Pre-Conference Presentation: LAST Techniques For the Knee with Robert Libbey

My aim is to educate the therapists on a safe, ethical and effective treatment technique by providing education congruent with current evidence informed research and by developing the therapists skill, confidence and proficiency for the treatment of injured ligaments and the surrounding tissues.

LAST is a precise, principle based, mechanoreceptor specific manual therapy technique, supported by evidence-informed research, utilized in the treatment of peripheral joint tissue injuries to improve treatment outcomes and improve the quality of life of patients. LAST influences the fascial system and CNS modulation by targeting the ligamentoperiosteal and tenoperiosteal enthuses; areas known to have high concentrations of mechanoreceptors. Mechanoreceptor specific techniques, targeting peripheral joint tissues, affect autonomic nervous system functions resulting in decreased protective myofascial engagement, increased pain pressure sensitivity, normalize kinesthetic and proprioceptive awareness improving treatment outcomes.

Ligaments & joint capsules are embedded, local densifications, local specifications of a body wide collagenous and fibrous, tension driven interconnected system. Ligamentous/Peripheral Joint Injuries are neurophysiologic dysfunctions influencing “Executive Functions” such as processing of somatosensory information by the prefrontal cortex, causing reorganization of the central nervous system, in essence affecting neuroplasticity.

Peripheral joint injuries affect the healthy functioning of our tissues and produce disrupt nerve signaling that causes pain, and protective musculoskeletal guarding. These altered processes decrease the quality of life in our patients.

Our nervous system plays a vital role in maintaining all aspects of physical and mental health. A complex network of mechanoreceptors and sensory nerves continuously monitors health and safety status of our tissues and triggers reflexive/protective responses in the CNS when an injury or perceived threat is detected.

Making changes to how the mechanoreceptors and articular sensory nerves provide information to the CNS is the primary goal of LAST. The technique manually targets mechanoreceptors located at the ligamentoperiosteal and tenoperiosteal junction/enthuses.

Current research has shown that techniques, which target areas of high concentration of mechanoreceptors (entheses), have longer lasting effects. Current research has also shown that combining LAST with other techniques such as MET significantly improved treatment outcomes. Manual techniques, such as LAST, which target mechanoreceptors and peripheral joint tissues have been shown to affect autonomic functions by:

• lowering sympathetic nervous system activity

• globally decreasing deep tissue pressure sensitivity

• increasing pressure pain threshold

• lowering resting pain perception

• increasing local proprioceptive attention

• decreasing muscle tonicity

• changing local blood supply and local tissue viscosity

Each course provides the therapist with information obtained from research pertaining to Neurology, Fascia, Mechanoreceptors, Ligamentomuscular reflexes and the physiological effects manual therapies such as LAST have on the body. Therapists will be able to educate and inform their patients on the reasoning for, the effects of, and expected outcomes of incorporating and utilizing L.A.S.T.

-Robert Libbey