Getting a Grip

Pain Points

Myofascial release (MFR) is a manual therapy that involves the usage of intense pressure, long duration stretches to the myofascial complex, intended to revive optimal length, decrease pain, and improve function. Postural muscles demand more oxygen to supply sustainability of bodily functions whilst phasic muscles prefer burning glucose for fuel. When tension, trauma and poor body mechanics reduce the amount of oxygen to the postural muscles they fatigue and the gravitational load shifts to the phasic musculature. Phasic muscles have a greater number of fast twitch fibres and do not respond well to prolonged overloading and begin to shift the load back to the already exhausted postural muscles.

The fascial network around the muscles is then recruited to support creating a splinting effect cascading an insidious ‘creep’ throughout the entire network affecting every other cell in the body. Injured muscle cells break down causing a release of calcium and histamines. Calcium normally reacts with adenosine triphosphate (ATP) to produce muscle contraction promoting energy, however in already constricted tissue this combination further creates painful contraction and muscular spasm.

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Myofascial Release may be a relatively new addition to the armamentarium of the physiotherapist. As it is somewhat different from traditional physical therapy, many individuals suffering from it ask questions such as “What is it?” and “How does it work?”. Herein experts and therapists talk of the Massage-myofascial release therapy, that reduces the sensitivity to pain at tender points in patients with fibromyalgia, improving their pain perception. Release of fascial restrictions in such patients also reduces anxiety levels and improves sleep quality, physical function, and physical role. Massage-myofascial program can be considered as an alternative and complementary therapy that can achieve transient improvements in the symptoms of these patients.

Fascia

Also known as the connective tissue, fascia is a tissue system of the body to which relatively little attention has been given in the past. Fascia is composed of two types of fibers:

a) Collagenous fibers which are very tough and have little stretchability.

b) Elastic fibers which are stretchable.

From the functional point of view, the body fascia could also be considered as an endless laminated sheet of tissue that extends without interruption from the highest of the top to the tip of the toes. It surrounds and invades every other tissue and organ of the body, including nerves, vessels, muscle and bone. Fascia is more dense in some areas than others.

Anatomy

The majority of the fascia of the body is oriented vertically. There are, however, four major planes of fascia within the body that are oriented in additional of a crosswise (or transverse) plane. These four transverse planes are extremely dense. They are called the pelvic diaphragm, respiratory diaphragm, thoracic inlet and cranial base. Frequently, all four of those transverse planes will become restricted when fascial adhesions occur about any part of the body. This is because this fascia of the body is all interconnected, and a restriction in one region can theoretically put a “drag” on the fascia in the other direction.

Treatment

According to leading scientific experts and doctors, the current evidence on myofascial release therapy is not sufficient to warrant the treatment in chronic musculoskeletal pain. But the point of all the above information is to assist you understand that in myofascial release treatments, you’ll be treated in areas that you simply might not think are related to your condition. Experts and trained therapist’s have a radical understanding of the fascial system and can “release” the fascia in areas that they know have a robust “drag” on your area of injury. This is, therefore, an entire body approach toward the treatment. A good example for this is the chronic low back pain in an individual; although the low back is primarily involved, the individiual may also have significant discomfort in the neck. This is due to the gradual tightening of the muscles and particularly of the fascia, as this tightness has crept its stronghold, eventually creating neck and head pain. Research shows that optimal resolution of the low back pain requires release of the fascia of both the top and neck; if the neck tightness isn’t also released it will still apply a “drag” within the downward direction until fascial restriction and pain has again returned to the low back.

Muscle provides the best bulk of our body’s soft tissue. As all muscle is enveloped by and ingrained with fascia, myofascial release is the term that has been given to the techniques that relieve soft tissue from the abnormal grip of tight fascia (“myo” means “Muscle”).

The type of myofascial release technique chosen by the therapist will depend on where in your body the therapist finds the fascia restricted. If it’s restricted through the neck to the arm, he/she may apply a really gentle traction to the arm, very slowly moving the arm through range as restrictions are released. If it’s restricted within the back (more superficial than deep) he/she may apply a really gentle stretch on the skin across the rear , with the utilisation of two hands. If the thoracic inlet, deep transverse fascia is suspected of being restricted, the therapist may place one hand on the upper back and one over the collarbone area in front and apply extremely gentle pressure.

A key to the success of myofascial release treatments is to maintain the pressure and stretch extremely mild. Muscle tissue responds to a comparatively firm stretch, but this is often not the case with fascia. Remember the collagenous fibers of fascia are extremely tough and immune to stretch. In fact, it’s estimated that fascia features a lastingness of the maximum amount as 2000 pounds per sq in . (No wonder when it tightens, it can cause pain.)

However, it has been shown that under a small amount of pressure (applied by a therapist’s hands) fascia will soften and begin to release when the pressure is sustained over time. This can be likened to pulling on a bit of taffy with only a little, sustained pressure.

Another important aspect of myofascial release techniques is holding the technique long enough. The therapeutic affect will require one to change their pressure positioning after holding a mild stretch and following the tissue three dimensionally with skilled, sensitive hands.

Myofascial Release is gentle, but it has profound effects upon the body tissues. Do not let the gentleness deceive you. You may leave after the first treatment feeling like nothing happened. Later (even a day later) you may begin to feel the effects of the treatment.

In general, acute cases will resolve with a few treatments. The longer the problem has been present, generally the longer it will take to resolve the problem. Many chronic conditions (that have developed over a period of years) may require three to four months of treatments three times per week to obtain optimal results. Experience indicates that fewer than two treatments per week will often result in fascial tightness creeping back to the level prior to the last treatment. Range of motion and stretching exercise given to you will, however, keep this regression between treatments minimal.

Frequently there is increased pain for several hours to a day after treatment, followed by remarkable improvement. Often remarkable improvement is noted immediately during or after a treatment. Sometimes new pains in new areas will be experienced. There is sometimes a feeling of lightheadedness or nausea. Sometimes a patient experiences a temporary emotion change. All of these are normal reactions of the body to the profound, but positive, changes that have occurred by releasing fascial restrictions.

It is felt that release of tight tissue is accompanied by release of trapped metabolic waste products in the surrounding tissue and blood stream. We highly recommend that you “flush your system” by drinking a lot of fluid during the course of your treatments, so that reactions like nausea and lightheadedness will remain minimal or nil. At the same point of time medications such as non-steroidal anti-inflammatories, acetaminophen or opioids may be used to treat myofascial pain. Medications for sleep, depression or muscle spasm are sometimes used, as well. Non-drug treatments may include: Physical therapy, to help reduce micro-cramps also known as trigger points, and offer some potential for relief.

From the February 2020 issue of FHM India.