Myofascial Release

Massage Technique of the Week

• Direct Fascial Techniques:

  • Techniques include:

    • Skin Rolling

    • Cross Hand Fascial Stretch

    • Fascial Spreading/Shearing

    • Cutting Techniques

    • Fascial Torquing

Myofascial Release

• Definition:

  • A technique combining non-gliding fascial traction with orthopedic stretch to provide moderate, sustained tension.

  • Results in viscoelastic lengthening, known as "creep."

• Types of MFR:

  • Direct MFR: Applies force towards and through primary tissue restriction.

  • Indirect MFR: Applies force away from fascial barrier.

• Evidence:

  • Stimulates neuroreceptors in skin, fascia, and muscle.

  • Common uses include treating soft tissue contracture, scar tissue, fascial restriction, and pain reduction.

• Application:

  • Position muscles neutrally/slack.

  • Apply technique slowly and wait for release.

  • Aim for decreasing patient discomfort with each application.

  • Clear the area with flushing techniques (deep stroking, effleurage).

Outcomes and Evidence

• Myofascial release impacts physiological and psychological states.

• It effectively addresses chronic fascial shortening causing limited joint range and movement ease, applicable to conditions like:

  • Kyphosis, lordosis, scoliosis, elevated shoulders, anterior head posture, chronic traumas, compartment syndromes, and circulatory/neurologic compression syndromes (e.g., thoracic outlet syndrome).

• Contributes to improved alignment, muscle function, movement quality and quantity, and pain reduction, notably alleviating trigger points and stress effects.

Mechanisms of Action

• Mechanical Effects:

  • Sustained tension on fascia causes minor ruptures in collagen molecules and rebalances tension in the myofascial network.

• May alter autonomic nervous system function and increase relaxation, though mechanisms are not wholly understood.

Connective Tissue Response to Stretching Forces

• Definitions:

  • Tension: Forces that lengthen structures.

  • Elastic Behavior: Resembles a spring; stretch disappears after force is released.

  • Viscous/Plastic Behavior: Resembles putty; stretch remains post-force release.

  • Viscoelastic Behavior: Mixed elastic and viscous properties; tissue retains some length after release.

• Creep:

  • Lengthening of connective tissue from sustained tension.

• Technique:

  • Prolonged low-intensity forces are ideal for permanently lengthening structures without compromising integrity.

  • Skin rolling improves motion range through greater force application to deepen layers.

Connective Tissue Response to Immobilization

• Biochemical Changes from Immobilization:

  • Decreased hyaluronic acid concentration, water bonding, and water content.

  • Collagen fibers approximate and cross-link increases, leading to stiffness and mobility restrictions.

  • Properly applied stress during healing can enhance hydration and collagen deposition in tissue recovery.

Cautions and Contraindications

• Contraindications for myofascial release include:

  • Malignancy, cellulitis, fever, infections, acute circulatory conditions, osteoporosis, anticoagulant therapy, and more.

  • Caution needed in areas of paralysis, lax or unstable joints.

Direct Fascial Techniques

• Definition:

  • Slow gliding technique applying moderate, sustained tension yielding palpable viscoelastic lengthening.

  • Engages soft tissue barrier; pain usually described as burning or pinching.

• Application:

  • Pressure engages tissue appropriately; hold stretch to break fiber bonds; results in tissue softening.

Components of Direct Fascial Technique

• Contact Methods:

  • Fingers, knuckles, fist, elbows engaged with varying pressure.

• Technique Details:

  • Direction of force varies, with slow application recommended (5-15 cm/s).

  • Combine with stripping and myofascial release for enhanced effects.

• Technique Context:

  • Used alone or prior to myofascial release, with broad-contact petrissage advised for inexperienced therapists.

Skin Rolling Technique

• Definition:

  • Gliding stroke that lifts and rolls tissues over the underlying layers, categorized under petrissage but fundamentally distinct.

• Mechanism of Action:

  • Applies tension to connective tissue, producing viscoelastic stretch and potentially deeper layer benefits.

Cautions and Contraindications for Skin Rolling

• Avoid in acute inflammation areas, around unstable joints, or in fragile skin cases.

• Can introduce pain; therapists must assess client tolerance.

Mobilizing Chronic-Stage Scars

• Skin rolling is the initial technique for chronic scar mobilization, effective when combined with direct fascial techniques and myofascial release.

• Teach self-skin rolling to clients for accessible areas.

Additional Techniques Mentioned

• Cross Hand Fascial Stretch - Forearms held parallel, engage tissue to decrease slack; no oil used.

• Fascial Spreading/Shearing - Fingertips move apart, engaging the required depth.

• Cutting Techniques - Cutting motion through tissues, deepening the strokes progressively.

• Fascial Torquing - Engaging tissue through twisting to maximize treatment effects.

Muscle Stripping

• Definition:

  • Gliding technique applied from one muscle attachment to another, effective on trigger points and chronic muscle tension.

• Techniques and Effects:

  • Increases blood flow and reduces restrictions and pain; uses thumb pressure and body weight for effectiveness.

Summary of Contraindications for Modalities**

• Includes conditions like hemophilia, acute inflammation, potential thrombus, and early wound healing stages.