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Decompression
Techniques; MFD
TM
COURSE OUTLINE
8:00-9:00 Intro. Anatomy, histology, & physiology review.
East/West perspectives, cuptherapy historical perspective
9:00-10:30 Literature review, collagen, ECM, Tensegrity,
trigger point theory, fascial lines, and Janda syndromes
10:30 Getting started, operation/application. MFD
approach and techniques, precautions & contraindications.
10:45 Instrument Assisted Soft Tissue (IASTM) Demos..
11:30-12:30 Breakout labs: Junctional Zones. ITB. Upper
traps and levator scap, PNF patterns
12:30-1:15 Lunch
1:15-1:45 Recovery, sports medicine, and performance
1:45- 2:30 Treating T/L fascia, shoulder impairments
2:30-3:15 Treating PFPS, P/O ACL, flexion contractures,
Hamstring strain vs tears.
3:10-3:45 Treating lower leg dysfunction, ankle/foot.
Tendonosis.
3:45-4:30 Clinical case studies, appropriate athlete care,
future research/evidence. Summary, evaluations
* Course is 60% lab, and 40% didactic. Student to Faculty PT <=15:1
www.MyofascialDecompression.com
5/27/2015
Myofascial
Decompression
Techniques
TM
Your Instructors
Christopher DaPrato
DPT,SCS,CSCS,PES, cert.SMT
Lab Assisting:
5/27/2015
A hands on experience
Tools you can use Monday morning; another tool in the box
Integration of concepts and physiologic principles
Fun and novel approach to STM and manual therapy
5/27/2015
Course Objectives
Implement basic neuromuscular
re-education principles after using MFD to
restore optimal function.
Understand proper documentation and
billing.
Integrate MFD into your manual practice to
expedite results, increase efficiency, and
drastically improve outcomes.
5/27/2015
Native Americans
Mexican-American healer
Curandera
Sobadera
South Americans
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Evolution of MFDTM
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TM
5/27/2015
Integument
5/27/2015
Petechiae
5/27/2015
Fascial Layers
Superficial
Deep = Aponerotic & Epimysial
TLF, TFL, rectus sheath
Intermuscular
Visceral
5/27/2015
Retinacula Cutis
Fascia is analogous
5/27/2015
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Fascial Components
Fibroblasts
Make and secrete all fibers of areolar connective tissue
Collagen fibers
Strongest and most abundant; cross linking leads to immense tensile strength
Elastic fibers
Rubber like proteins which allow tissue to return to original shape
Reticular fibers
Connect vessels and nerves; have more give than collagen
Ground substance
Extracellular matrix that holds interstitial fluid via sugar-protein molecules that soak fluid like
a sponge; with increased inflammatory response it becomes more viscous
5/27/2015
REMEMBER:
THIS IS FASCIA
Living tissue is hydrated and dynamic
5/27/2015
Skin layers
Layers
Superficial fascia
Myofascial Decompression Techniques
very effective
Deep fascia
Around deep muscles, viscera
Visceral Mobilization
Gail Wetzler, RPT, CVMI
Barral Institute
Institute of Physical Art
5/27/2015
Fascial Contributions
Support structure, tension, and
suspension for tissues; scaffolding
Fluid mobility; high amount of plasticity
Connecting multiple muscles = functional
kinetic chain
Has been shown to have myofibroblasts
Contraction of myofibroblasts influences
movement?
10
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Viscoelastic properties
11
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Viscoelastic properties:
12
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Viscoelastic properties:
Creep and Hysteresis
In relation to MFR creep is the distortion of
tissues as a function of pressure over time
Hysteresis is the exchange of heat and
energy as tissues are distorted; permanent
deformation. Microtrauma.
With MFR 90-120 seconds is the time for
generally the first barrier (R1) to release and
push into new range of extensibility.
Tendon Hysteresis in 5-10 minutes(Kubo 2001)
13
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(Hayes 2012)
Stretching
14
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Tensegrity
15
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Tensegrity
Tensional integrity
Fuller 1950s first visualized by the sculptor
Kenneth Snelson (Snelson, 1996).Fuller
defines tensegrity systems as structures that
stabilize their shape by continuous tension
rather than by continuous compression
Micro: studies of both cultured cells and
whole tissues indicate that cell shape stability
depends on a balance between microtubules
and opposing contractile microfilaments
Tensegrity
16
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Abscesses
Intercostal neuralgia
Intestinal disorders
Rheumatism
Bronchial asthma &
congestion
Gynecological
disorders
Kidney disorders
Dispels colds and
respiratory infections
Constipation and
diarrhea
Liver disorders
Gallbladder
disorders
Dermatologica
Depression
Anxiety & insomnia
Cellulite
Vertigo
Menopause
Gastrointestinal
symptoms
5/27/2015
No literature supporting
Reduces stiffness/pain;
Increases mobility;
Restores normal metabolic
processes by movement of fluids
carrying nutrients to tissues and
removing metabolic waste;
Mimics sweating/reduces fever;
Moves stagnant blood, promotes
circulation to treatment area and
to tissues/organs, etc.
