Myofascial Release Explained
Fascia is located between the skin and the underlying structure of muscle and bone, it is a seamless web of connective tissue that covers and connects the muscles, organs, and skeletal structures in our body. Muscle and fascia are united forming 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, Rolfing, 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 directly on the restricted fascia. The practitioners use knuckles, elbows, or other tools to slowly sink into the restricted fascia applying a few kilograms-force or tens of newtons and then stretch the fascia. 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. There can be a misconception that the direct method is violent and painful. It is not essentially aggressive and painful, as 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 called Fascial Twist. Dr. Ida Rolf developed Structural Integration or Rolfing in the 1950s, a holistic system of soft tissue manipulation and movement education that with the goal of balancing the body in gravitational field. She discovered that she could remarkably 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 according their own flavours, lights and remembrance.
Until recently (in 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: John F. Barnes, PT from a Physical Therapy background, and from a Rolfing or Structural Integration background, Art Riggs, Michael Stanborough, Tom Myers, and others.
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.
- Exit gracefully.
As Dr. Rolf said, "Put the tissue where it should be and then ask for movement."
Indirect myofascial release
The indirect method gentle stretch, the pressure is in few grams, the hands tend to go with the restricted fascia, hold the stretch, and allow the fascia to 'unwind' itself. The gentle traction applied to the restricted fascia will result in heat, increase blood flow in the area. The intention is to allow the body's inherent ability for self correction returns, 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- too fast, and it shreds.
The indirect technique originated in osteopathy schools and also popular in physical therapy. German physiotherapist Elizabeth Dicke developed Connective Tissue Massage (Bindegewebbsmassage) in the 1920s with superficial stretching of the myofascia. 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, and until 1980s they were popularised. 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.
John F. Barnes, PT has developed a unique approach to Myofascial Release that utilizes both direct and indirect techniques. He teaches his approach to Myofascial Release to healthcare professionals across the country
Carol Manheim summarised Myofascial Release principles:
- 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 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, e.g. cross hand technique according to John Barnes is as follow:
- With relaxed hand lightly contact the fascia.
- Slowly stretch the fascia until reaching a barrier/ restriction.
- Maintain a light pressure to stretch the barrier and wait 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.
- John F. Barnes. 1990. Myofascial Release: The Search for Excellence, 10th Edition. Myofascial Release Treatment Center.
- John F. Barnes. 2000. Healing Ancient Wounds: The Renegade's Wisdom. Myofascial Release Treatment Center.
- Robert I Cantu, Alan J. Grodin. 2001. Myofascial Manipulation, Theory and Clinical Application, 2nd ed. Aspen Publishers Inc.
- Carol Manheim. 2001. The Myofascial Release Manual. 3rd Edition. Slack Inc.
- Tom Myers. 2004. Structural Integration - developments in Ida Rolf's 'Recipe'- 1. Journal of Bodywork and Movement Therapies 8, 131-142.
- Michael Stanborough. 2004. Direct Release Myofascial Technique. Elsevier.
- Ward, RC, 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
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