching Active strengthening exercise	Gradual progress with significant pain reduction post treatment 1 /week		X			X
> 8	As above PRN	Permanent and stationary with flare-up management				X

ATTENUATING FACTORS: The patient's sleep habits, mental stress levels and compliance with home exercise may all contribute to reduced response.

PRN = per required need (patient requests)

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