Myofascial Release - Brisbane MSK Clinic

Myofascial Release Treatment aims to treat MSK conditions, restricted mobility and provide fascial pain relief by releasing fascia and muscles. Terry at TotalMSK has specialised in Myofascial Release techniques since 2008 to improve performance and treat acute and chronic conditions, including sports injuries and work-related injuries. Myofascial release techniques take many forms and vary in how they work, feel, and are applied. What one feels when being treated depends on the myofascial release therapist's experience, knowledge, training, and technique skills. Hence, individual patient experiences can vary hugely between one practitioner and another.

Historical Context of Myofascial Release (MFR)

The word "Myofascial" has origins in ancient Greek and Latin and is formed from "Myo" (muscle) and "Fascial" (fascia). In simple terms, muscles sit inside bags of fascia, hence the term Myofascial. However, fascia exists in every part of the body and serves many purposes. Andrew Still, the medical doctor and founder of Osteopathic Medicine, is credited with pioneering various fascial releasing techniques. However, other well-known contributors to MFR techniques include Ida Rolf (Rolfing). The specific term Myofascial Release came about much later in the 1960s through the work of an Osteopath "Robert Ward" and Physiotherapist "John Barnes". Muscles, fascia and the fascial network play a large part in the theory behind the method. Myofascial therapy aims to identify and treat adhesions within soft tissues and fascia to free movement and reduce pain.

The image on the left shows a piece of chicken breast. The shiny, white material is fascia, which separates the muscles. The photo shows the fascia between the tenderloin and the breast. The link explains more about how fascia relates to myofascial and chronic pain. Myofascial pain may feel like a deep muscular aching or localised tenderness that persists or worsens. Besides pain, fascia may restrict mobility and lead to tension, muscle cramps and nerve or blood supply symptoms. Repeated sports injuries may also be a sign of myofascial problems. A core part of any myofascial therapy treatment involves Myofascial Trigger Points (MTrPs). The link provides much more detail on how MTrPs may form, their characteristics, the research, and how they relate to pain.

Techniques also differ in how a myofascial release therapist identifies and treats pain and soft tissue issues. Some methods look to identify and directly treat myofascial trigger points, such as Direct Myofascial Release. In contrast, other fascial release methods indirectly treat trigger points (TrPs). Although some techniques have origins in direct myofascial release, it is possible to use many such methods indirectly, too. Many types of myofascial release techniques are available at the Brisbane MSK Therapy and Chronic Pain Clinic (Morningside).

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Myofascial Massage vs Myofascial Release?

Although it is common to hear about myofascial massage, many techniques look little like actual massage in practice. Fascial releasing techniques do not feel or resemble a typical relaxing massage. Any soft tissue therapy or massage will impact fascia to some extent due to the presence of fascia throughout the body. Hence, there is some relation between massage and fascial release. Fascial releasing techniques are often precise and involve the therapist applying techniques in different planes, combining sustained compressive, tractional and rotational forces. Also, fascial release techniques tend to treat deeper tissues than massage. Massage therapy is also less specific, with more vigorous tissue movements and gentle stroking-type massage strokes.

Although anybody can call themselves a massage therapist or a myofascial release therapist in most countries, there are differences between those trained and registered with professional bodies and those who are not. Massage therapists often perform a whole-body treatment routine and have limited training in assessment, diagnostic testing and conditions. It is possible to use techniques from base-level massage therapy to treat fascial restrictions to some extent, such as petrissage, friction and skin rolling , which may explain the phrase myofascial massage. For ease of understanding, anatomy education refers to layers when learning about soft tissues, going from superficial (surface or skin) to deep. Deep tissue massage refers to the level or layer of tissues treated, so deeper layers. Deep tissue massage may involve fascial releasing techniques from sports massage therapy, such as deep frictions or muscle stripping. The Active Release Technique (ART) ® is, in essence, a form of sports massage muscle-stripping with active muscle movement and a set protocol.

However, effective treatment involves more than just applying a technique to a problem of unknown origin. In some cases, it may even be contraindicated or unsafe to treat or use a specific technique. Training in fascial releasing techniques tends to occur at a higher level than massage therapy.

