Myofascial release is a soft tissue therapy for the treatment of skeletal muscle immobility and pain. First described by Andrew Taylor Still and his early students, the therapy relaxes contracted muscles, improves blood and lymphatic circulation, and stimulates the stretch reflex in muscles.
Background and terminology
Fascia is the soft tissue component of the connective tissue that provides support and protection for most structures within the human body, including muscle. Osteopathic theory proposes that 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 addressed as well, including other connective tissue.
The term myofascial was first used in medical literature by Janet G. Travell in the 1940s in reference to musculoskeletal pain syndromes and trigger points. In 1976, 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, Rolfing, and strain-counterstrain techniques.
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 engages the myofascial tissue "restrictive barrier" (tension). The tissue is loaded with a constant force until 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 is an attempt to bring about changes in the myofascial structures by stretching or elongation of fascia, or mobilizing adhesive tissues. The practitioner moves slowly through the layers of the fascia until the deep tissues are reached.
Robert Ward 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 (German: Bindegewebsmassage) in the 1920s, which involved superficial stretching of the myofascia. Ida Rolf developed structural integration, in the 1950s, a 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 proposed 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 developed her theory and methods.
Rolf reduced her practice to a maxim: "Put the tissue where it should be and then ask for movement."
- 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 style, knowledge, and experience to their work which can have a significant effect on their client's 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 indirect technique originated in osteopathy schools and is also popular in physiotherapy. According to Robert 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.[vague] 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.
- 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 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.
- "Glossary of Osteopathic Terminology". American Association of Colleges of Osteopathic Medicine. April 2009. p. 28. Retrieved 25 August 2012.
- DiGiovanna, Eileen; Stanley Schiowitz, Dennis J. Dowling (2005) . "Myofascial (Soft Tissue) Techniques (Chapter 12)". An Osteopathic Approach to Diagnosis and Treatment (Third ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 80–82.
- Travell, Janet G. (1983). The trigger point manual.
- Stanborough, Michael (2004). Direct release myofascial technique : an illustrated guide for practitioners. Edinburgh: Churchill Livingstone. ISBN 978-0443073908.
- Ward, Robert C. (2002). Foundations for osteopathic medicine (2nd ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 932–968. ISBN 978-0781734974.
- Manheim, Carol J. (2008). The myofascial release manual (4th ed.). Thorofare, New Jersey: Slack. ISBN 978-1556428357.
- Barnes, John F. (1990). Myofascial release : the search for excellence. Rehabilitation Services. ISBN 978-1929894000.
- Cantu, Robert I. & Grodin, Alan J. 2001. Myofascial Manipulation, Theory and Clinical Application, 2nd ed. Aspen Publishers Inc.
- Myers, Tom. 2004. Structural Integration – developments in Ida Rolf's 'Recipe'- 1. Journal of Bodywork and Movement Therapies 8, 131–142.
- Effects of myofascial release after high-intensity exercise: a randomized clinical trial, Journal of Manipulative Physiological Therapy 2008 March 31(3):217–23.
- Tavolacci, Phil. (2013). What's In Your Web?: Stories of Fascial Freedom. ISBN 978-1452576978.