Myofascial Release
Introduction
Myofascial Release is a relatively new addition to the armamentarium of the physical therapist. Because it is
somewhat different from traditional physical therapy, many patients ask questions such as "What is it?" and
"How does it work?" Myofascial Release is generally an extremely mild and gentle form of stretching that has a
profound effect upon the body tissues. Because of its gentleness, many individuals wonder how it could
possibly work. To help you understand, we are providing you with this article.
Myofascial Release is a relatively new addition to the armamentarium of the physical therapist. Because it is
somewhat different from traditional physical therapy, many patients ask questions such as "What is it?" and
"How does it work?" Myofascial Release is generally an extremely mild and gentle form of stretching that has a
profound effect upon the body tissues. Because of its gentleness, many individuals wonder how it could
possibly work. To help you understand, we are providing you with this article.
By: Tim Juett, PT
Fascia
Fascia (also called connective tissue) is a tissue system of the body to which relatively little attention has been
given in the past. Fascia is composed of two types of fibers:
A) Collagenous fibers which are very tough and have little stretchability;
B) Elastic fibers which are stretchable.
From the functional point of view, the body fascia may be regarded as a continuous laminated sheet of
connective tissue that extends without interruption from the top of the head to the tip of the toes. It
surrounds and invades every other tissue and organ of the body, including nerves, vessels, muscle and bone.
Fascia is more dense in some areas than others. Dense fascia is easily recognizable (for example, the tough
white membrane that we often find surrounding butchered meat).
When Fascia is Injured
Because fascia permeates all regions of the body and is all interconnected, when it scars and hardens in one
area (following injury, inflammation, disease, surgery, etc.), it can put tension on adjacent pain-sensitive
structures as well as on structures in fas-away areas. Some patients have bizarre pain symptoms that appear to
be unrelated to the original or primary complaint. These bizarre symptoms can now often be understood in
relationship to our understanding of the fascial system.
Anatomy of Fascia
The majority of the fascia of the body is oriented vertically. There are, however, four major planes of fascia in
the body that are oriented in more of a crosswise (or transverse) plane. These four transverse planes are
extremely dense. They are called the pelvic diaphragm, respiratory diaphragm, thoracic inlet and cranial base.
Frequently, all four of these transverse planes will become restricted when fascial adhesions occur in just about
any part of the body. This is because this fascia of the body is all interconnected, and a restriction in one
region can theoretically put a "drag" on the fascia in any other direction.
Treating Fascial Restrictions
The point of all the above information is to help you understand that during myofascial release treatments, you
may be treated in areas that you may not think are related to your condition. The trained therapist has a
thorough understanding of the fascial system and will "release" the fascia in areas that he knows have a strong
"drag" on your area of injury. This is, therefore, a whole body approach to treatment.
A good example is the chronic low back pain patient; although the low back is primarily involved, the patient
may also have significant discomfort in the neck. This is due to the gradual tightening of the muscles and
especially of the fascia, as this tightness has crept its way up the back, eventually creating neck and head pain.
Experience shows that optimal resolution of the low back pain requires release of the fascia of both the head
and neck; if the neck tightness is not also released it will continue to apply a "drag" in the downward direction
until fascial restriction and pain has again returned to the low back.
Muscle provides the greatest bulk of our body's soft tissue. Because all muscle is enveloped by a nd ingrained
with fascia, myofascial release is the term that has been given to the techniques that are used to relieve soft
tissue from the abnormal grip of tight fascia ("myo" means "muscle").
The type of myofascial release technique chosen by the therapist will depend upon where in your body the
therapist finds the fascia restricted. If it is restricted through the neck to the arm, he/she may apply a very
gentle traction to the arm, very slowly moving the arm through range as restrictions are released. If itis
restricted in the back (more superficial than deep) he may apply a very gentle stretch on the skin across the
back with the use of two hands. If the thoracic inlet, deep transverse fascia is suspected of being restricted,
the therapist may place one hand on the upper back and one over the collarbone area in front and apply
extremely gentle pressure.