No pain;
Immediate relief;
Treats:
Cases of pain or discomfort
Upper respiratory issues
Fever
5/27/2015
TM
Trigger Points
5/27/2015
Trigger Points
5/27/2015
Literature:
Ge et al. 2008 studied involvement of central
sensitization mechanisms in local pain syndromes
pain perception may result from a deregulation in
peripheral afferent and central nervous system
pathways- chronic excitability
5/27/2015
Teres Major
5/27/2015
Teres Major
Gluteus medius
5/27/2015
Gluteus medius
Rectus Femoris
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Rectus Femoris
Neurophysiologic responses
tissues become ischemic
thereafter blood reenters areas as indicated
flushing, hyperemia
produce endogenous opioids or endorphins
that affect the limbic system and brain
stem, enkephalins that affect the central
nervous system
MFD therapy relieves pain by acting as a
counterirritant
5/27/2015
Neurophysiologic responses
Mechanoreceptors, the morphologic
substrate for proprioception and kinesthesis
Muscle spindles and Golgi tendon organs
(GTOs) are the best-known types of
receptors, but must also consider free
nerve endings.
Melzack and Wall's gate-control theory of
pain, the large diameter A-beta nerve fibers
that transmit superficial pain can inhibit the
small diameter A-delta and C nerve fibers
that transmit deep pain
Neurophysiologic responses
Simply mechanical decompression of a
Nerve Entrapment and/or Compression
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Myofascial Lines
Work of Thomas Myers
Myofascial Tracks= muscles,
tendons, ligaments and fascia
Bony Stations= joints or
insertional sites at bony landmark
Have to be of similar depth
Can be static or motion driven
Picture: Pec minor, biceps,
coracobrachialis, rectus abdominis
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Lateral Line
Often involved with leg length differences
and pelvic obliquities
Includes:
Peroneals
Anterior ligament of the head of fibula
ITB and TFL
Superior fibers of glute max, medius
External and internal obliques
Splenius capitis and SCM
10
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Fascial mechanics
Translating forces =Slings
Lats to TLF to contra glute max and
down lateral thigh =ITB Tx
11
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12
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Postural Syndromes
Vladimir Janda, MD, DSc
Czech neurologist and physiatrist
Described characteristic patterns and
syndromes of muscle imbalance that
lead to chronic pain and disability
The Sensorimotor system functions as one entity,
integrating the central nervous system (CNS) and
musculoskeletal system.
The muscles are often a window to the function of the CNS.
The CNS regulates two phylogenic subsystems: the tonic
muscle groups and the phasic muscles
Crossed
U
P
P
E
R
Inhibited:
Deep cervical flexors
Facilitated:
SCM /Pectorals
L
O
W
E
R
Inhibited:
Abdominals
Facilitated: Thoraco-lumbar
extensors, QL
Facilitated: Rectus
femoris / Iliopsoas, TFL
Inhibited:
Gluteus Min / Med/ Max
C
R
O
S
S
C
R
O
S
S
13
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Gastroc-Soleus
Hip Adductors
Hamstrings
Rectus Femoris
Iliopsoas
Tensor Fascia Lata
Piriformis
Thoraco-lumbar
extensors
Quadratus Lumborum
Phasic/Lengthened
Peroneus Longus,
Brevis
Vastus Medialis,
Lateralis
Gluteus Maximus,
Medius, Minimus
Rectus Abdominus
Phasic/Lengthened
Serratus Anterior
Rhomboids
Lower Trapezius,
Middle Trap
Deep neck flexors
14
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Postural Distortions
Therefore patterns of muscle imbalance may be
due to CNS influence, rather than structural
changes within the muscle itself.