It is common to see massage therapists, and even health professionals claim that myofascial release involves breaking down scar tissue and fascia. Even though there is a wide diversity of myofascial release techniques, many involve no actions remotely likely to break down scar tissue or fascia. Yet, such methods are still effective in relieving myofascial pain and improving mobility. Myofascial release is more about releasing "stuck" tissues, Myofascial Trigger points (MTrPs), or TrPs for short, than breaking anything down. In brief, trigger points appear as tiny nodules with tight bands of skeletal muscle. These nodules and the tension within and around the tissues make the areas very sensitive, causing fascial pain.

Some forms of fascial release look to locate and treat TrPs, and other methods work more broadly. However, all tissues are connected (biotensegrity) and not layers per se, with tissues gliding over each other to enable pain-free unrestricted movement. Fascia can become "sticky" for many reasons, making it harder for tissues to glide over each other, thus restricting mobility. Releasing such fascial restrictions frees these areas of stickiness. It enables normal pain-free movement, though the aim is not to break up the fascia. As previously mentioned, fascia performs multiple functions, including structural biotensegrity functions. Hence, breaking fascia down makes little sense. Actual research relating to the field of fascia is a relatively new area of study (a few decades).

Simply put, myofascial release does not have to be painful. Much like sports massage, there is often a public impression that myofascial release is hugely painful and that a painful treatment is a good thing. Fascial release may involve discomfort, though people usually refer to it as 'good pain'. However, sometimes, people experience large amounts of pain during treatment. The experience a patient has largely depends on the therapist's training, skills, and experience with assessment and myofascial release techniques. Some techniques can prove painful when used in certain instances but not in others or if done poorly. Hence, a poor patient experience might be due to the therapist, not the fascial release method. Equally, the current state of tissues can affect tissue pain sensitivity, especially when dealing with acute and chronic conditions. Acute conditions involve recent tissue injury, inflammation, and limited tissue adaption. Chronic conditions often involve many soft tissue changes, adaptations, and inflammation affecting multiple areas beyond the original injury site.

The research suggests that releasing fascia, specifically myofascial trigger points, positively affects movement and reduces myofascial pain. Some fascial releasing techniques have more research evidence than others. However, there are often less apparent reasons for the varying levels of research on myofascial release techniques in general. Most allied health professionals within the MSK field learn varying levels of soft tissue therapy techniques. Most Allied Health Professionals must complete a research element during their higher education studies. However, this research tends to be specific to each profession rather than assist competing professions. Allied health professionals may or may not learn fascial releasing methods as part of their higher education training, which impacts the possible research base. Some professionals will undertake further training in fascial techniques after qualifying in their chosen profession. However, additional training, research and understanding can vary hugely between professionals, even within the same profession. Personal interests can greatly impact individual learning, knowledge and experience.

Our principal Musculoskeletal therapist has used many fascial releasing techniques during his 16 years in practice and found them highly effective. He has also found that such methods can produce fast, long-lasting and even sometimes profound results in Chronic pain cases. As an veteran who is still highly physically active, our principal became interested in MFR to treat some historical injuries impacting his performance. The general medicine approach did not resolve these injuries (see the ankle injury article for further details). The process involved a lot of self-experimentation with specific techniques, further research and additional training in other methods.

There are many effective methods for treating fascial restrictions within soft tissues, each working slightly differently. Knowing when or not to apply a specific process will depend on clinical judgement, training, education and practitioner experience. With the correct knowledge and technique application, it is possible to produce some fast-acting and long-lasting results for patients. One of the best aspects of some fascial techniques is the ability to apply such methods passively or actively. Purely passively treating tissues tends not to utilise tissues as one would naturally use them when performing normal activities. Hence, everything may seem fine during treatment but not later while performing activities. Unlike typical prescriptive exercises (stretches), many fascial releasing techniques aim to treat virtually all the tissues or structures causing the patient's symptoms. Self-myofascial release(SMFR) can also prove helpful in some cases. However, there are limits to what one can achieve (see the SMFR section and articles later). Sometimes, SMFR may not be practical or make things worse.

Although some methods require direct skin contact, undressing (the treatment area), and massage lotion or oil, other techniques do not. Some methods work through clothing and without lotion. Hence, the feeling of getting dressed with oily skin is avoidable. Different approaches work well with small amounts of lotion and through clothing or towels. The versatility of the methods means that treatment is possible without a massage coach and track-side. For example, Terry released a friend's cramping leg during a half-marathon at around the 8-mile mark, enabling the two to still finish with a good time. Treatments aim to treat myofascial pain, restricted mobility, and dysfunctional tissues, including fascia, muscles, tendons, and ligaments. Such methods are well suited to treating acute and chronic pain conditions (see article). A variety of work and sports injuries, including more complicated conditions such as neck pain, headaches, bursitis, repetitive strain injury (RSI), and more, can respond well to treatment.

