Myofascial Release
Encyclopedia
The myofascial release approach is a form of soft tissue therapy
used to treat somatic dysfunction
and resulting pain and restriction of motion. It is a treatment described by Andrew Taylor Still
, founder of osteopathy
/osteopathic medicine, and his early students, which uses continual palpatory feedback to achieve release of
myofascial tissues. This is accomplished by relaxing contracted muscles, increasing circulation and lymphatic
drainage, and stimulating the stretch reflex
of muscles and overlying fascia
.
is the soft tissue
component of the connective tissue
that provides support and protection for most structures within the human body, including muscle
. This soft tissue can become restricted due to psychogenic disease
, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow
. Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be affected as well, including other connective tissue.
As in most tissue, irritation of fascia or muscle causes local inflammation
. Chronic inflammation results in fibrosis
, or thickening of the connective tissue, and this thickening causes pain and irritation, resulting in reflexive muscle tension that causes more inflammation. In this way, the cycle creates a positive feedback loop and can result in ischemia
and somatic dysfunction even in the absence of the original offending agent. Myofascial techniques aim to break this cycle through a variety of methods acting on multiple stages of the cycle.
In medical literature, the term myofascial was historically used by Janet G. Travell
, M.D. in the 1940s referring to musculoskeletal pain syndromes and trigger point
s. In 1976 Dr. Travell began using the term "Myofascial Trigger Point" and in 1983 published the reference "Myofascial Pain & Dysfunction: The Trigger Point Manual". There is no evidence she actually used what is now termed "myofascial release". Some practitioners use the term "Myofascial Therapy" or "Myofascial Trigger Point Therapy" referring to the treatment of trigger points, usually in medical-clinical sense. The phrase has also been loosely used for different manual therapy
techniques, including soft tissue manipulation work such as connective tissue massage, soft tissue mobilization, foam rolling
, structural integration, and strain-counterstrain techniques. However, in current medical terminology, myofascial release refers mainly to the soft tissue manipulation techniques described below.
Myofascial techniques generally fall under the two main categories of passive (patient stays completely relaxed) or active (patient provides resistance as necessary), with direct and indirect techniques used in each.
tissue is loaded with a constant force until tissue release occurs.
Practitioners use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a few kilograms-force or tens of newtons. 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, DO suggested that the intermolecular forces 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 (Bindegewebsmassage) in the 1920s, which involved superficial stretching of the myofascia. Dr. Ida Rolf developed structural integration, in the 1950s, an holistic system of soft tissue manipulation and movement education based on yoga, osteopathic manipulation, and the movement schools of the early part of the twentieth century, with the goal of balancing the body by stretching the skin in oscillatory patterns. She discovered that she could improve a patient's body posture and structure by bringing the myofascial system back toward its normal pattern. Since Rolf's death in 1979, various structural integration schools have adopted and evolved her theory and methods.
Dr. Rolf reduced her practice to a maxim: "Put the tissue where it should be and then ask for movement."
Michael Stanborough summarized his style of direct myofascial release technique as follows:
Different practitioners bring their own sensibility, style, level of maturity, and awareness to their work with clients which can have a significant effect on the clients experience.
The indirect technique originated in osteopathy schools and is also popular in physiotherapy. 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 at Michigan State University. It was popularized and taught to physical therapists, massage therapists, occupational therapists and physicians by John F. Barnes, PT, LMT, NCTMB through his Myofascial release seminar series. (http://www.myofascialrelease.com/fascia_massage/public/default.asp?)
Carol Manheim summarized the principles of myofascial release:
The indirect myofascial release technique, according to John Barnes, is as follows:
Soft tissue therapy
Soft tissue therapy is the assessment, treatment and management of soft tissue injury, pain and dysfunction primarily of the neuromusculoskeletal system....
used to treat somatic dysfunction
Somatic dysfunction
In osteopathic medicine and osteopathy, somatic dysfunction is the impaired or altered function of bodily structures treated by osteopathic manual technique .-Diagnosis:...
and resulting pain and restriction of motion. It is a treatment described by Andrew Taylor Still
Andrew Taylor Still
Andrew Taylor Still is considered the father of osteopathy and osteopathic medicine. He was also a physician & surgeon, author, inventor and Kansas territorial & state legislator. He was one of the founders of Baker University, the oldest 4-year college in the state of Kansas, and was the founder...
, founder of osteopathy
Osteopathy
Osteopathy and osteopathic medicine are often used interchangeably for the philosophy and system of alternative medical practice first proposed by A. T. Still MD, DO in 1874....
/osteopathic medicine, and his early students, which uses continual palpatory feedback to achieve release of
myofascial tissues. This is accomplished by relaxing contracted muscles, increasing circulation and lymphatic
Lymph
Lymph is considered a part of the interstitial fluid, the fluid which lies in the interstices of all body tissues. Interstitial fluid becomes lymph when it enters a lymph capillary...
drainage, and stimulating the stretch reflex
Stretch reflex
The stretch reflex is a muscle contraction in response to stretching within the muscle. It is a monosynaptic reflex which provides automatic regulation of skeletal muscle length....
of muscles and overlying fascia
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
.
Background and terminology
FasciaFascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
is the soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...
component of the connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...
that provides support and protection for most structures within the human body, including muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
. This soft tissue can become restricted due to psychogenic disease
Psychogenic disease
A psychogenic disease is a set of symptoms or complaints whose origin likely lies within the complex interactions of the frontal lobes of the brain and the system in which the complaint manifests...
, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
. Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be affected as well, including other connective tissue.
As in most tissue, irritation of fascia or muscle causes local inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
. Chronic inflammation results in fibrosis
Fibrosis
Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process. This is as opposed to formation of fibrous tissue as a normal constituent of an organ or tissue...
, or thickening of the connective tissue, and this thickening causes pain and irritation, resulting in reflexive muscle tension that causes more inflammation. In this way, the cycle creates a positive feedback loop and can result in ischemia
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
and somatic dysfunction even in the absence of the original offending agent. Myofascial techniques aim to break this cycle through a variety of methods acting on multiple stages of the cycle.
In medical literature, the term myofascial was historically used by Janet G. Travell
Janet G. Travell
Dr. Janet Graeme Travell, M.D. was an American physician and medical researcher. She was born in 1901 to Willard and Janet Davidson Travell. Heavily influenced by her father's profession of physician, Travell made the decision to pursue a career in the medical field. In 1929, Janet married John...
, M.D. in the 1940s referring to musculoskeletal pain syndromes and trigger point
Trigger point
Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point practitioners believe that palpable nodules are small contraction knots and a common cause of...
s. In 1976 Dr. Travell began using the term "Myofascial Trigger Point" and in 1983 published the reference "Myofascial Pain & Dysfunction: The Trigger Point Manual". There is no evidence she actually used what is now termed "myofascial release". Some practitioners use the term "Myofascial Therapy" or "Myofascial Trigger Point Therapy" referring to the treatment of trigger points, usually in medical-clinical sense. The phrase has also been loosely used for different manual therapy
Manual therapy
Manual therapy, manipulative therapy, or manual & manipulative therapy is a physical treatment primarily used by physiotherapists, chiropractors, osteopaths to treat musculoskeletal pain and disability; it most commonly includes massage therapy, joint mobilization and joint...
techniques, including soft tissue manipulation work such as connective tissue massage, soft tissue mobilization, foam rolling
Foam rolling
Foam rolling is a self-myofascial release technique that is used by athletes and physical therapists to inhibit overactive muscles. This form of stretching utilizes the concept of autogenic inhibition to improve soft tissue extensibility, thus relaxing the muscle and allowing the activation of...
, structural integration, and strain-counterstrain techniques. However, in current medical terminology, myofascial release refers mainly to the soft tissue manipulation techniques described below.
Myofascial techniques generally fall under the two main categories of passive (patient stays completely relaxed) or active (patient provides resistance as necessary), with direct and indirect techniques used in each.
Direct myofascial release
The direct myofascial release (or deep tissue work) method works through engaging the myofascial tissue restrictive barrier, thetissue is loaded with a constant force until tissue release occurs.
Practitioners use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a few kilograms-force or tens of newtons. 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, DO suggested that the intermolecular forces direct method came from the osteopathy
Osteopathy
Osteopathy and osteopathic medicine are often used interchangeably for the philosophy and system of alternative medical practice first proposed by A. T. Still MD, DO in 1874....
school in the 1920s by William Neidner, at which point it was called "fascial twist". German physiotherapist Elizabeth Dicke developed Connective Tissue Massage (Bindegewebsmassage) in the 1920s, which involved superficial stretching of the myofascia. Dr. Ida Rolf developed structural integration, in the 1950s, an holistic system of soft tissue manipulation and movement education based on yoga, osteopathic manipulation, and the movement schools of the early part of the twentieth century, with the goal of balancing the body by stretching the skin in oscillatory patterns. She discovered that she could improve a patient's body posture and structure by bringing the myofascial system back toward its normal pattern. Since Rolf's death in 1979, various structural integration schools have adopted and evolved her theory and methods.
Dr. Rolf reduced her practice to a maxim: "Put the tissue where it should be and then ask for movement."
Michael Stanborough summarized his style of direct myofascial release technique as follows:
- 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.
Different practitioners bring their own sensibility, style, level of maturity, and awareness to their work with clients which can have a significant effect on the clients experience.
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 dysfunctional tissues are guided along the path of least resistance until free movement is achieved.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 physiotherapy. According to Robert C. Ward, myofascial release originated from the concept by Andrew Taylor Still
Andrew Taylor Still
Andrew Taylor Still is considered the father of osteopathy and osteopathic medicine. He was also a physician & surgeon, author, inventor and Kansas territorial & state legislator. He was one of the founders of Baker University, the oldest 4-year college in the state of Kansas, and was the founder...
, the founder of osteopathic medicine
Osteopathic medicine
Osteopathic medicine is a branch of the medical profession in the United States. Osteopathic physicians, known as DOs, are licensed to practice medicine and surgery in all 50 states and are recognized in forty-seven other countries, including most Canadian provinces.Frontier physician Andrew Taylor...
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 at Michigan State University. It was popularized and taught to physical therapists, massage therapists, occupational therapists and physicians by John F. Barnes, PT, LMT, NCTMB through his Myofascial release seminar series. (http://www.myofascialrelease.com/fascia_massage/public/default.asp?)
Carol Manheim summarized 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.
External links
- Effects of myofascial release after high-intensity exercise: a randomized clinical trial, Journal of Manipulative Physiological Therapy 2008 March 31(3):217–23.
- What is Myofascial Release?, Jackie Castro-Cooper 2008