The coordinated firing patterns of muscle are
more important than the absolute strength of
muscles; ie: HAMSTRINGS; function with hop
Sensorimotor Training- increasing proprioceptive
input into the CNS with a specific exercise
program using proper firing patterns and
recruitment = neuro re-ed
15
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16
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Getting Started
Magnets
1 gauss 1 Mx/cm2
1 Gauss = 104 kg C1 s1 .
8-10 gauss: human brain magnetic field
0.310.58 gauss: the Earths magnetic
field
50 gauss: a typical refrigerator magnet
100 gauss: a small iron magnet
Shape Matters
Size Matters
Largest size cups = 3 in
Large = 2.5 in
Medium size cups = 2 in
small cups =1.5, 1.25 in
baby cups = 1, in
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Practice Attachment
Pressure Generated
Much > than fire cup
Max pressure =.07Mpa*
=525.05 mm Hg
=10.153 pounds/sq inch
=47037 pounds/sq ft
=70,000 Newtons /sq M
*per
manufacture correspondence
Types of Lube
Lotion:
Creams: biotone,
freeup, deep prep
Oils: vegetable oil,
Liniments
Analgesics:
biofreeze, flexall
Practice Removal
2-3 Fingers on cup
2-3 Fingers on top
valve
5/27/2015
Envirocide
Sani-wipes, lysol
Clorox diluted 10:1
Soaking in solution
Do not get rubber valve
in solution!!
Made in China
Unscrew canister
from trigger
Unscrew trigger
from valve
Add grease every 3-4
months
Troubleshooting
If your trigger pops
loose:
If you break a valve on
the cup:
If the valve inside the
canister flips:
If the cup valve does
not release while on:
5/27/2015
C7/T1
T12/L1
SIJ
Sacrum/coccyx
Antero-lateral hip superior to gr.
trochanter
Inferior angle scap
Lateral joint line knee
T/L Junction
Quick Exercise
Take a partner and measure
forward flexion ROM:
-where is limiting
structure???
Place 1 cup on that point
and one proximal to it,
go back into flexion x 510 times.
Was there change in testing
fingertip to floor reach?
GuaSha = IASTM
ASTYM
Graston
SASTM
FAKTR
Iamtools
GuaSha Orthopedic
Target Point
Fuzion Tool
BioEdge
GuaSha Lab
Basic Steps:
Watch the area with movement patterns
Sweep area with hands/fingers
Trace and Isolate
4 directions, find most limited. Compare contralateral
Superficial scrape
Sense percussive info from tool
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Mobilization
Techniques
Cup Techniques:
Choosing where to start
Examination:
Subjective report: Hx, Hx, Hx!
A&PROM, MMT
Palpation
Hypertonicity
Scar mobility
Fascial Adhesions
5/27/2015
Techniques-Things to
consider
Cup Techniques
30-90 seconds
minimum
5/27/2015
Color vs Porosity vs
thickening
Cup Techniques
5/27/2015
Cup Techniques:
Facilitory
Facilitation of lengthening:
Elongation
Proximal to distal
Distal to proximal
Cup Techniques:
Inhibitory
AROM
Passive inhibition
Active inhibition
5/27/2015
Cup Techniques:
w/PROM
w/AROM
Cup Techniques:
single cup Static
Cup is stationary
Point release
5/27/2015
Cup Techniques:
single cup Static
With AROM
Supination
with elbow
flexion and
wrist flexion
Cup Techniques:
single cup Glide
5/27/2015
Cup Techniques:
single cup Glide
Cup Techniques:
single cup High-Velocity pop
Take the tissue to end range,
then pop cup off into the
direction of most restriction.
5/27/2015
Cup Techniques:
anchored glide
Cup Techniques:
multi cup Linear and Diagonal lines
5/27/2015
Cup Techniques:
w/ROM
PROM is the
workforce
AROM is the
workforce
After application
Use a flushing out technique immediately
after removing cup:
STM long strokes, milking fluid, Graston
Light Therapy; 30-50second bouts x4-8 Tx
Pulsed ultrasound; 20% or 50%
Generally, do not use ice for ~30min-2 hours after. If very
severe effects and raised tissue you may need to use ice
immediately. May use ice after time period.
5/27/2015
Contraindications
Eyes and genitalia
Unhealed wounds
Hemophilia, leukemia, active TB
Thrombocytopenia
Later stages of pregnancy
Influenza of fever
Moderate/severe anemia
Moderate/severe cardiac
conditions, high BP
Vasculitis
Skin elasticity disorders-EDS??
