RESTRICCIONES MIOFASCIALES DE LAS EXTREMIDADES INFERIORES

Fig. 34. Manos cruzadas en los flexores del muslo.

tcnica de manos cruzadas, realiza una presin tridimensional durante 3 a 5 minutos, hasta conseguir tres liberaciones consecutivas (Fig. 34). La colocacin de la
mano sobre la espina ilaca anterosuperior solamente sirve de referencia. No se
debe aplicar una presin directa sobre el hueso.

INDUCCIN MIOFASCIAL DEL ILACO

Objetivo
Eliminar las restricciones miofasciales del msculo ilaco que limitan la extensin del
muslo. Estas restricciones pueden desviar la pelvis hacia la anteversin e influir
negativamente sobre la cintica de la columna vertebral.
Posicin del paciente
En decbito supino, con las rodillas a 30 grados de flexin sobre una almohada.
Posicin del terapeuta
De pie en el lado que se va a tratar.
Tcnica
Tcnica A
Si la posicin adoptada no relaja el tejido, el terapeuta deber flexionar el muslo
hasta unos 110 grados. En esta posicin, con una de sus manos sobre la regin que
590

RESTRICCIONES MIOFASCIALES DE LAS EXTREMIDADES INFERIORES

Fig. 35. Induccin del msculo ilaco: fase A.

corresponde al msculo ilaco, el terapeuta realiza un deslizamiento longitudinal

desde el extremo proximal al distal; la otra mano controla el grado de flexin del
muslo. La maniobra se repite de 7 a 15 veces (Fig. 35).
Tcnica B
A continuacin, si el paciente logra tolerarlo, se debe aplicar en la misma regin el
deslizamiento transverso, segn los principios de esta tcnica descrita en el captulo sobre tcnicas bsicas (Fig. 36).

Fig. 36. Induccin del msculo ilaco: fase B.

591

RESTRICCIONES MIOFASCIALES DE LAS EXTREMIDADES INFERIORES

Fig. 37. Movilizacin de los aductores.

MOVILIZACIN DE LA FASCIA DE LOS ADUCTORES

Objetivo
Movilizar la fascia de los aductores del muslo.
Posicin del paciente
En decbito prono.
Posicin del terapeuta
De pie en el lado que se va a tratar.
Tcnica
El terapeuta flexiona la pierna del paciente a 90 grados y con su mano caudal mantiene esta posicin. La mano craneal la coloca sobre la regin de la mayor restriccion
dentro de la masa de los aductores y realiza con ella un deslizamiento transverso. La
mano caudal puede ayudar en la colocacin del muslo, cambiando su posicin entre
la rotacin externa y la interna, dependiendo del progreso de la liberacin (Fig. 37).

INDUCCIN TELESCPICA BILATERAL

Objetivo
Balancear la fascia de ambas extremidades inferiores y de la regin plvica.
Posicin del paciente
En decbito supino.
592

RESTRICCIONES MIOFASCIALES DE LAS EXTREMIDADES INFERIORES

Fig. 38. Induccin telescpica bilateral.

Posicin del terapeuta

De pie a los pies de la camilla.
Tcnica
Manteniendo sus codos extendidos, el terapeuta sujeta con ambas manos los talones del paciente y los tracciona balanceando simultneamente su cuerpo hacia atrs.
El cuerpo del terapeuta debe permanecer erguido y debe aprovechar el peso de su
cuerpo para realizar la traccin. No se debe aplicar una fuerza repentina, sino que
sta debe aumentarse de forma lenta y progresiva. La traccin se debe aplicar hasta
realizar tres liberaciones telescpicas consecutivas. Durante el proceso de liberacin, se
puede producir el movimiento espontneo de las piernas, pudiendo ir en una u otra
direccin, incluso opuestas entre s, y el terapeuta deber seguirlas (Fig. 38).

INDUCCIN TELESCPICA DEL MIEMBRO INFERIOR

Objetivo
Devolver el equilibrio al sistema miofascial de la extremidad inferior.

