Hydro release, myofascial release, peripheral nerve release

Marugame Kagawa

What is hydro release?

　Hydrorelease is a new concept of injection. By precisely injecting a liquid containing saline or lactated Ringer's solution into the affected area, this injection eliminates all adhesions, loss of motion, circulatory problems, and nerve irritation in the area. It is like a hardened sponge that softens when water is dripped on it. In various parts of the human body, sports injuries, over-exercise, continued poor posture, and aging cause all tissues such as muscles, fascia, nerves, ligaments, and joints to become stiff and stick together, preventing their natural movement and sliding, and in some cases, irritating the nerves and causing pain.
　Hydro release is its hardenedSoftens tissue (improves flexibility), improves movement (releases adhesions), relieves pressure (decompression), and dilutes painful substances (pain relief)It is believed that
　Our clinic's Hydro-Release uses echoes to inject precisely at the site of pain. We challenge ourselves to inject even in fine nerves that could not be injected accurately before, or in deep arthrodesis and nerves in the hip and lower back, to take away the pain that could not be removed.

Pain is present in connective tissue (fascia)

　Recent research has shown that pain sites called trigger points are located in various connective tissues such as muscles, fascia, tendons, ligaments, and fatty tissues.
　These fascia exist in the gaps between various tissues and are interconnected with each other to restrict or coordinate the body's movements (interlocking fascia).
　It is said that stiff shoulders, back pain, frozen shoulders, and neuralgia are caused by stiffening of the fascia, adhesion of the fascia to adjacent tissues, restriction of movement, accumulation of pain substances, and compression and strangulation of the nerves themselves due to poor posture or injury over many years. If we can identify and treat the area of the stiffened or attached fascia, we can improve the pain.

Echography can pinpoint the exact location of the source of the pain for immediate treatment.

　Echocardiography of the pain site and its associated areas shows white, overlapping abnormal fascia, which is less extensible and gliding in the area, sticking to the surrounding tissues and causing a buildup of pain material.
　Echo-guided hydrorelease is performed by injecting a chemical solution into the white, overlapping fascia, which is identified by ultrasound, to dislodge the attached tissue and push away the pain substance. Echocardiography confirms the effect by showing improved fascial sliding and increased pulsation of the surrounding blood vessels after injection. Most importantly, the pain improves quickly.
　The solution is either saline (salt water) or lactate Ringer's solution, so pregnant women and children can use it safely.
　Injections into these fascia and overlapping connective tissues are called ”hydro-release injections,” and are attracting attention as a new treatment alternative to conventional trigger point injections. In addition, ”peripheral nerve release” injections, which directly release the nerves around them, and injections into joints with limited range of motion are also being used to improve range of motion.

Fascia superposition (echo and schema diagrams)

Peripheral nerve compression is also improved (peripheral nerve release)

　Tennis elbow and stiff shoulders, which were once thought to be diseases of muscles and tendons, are now known to cause symptoms when the muscles become stiff and the nerves that pass between them become pinched.
　Spinal disease can also cause stiffening of the muscles under the control of the affected nerve, which can interfere with the peripheral nerves that run between the muscles. Peripheral nerve release,” in which hydraulic release is performed around these peripheral nerves, can relieve symptoms. With the introduction of high-definition echo, it is now possible to locate and release even the smallest peripheral nerves. This may be an option for patients with chronic nerve pain who have had no effect from other nerve blocks.
　Although the cause cannot be eliminated, experience has shown that the effect can last for a considerable period of time.

Since the pain is felt by the nerves, it is necessary to relax the muscles and at the same time treat the area around the nerves. With high-definition echo-guided hydrorelease, hydrorelease (nerve release) of various nerves is possible.

Advantages (benefits) and disadvantages (side effects)

　Because of the use of echo, the source of the pain can be approached precisely. In addition, since safe and secure saline solution is used, there are no allergic reactions or side effects. There are no restrictions on the location or frequency of administration.

　The disadvantages are that because it is an injection, it is painful and may cause bleeding and swelling. Also, the risk of infection, while very rare, is non-zero. Without exercise therapy and postural improvement, there may be only short-term effects.

　When performed by insurance, there are restrictions such as the need to use anesthetics and the ability to administer only one shot per week.

What diseases are covered by hydrorelease?

　Pain in connective tissue (including perineural connective tissue) can be effective for both acute and chronic pain.

　Specifically, they include a wide range of conditions such as: backaches, sleeping disorders, whiplash, chronic back pain, stiff shoulders, frozen shoulders, Achilles tendonitis, tennis elbow, separated muscles, neuralgia, tendonitis, carpal tunnel syndrome, elbow tunnel syndrome, nerve pain such as herniated discs and cervical spondylosis, and others. It is also a good indication for chronic pain that cannot be cured by massage, electrotherapy, or acupuncture.

　It is also possible to perform releases on both fascia and nerves at the same time.
　* Because the liquid removes and washes away the pain, it does not remove advanced adhesions or scars from trauma or post-operative surgery.

　Pain in the joint may be due to inflammation or physical irritation, not adhesions, and because the joint is an enclosed space, pain substances cannot be flushed out, so it is not indicated. Treatment for moyamoya vessels and inflammation, and treatment with hyaluronic acid are indicated.