A key to the success of myofascial release treatments is to keep the pressure and stretch extremely mild.
Muscle tissue responds to a relatively firm stretch, but this is not the case with fascia. Remember the
collagenous fibers of fascia are extremely touch and resistant to stretch. In fact, it is estimated that fascia has a
tensile strength as 2000 pounds per square inch. (No wonder when it tightens, it can cause pain.)
However, it has been shown that under a small amount of pressure (applied by a therapist's hands) fascia will
soften and begin to release when the pressure is sustained over time. This can be likened to pulling on a piece
of taffy with only a small, sustained pressure.
Another important aspect of myofascial release techniques is holding the technique long enough. The
therapeutic affect will begin to take place after holding a gentle stretch and following the tissue
three-dimensionally with skilled, sensitive hands.
Myofascial Release is gentle, but it has profound effects upon the body tissues. Do not let the gentleness
deceive you. You may leave after the first treatment feeling like nothing happened. Later (even a day later) you
may begin to feel the effects of the treatment.
In general, acute cases will resolve with a few treatments. The longer the problem has been present, generally
longer it will take to resolve the problem. Many chronic conditions (that have developed over a period of years)
may require three to four months of treatments three times per week to obtain optimal results. Experience
indicates that fewer than two treatments per week will often result in fascial tightness creeping back to the
level prior to the last treatment. Range of motion and stretching exercise given to you will, however, keep this
regression between treatments minimal.
Frequently there is increased pain for several hours to a day after treatment, followed by remarkable
improvement. Often remarkable improvement is noted immediately during or after a treatment. Sometimes new
pains in new areas will be experienced. There is sometimes a feeling of light-headedness or nausea. Sometimes
a patient experiences a temporary emotion change. All of these are normal reactions of the body to the
profound, but positive, changes that have occurred by releasing fascial restrictions.
It is felt that release of tight tissue is accompanied by release of trapped metabolic waste products in the
surrounding tissue and blood stream. We highly recommend that you "flush your system" by drinking a lot of fluid
during the course of your treatments, so that reactions like nausea and light-headedness will remain minimal or
nil.
If patients have any questions or concerns that arise concerning myofascial release, they should be encouraged
to discuss them with the therapist.
Fascia (also called connective tissue) is a tissue system of the body to which relatively little attention has been
given in the past. Fascia is composed of two types of fibers:
A) Collagenous fibers which are very tough and have little stretchability;
B) Elastic fibers which are stretchable.
From the functional point of view, the body fascia may be regarded as a continuous laminated sheet of
connective tissue that extends without interruption from the top of the head to the tip of the toes. It
surrounds and invades every other tissue and organ of the body, including nerves, vessels, muscle and bone.
Fascia is more dense in some areas than others. Dense fascia is easily recognizable (for example, the tough
white membrane that we often find surrounding butchered meat).
When Fascia is Injured
Because fascia permeates all regions of the body and is all interconnected, when it scars and hardens in one
area (following injury, inflammation, disease, surgery, etc.), it can put tension on adjacent pain-sensitive
structures as well as on structures in fas-away areas. Some patients have bizarre pain symptoms that appear to
be unrelated to the original or primary complaint. These bizarre symptoms can now often be understood in
relationship to our understanding of the fascial system.
Anatomy of Fascia
The majority of the fascia of the body is oriented vertically. There are, however, four major planes of fascia in
the body that are oriented in more of a crosswise (or transverse) plane. These four transverse planes are
extremely dense. They are called the pelvic diaphragm, respiratory diaphragm, thoracic inlet and cranial base.
Frequently, all four of these transverse planes will become restricted when fascial adhesions occur in just about
any part of the body. This is because this fascia of the body is all interconnected, and a restriction in one
region can theoretically put a "drag" on the fascia in any other direction.