NOTA:
Al aplicar las tcnicas telescpicas en las extremidades inferiores se debe tener
un cuidado especial con los pacientes que presenten desrdenes en las articulaciones sacroilacas y coxofemorales. La tcnica est contraindicada en los
pacientes portadores de implantes intraarticulares.

593

RESTRICCIONES MIOFASCIALES DE LAS EXTREMIDADES INFERIORES

Posicin del paciente

En decbito supino.
Posicin del terapeuta
De pie en el extremo de la camilla.
Tcnica
Fase A
El terapeuta, con una de sus manos, tracciona suavemente el miembro inferior del
paciente, permitiendo una ligera rotacin externa (Fig. 39).
Fase B
Posteriormente, tras conseguir tres liberaciones telescpicas consecutivas, facilite
de una manera lenta y pogresiva el movimiento de abduccin y flexin de la cadera
(Figs. 40 y 41).
Fase C
Manteniendo la traccin de la pierna, llegar a flexionar totalmente la cadera (Fig. 42).
Fase D
En esta fase (manteniendo siempre la traccin), se realiza el movimiento de rotacin interna y de aduccin, que producir lentamente una rotacin del tronco
(Fig. 43).

Fig. 39. Tcnica telescpica para la extremidad inferior: fase A.

594

RESTRICCIONES MIOFASCIALES DE LAS EXTREMIDADES INFERIORES

Fig. 40. Tcnica telescpica para la extremidad inferior: fase B.

Fig. 41. Tcnica telescpica para la extremidad inferior: fase B.

Fase E
Tras conseguir la liberacin se debe regresar a la posicin de partida (Fig. 44).
Toda la tcnica debe realizarse de manera lenta y progresiva, segn los principios
de la tcnica telescpica explicados en el captulo sobre la aplicacin de las tcnicas
bsicas.
595

RESTRICCIONES MIOFASCIALES DE LAS EXTREMIDADES INFERIORES

Fig. 42. Tcnica telescpica para la extremidad inferior: fase C.

Fig. 43. Tcnica telescpica para la extremidad inferior: fase D.

Fig. 44. Tcnica telescpica para la extremidad inferior: fase E.

596

RECOMENDACIONES FINALES

RECOMENDACIONES FINALES
Pudiera sorprender al lector la falta de protocolos precisos en la aplicacin de los tratamientos realizados en las terapias miofasciales. Su ausencia en el libro no es casual.
Tratar a los pacientes con la aplicacin exclusiva de las tcnicas miofasciales no es una
tarea fcil y requiere de experiencia. No hay marcos rgidos. Por esta razn, se recomienda, para un principiante, la aplicacin de las tcnicas de induccin miofascial dentro de
los tratamientos rutinarios, complementando o sustituyendo gradualmente con ellas a
las tcnicas habituales, segn los requerimientos de cada paciente. Es cada profesional
quien segn su experiencia, elegir los caminos apropiados para su incorporacin.
Debemos recordar que la lectura del libro no puede sustituir a un entrenamiento apropiado, y as como se mencion en las pginas anteriores, se recomienda a
cada terapeuta la experiencia como paciente, para entender mejor las reacciones
que se producen durante el proceso del tratamiento.
Durante cada fase de maduracin profesional en la aplicacin de las terapias
miofasciales, no se debera perder de vista la visin global del sistema fascial. Siempre recordando la poderosa accin del tacto sobre el omnipresente sistema fascial
(Fig. 1). Considero que ste es el camino para mantener el funcionamiento motor
del cuerpo sin restricciones (Fig. 2) y en su ptimo nivel de funcionamiento.
in

ci

es

Pr

c
Tra

to

c
Ta

n
ci ta
Acirec
d

n
ci ta
Acdirec
in

Fig. 1. Esquema de acciones mecnicas del, y

dentro del, sistema fascial del cuerpo.
cia

s
Fa

ios
mb la ra
Ca enuctu
tr
es

ios
mb la a
Ca en log
o
i
fis

de
ca s
mi ido
ns flu
i
D lo

n a
ci ric
ac ct
Rezoel
pie

597

RECOMENDACIONES FINALES

Fig. 2. Atrapamientos del sistema fascial. Los puntos, las bandas y las
zonas de atrapamiento superficial y profundo del, y dentro del, sistema
fascial impiden el desenvolvimiento fisiolgico del cuerpo en todos los
niveles de la funcin corporal. Se podra describir la sensacin corporal como un encadenamiento.

