What is Myofascial Release (MFR)
Myofascial Release (MFR) refers to a group of methods designed to assess and treat painful and dysfunctional tissues. Hypertonic tissues often result in restricted mobility and myofascial pain and releasing such tissues can help to alleviate such symptoms. The initial concepts of Myofascial treatments appear to have been developed by the medical doctor and founder of Osteopathic Medicine, Andrew Still. However, there have been other well-known contributions to MFR techniques notably by Ida Rolf (Rolfing). Fascia and the fascial network play are a large part in the theory behind the method and its development. However, actual research relating to the field of fascia is a relatively new area of study (a few decades).
Fascia and its relevance
Fascia can be found throughout the human body and does not look too dissimilar to cotton wool or a spiders silk under magnification. It is a densely woven collagen fibre matrix that is believed to penetrate every tissue within the body and cover muscles and organs. There are also specific deep and superficial layers of fascia, which aid with functional movement, support structures within the body and provide stability. Without fascia ones, muscles would lack their distinctive shape. It is relatively easy to see fascia within a piece of raw chicken breast or other meat. A chicken breast typically has a thin translucent portion of fascia between the breast meat and the tenderloin.
In normal, circumstances fascia is a well hydrated, smooth, translucent, slippery and a durable material. However, these properties of fascia can change as a result of other factors including injury, dehydration, specific medical conditions, changes to other tissues/structures and possibly other factors such as diet (nutrients). The anatomist Tom Myers has been conducting work relating to fascia and the fascial network for well over 20 years. During, his research Tom Myers (the anatomist) has identified multiple specific facial lines which are thought to support functional movement namely; the superficial front and back lines, lateral line, spiral line, arm lines, functional lines and deep front line. At least, four distinctive types of fascia have been identified and with each providing a different function. The four types of fascia identified to date include inter-structural, spinal, structural and visceral.
As with various tissues and structures within the body, things can go wrong or become dysfunctional. Fascia is thought to not only support multiple functional movements but facilitate movement too. The human body consists of a vast number of tissues, structures and various layers thereof. Fascia is thought to not only separate these tissues and structures but also hold them together in many respects. Primary, human movement requires multiple muscles and layers to either contract, relax or stabilise for any given action. Also, muscles have different origins and insertions, or in other words attachment points, e.g. from “a to b” in the simplest muscles. The section about Soft Tissue Release (STR) explains muscle origins and insertions in more detail. For muscles to be able to move and not interfere with the operation and movement of other muscles or structures, they need to be able to glide over each other. Fascia, conveniently separates the muscles into separate bags or compartments, allowing each muscle to slide over the next unhindered. However, fascia can become dysfunctional, and this is thought to impact how muscles then slide over each other. In essence, parts of the fascia are thought to become sticky, and this stickiness then affects other tissues, movement and may even explain Myofascial pain symptoms. There are various ideas as to why fascia can become dysfunctional, including postural related (muscular fatigue), lack of hydration, specific medical conditions, trauma, diet, activity levels and age. Tom Myers (the anatomist) has noted that the fascial lines that he has identified perform different supportive functions and that dysfunction in one area can impact other areas.
The Kinetic Chain and Fascia
The kinetic chain theory proposes that various segments of the body have a direct impact on other neighbouring ones. Typically, the body is divided up into sections which consist of joints and other structures such as; ankles, knees, hips, lumbar spine, thoracic spine and cervical spine. These segments or sections form a "kinetic chain" when one moves. If all parts of the chain are operating correctly or normally, then one tends not to experience pain, discomfort or restricted mobility. If tissues, joints or other structures are not functioning correctly, this can affect how a specific segment moves. Logically, if one section is not working correctly, it would soon lead to other areas in the kinetic chain also encountering problems. However, the body is extremely good at adapting (see adaption article) to avoid pain, and so it may take a while to notice changes to the kinetic chain. The supportive fascial lines identified by Tom Myers (the anatomist) are also thought to have a major impact on the “kinetic chain”. Biomechanically, the “kinetic chain” concept makes a great deal of sense and dysfunction in one area of the “kinetic chain” can affect both sides of the body and not just (higher) or (lower) than the affected segment side. A more encompassing way to view the human body is through compressive and tensile forces and Biotensegrity (see the article on Biotensegrity for further details).
Does releasing muscle and fascial tissue Work?
Although there is some fascinating research relating to the roles that fascia plays within the human body, there is far less conclusive research concerning the efficacy of MFR. Much of the research behind the roles of fascia stems from anatomists and under the umbrella of medicine. As with any research, research costs time and money and requires funding. Most Allied Health Professionals are required to complete a research component as part of their higher education qualifications, though this research tends to be profession-specific. Some musculoskeletal professionals such as Chiropractors, Osteopaths and Physiotherapists learn many styles of soft-tissue therapy. Allied health professionals may or may not learn Myofascial therapies as part of their higher education training. That said, some such professionals will undertake further training in Myofascial techniques during or post-qualifying in their chosen profession. However, just because MFR techniques may not have conclusive research regarding the efficacy of such techniques does not mean they do not work. Clinical judgement based on training, education, accumulated clinical experience and research covering related areas is all highly relevant. Our principal Musculoskeletal therapist has been using may different myofascial techniques for well over a decade and found them to be extremely effective. He has also found that it is possible to produce fast and sometimes profound and long-lasting results for consumers. As an ex-veteran and somebody who has and continues to be extremely active, our principal became interested in MFR as a means of treating some historic injuries he had and which were not being resolved by a general medicine. The process involved a lot of self-experimentation and additional training in a multitude of methods.