Precautions
-Those that are over eager
- addictive personalities
-Blood thinners
-Healing or thin skin
Elderly, Psoriasis
-Pregnancy
-Areas of ecchymosis
10
5/27/2015
Precautions
Vasovagal Response
Vasovagal syncope is a temporary failure of the
brain to maintain blood pressure and heart rate
that causes the individual to possibly lose
consciousness. Causes of vasovagal syncope
include fear, pain, anxiety, trauma, blood loss,
extreme exertion, prolonged static standing,
physical or emotional stress, or an unpleasant
sight, sound, or smell.
Post-Surgical:
o
Precautions
**Nearly always neuromuscular re-education is needed
head effect
11
5/27/2015
Documentation
MFD; (-) pressure STM
IE: ITB MFD; (-) pressure STM, Obers position
Significant other
Domestic abuse
Drinking water next 24 hours
Warning the MD
12
5/27/2015
C. DaPrato DPT,SCS,CSCS
Pre
point assessments
Functional activity
tolerance
squats, lunge, hop tests,
specific training
5/27/2015
Testing for Dx =
Patient positioning =
Cup placement =
Time and motion =
Most
5/27/2015
Origin: anterior iliac crest outer lip, anterior border of the ilium, outer
surface of anterior superior iliac spine
Insertion: iliotibial band of fascia lata on lateroanterior aspect of thigh,
about 1/3 of the way down; inserts proximally into the lateral
epicondyle of the femur then passes in its broad expansion between
lateral aspect of patella; inserts distally on gerdy's tubercle: on the
lateral aspect of tibia tubercle
Action: thigh flexion at the hip, abduction, and medial rotation;
stabilizes the knee laterally; iliotibial band moves forward in extension
and backward in flexion but is tense in both positions
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Lateral
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Cervical
retractions
Posterior depression PNF
Wall retractions with shoulder ABD
High row for Lower trap= elbows
straight
5/27/2015
5/27/2015
Posterior
tilt patterns
Pelvic Clock sitting on ball
Foam roller 1 foot march
Bridge with posterior tilt
Glute med/max retraining
Lower abdominal ball roll
Nordic Hamstring
Teres
Major and
Infraspinatus
Tricep proximal
Lateral lat. line
5/27/2015
10
5/27/2015
ER
French doors
Doorway
pec stretch
High row for Lower trap
Wide grip lat pulldowns
Foam roller is a must
Dont forget Subscap and Pec minor manual release
11
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12
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VMO
13
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Gait
14
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End
range flexion
restriction secondary to
posterior knee pain
Posterior capsule
edema leading to
popliteus and lateral
head of gastroc
After MFD with AROM
retest flexion and most
pain should be anterior
scar site
15
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16
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(b)
Pes Anserine
FC
17
5/27/2015
Glute
firing pattern
unilateral bridge
H/S ball curls with core and obliques
Lateral band squats
Pilates reformer hip ABD
Clam shells
Ajimsha
18
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19
5/27/2015
20
5/27/2015
Case Presentations
MFD Results
Rib dysfunctions
21 y/o lacrosse
player, chronic rib
tension T6 facet
and down rib 5,
four weeks
HVLAT and MFD
diagonal line ,
resolved after 2
sessions
5/27/2015
45y/o female
Short head BB and
pec minor
restrictions after
SAD and mumford
Chronic anterior
shoulder pain
MFD anchored
glide with AROM
22 y/o rugby
player in 2 weeks
after max squat
Moderate flexion
restrictions, but
tolerates prayer
well.
4 treatments over
3 weeks and back
to practice
5/27/2015
Bicipital tendonosis
22y/o softball
player
Pre treat flexion
painfree ROM=135
MFD BB long head
above bicipital
groove, and short
head to coracoid
Post treat flexion
painfree ROM=158
5/27/2015
Chronic LBP
Nerve Entrapments
32y/o radiculitis
SLR pre-Tx
=30 degrees (+)
MFD spiral line and
superficial back
line
SLR post-Tx
= 57 degrees,
mild L/S referral
only, with Add/IR
5/27/2015
NCAA National
champion relay
swimmer
Anterior
Impingement
and A/C joint
irritability
No pain after 2
treatment
sessions
5/27/2015
31y/o male,
training for
marathon
R lateral/superior
knee pain greater
than 3 miles
Elys Prone knee
bend R=128,
L=140
MFD linear line
with PROM
Post-Op Bankart
5/27/2015
29 y/o grad
student with
bilateral L>R
interscap pain with
lifting and working
on computer
Mild levoscoliosis
FRS correction and
MFD L interscap
and lat chain
release
THANK YOU!!!
