- TODAY'S TOPICS ARE TARGETD TO INDIAN PHYSIOS. WE IN OUR CORRICULLUM ARE DEFIENT IN
- FUNDAMENTAL UNDERSTNDING OF FASCIA & IT'S STATIC/DYNAMIC BEHAVIOUR
- MYOFASCIAL RELEASES
- WE BELIEVE THEY ARE HIGHLY EFFECTIVE TECHNIQUES & MUST BE INCLUDED IN OUR SYLLABUS.
- Myofascial Release is a form of soft tissue therapy which includes, but is not limited to, structural assessments and manual massage techniques for stretching the fascia and releasing bonds between fascia, integument, muscles, and bones are applied with the goal of eliminating pain, increasing range of motion and balancing the body. The fascia is manipulated, directly or indirectly, which allows the connective tissue fibers to reorganize themselves in a more flexible, functional fashion. In addition, Myofascial release (note the lower case r) may be considered a general manual massage technique any 'lay person' can use to eliminate general fascial restrictions on a living mammalian body.
Fascia is a seamless web of connective tissue that covers and connects the muscles, organs, and skeletal structures in our body, which is located between the skin and the underlying structure of muscle and bone. Muscle and fascia form the myofascia system.
Injuries, stress, inflammation, trauma, and poor posture can cause restriction to fascia. Since fascia is an interconnected web, the restriction or tightness to fascia at a place, with time can spread to other places in the body like a pull in a sweater. The goal of myofascial release is to release fascia restriction and restore its tissue health.
In medical literature, the term myofascial was 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 famous reference "Myofascial Pain & Dysfunction: The Trigger Point Manual". Some practitioners use the term "Myofascial Therapy" or "Myofascial Trigger Point Therapy" referring to the treatment of trigger points, this is usually in medical-clinical sense.
Here the term Myofascial Release refers to soft tissue manipulation techniques. It has been loosely used for different manual therapy, soft tissue manipulation work (connective tissue massage, soft tissue mobilization, Structural Integration, strain-counterstrain etc). There are two main schools of myofascial release: the direct and indirect method.
Direct myofascial release
The direct Myofascial Release method works on the restricted fascia. The practitioners use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a few kilograms-force or tens of newtons. This is sometimes referred to as deep tissue work. 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 suggested that the 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 (Bindegewebbsmassage) in the 1920s, which involved superficial stretching of the myofascia. Dr. Ida Rolf developed Structural Integration, in the 1950s, a holistic system of soft tissue manipulation and movement education that with the goal of balancing the body. She discovered that she could change the body posture and structure by manipulating the myofascial system. Rolfing is the nickname that many clients and practitioners gave this work. Since her death in 1979, various Structural Integration schools arose which have adapted her original idea to their own needs and uses.
Until the 1990s, instruction in direct myofascial release was rarely available outside of Structural Integration or Physical Therapy training programs. Currently, however, texts and courses are offered to general bodyworkers from a Physical Therapy background, and from a Structural Integration background.
Michael Stanborough has summarised his style of Direct Myofascial Release technique as:
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.
As Dr. Rolf said, "Put the tissue where it should be and then ask for movement."
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 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 physical therapy. 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 in Michigan State University. It was popularized and taught to physical therapists, massage therapists, occupational therapists and physicians by John F.Barnes PT through his Myofascial release seminar series.
Carol Manheim summarised 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.
Source: From Wikipedia.
Self Myofascial Release Exercises
For these exercises you will need a foam roll (which is very inexpensive). You can get them from anywhere that sell sports medicine or physical therapy supplies.
Adductor Self Myofascial Release
- 1. Extend the thigh and place foam roll in the groin region with body prone (face down) on the floor. 2. Be cautious when rolling near the adductor complex origins at the pelvis. 3. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.
Hamstring Self Myofascial Release
- 1. Place hamstrings on the roll with hips unsupported.2. Feet can be crossed so that only leg at a time is one the foam roll. 3. Roll from knee toward posterior hip. 4. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.
- Quadriceps Slef Myofascial Release
- 1. Body is positioned prone (face down) with quadriceps on foam roll2. It is very important to maintain proper core control (abdominal drawn-in position & tight gluteus) to prevent low back compensations 3. Roll from pelvic bone to knee, emphasizing the lateral (outside) thigh 4. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.
- Iliotibial Band Self Myofascial Release
- 1. Position yourself on your side lying on foam roll.2. Bottom leg is raised slightly off floor. 3. Maintain head in “neutral” position with ears aligned with shoulders. 4. This may be PAINFUL for many, and should be done in moderation.5. Roll just below hip joint down the outside thigh to the knee. 6. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.
- Upper Back Self Myofascial Release
- 1. Place hands behind head or wrap arms around chest to clear the shoulder blades across the thoracic wall.2. Raise hips until unsupported.4. Stabilize the head in a “neutral” position. 5. Roll mid-back area on the foam roll. 6. If a “tender point” is located, stop rolling, and rest on the tender point until pain decreases by 75%.
1. Spend 1-2 minutes per self myofascial release technique and on each each side (when applicable).
2. When a trigger point is found (painful area) hold for 30-45 seconds.
3. Keep the abdominal muscles tight which provides stability to the lumbo-pelvic-hip complex during rolling.
4. Remember to breathe slowly as this will help to reduce any tense reflexes caused by discomfort.
5. Complete the self myofascial release exercises 1-2 x daily.