|Manipulative and body-based methods - edit|
|Some or all of this article's listed sources may not be reliable. (January 2014)|
Myofascial release (or MFR) is a soft tissue therapy for the treatment of skeletal muscle immobility and pain. This alternative medicine therapy aims to relax contracted muscles, improve blood and lymphatic circulation, and stimulate the stretch reflex in muscles.
Fascia is a thin, tough, elastic type of connective tissue that wraps most structures within the human body, including muscle. Fascia supports and protects these structures. 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 use of myofascial release as a treatment is not supported by good evidence, and using it as a replacement for conventional treatment risks causing harm.
Background and terminology
The approach was first described by osteopath Andrew Taylor Still and his early students. 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. The exact phrase "myofascial release" was coined in the 1960s by Robert Ward, an osteopath who studied with Ida Rolf, the originator of Rolfing. Ward, along with physical therapist John Barnes, are considered the two primary founders of Myofascial Release.  Some practitioners use the term "myofascial therapy" or "myofascial trigger point therapy" referring to the treatment of trigger points. 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, and strain-counterstrain techniques. Myofascial techniques can be described as passive (patient stays completely relaxed) or active (patient provides resistance as necessary), with direct and indirect techniques used in each.
The American Cancer Society state that "There is little scientific evidence available to support proponents' claims that myofascial release relieves pain or restores flexibility" and caution against using it as a substitute for conventional treatment.
In 2011, the UK Advertising Standards Authority received a complaint regarding the effectiveness claims published in an advertising leaflet produced by the Myofascial Release UK health care service. In response to the complaint, the ASA ruled that materials presented by Myofascial Release UK in support of the claims made in their ad were inadequate to establish a "body of robust scientific evidence" to substantiate Myofascial Release UK's range of claims. In addition, the ASA determined that the ad breached advertising rules by introducing a risk that readers might be discouraged from seeking other essential medical treatments.
Direct myofascial release
The direct myofascial release method claims to engage the myofascial tissue "restrictive barrier" (tension). The tissue is loaded with a constant force until "release" occurs. Direct release is sometimes called "deep tissue work", a misnomer as some of the important tissues are quite superficial. Practitioners use knuckles, elbows, or other tools to slowly stretch the 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 deeper 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 1940s, a holistic system of connective tissue manipulation and movement education, with the goal of balancing the body. She proposed that she could improve a patient's body posture and movement by bringing the myofascial system toward its optimal pattern. Since Rolf's death in 1979, over a dozen structural integration schools have split off from Rolfing with minor variations on the theme from her original teachings. Rolf's schools maintain that their lineage is distinct from the massage profession, but myofascial release and the larger massage profession have been significantly influenced by her ideas and methods.
Michael Stanborough borrows principles from Rolfing which can be applied for direct myofascial release technique:
- 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.
Indirect myofascial release
The indirect method involves a gentle stretch, with only a few grams of pressure, which is said to allow the fascia to "unwind" itself, guiding the dysfunctional tissue "along the path of least resistance until free movement is achieved."
Carol Manheim summarized the assumptions underlying the practice 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 through an unknown mechanism.
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.
- Spinaris T, DiGiovanna EL (2005). Chapter 12: Myofascial release. An Osteopathic Approach to Diagnosis and Treatment (3rd ed.) (Lippincott Williams & Wilkins). pp. 80–82. ISBN 978-0-7817-4293-1.
- Ades TB, ed. (2009). "Myofascial release". American Cancer Society Complete Guide to Complementary and Alternative Cancer Therapies (2nd ed.). American Cancer Society. pp. 226–228. ISBN 978-0-944235-71-3.
- "Glossary of Osteopathic Terminology". American Association of Colleges of Osteopathic Medicine. April 2009. p. 28. Retrieved 25 August 2012.
- Travell, Janet G.; Simons, David G. (1992). Myofascial Pain and Dysfunction: The Trigger Point Manual. Lippincott Williams & Wilkins. ISBN 978-0-683-08367-5.
- Stillerman, Elaine (2009). Modalities for Massage and Bodywork. Mosby. pp. 151–2. ISBN 0-323-05255-X.
- Knaster, Mirka (1996). Discovering the Body's Wisdom: A Comprehensive Guide to More Than Fifty Mind-Body Practices. Bantam. p. 208. ISBN 978-0-307-57550-0.
- "ASA Adjudication on Myofascial Release UK – Advertising Standards Authority". Asa.org.uk. 2011-03-16. Retrieved 2015-04-21.
- Myers, Thomas W. (2004). "Structural integration -- Developments in Ida Rolf's 'Recipe'-- I". Journal of Bodywork and Movement Therapies 8 (2): 131–42. doi:10.1016/S1360-8592(03)00088-3.
- Claire, Thomas (1995). Bodywork: What Type of Massage to Get and How to Make the Most of It. William Morrow and Co. p. 308. ISBN 978-1-59120-232-5.
- Stanborough, Michael (2004). Direct Release Myofascial Technique: An Illustrated Guide for Practitioners. Edinburgh: Churchill Livingstone. ISBN 978-0-443-07390-8.
- Manheim, Carol J. (2008). The Myofascial Release Manual (4th ed.). Thorofare, NJ: Slack. ISBN 978-1-55642-835-7.
- Barnes, John F. (1990). Myofascial Release: The Search for Excellence. Rehabilitation Services. ISBN 978-1-929894-00-0.