MYOFASCIAL RELEASE THERAPY

MYOFASCIAL RELEASE THERAPY--- A Brief Note

Myofascial release is a form of massage therapy that uses sustained pressure to loosen or release tightness in connective tissues (fascia). It is thought that tightness within the fascia causes restriction of muscle and other tissues, resulting in back pain and loss of motion. Injuries, stress, inflammation, trauma and poor posture supposedly contribute to this tightness. These myofascial restrictions can't be detected with standard medical imaging studies, such as X-rays or MRIs. It can be diagnosed by palpatory findings.

These techniques which depict hands-on treatment using the fascia have been recorded in the earliest of our historical references.  Items from Ayurvedic medicine, which goes back around 5000 years, Chinese and Egyptian depictions that go back around 3000 years, and Greek descriptions by Hippocrates and others which go back around 2300-2500 years, all show hands on approaches that most certainly utilized the fascia as an element of diagnosis and treatment.

v Uniqueness of Myofascial release therapy  against other stretching

Myofascial release therapy is a highly interactive stretching technique that requires feedback from 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 appreciates that an individual muscle cannot be isolated from the other structures of the body due to the existence of fascia. (Manheim, 1994).

Barnes (1990) reported that Myofascial release therapy is a manually applied, whole body treatment approach which is aimed at fascial system. He contends that myofascial release is the only treatment that addresses the collagenous component of fascia via its effects on the viscosity of its ground substance. Whereas modalities, exercises, manual therapy, massage and muscle energy techniques only affect the muscle and elastic component of fascia.

Application of Myofascial release technique, the therapist monitors tissue tightness by developing a kinesthetic link with the patient touch. Through this link, the therapist feels the patient’s inherent tissue movement and underlying neurophysiologic tissue tone as well as the more overt muscle tone. Once adapt at sensing the patient’s muscle tone and tightness, the therapist is able to detect subtle restrictions can only be detected through touch and eliminated by using myofascial release technique. Thus, myofascial release technique focuses directly on the restricted myofascial elements while all other stretching techniques and commonly used active stretching exercises use relatively gross motions that may not stretch individual myofascial units that are restricted. (Manheim 2001).

v Principles of Myofascial release technique

The principles of myofascial release therapy includes

1.      Fascia covers all organs of the body

2.      Muscles and fascia cannot be separated

3.      All muscles stretching is myofascial stretching

4.      Myofascial stretching in one body area will be felt and will affect that and other body areas.

5.      Release of myofascial restrictions can affect other body organs through a release of tension in greater fascial system

6.      Myofascial release can alter body misalignment if structures are not fixed by bone remodeling.

7.      Myofascial release generally more comfortable than other stretching techniques.

8.      Progress is measured by improvement in postural asymmetry, reduction of subjective pain complains, and increased fluidity of movement.

9.      Treatment using myofascial release changes constantly in response to feed back.

v Protocols for myofascial release therapy techniques:

A) INDICATIONS:

Myofascial release is the treatment of choice in the following situations,

        i.  The patient’s pain compliant has not been alleviated by traditional physical therapy treatment.

         ii.   The patient has a complex, global, or specific pain compliant that does not follow dermatomes, myotomes, or visceral referred symptoms.

               iii.  The patient has an underlying chronic condition that causes tightness and restrictions in the soft tissues (e.g. fibromyalgia, and post-polio syndrome). 

                                iv.   The patient has painful complex postural asymmetries

                          v.  The patient has asymmetrical muscle weakness due to an acute or chronic peripheral or central neuropathy.

       vi.            The patient has impaired respiration and an inflexible rib cage due to chronic respiratory disease, central nervous system injury, or faulty mechanical relationships of the skeletal structure and soft tissues.

      vii.            The Patient has frequent, intense headaches that are triggered by a variety of stimuli including myofascial trigger points, tension in the posterior cervical musculature, temporamandibular joint dysfunction and symmetrical muscle tightness.

     viii.            The patient has impaired mouth closure, swallowing and phonation resulting in tightness and restriction of the hyoids and the muscles of mastication

         ix.            The patient experiences non-labyrinthine induced vertigo and dizziness secondary to active myofascial trigger points.

        x.            The patient is a competitive athlete or performer who needs subtle stretching to increase speed or accuracy and to prevent injury at the extreme range of motion.