There are various reasons for fascia becoming dysfunctional, resulting in restricted mobility, muscle spasms, cramps, headaches, pain or recurring injuries. Changes within the fascial network can occur due to physical trauma, hydration levels, habits and activities, diet, medical conditions and other factors. Unresolved injuries often lead to further and seemingly unrelated injuries or problems. Stretching and self-care have limitations, though they are generally good as part of an injury prevention strategy. It can be helpful to see somebody specialising in fascial techniques when other methods or the traditional medical approach are ineffective. As with many types of treatment, the frequency and need for any soft tissue therapy depend on many factors, such as previous injury history, medical conditions, hobbies, interests, activities and other aspects of health.

Prevention can make a huge difference, as can changing contributory factors causing symptoms. Sometimes, treatment might be weekly, alongside prescriptive exercises, for a few weeks and then more spaced out. In other cases, treatment might be every month or longer. Individual patient motivation can play a huge part, as can following professional guidance. Aftercare advice is as important as physical treatment and enhances the effects of treatment if followed correctly. Hence, people must be honest with themself and make personal choices to follow or not follow advice, as it greatly impacts positive treatment outcomes. Patients can choose to take a passive or active part in their treatment process. Pharmaceutical pain-relieving products rely on the consumer to take a passive treatment approach. Such an approach is simple and only involves consumers buying pills, pain relieving gel, etc., to mask the pain without addressing the reason for symptoms. Bad actors within the MSK Therapy profession also rely on consumers taking a passive approach to treatment and depending purely on the therapist, tying the consumer to prolonged treatment. An active approach is patient-centred, requires work on the part of the therapist and patient and produces the best and fastest results.

Depending on the specific method, technique application and therapist's knowledge and experience, there can be differences in what one feels. A familiar feeling with most techniques is a sensation of tension or pressure building in and around the soft tissues under treatment, shortly followed by a softening. The release often feels like a "melting sensation" as the pressure and tension melt away. Although there is usually an element of discomfort with fascial work, the phrase "good pain" is often used by the patient.

The experience and skill of how the therapist uses and applies a technique, rather than just the technique, can change what one feels. Seeing a regulated health professional does not guarantee good technique application or the best results. Qualified professionals working in non-regulated MSK and soft tissue therapists may have considerably more experience using fascial releasing techniques. It is possible to perform any method poorly. There can be large differences between professionals within the same field, so a bad experience with one does not mean the same is true of others. Likewise, a poor experience with one technique may relate more to the person performing it than the technique. People work differently for many reasons, so find a good MSK professional.

It is possible to perform myofascial release on yourself despite limitations, which can impact effectiveness. It is essential to understand that many myofascial release tools are designed to substitute a trained therapist performing a specific treatment technique. Therapists have also created tools to reduce the load on their hands while performing techniques. Hence, not all tools are particularly suitable in a self-treatment context, especially if intended for use by a therapist. However, Self-Myofascial Release (SMFR) can prove a highly effective addition to one's self-maintenance routine and for prevention when used correctly.

One should understand that a trained fascial release therapist has training covering assessment, anatomy, physiology, correct technique application and knowledge of when it is safe or unsafe (contraindicated) to use a particular method. However, the market for selling such products to therapists is limited, unlike the mass market of the general public. One could say similar about the massage therapy guns that are now popular. Percussion massagers and impulse guns originated in chiropractic clinics between the 1970s and early 1980s. The term "adjusting gun" is commonly used to describe these products designed to apply chiropractic "adjustments.". Besides being mains powered, the current massage guns and attachments do not look very dissimilar to the original products. Again, the initial design of such devices was not for use in a self-treatment capacity or for fascial release, which is highly relevant to outcomes. As with any treatment technique, there is a time and a place for using different types of myofascial release tools. Sadly, anybody can call themselves an expert and post videos on social media of them performing self-myofascial release with little knowledge of basic anatomy, physiology or the technique. Some such videos show unsafe practices, which are likely to cause damage. The article on Self-Myofascial Release (SMFR) tools and techniques explains more.