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NAME:_____________________________
DATE:__________
Right
YES
Foot
Knee
Moves Inward
Left
YES
Moves Outward
Lateral View
(Right Side)
L-P-H-C Excessive
Forward
Lean
Low Back
Arches
Low Back
Rounds
Arms Fall
Upper
Forward
Body
YES
Posterior View
Right
Yes
Left
YES
Heel of Foot
Rises
Foot
Foot Flattens
L-P-H-C
Asymmetrical
Weight Shift
MODIFIED:
HEELS ELEVATED
ARMS DOWN
FEET
KNEES
LPHC
UPPER
NOTES:
LEFT Leg
Right
YES
Left
YES
Foot
Foot Flattens
Foot
Foot Flattens
Knee
Moves Inward
Knee
Moves Inward
Moves Outward
L-P-H-C
Hip Hike
Moves Outward
L-P-H-C
Hip Drop
Upper Body
NOTES:
Hip Hike
Hip Drop
Upper Body
Anterior
View
Checkpoint
Compensation
Probable Overactive
Muscles
Probable Underactive
Muscles
Example Strengthening
Exercise
Foot
Soleus
Lat. Gastrocnemius
Bicep Femoris (short head)
Tensor Fascia Latae
Med. Gastrocnemius
Med. Hamstring
Gluteus Medius/Maximus
Gracilis
Popliteus
Calf Stretch
Hamstring Stretch
Standing TFL Stretch
Knee
Moves Inward
Adductor Complex
Bicep Femoris (short head)
Tensor Fascia Latae
Vastus Lateralis
Lat. Gastrocnemius
Gluteus Medius/Maximus
Vastus Medialis Oblique (VMO)
Med. Hamstring
Med. Gastrocnemius
Adductor Stretch
Hamstring Stretch
TFL Stretch
Calf Stretch
Moves Outward
Piriformis,
Biceps Femoris
Tensor Fascia Latae
Gluteus Minimus/ Medius
Adductor Complex
Med. Hamstring
Gluteus Maximus
Piriformis Stretch,
Hamstring Stretch
TFL Stretch
Excessive
Forward Lean
Soleus
Gastrocnemius
Hip Flexor Complex
Abdominal Complex (rectus
abdominus, external oblique)
Anterior Tibialis
Gluteus Maximus
Erector Spinae
Calf Stretch
Hip Flexor Stretch
Ball Abdominal
Stretch
Ball Squat
Gluteus Maximus
Hamstrings
Intrinsic Core Stabilizers
(transverse abdominis,
multifidus, internal oblique,
transversospinalis, pelvic floor
muscles)
Ball Squat
Floor Bridge
Ball Bridge
Hamstrings
Adductor Magnus
Rectus Abdominus
External Obliques
Gluteus Maximus
Erector Spinae
Intrinsic Core Stabilizers
(transverse abdominis,
multifidus, internal oblique,
pelvic floor muscles,
transversospinalis)
Hamstring Stretch
Adductor Magnus Stretch
Ball Abdominal Stretch
Floor Cobra
Ball Cobra
Ball Back Extension
Latissumus Dorsi
Pectoralis Major/ Minor
Teres Major
Coracobrachialis
Mid/Lower Trapezius
Rhomboids
Rotator Cuff
Posterior Deltoid
Floor Cobra
Ball Cobra
Squat to Row
Forward Head
(pushing/pulling
assessment)
Levator Scapula
Sternocleidomastoid
Scalenes
Shoulder
Elevation
(pushing/pulling
assessment)
Upper Trapezius
Sternocleidomastoid Levator
Scapulae
Mid/lower Trapezius
Rhomboids
Rotator Cuff
Floor Cobra
Ball Cobra
Foot Flattens
Peroneals
Lat. Gastrocnemius
Bicep Femoris (short head)
Tensor Fascia Latae
Anterior Tibialis
Posterior Tibialis
Med. Gastrocnemius
Gluteus Medius
Peroneal Stretch
Calf Stretch
Hamstring Stretch
Standing TFL Stretch
Heel Rises
Soleus
Anterior Tibialis
Soleus Stretch
Asymmetrical
Weight Shift
Adductor Complex
Tensor Fascia Latae
(same side)
Piriformis
Bicep Femoris
Gluteus Medius
(opposite side)
Gluteus Medius
(same side)
Adductor Stretch
(same side)
Tensor Fascia Latae Stretch
Piriformis Stretch
Hamstring Stretch
(opposite side)
Gluteus Medius
(same side)
Lateral
L-P-H-C
Upper Body
Foot
Posterior
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L-P-H-C
Adductor Complex
(opposite side)
Adductor Complex
(opposite side)