Recordemos que el sistema fascial forma una ininterrumpida red que, de diferentes maneras, controla todos los componentes de nuestro cuerpo. No es posible
mantener a un cuerpo saludable sin un sistema fascial saludable (Fig. 3). Este sistema debera encontrarse en un equilibrio funcional para asegurarle al cuerpo el
desenvolvimiento ptimo en sus tareas. La eleccin del camino apropiado depende
de nosotros.

Fig. 3. La presencia de las restricciones del, y

dentro del, sistema fascial crea incomodidades que interfieren con el apropiado desenvolvimiento funcional de todos los sistemas
corporales. El sistema fascial puede encontrarse en una excesiva tensin, o puede estar demasiado distendido. En ambas situaciones, la
funcin corporal queda afectada. Se puede
comparar este comportamiento con tres formas
de acostarse en una hamaca: demasiado tensa,
muy floja, o perfectamente balanceada entre
dos troncos. Solamente en la ltima, el cuerpo
se encuentra cmodo.

598

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616

NDICE

NDICE
A
Absorcin, 67
Aceleracin, 116
cido hialurnico, 67, 84
Alcance plstico, 119
Alexander, tcnica, 166, 167
Amortiguacin, 67
Amplitud de los movimientos activos, 294
Anlisis a travs del tacto, 241
Aponeurosis, 30
Aracnoides, 56, 59
Arteria vertebral, 431
prueba, 433
Articulaciones sacroilacas, 291
Atrapamiento
bandas, 218, 220
niveles, 219
patrones, 238
puntos, 218, 219
B
Balanceo de la duramadre, 344
Baln abdominal, teora, 133, 134
C
Carga, 115
Cartlago, 34
Clulas, 79, 110
adiposas, 79
fijas, 79
libres, 79
Ciegos, comportamiento postural, 173
Cizallamiento, 118
Colgeno, 29, 31, 79, 81, 90, 95, 96
entrecruzamientos, 98, 102
Compensacin, fenmeno, 187
Compresin, 118, 120, 121, 192
Craneosacro, sistema, 381, 383
Creep, 124, 128
D
De Quervain, enfermedad, 512
Deformacin, 119

elstica, 112, 120

plstica, 114, 124
preelstica, 112, 120
viscoelstica, 124, 126, 127
Deslizamiento
en forma de J, 324
transverso, 328
Desplazamiento, 118
Duramadre, 56, 292
balanceo, 344
E
Elasticidad, 113, 119
Elastina, 79, 80
Elongacin, 118, 120
oblicua de la fascia cervical, 419
Endomisio, 36
Endoneuro, 53
Entrecruzamientos, 202
formacin, 206, 207
Epimisio, 36, 38
Epineuro, 53
Equilibrio, 116
Escoliosis, 187
Estrs, 118
Evaluacin, 215
activa, 226
de la mitad inferior del cuerpo, 287
de la mitad superior del cuerpo, 255
de los movimientos, 233
a travs de los movimientos, 234
de los patrones de Zink, 239
con tensin selectiva, 243
a travs de la apreciacin visual, 217,
218, 260, 293
Expansin, 118
Extraestiramiento, 113
Extremidades inferiores, discrepancia, 290
F
Faciales, compartimientos, 25, 47, 68
Fascia
funciones, 66
soporte, 71

617

NDICE

sostn, 70
suspensin, 69
profunda, 25, 29
superficial, 24, 25, 27, 28
toracolumbar, 131, 133
accin cruzada, 138
inervacin, 140
Fascial(es)
compartimientos, 25, 47
microestructura, 25, 43
modelo del cuerpo, 185
modelo de distorsin, 204
planos, 23
sistema, lesiones, 198
subcutneo, 24
subseroso, 24
Fibroblastos, 44, 79
Fibrocartlago, 33, 34
Fibromialgia, 29
Fuerza, 115
momento, 115, 132
de relajacin, 121
par, 115
Fukuda, prueba, 176
G
Galileo Galilei, 105
Geodsica, estructura, 143
Glucosaminoglucanos, 83
Gran ligamento de la nuca, 62
Grasa, 26, 27
Gravedad, 168, 187
centro, 169
fuerzas, 169
H
Histresis, 128
Hook, ley, 112
Hoz del cerebelo, 57, 60
del cerebro, 56, 60
I
Induccin de
aductores, 592
angular del omplato, 421, 551
antebrazo, 512

