Getting A Grip
Myofascial Release (MFR) is a manual therapy that involves exposing the myofascial complex to long periods of high-pressure stretches, which help regain optimal muscle length, decrease pain, and improve function. Postural muscles demand more oxygen to maintain sustainability of different bodily functions, whilst phasic muscles prefer burning glucose for fuel. When tension, trauma and poor body mechanics reduce the amount of oxygen to the postural muscles, they get fatigued and the gravitational load shifts to the phasic musculature. Unfortunately, phasic muscles have a greater number of fast twitch fibres, and do not respond well to prolonged overloading. As a result, they begin to shift the load back to the already exhausted postural muscles.
The fascial network around the muscles is then recruited to create a splinting effect, cascading throughout the entire network, and affecting every other cell in the body. Eventually, injured muscle cells break down, causing a release of calcium and histamines. Calcium normally reacts with adenosine triphosphate (ATP) to produce muscle contraction, which in turn promotes the release of energy. However, in an already constricted tissue this combination creates painful contractions and muscular spasms.
Myofascial Release is a relatively new addition to the armamentarium of physiotherapists. As, it is somewhat different from traditional physical therapy, many individuals exposed to it ask questions such as, “What is it?” and “How does it work?”. Herein, experts and therapists talk of the Massage-Myofascial Release therapy that reduces the pain sensitivity of tender points, in patients with fibromyalgia. Release of fascial restrictions in such patients also reduces anxiety levels, and improves sleep quality and physical functions. Massage-Myofascial programs can be considered as an alternative and/or complementary therapy that promises to deliver noticeable improvements.
Also known as the connective tissue, fascia is a tissue system, which has gotten relatively little attention in the past. Fascia is composed of two types of fibres; collagenous fibres, the ones that are very tough and have little stretchability, and elastic fibres, the ones that are stretchable.
From a functional point of view, the fascia can be imagined as an endless laminated sheet of tissues, which extends without interruption, from the highest point at the top of the head, to the very tip of the toes. It surrounds and invades every other part of the body, including nerves, vessels, muscles and bones. It is important to note that the density of the fascia is variable from area to area.
The majority of the fascia in the human body is oriented vertically. There are however, four major planes of fascia within the body, which are oriented in a crosswise (or transverse) plane. These four transverse planes are extremely dense and are called-pelvic diaphragm, respiratory diaphragm, thoracic inlet and cranial base. Frequently, all four of these transverse planes will become restricted, when fascial adhesions occur in any part of the body. This is because this part of the fascia is interconnected, and a restriction in one region can theoretically put a “drag” in the other direction.
According to leading scientific experts and doctors, the current evidence on the effectiveness of Myofascial Release therapy is not sufficient to warrant the use of the said treatment in cases with chronic musculoskeletal pain. At the same time, the point of all the information provided above is to assist you to understand that in myofascial release treatments, you’ll be treated in areas, which you might not think are related to your condition at all. Experts and trained therapists have a radical understanding of the fascial system, and can therefore “release” the fascia in areas that they know have a robust “drag” on your particulate area of injury. This is, therefore, a full-body approach towards the treatment as opposed to other types of physical therapy. A good example of this is chronic lower-back pain in any given individual. Although the lower back is primarily involved, the individual may also have significant discomfort in the neck due to the gradual tightening of the muscles, particularly the fascia. This tightness strengthens over time, eventually creating pain in the neck and head. Research shows that optimal resolution of lower back pain requires release of the fascia of both the top and in the neck; if the tightness in the neck isn’t released as well, it will continue to apply a “drag” in the downward direction, until fascial restriction and pain returns to the lower back.
Muscle makes up most of the bulk of our body’s soft tissue. As all muscle is enveloped by and ingrained with fascia, we can use the term Myofascial Release for any techniques that help relieve the soft tissue from the abnormal grip of a tight fascia (“myo” means “muscle”).
The type of Myofascial Release technique chosen by the therapist will depend on the location of the restricted fascia in your body. If it is restricted through the neck, all the way to the arm, then he/she may use a really gentle grip on the arm, to slowly move the arm through it’s range of motion, as restrictions are released. If it is restricted within the back (more superficial than deep) he/she may gently stretch the skin across the rear, with the utilisation of two hands. If the thoracic inlet; part of the deep transverse fascia, is suspected of being restricted, the therapist may place one hand on the upper back and one over the collarbone area in front, gently applying pressure until the stress is resolved.
A key to the success of Myofascial Release treatments, is to maintain constant pressure while doing extremely mild stretching. Even though muscle tissues easily respond to a firm stretch, this is often not the case with fascia. Remember, the collagenous fibres of fascia are extremely tough and immune to stretching. In fact, it is estimated that a tightened fascia can put as much as 2000 pounds/sq. inch of pressure on the organs and other body parts. (No wonder when it tightens, it causes a lot of pain.)
However, it has been shown that under a small amount of pressure, (applied by a skilled therapist’s hands) the fascia will soften and begin to release, if the pressure is sustained over time. This can be likened to pulling on a bit of taffy with only a little, sustained pressure.
Another important aspect related to the success of Myofascial Release techniques, is holding the stretch long enough. It will require one to change the pressure points after holding a mild stretch, then following the tissue three dimensionally with sensitive hands until the entire connection is free from kinks.
Myofascial Release is gentle, but it has a profound affect upon the body tissue. Do not let the gentleness deceive you. You may leave after the first treatment feeling like nothing happened, to only later, (even a day later) begin to feel the effects of the treatment.
In general, acute cases will resolve with a few treatments. Generally, the longer the problem has been present, the longer it will take to resolve it. Many chronic conditions (that have developed over a period of years) may require three to four months of treatments, at least three times per week, to obtain optimal results. Experience indicates that fewer than two treatments per week will often result in fascial tightness creeping back to the levels prior to the last treatment. However, the stretching exercises given to you, in order to maintain the range of motion will keep the regression between treatments to a minimal.
One thing to keep in mind, is that often the pain might increase for several hours to a day after the treatment, followed by remarkable improvements. Sometimes, you might experience new pains in new areas. You might also experience the feeling of light-headedness or nausea. The patient might even experience a temporary emotional change. All of these are normal reactions of the body, to the profound but positive changes that occur as a result of Myofascial Release.
It is believed that the release of tight tissue is also accompanied by the release of trapped metabolic waste products in the surrounding area. We highly recommend that you “flush your system” by drinking lots of fluids during the course of your treatments, so that reactions like nausea and light-headedness have minimal impact. At the same time, medications such as nonsteroidal anti-inflammatories, acetaminophen or opioids can also be used to treat Myofascial pain. Medications for sleep, depression or muscle spasms are used as well. Non-drug treatments revolve around physical therapy, which helps offer potential relief and helps reduce micro-cramps, also known as trigger points for fascia tightening.