Treating Fascial Restrictions
The point of all the above information is to help you understand that during myofascial release treatments, you
may be treated in areas that you may not think are related to your condition. The trained therapist has a
thorough understanding of the fascial system and will "release" the fascia in areas that he knows have a strong
"drag" on your area of injury. This is, therefore, a whole body approach to treatment.
A good example is the chronic low back pain patient; although the low back is primarily involved, the patient
may also have significant discomfort in the neck. This is due to the gradual tightening of the muscles and
especially of the fascia, as this tightness has crept its way up the back, eventually creating neck and head pain.
Experience shows that optimal resolution of the low back pain requires release of the fascia of both the head
and neck; if the neck tightness is not also released it will continue to apply a "drag" in the downward direction
until fascial restriction and pain has again returned to the low back.
Muscle provides the greatest bulk of our body's soft tissue. Because all muscle is enveloped by a nd ingrained
with fascia, myofascial release is the term that has been given to the techniques that are used to relieve soft
tissue from the abnormal grip of tight fascia ("myo" means "muscle").
The type of myofascial release technique chosen by the therapist will depend upon where in your body the
therapist finds the fascia restricted. If it is restricted through the neck to the arm, he/she may apply a very
gentle traction to the arm, very slowly moving the arm through range as restrictions are released. If itis
restricted in the back (more superficial than deep) he may apply a very gentle stretch on the skin across the
back with the use of two hands. If the thoracic inlet, deep transverse fascia is suspected of being restricted,
the therapist may place one hand on the upper back and one over the collarbone area in front and apply
extremely gentle pressure.
A key to the success of myofascial release treatments is to keep the pressure and stretch extremely mild.
Muscle tissue responds to a relatively firm stretch, but this is not the case with fascia. Remember the
collagenous fibers of fascia are extremely touch and resistant to stretch. In fact, it is estimated that fascia has a
tensile strength as 2000 pounds per square inch. (No wonder when it tightens, it can cause pain.)
However, it has been shown that under a small amount of pressure (applied by a therapist's hands) fascia will
soften and begin to release when the pressure is sustained over time. This can be likened to pulling on a piece
of taffy with only a small, sustained pressure.
Another important aspect of myofascial release techniques is holding the technique long enough. The
therapeutic affect will begin to take place after holding a gentle stretch and following the tissue
three-dimensionally with skilled, sensitive hands.
Myofascial Release is gentle, but it has profound effects upon the body tissues. Do not let the gentleness
deceive you. You may leave after the first treatment feeling like nothing happened. Later (even a day later) you
may begin to feel the effects of the treatment.
In general, acute cases will resolve with a few treatments. The longer the problem has been present, generally
longer it will take to resolve the problem. Many chronic conditions (that have developed over a period of years)
may require three to four months of treatments three times per week to obtain optimal results. Experience
indicates that fewer than two treatments per week will often result in fascial tightness creeping back to the
level prior to the last treatment. Range of motion and stretching exercise given to you will, however, keep this
regression between treatments minimal.
Frequently there is increased pain for several hours to a day after treatment, followed by remarkable
improvement. Often remarkable improvement is noted immediately during or after a treatment. Sometimes new
pains in new areas will be experienced. There is sometimes a feeling of light-headedness or nausea. Sometimes
a patient experiences a temporary emotion change. All of these are normal reactions of the body to the
profound, but positive, changes that have occurred by releasing fascial restrictions.
It is felt that release of tight tissue is accompanied by release of trapped metabolic waste products in the
surrounding tissue and blood stream. We highly recommend that you "flush your system" by drinking a lot of fluid
during the course of your treatments, so that reactions like nausea and light-headedness will remain minimal or
nil.
If patients have any questions or concerns that arise concerning myofascial release, they should be encouraged
to discuss them with the therapist.
MYOFASCIAL RELEASE - AN INTRODUCTION FOR THE PATIENT
| Author: Jarmila Svoboda Copyright @ 2007 All rights reserved. Revised: 5/3/2011 |
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