Myofascial release

The myofascial release approach is a form of soft tissue therapy used to treat somatic dysfunction and resulting pain and restriction of motion. It is a treatment described by Andrew Taylor Still, founder of osteopathy/osteopathic medicine, and his early students, which uses continual palpatory feedback to achieve release of myofascial tissues.^[1] This is accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the stretch reflex of muscles and overlying fascia.^[2]

Background and terminology

Fascia is the soft tissue component of the connective tissue that provides support and protection for most structures within the human body, including muscle. This soft tissue can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow. Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be affected as well, including other connective tissue.^[2]

As in most tissue, irritation of fascia or muscle causes local inflammation. Chronic inflammation results in fibrosis, or thickening of the connective tissue, and this thickening causes pain and irritation, resulting in reflexive muscle tension that causes more inflammation. In this way, the cycle creates a positive feedback loop and can result in ischemia and somatic dysfunction even in the absence of the original offending agent. Myofascial techniques aim to break this cycle through a variety of methods acting on multiple stages of the cycle.^[2]

In medical literature, the term myofascial was historically used by Janet G. Travell, M.D. in the 1940s referring to musculoskeletal pain syndromes and trigger points. In 1976 Dr. Travell began using the term "Myofascial Trigger Point" and in 1983 published the reference "Myofascial Pain & Dysfunction: The Trigger Point Manual".^[3] There is no evidence she actually used what is now termed "myofascial release". Some practitioners use the term "Myofascial Therapy" or "Myofascial Trigger Point Therapy" referring to the treatment of trigger points, usually in medical-clinical sense. The phrase has also been loosely used for different manual therapy techniques, including soft tissue manipulation work such as connective tissue massage, soft tissue mobilization, foam rolling, structural integration, and strain-counterstrain techniques. However, in current medical terminology, myofascial release refers mainly to the soft tissue manipulation techniques described below.

Myofascial techniques generally fall under the two main categories of passive (patient stays completely relaxed) or active (patient provides resistance as necessary), with direct and indirect techniques used in each.

Direct myofascial release

The direct myofascial release (or deep tissue work) method works through engaging the myofascial tissue restrictive barrier, the tissue is loaded with a constant force until tissue release occurs.^[1] Practitioners use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a few kilograms-force or tens of newtons. Direct myofascial release seeks for changes in the myofascial structures by stretching, elongation of fascia, or mobilising adhesive tissues. The practitioner moves slowly through the layers of the fascia until the deep tissues are reached.

Robert Ward, DO suggested that the intermolecular forces direct method came from the osteopathy school in the 1920s by William Neidner, at which point it was called "fascial twist". German physiotherapist Elizabeth Dicke developed Connective Tissue Massage (Bindegewebsmassage) in the 1920s, which involved superficial stretching of the myofascia. Dr. Ida Rolf developed structural integration, in the 1950s, an holistic system of soft tissue manipulation and movement education based on yoga, osteopathic manipulation, and the movement schools of the early part of the twentieth century, with the goal of balancing the body by stretching the skin in oscillatory patterns. She discovered that she could improve a patient's body posture and structure by bringing the myofascial system back toward its normal pattern. Since Rolf's death in 1979, various structural integration schools have adopted and evolved her theory and methods.

Dr. Rolf reduced her practice to a maxim: "Put the tissue where it should be and then ask for movement."

Michael Stanborough summarized his style of direct myofascial release technique as follows:

• Land on the surface of the body with the appropriate 'tool' (knuckles, or forearm etc.).
• Sink into the soft tissue.
• Contact the first barrier/restricted layer.
• Put in a 'line of tension'.
• Engage the fascia by taking up the slack in the tissue.
• Finally, move or drag the fascia across the surface while staying in touch with the underlying layers.
• Exit gracefully.

Different practitioners bring their own sensibility, style, level of maturity, and awareness to their work with clients which can have a significant effect on the clients experience.

Indirect myofascial release

The indirect method involves a gentle stretch, with only a few grams of pressure, which allows the fascia to 'unwind' itself. The dysfunctional tissues are guided along the path of least resistance until free movement is achieved.^[1]The gentle traction applied to the restricted fascia will result in heat and increased blood flow in the area. This allows the body's inherent ability for self correction to return, thus eliminating pain and restoring the optimum performance of the body. This concept was suggested by Paul Svacina to be analogous to pulling apart a chicken carcass: when it is pulled apart slowly, the layers peel off intact; too fast, and it shreds.

The indirect technique originated in osteopathy schools and is also popular in physiotherapy. According to Robert C. Ward, myofascial release originated from the concept by Andrew Taylor Still, the founder of osteopathic medicine in the late 19th century. The concepts and techniques were subsequently developed by his successor. Robert Ward further suggested that the term Myofascial Release as a technique was coined in 1981 when it was used as a course title at Michigan State University. It was popularized and taught to physical therapists, massage therapists, occupational therapists and physicians by John F. Barnes, PT, LMT, NCTMB through his Myofascial release seminar series. (http://www.myofascialrelease.com/fascia_massage/public/default.asp?)

Carol Manheim summarized the principles of myofascial release:

• Fascia covers all organs of the body, muscle and fascia cannot be separated.
• All muscle stretching is myofascial stretching.
• Myofascial stretching in one area of the body can be felt in and will affect the other body areas.
• Release of myofascial restrictions can affect other body organs through a release of tension in the whole fascia system.
• Myofascial release techniques work even though the exact mechanism is not yet fully understood.

The indirect myofascial release technique, according to John Barnes, is as follows:

• Lightly contact the fascia with relaxed hands.
• Slowly stretch the fascia until reaching a barrier/restriction.
• Maintain a light pressure to stretch the barrier for approximately 3–5 minutes.
• Prior to release, the therapist will feel a therapeutic pulse (e.g. heat).
• As the barrier releases, the hand will feel the motion and softening of the tissue.
• The key is sustained pressure over time.

References

1. ^ ^{a b c} Glossary of Osteopathic Terminology, Educational Council on Osteopathic Principles (ECOP), American Association of Colleges of Osteopathic Medicine (AACOM), Revised April 2009, page 31.
2. ^ ^{a b c} DiGiovanna, Eileen; Stanley Schiowitz, Dennis J. Dowling (2005) [1991]. "Myofascial (Soft Tissue) Techniques (Chapter 12)". An Osteopathic Approach to Diagnosis and Treatment (Third ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 80–82. 
3. ^ The Trigger Point Manual

• Barnes, John F. 1990. Myofascial Release: The Search for Excellence, 10th Edition. Rehabilitation Services Inc.
• Cantu, Robert I. & Grodin, Alan J. 2001. Myofascial Manipulation, Theory and Clinical Application, 2nd ed. Aspen Publishers Inc.
• Manheim, Carol. 2001. The Myofascial Release Manual. 3rd Edition. Slack Inc.
• Myers, Tom. 2004. Structural Integration – developments in Ida Rolf's 'Recipe'- 1. Journal of Bodywork and Movement Therapies 8, 131–142.
• Stanborough, Michael. 2004. Direct Release Myofascial Technique. Elsevier.
• Ward, Robert C. 2003, Integrated Neuromusculoskeletal Release and Myofascial Release, in Ward RC, 2003, Foundations for Osteopathic Medicine, 2nd edition, Chapter 60, pp 932–968, Lippincott, Williams and Wilkins, Philadelphia

See also

• Muscle correction therapy

External links

• Effects of myofascial release after high-intensity exercise: a randomized clinical trial, Journal of Manipulative Physiological Therapy 2008 March 31(3):217–23.
• What is Myofascial Release?, Jackie Castro-Cooper 2008