618

articulaciones sacroilacas, 494

ATM, 395, 407, 408
banda iliotibial, 581
base del crneo, 385
brazo, 525
compartimiento anterior, 568, 569
complejo articular del hombro, 537
cuadrado lumbar, 498, 501
cuadrceps, 571
diafragma, 472
dorsal ancho, 536
espacios intercostales, 547
esternocleidomastoideo, 422, 423
estructuras craneales, 377
extensores de la regin lumbar, 460
fascia, bicipital, profunda, 526
cervical, 413
asistida, 435
profunda, 436
gltea, 493
hioidea, 447, 448
palmar, 518
paravertebral, 503
de la pierna, 562
del psoas, 490
plantar, 559, 560, 561, 562
torcica oblicua, 469
flexores de la mueca y los dedos, deslizamiento longitudinal, 521
deslizamiento transversal, 521
flexores del muslo, 589
global de la extremidad superior, 553
global de la fascia cervicodorsal, 426
glteo medio, 497
hombro, 542
hoz del cerebro, 387
ilaco, 590
infraespinoso, 536
interseos, 517
isquiotibiales, 585
largo de la cabeza y largo del cuello, 424
lengua, 372, 373
limitaciones funcionales del pulgar, 515
longitudinal, 330
paravertebral, 458
mano, 512
masetero, 363, 365, 366

NDICE

masticadores, 355
pared torcica anterior, 468
pectorales, 541
mayor, 542, 543, 544, 545
menor, 544, 545
piramidal de la pelvis, 496
pliegue axilar posterior, 535
pterigoideo, externo, 367, 369, 370
interno, 371
regin, cigomtica, 353
ocular, 352
temporal, 359, 362
regin, cigomtica y ocular, 351
hioidea, 444
lumboplvica, 477
pectoral, 470
pbica, 504, 505
suboccipital, 439
trocantrea, 582
rodilla, 571, 584
romboides, 550
sacro, 495
subescapular, 533
suboccipital, 386, 441
suelo plvico, 506
tensor de la fascia lata, 578
tienda del cerebelo, 388, 390, 392, 393
trax, 454
transversa paravertebral, 459
trapecio superior, 550
tringulo escapular, 563
trceps sural, 566
tnel carpiano, 518
Inercia, 116
L
Lquido cefalorraqudeo, 59, 60
M
Macrfagos, 79, 80
Marcha, valoracin, 238
Mastocitos, 80
Matriz, 33
extracelular, 38, 76, 80, 106
Mecanismo hidrulico amplificador, 137,
138
Mecanorreceptores, 44

Meninges, 25, 30, 55

Miofascia, 25, 30
Miofascial
disfuncin, 213
restriccin, 205
sndrome, tratamiento, 315
Movimiento(s), 115
acoplado, 116
activos, prueba, 262
browniano, 111, 116
global, 216
inherente, 233
involuntario, 233
lubricacin, 130
palancas, 116
plano, 115
relativo, 115
voluntario, 233
Msculo, 33
cuadrado lumbar, 42
cutneo del cuello, 359
masetero, 355, 356
psoas, 41, 42
recto posterior menor de la cabeza, 62, 63
P
Patomecnica de
cutneo del cuello, 359
masetero, 355, 356
mitad inferior del cuerpo, 288
posicin protruida de la cabeza, 256,
259
pterigoideo, externo, 355, 357
interno, 355, 358
Patrones de Zink, 238
compensado, 239
descompensado, 239
Pelvis, equilibrio, 295
Perimisio, 36, 37
Perin, 24, 26, 28
Perineuro, 53
Periostio, 35
Peritoneo, 42
Peso, levantamiento, 131
Piamadre, 56, 59
Piezoelectricidad, 153
Plano transverso, tcnica, 340