Mechanism of pain from stiff shoulders and back

(1) Muscle "stiffness" becomes chronic due to poor posture, etc., and myofascial fibers stick together (adhesion).

2) Stiff muscles are pulled further by stooping or downward posture.

(iii) Fascia and muscle fibers are torn because they are attached and cannot be elongated

(4) The attached fascia attaches to the nerve, irritating the nerve and causing pain.

　Repeated muscle fatigue due to poor posture or repetitive movements results in microscopic damage that causes adhesions (sticking), preventing the overall movement of muscles and tendons. In addition, the blood vessels that run between the pulled muscles collapse, causing a lack of nutrition and acidity in the tissues and further hardening them (muscle spasm).
　Tightened and attached muscles are unable to stretch properly, and when pulled further, cause muscle damage (separation) or abnormal joint movement at a slight distance, resulting in a sudden increase in pain. (Mechanism of sprained back)

Echographic images of hydrolysis for muscle stiffness and its imaging

　Using echo, saline or lactate Ringer's solution is injected into the submandibular area to improve the sliding of fascia and connective tissue, as well as to push away pain substances and improve symptoms.

To maintain the effectiveness of hydrolysis

To maintain the effects of hydrolysis, it is important to keep the reattachment, muscles, and fascia in good condition. For this reason, after the pain is removed by injection (the fascia is removed and gliding), it is important to develop a habit of daily stretching, muscle strengthening, and exercise, and to work on improving the usual slouching and rounded posture. Otherwise, adhesions and pain will recur. (You can have as many injections as you want, but it is better to have as few injections as possible.)
The clinic offers rehabilitation as well as hydrorelease to perform specific exercises, improve residual adhesions, and correct posture.

Hydrorelease and rehabilitation together is more effective.

For patients who wish to have Hydro-Release

　Hydrorelease is performed using echo. Since there may be multiple adhesions, the number of injections may be multiple, and it may take time to examine the adhesions and painful areas. Please understand that we may not be able to perform the procedure on the same day depending on the number of patients.

Types of hydrolysis performed at our clinic

　With the introduction of high-definition echo technology, the treatment area for hydro release can now include not only the muscles and fascia, but also the fine areas around nerves that were previously unimaginable. As a result, it is now possible to improve various conditions caused by nerve damage and muscle spasm (when muscles do not move as they should due to nerve damage and become stiff).
　Improvement of muscle spasms causes improved movement and increases the afferent nature of the joints, making them more conditioned and less prone to disability.

Cervico-shoulder area (shoulder and neck area)

　The diseases that are the target of such treatment are very wide-ranging, and even if limited to the neck and shoulder region, they include the following diseases.
　Chronic conditions include stiff shoulders and necks, subacromial impingement syndrome, rotator cuff injuries and rotator cuff tears, shoulder joint stiffness such as frozen shoulder, and frozen shoulder and periarthritis.
　In addition, shoulders with throwing injuries due to sports and overhead sports (SLAP injuries, internal impingement, Bennett's lesion, anterior and posterior labral injuries, torn labrum, UPS, biceps tendon tendinitis, RI lesion, etc.) are also good indications.
　Hydrorelease injections are also effective for cervical nerve root disease, axillary nerve palsy (QLS syndrome, psoas syndrome), suprascapular nerve palsy (ganglion), and nerve-related pain after shoulder dislocation surgery.
　Although also related to the above diseases, pain and decreased movement caused by scapular malposition and dysfunction (dyskinesia) can also be expected to improve with hydrorelease injections and exercise therapy.

Lumbar lord area (around the hips)

　The treatment areas of the lumbosacral region are very diverse. In addition, the diagnosis is often difficult because pain often occurs in more than one location.
　Even if one area is treated, the treatment period may take a little longer because the patient often begins to feel pain in other areas that he or she had not noticed before.
　Target disorders include lumbar myofascial pain (e.g., erector spinae, multifidus, quadratus lumborum, psoas major, iliopsoas, gluteal muscles, and hip external rotators such as piriformis), herniated discs, intervertebral joint disorders, sacroiliac joint disorders, sciatica, groin pain syndrome, erector spinae attachment disorders, spinous process impingement syndrome, lumbar ligament injuries (e.g., supraspinous ligament, interspinous ligament, intertransverse process ligament) are covered.
　It can also approach fine nerves and treat nerve pain due to shingles, intercostal neuralgia, pisiform muscle syndrome, superior cutaneous nerve, middle cutaneous nerve, superior and inferior cutaneous nerve pain, posterior cutaneous nerve and sciatic nerve pain after hamstring injury, lateral cutaneous nerve pain, and tensor fascia major muscle pain.
　The most difficult part is diagnosis, which may require more injections because there is no way to diagnose it other than tenderness or pain on movement, or sometimes even no tenderness.
　In this situation, our clinic enhances the effectiveness by accurately identifying and releasing nerves and muscles with our expertise and high-definition echography.

Responsibility: Dr. Yuki Toya, Orthopedic Surgeon, Hand Surgery Specialist/Supervisor