B) CONTRAINDICATIONS:

Myofascial release should not be used in the following situations,

                    i.            The patient does not understand or respect boundaries.

                 ii.            The patient does not tolerate close physical contact or touch.

               iii.            The patient has an unstable medical conditions, e.g., unstable angina

               iv.            The patient has a dermatitis

                  v.            The patient has a contagious or infectious disease that is transmitted by the upper respiratory tract or by direct contact with the skin

               vi.            The patient does not trust the therapist

             vii.            The patient does not understand the concept of the “Good Hurt”.

          viii.            The patient is under the influence of the drugs or alcohol.

               ix.            The patient is unable to give informed consent to treatment due to his mental status.

                  x.            The therapist does not feel comfortable with the patient (i.e. after initial interview and evaluation, the therapist’s “gut response” says not to treat this patient with myofascial release or not to treat this patient at all).

C) PRECAUTIONS:

                    i.            Myofascial Release consistently lowers blood pressure. All patients must rest in a horizontal position for 10-15 minutes following treatment. The patient should get up slowly and not get off the treatment table until any dizziness has resolved. 

                 ii.            Myofascial release may lower blood sugar levels, particularly when deep trigger point releases are performed. Individuals who are diabetic should check their blood glucose level prior to treatment. Individuals who are prone to hypoglycemia should have a snack prior to treatment.

               iii.            Individuals with healing fractures or wounds may receive myofascial release to uninvolved areas.

               iv.            Individuals with compromised circulation may be treated with myofascial release to the uninvolved areas and to the area of compromise while being closely monitored.

                  v.            The patient is taking medication that increases blood-clotting times and causes the patient to bruise easily.

               vi.            When treating a child or a mentally incompetent adult, the caregiver or other responsible adult should always be present. The therapist should carefully explain the treatment to the caregiver.

v Theoretical framework behind the effectiveness of Myofascial release therapy

     It is assumed through the application of slow, steady force carefully directed against barriers, fascial restrictions release. They occur in four ways as described by Gould (1997).

1.      Forcible Separation or compression of joints.

As external loading either separates or compresses, everything from the skin surface to deepest component of spinal complex is forced to respond.

2.      General Myotactically, Controlled, Mechanoreceptors response.

Golgi tendon organs exit in all soft tissue including fascial sheaths. They do not exhibit neural plasticity and readily respond to outside force, such as manual therapies. They can assume new barriers either normal or pathological.

3.      Muscle Tightening and Asymmetries

Tightness and Asymmetries is maintained through 1a afferents. Gamma efferent effects are particularly important. Emotional and stress related mechanism often are major contributors. Traumatic forces massively stimulate 1a afferent. Descending, inhibitory factors are overwhelmed and unable to control inputs.

4.      Centrally controlled Relaxation

Effects occur as myofascial tightness and muscle spasm releases. Assertive, slow carefully directed soft tissue loading can overcome many of these effects assuming massive neutral and other soft tissue has not occurred. It is assumed such loading involves myotactic reflexes.

The Arndt-Schulz law states that gentle touch increases physiologic activity while heavy tough is inhibitory. Myofascial release therapy uses both types of touch, depending upon the need of the patient. Light touch and light stretching encourages release of asymmetrical soft tissue stresses and reflex relaxation of tissues both proximal and distal to the treatment site. This gentle touch also allows the therapist assess to area of tightness without triggering reflex muscle guarding. As new movement pattern are facilitated by the gentle stretch, central nervous system reeducation occurs. Heavier pressure is used during trigger point release to inhibit the micro-muscle spasm that perpetuates the trigger point. (Manheim, 1994).

When peripheral or central nervous system is stimulated, the stimulus is carried throughout the body in accordance with the law of diffusion. For example, while only the spinal column has been changed with the insertion of Harrington rod, the altered sensory input changes the patient’s perception of his entire body. There is no way to affect one area of the body without affecting the entire person. In contrast, the law of Avalanche states that multiple sensations may be aroused in the brain by a simple stimulus in the periphery. Many feelings and responses may be aroused by any peripheral stimulus. (Manheim, 1994).