Myofascial Release Technique
Myo = muscle
Fascia = (pl. fasciae) connective tissue forming fibrous layer of variable thickness in all regions of the body. Fascia surrounds organs and tissues and is divided into superficial fascia which is a loose fibrous envelope found immediately beneath the skin, containing fat in its meshes or fasciculi (a band or bundle of fibres) of muscular tissue. And the deep fascia which forms sheaths for muscles and muscle groups that separate them into layers, sheaths for the nerves and vessles, becomes specialized around the joints to form or strengthen ligaments, envelops various organs and glands, and binds all structures together into a firm compact mass.
It’s very important to grasp the concept that: when one stretches to gain flexibility (e.g. the leg’s calf muscle), it’s really the myofascial network/web which is being affected, rather than just simply stretching a local muscle/area. When discussing Myofascial Release it helps to understand that:
- Fascia covers all organs of the body.
- All muscle stretching is myofascial stretching.
- Myofascial Release in one body area will be felt and will affect that and other body areas.
- Progress is measured by improvement in postural symmetry, reduction of subjective pain complaints and increased freedom of movement.
- Treatment using Myofascial Release changes constantly in response to feedback.
Osteopathic techniques are classified in many ways. They are classified according to the direction of the therapeutic:
- patient participation in the process of treatment
- goals of the treatment process
- names of the techniques.
Direction of the therapeutic motion
- Direct (toward bind): a technique is known as a direct technique if the starting position into which a motion is applied is “against the barrier,” that is, in the direction in which the motion is restricted. The goal of a direct technique is to use force in such a way that motion will be created through and beyond the restrictive barrier.
- Indirect (toward ease): a technique is indirect when the motion is applied in the direction away from the barrier or restriction of motion. The goal then is to allow the body’s inherent neurological or intrinsic forces to free up the restriction of motion so that the body will regain its ability to move freely through the barrier. This may be compared to a stuck drawer that is pulled back away from the direction that had previously restricted motion.
As a technique, the term Myofascial Release has been used to describe both indirect and direct release procedures designed to directly stress firmly apparent movement barriers that typically occur in three-dimensionally related patterns.
The term Myofascial Release as a technique was coined in 1981, when it was used as the title of the first soft tissue release courses taught at Michigan State University by Anthony Chila, DO, John Peckham, DO, and Robart Ward, DO.
Myofascial Release work relies and expands upon the concepts and systems developed by the founder of osteopathic medicine, Andrew Taylor Still, and his physician colleagues in the late 19th century. The osteopathic systems were not named using myofascial designations. These early treatment systems included guided joint articulatory release, high velocity spinal maneuvers (without reference to amplitude), and soft tissue kneading.
The Education Council on Osteopathic Principals has defined myofascial release technique as a:
- “system of diagnosis and treatment first described by Andrew Still and his early students, which engages continual palpatory feedback to achieve release of myofascial tissues”.
In this style of soft tissue techniques, hand placement and force vector directions are very important. Whereas soft tissue techniques have been historically direct in classification, myofascial release can be performed in either a direct or indirect manner. Therefore, some would classify it as a combined technique.
The osteopathic practitioner will use epicritic (describing or relating to sensory nerve fibres responsible for the fine degree of sensation, as of temperature and touch) palpation to determine the soft tissue compliance (looseness, ease, freedom) and stiffness (tightness, bind, restriction).
Barriers may be identified with the patient passive or active. The treatment may also consist of these alternatives. The patient’s respiratory assistance, specifically directed isometric muscle contractions (e.g., clenching fists or jaw), tongue movements or ocular movements, and so on are often used to potentiate the technique. These are generally referred to as release-enhancing mechanisms.
As the fascia is so deeply incorporated into the muscles and the rest of the body, any force directed on it may affect the ligamentous and capsular (articular) tissues and structures very distal to the specific area being palpated and treated. Therefore, this technique may effect widespread reactions. For example, releasing the area surrounding T7 and T8 may cause the patient to have less suboccipital symptoms through the positive effect of the technique on the trapezius muscle.
Myofascial Release is not a new or recently developed treatment approach to soft tissue work, With a history that began with osteopathic medicine in the late 19th century, Myofascial Release continues to evolve as a soft tissue technique utilized by a wide variety of practitioners. Application of this soft tissue mobilization technique is limited only be the knowledge and skill of the individual practitioner.
Myofascial models, described in the osteopathic literature from its inception, gained more attention beginning in the 1950′s. Other contemporary treatment approaches such as connective tissue massage, Rolfing, strain and counterstrain and soft tissue mobilization, use the same myofascial models.
Carol Manheim gives excellent description of different aspects of Myofascial Release in her book ‘The Myofascial Release Manual’ (2001): “Myofascial Release is a highly interactive stretching technique that requires feedback from the patient’s body” to determine the direction, force and duration of the stretch and to facilitate maximum relaxation of tight or restricted tissues. Myofascial Release recognizes that a muscle cannot be isolated from other structures of the body, including muscles and their individual myofibrils. Therefore, all “muscle stretching” is actually stretching of myofascial units.
When using Myofascial Relesae techniques, the practitioner monitors tissue tightness by developing a kinesthetic link with the patient through touch. Through this link, the therapist feels the patient’s inherent tissue movement and underlying neurophysiologic tissue tone as well as the more overt (plainly to be seen or detected) muscle tone. Once adept at sensing the patient’s muscle tone and tightness, the therapist is able to detect subtle restrictions to efficient movement within individual myofacial units. These subtle restrictions can only be detected through touch and eliminated by using Myofascial Release techniques.
