Myofascial release   

Myofascial release

Myofascial release is a form of manual therapy treatment which aims to improve the quality and function of muscle and its surrounding tissue, fascia. Adhesions and restriction in fascial movement can commonly impede muscle function. A gentle and sustained pressure is applied to release the tight areas of myofascial tissues in the body which are contributing to your symptoms in order to reduce pain and improve movement. Trigger point therapy is also a form of myofascial release which requires the application of a firmer pressure directly upon the trigger point/muscle knot.

What is Myofascia?
“Myo” latin – Muscle, “Fascia” latin “band”

Fascia is a broad sheet of multi-layered connective tissue that surrounds muscles and bones, interconnects organs and structures, provides boundaries between structures, enables movement between structures and allows for the free transit of nerves, blood and lymphatic vessels from one area to another.

Fascia is a tissue in our body which provides support, strength, elasticity and cushioning. It forms an integral part of the structure and mechanics of the body and surrounds and connects every cell in our body, essentially making it a tissue which forms a communication system. Those who experience physical symptoms of pain and discomfort in one part of the body, can be experiencing this due to a problem elsewhere in the body. This can be a result of myofascial pain and restriction which requires an assessment and subsequent management of the problem.

In order to treat myofascial pain and restriction, a gentle, sustained pressure is applied over a period of time, which allows the tissue to release and become malleable, thereby improving its mobility and restoring its original fluid state. Due to the subtle nature of myofascial release, this method of manual therapy is not usually painful. Instead, individuals who have undergone myofascial release as part of their treatment, report a feeling of calm, feeling lighter and improved mobility. The experience that people take away from myofascial release differs, due to the origin of why the problem is occurring in the body, is different for everybody. Some may find that myofascial pain is a result of surgery or physical trauma, while others may find that their physical symptoms are a result of compounding emotional and mental strain, which can transpire into physical symptoms. It is for these reasons that an assessment is vital to forming a foundation as to why a problem has occurred in order for it to managed appropriately.

AN EVIDENCE BASED PRACTICE

• In a 2015 systematic review of published Randomized Control Trials (RCTs) investigating the effectiveness of Myofascial Release (MFR), Qatar’s Hamad Medical Department of Physiotherapy observed that

“. . . the result of the studies was encouraging, particularly with the recently published studies. MFR is emerging as a strategy with a solid evidence base and tremendous potential.” (Ajimsha, Al-Mudahka and Al-Madzhar, 2015)

Recent similar findings have been published by the University of Colorado’s Department of Health Sciences in the Journal of Athletic Training; describing overall outcomes from MRT as positive for Orthopaedic Conditions. (McKenney et al., 2013)

• A German 2006 Study indicated that fasciae continues to change into a more fluid state up to 3 hours after treatment. (R. Schleip 2006) So your MRT treatment will continue long after you’ve left the clinic!

Clinical Relevance: The importance of Fasciae. . .
Clinically fascias can respond to injury like any other tissue. They are extremely important because they often limit the spread of infection and malignant diseases. (Drake et al., n.d.)

The Piezoelectric Effect
This latest theory suggests that intermolecular bonds producing a small electric charge is stretched due to mechanical stress. This action influences the body’s collagen producing framework. The end result leads to an increase of tough collagenous tissue in areas of the body to support inefficient structural postures.

What to expect?

Palpatory Assessment for:

  • Local and Global Mobility: Identifying where fascia can become resistant to movement is the foundation of the palpatory assessment
  • Adhesions can become hardened, restricting local and global soft tissue movement.
  • Scar Tissue: The latest research conducted via MRI Technology disputes that the consistency of scar tissue can only change marginally after Soft Tissue Release Techniques. MRT, however, is most effective in restoring fluidity to neighbouring tissues – improving renewed elasticity and local mobility.

Myofascial Release Technique (MRT):
Fasciae have tissue receptors that send information into the nervous system. Among these receptors are closely packed bundles of collagen fibres oriented in a wavy pattern parallel to the direction of pull. Consequently, these flexible structures are able to resist great unidirectional tension forces until the pulling force has straightened out the wavy pattern fibers.

A variety of techniques start with static compression of trigger points or tissue adhesions affective nerves, progressing to compression of trigger points with passive muscle elongation or stretching, and progressing to compression of trigger points during active stretch of the shortened muscle. (Whyte-Ferguson and Gerwin, 2005) This enables colloids within the fibre bundles to move from a “gel” state to a more fluid “sol” state by the application of energy.

A Neurological Response . . .
MRT mostly uses sustained tangential forces as they’ve been shown to be most effective at encouraging neuro-receptor responses. Furthermore, stimulating the parasympathetic nervous system eliciting a relaxing response.


References

  • Ajimsha, M., Al-Mudahka, N. and Al-Madzhar, J. (2015). Effectiveness of myofascial release: Systematic review of randomized controlled trials. Journal of Bodywork and Movement Therapies, [online] 19(1), pp.102-112. Available at: https://www.bodyworkmovementtherapies.com/article/S1360-8592(14)00086-2/fulltext [Accessed 10 Jun. 2019].
  • Drake, R., Vogl, W., Mitchell, A. and Gray, H. (n.d.). Gray's anatomy for students. 3rd ed. Churchill Livingstone.
  • En.wikipedia.org. (2019). Fascia. [online] Available at: https://en.wikipedia.org/wiki/Fascia [Accessed 10 Jun. 2019].
  • Fugallo, A. (2018). Myofascial Release Technique.
  • KUNTZMAN, A. and Tortora, G. (2010). Anatomy and physiology for the manual therapies + wileyplus. Danvers: JOHN WILEY.
    McKenney, K., Elder, A., Elder, C. and Hutchins, A. (2013). Myofascial Release as a Treatment for Orthopaedic Conditions: A Systematic Review. Journal of Athletic Training, [online] 48(4), pp.522-527. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718355/ [Accessed 10 Jun. 2019].
  • Whyte-Ferguson, L. and Gerwin, R. (2005). Clinical mastery in the treatment of myofascial pain. Philadelphia..[etc]: Lippincot Williams & Wilkins.