619

NDICE

Postura, 163
correcta, 170, 177
dinmica, 168
esttica, 168
patrn, 226, 227
Proteoglucanos, 67
Prueba(s) de
ATM, 274
banda iliotibial, 306
Barlow, 262
control escapular, 267
distancia dedos-suelo, 234
estabilidad cervical, 266
expansin torcica, 273
extensores profundos, 265
flexores, de la cadera, 300, 301
profundos, 264
funcionales, 262, 296
Kibler, 270, 271
patrn respiratorio, 272
piramidal de la pelvis, 306
pliegue cutneo, 247
recto anterior, 302
retraccin glenohumeral, 268
retraccin de los msculos pectorales, 269
tensor de la fascia lata, 303
Thompson, 307
Puente miodural, 25, 61
R
Receptores
de Golgi, 43
musculares intersticiales, 44, 45
de Pacini, 43
de Ruffini, 43, 44
Relajacin, fuerza, 121
Resistencia final, 233
Respuesta vasomotora, 336
Restriccin, barreras, 244
Reticulina, 82
Ritmo craneosacro, 249, 466
S
Sensibilidad promedio a la carga aplicada,
128
Signo, de Ott, 235

620

de Schober, 235, 236

Sistema, nervioso, 52
somatosensitivo, 171
vestibular, 171, 172, 174
visual, 171, 174
Subdermis, 26
Sustancia fundamental, 78, 83
T
Tcnica(s)
descompresin lumbosacra, 489
deslizamiento transverso, en la corredera bicipital, 527
para el bceps braquial, 526
sobre el tendn del trceps braquial, 528
(elongacin) de la fascia cervical en la
posicin supina, 418
indirectas, 331
manos cruzadas, 464, 465
para los extensores de la mueca y los
dedos, 524
para los flexores de la mueca y los
dedos, 522
plano transverso diafragmtico, 473
clavicular, 467
plvico, 488
profundas, 331
sostenidas, 331
superficiales, 321
telescpica, 342
bilateral de las extremidades inferiores, 592
miembro inferior, 593
para los dedos de las manos, 516
Tejido conectivo, 75, 76, 87
denso, irregular, 76, 90
regular, 76, 87
extracelular, 31
intramuscular, 25, 31, 36, 38
laxo, 90,
textura, 243
Tendn, 25, 30, 31, 32, 33
Tensegridad, 140, 143, 185
Tensin, 118, 120, 121
Tienda, del cerebelo, 56, 61
hipfisis, 57
Tixotropa, 119

NDICE

Torque, 115
Traccin, 192
Tratamiento
frecuencia, 320
objetivos, 321
secuencia, 319
Tringulo del talle, 293
Tropocolgeno, 90, 91, 92, 93
Tubo dural, 61
Tnel carpiano, 513

V
Velocidad, 116
Viscerofascia, 25, 30, 40, 41, 42
Viscoelasticidad, 113, 119
Viscosidad, 119
W
Weber-Barston, maniobra, 297
Wolf, ley, 105

U
Unin musculotendinosa, 30, 31, 33

621

Este libro revisa los aspectos tericos de la siologa, la mecnica y la

patomecnica del sistema miofascial para, a continuacin, presentar
un anlisis funcional de las posibles alteraciones del aparato locomotor, con numerosas imgenes ilustrativas de las tcnicas de evaluacin
y tratamiento.
Andrzej Pilat se form en sioterapia, terapia ortopdica y terapia
manual en Polonia, Inglaterra, Estados Unidos, Canad y China. Ha
sido profesor del C universitario Cecilio Acosta en Venezuela, profesor de posgrado de la Escuela Universitaria de la ONCE, de la Universidad Autnoma de Madrid y de la Escuela de Osteopata de Madrid.
Su actividad docente le ha llevado a impartir cursos de posgrado en numerosas Universidades de Espaa e Hispanoamrica. Es director de la
Escuela de Terapias Miofasciales, Presidente de la Sociedad Venezolana
de Fisioterapia Manual y Ortopdica y Director de la revista Terapia
Manual Venezolana.