Myofascial Release focuses directly on the restricted myofascial elements. All other stretching techniques and commonly used active stretchnig exercises use relatively gross motions that may not stretch individual myofascial units that are restriced. Myofascial Release treats the patient’s current problem as well as all somatic (relating to the body) dysfunctions that may predispose the patient to future injury.
Myofascial Release is a passive stretching technique in the sense that the patient is not actively contracting any muscles to stretch the tightness or restriction. The patient’s role as the leader is to lie on the tratment table, focus on the sensations from their body, and allow their body to direct the practitioner’s teatment.
The patient must allow their body to move without inhibiting the movement. The patient must be actively passive and introspective (observation or examination of one’s own emotional state and mental processes) instead of trying to rationally lead the therapist. When the patient functions on this level, Myofascial Release takes on the quality of a dance so smooth that it is impossible to tell who is leading and who is following. Since neither the targeted muscle nor its antagonist (a muscle whose action [contraction] opposes that of another muscle) is working against a stretch, activation of pain fibres is less likely. This, stretching myofascial restrictions is generally quite comfortable. It is not unusual for the patient to fall asleep during treatment.
Unlike other treatment approaches, Myofascial Release accepts the patient’s present body alignment as their current “normal” without criticism. Myofascial Release does not command or demand tissues to relax or stretch to change the patient’s alignment to a predetermined optimum. Myofascial Release asks the tissues if this is the appropriate time and position to elongate and release the tightness or restrictions that limit motion.
The hands of the practitioner continually search for areas of restricted tissue that impede efficient motion through feedback from the kinesthetic link with the patient. When uneven soft tissue tightness and restrictions are located, the initial treatment goal is to make these asymmetrical stresses symmetrical.
Using feedback from the soft tissues, Myofascial Release will minimize or eliminate the excess stress on the soft tissues.
The sensitivity of the practitioner’s hands in detecting tightness and restrictions in the patient’s soft tissues determines the effectiveness of the practitioner using this technique. Anyone who has performed any type of massage can feel gross tightness in muscles. With only moderate sensitivity of touch, areas can be detected that are variously described as “congestion,” “crunchiness,” or “knots” in muscles. The practitioner with more sensitive hands is able to detect subtle tightness or restriction that may involve one or more myofibrils (one of numerous contractile filaments found within the cyotoplasm of striated muscle cells) within a muscle.
The patient may relay to the practitioner every sensation anywhere in their body in response to what the practitioner is doing. The patient may also interpret what that feeling means to them.
Sometimes location of the pain is not the site of dysfunction. Therefore, the practitioner must always believe the physical feedback when there is a conflict between the physical and verbal feedback.
Treatment with Myofascial Release disrupts the patient’s homeostasis (the physiological process by which the internal systems of the body are maintained at equilibrium, despite variations in the external environment). As the asymmetrical soft tissue stressses are released, the patient must accept as “normal” an entirely foreign posture, a different state of soft tissue stress and unfamiiar movement patterns.
Initially, the patient may feel more comfortable and may experience “new” pain as muscles learn to function in an unfamiliar alignment. Bursae (occur where parts move over one another; they help to reduce friction; they are normally formed around joints and places where ligaments and tendons pass over bone) may become irritated and inflammed from unfamiliar forces exerted on them.
Temporary balance impairments may occur as posture becomes more symmetrical. The patient may complain of feeling “clumsy” or “uncoordinated.” These new physical sensations may also translate into emotional lability (apt to change) or irritability for some patients.
These responses should not be taken as an indication that the patient is unable to tolerate physical change. This distruption of the patient’s homeostasis is the result of the effect of Myofascial Release on the central nervous system.
Postural change is mediated in the central nervous system. The central nervous system must be re-educated to accept and maintain the more energy efficient posture.
Initially, the central nervous system recognizes the old postures as more comfortable and familiar while the new posture is more painful and strange. Gradually, as posture changes, the central nervous system recognizes the new posture as more efficient, but still painful and unfamilar. As the new posture becomes perceived as less painful, the new posture is maintained more consistently.
Finally, the central nervous system recognizes the new posture to be more energy efficient and comfortable while the old posture is less efficient and painful.
We will use the analogy of an onion to help conceptualize the interlocking reciprocal relationships of one body area to another, and one body area to the entire body; since there is no identified physical structure other than the fascia to transmit these subjective (characteristic of an individual, personal) sensations. There is no “ideal” and no “norm” with which to compare.
Treatment using Myofascial Release begins with regional (gross) superficial stretches of the flank outer layer of the onion. Feedback from the gross stretches leads to the next layer of tightness and restriction. Releases in one body area within the same and deeper onion layers. A release in the same onion layer may not be possible until deeper layers harboring a trigger point is released. The trigger point draws the treating hand deeper into the onion and abruptly pushes it back out to the original layer when the trigger point is released.
Treatment continues layer by layer with frquent detours into deeper and occasionally more superficial layers as other trigger points and restrictions are revealed through feedback felt through the practitioner’s hands. At the same time, the patient has to make continual postural adjustments and contend with the disorientation inherent in his changing sense of proprioception (a sense or perception usually at a subconscious level, of the movements and position of the body and especially its limbs, independent of vision; this sense is gained primarily from input from sensory nerve terminals in muscles and tendons [muscle spindles] and the fibrous capsule of joints combined with input from the vestibular [ear] apparatus) and balance.
With each treatment session new neural pathways are created, the central nervous system is modified, and motor re-learning of more efficient movement patterns occur. When all of this comes together, when the core of the onion is reached and fully released, the patient has a wonderful sense of freedom of movement, balance, and energy.