What are the benefits of MFR?
There are many myofascial styles which can effectively release tissues in slightly different ways. Knowing when to apply or not to apply a specific method will be dependent 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 consumers. One of the best aspects of myofascial treatments is the ability to be 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 at the time of treatment, but not later while performing normal activities. Unlike normal prescriptive exercises (stretches), many myofascial techniques aim to treat virtually the entirety of the tissues or structures, suspected of causing the consumer's/patient's symptoms.
Myofascial Release techniques
There are many methods for assessing, treating and performing myofascial therapy. Treatments aim to treat myofascial pain and dysfunctional tissues, including fascia, muscles, tendons and ligaments. Treatment may also use a style that works in a "static" or "dynamic" way. Typically, "static" releases would involve the practitioner assessing and treating tissues with the consumer/patient staying still "static". Dynamically, applied releases would involve the consumer/patient moving the tissues being assessed/treated, with or without the therapist applying a technique with movement. Therapists can also treat tissues in either weight-bearing or non-weight-bearing positions. Myofascial therapy techniques can be used to treat a vast area of muscles and tissues, provided the practitioner has excellent physiological and anatomical knowledge. Some therapy techniques have patented protocols or are registered trademarks, such as Active Release Technique (ART) ®. Soft Tissue Release (STR) is also another and yet a very different method of myofascial treatment. Some versions use specially shaped tools to replace a therapists hand, forearm etc. Many of the methods which use shaped myofascial release tools are often referred to as Instrument Assisted Soft Tissue Mobilisation (IASTM) these days. Again there are patented and trademarked versions of such methods including, Graston Technique ®. That said, just because something is trademarked or patented does not necessarily mean that it is better than other treatment methods. Foam rolling is another form of Myofascial treatment. Muscle Energy Technique (MET) and variants of this are also forms of releasing myofascia and tend to be used in specific circumstances. Another very useful method or protocol is that of Positional Release Technique (PRT) and when used correctly can prove highly effective at reducing Myofascial pain and spasms. Some soft-tissue release treatments specifically aim to treat focal points of pain within tissues or trigger points. Techniques such as, Acupressure, Neuromuscular Technique (NMT) and trigger point therapy work with myofascial trigger points (MTrP). That said, cupping and acupuncture may, too, depending on how the practitioner uses the techniques. A more invasive and precise technique for treating myofascial pain is Myofascial Dry Needling (DN), though some consumers may not like the idea of needling. A good practitioner should have training, knowledge and experience in various techniques and know-how and in what circumstances to apply each technique. Hence, if a technique is not suitable for a consumer/patient, the practitioner can still facilitate the consumer's/patient's treatment goals using other techniques.
Self-Myofascial Release (SMR)
There are many types of soft-tissue release techniques, and part of the skill of a good therapist is knowing when it is "safe" and appropriate to use each particular method. Equally, there are many self-myofascial release (SMR) tools on the market. However, it would appear that some people demonstrating the use of such devices have extremely questionable anatomy, physiology and technique understanding. Some tools can be used fairly effectively for forms of Neuromuscular Technique (NMT) and Trigger Point Therapy (Massage balls, squash balls), (see the article on Self Trigger Point Therapy (TPT) and Massage Balls). Others can prove useful for petrissage type release techniques (foam roller and massage sticks). Equally, with the correct knowledge, it is possible to use a spiky myofascial release ball in a self soft tissue release (STR) context (see the article Self-Myofascial Release (SMR) for legs - not just runners). These techniques all work differently and can work well when applied in the correct situation and when tissues are in a suitable state to use the method. However, there is not a "one tool fits all" and regardless of what people think one cannot effectively treat the entire body with these tools. Tissues under treatment in a self-treatment context tend not to be in a relaxed state. Self-treatment also frequently involves contorting one's body to access tissues, and this creates changes in biotensegrity. Such changes in a self-treatment context affect the ability to apply techniques correctly and the state of the tissues under treatment. The internet is full of videos of people supposedly foam rolling all kinds of muscles. The article on Self-Myofascial Release (SMR) using Foam Roller provides some useful pointers. It can be easy to bruise muscles or make symptoms far worse by attempting to use the wrong technique in the wrong circumstances. Self-maintenance is still advisable, but it is just essential to understand the limitations of the tools, techniques and treatment in a self context. Even therapists need outside treatment help. The link provides further details on self-myofascial release (SMR) techniques, tools and limitations.
Massage and Myotherapy Registrations
Terry brings over 15 years of experience working in the MSK field back to Australia from the UK. He also has training in a wide array of techniques and currently works as a Myotherapist. His main areas of interest relate to trauma and myofascial pain relief. He has also taught as a senior course coach on one of the first myotherapy courses in Brisbane.