Myofascial Release Technique

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Fascia

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Introduction
 Fascia is tough connective tissue which
spreads throughout the body in a three-
dimensional web from head to toe.
 The fascia is ubiquitous, surrounding every
muscle, bone, nerve, blood vessel and organ
all the way down to the cellular level.
 Generally, the fasciai system provides
support, stability and cushioning.
 It is also a system of locomotion and
dynamic flexibility forming muscle.

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 Tightening of the fascial system is a histologic,
physiologic and biomechanic protective
mechanism that is a response to trauma.
 The fascia loses its pliability, becomes restricted,
and is a source of tension to the rest of the body.
 The ground substance solidifies, the collagen
becomes dense and fibrous, and the elastin loses
its resiliency.
 Over time this can lead to poor muscular
biomechanics, altered structural alignment, and
decreased strength, endurance and motor
coordination.
 Subsequently, the patient is in pain and functional
capacity is lost.

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 What causes
Myofascial restrictions?

 Physical or psychological trauma,

inflammation, poor posture, repetitive
motion and scar tissue can dehydrate the
fluid components of fascia exerting
enormous pressure, up to 2,000 pounds
per square inch on pain sensitive
structures (nerves, blood vessels, muscles,
osseous structures, and or organs) and
inhibiting vital communication in the body.
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 Definition

• The word "myofascial" is derived from the

Greek word "myo", which means "muscle,"
and the word fascial

• Myofascial release is the application of the

gentle manual application of sustained
pressure to release fascial restriction.

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The term Myofascial Release refers to
soft tissue manipulation techniques. It
has been loosely used for different
manual therapy, soft tissue manipulation
work (connective tissue massage, soft
tissue mobilization, Structural
Integration, strain-counterstrain). There
are two main schools of myofascial
release: the direct and indirect method.

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Direct myofascial release

 The direct myofascial release (or deep tissue work)

method works on the restricted fascia. Practitioners
use knuckles, elbows, or other tools to slowly
stretch the restricted fascia by applying a few
kilograms-force.

 Direct myofascial release seeks for changes in the

myofascial structures by stretching, elongation of
fascia, or mobilising adhesive tissues.

 The practitioner moves slowly through the layers of
the fascia until the deep tissues are reached.

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Direct myofascial release
technique as:
 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.

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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 gentle traction applied to the restricted
fascia will result in heat and increased blood
flow in the area.
 This allows the body's inherent ability for self
correction to return, thus eliminating pain and
restoring the optimum performance of the
body.

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The indirect myofascial release
technique:
◦ 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.
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 The principles 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 even though
the exact mechanism is not yet fully understood.

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How Myofascial Release Work?
 The gentle and sustained myofascial release is
believed to supply mechanical and thermal energy
which converts the ground substance into gel state
again which allow facilitation of sliding movement
of collagen and elastin fibers.

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• The gentle and sustained pressure and stretch of
myofascial release is believed to free these adhesions
and soften and lengthen the fascia.

• By freeing up fascia that may cause compression on

blood vessels or nerves, myofascial release is also
said to improve circulation and nervous system
transmission.

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 Basic Steps: An Overview of
Treatment
Gross Stretch of Muscle:
 A gross stretch of an entire body area or an
entire muscle group is always performed first
to release the more superficial tightness and
restrictions and to guide the therapist to the
muscles that need specific attention.
 Any muscle or myofascial unit that allows the
placement of two hands or two fingers can be
stretched to release myofascial tightness or
restrictions.
 One hand or finger acts as the anchor from
which the stretch originates. 15
 The other is used to provide the stretching
force.
 Alternately, body weight can be used as the
tabilizing force, freeing the therapist's hands
to provide the stretching force in two
directions on larger muscle when
perceived restriction is between the two
stretching hands.
 Hand and body placement should be
comfortable for both the therapist and the
patient.

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 For large mucles such as the Erector
Spinae, the Middle Trapezii, or the Quadri
ceps Femoris, better leg rage may be gained
by using crossed hands and a pushing
motion to stretch.
 Whenever possible, a broad surface should
be used to apply the stretching force.
 This surface can be the entire palm, the
ulnar border of the palm, the entir surface
of the thumbs or several fingers held
together

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 Focused Stretch of Any Muscle
 Using one or two fingers of each hand or two
fingers on one hand, stretch a small segment of
muscle to take up the available slack
 The distance between fingers can be as small as
several millimeters or as large as several inches.
Hold, wait for the release and stretch again.
 Repeat this sequence until an end-feel is reached.
Move either one or both fingers to the next section
of the same muscle, and repeat the entire sequence.
 Continue until the entire muscle has been released.
Finish with a gross stretch of the entire muscle.

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 A focused stretch can also be performed using a
vertical stretch.
 Hold all or some fingers tightly together, and apply
pressure vertically down to take up the available
slack.
 Hold, wait for the release and stretch again.
 Repeat this sequence until an end-feel is reached.
 A more finely focused stretch can be performed
using one or two fingers, either held tightly
together or one reinforced by the other
 The release sequence is the same.
 After a vertical focused stretch, repeat the gross
stretch of the entire muscle.

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Effect of Myofascial Release

• Relieve pain
• Restore function
• Increase range of motion
• Improve motor performance
• Restore body equilibrium

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Indications
 Myofascial Release is the treatment of choice in the
following situations:
 1. The patient's pain complaint has not been alleviated
by traditional physical therapy treatment.
 2. The patient has a complex, global, or specific pain
complaint that does not follow dermatomes,
myotomes, or visceral referral patterns.
 3. The patient has an underlying chronic condition
that causes tightness and restrictions in the soft
tissues (e.g., fibromyalgia and post-polio syndrome).
 4. The patient has painful complete postural
symmetries.

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 5. The patient has asymmetrical muscle weakness
due to an acute or chronic peripheral or central
neuropathy.
 6. The patient has impaired respiration and an
inflexible rib cage due to chronic respiratory
disease, central nervous system injury, or faulty
mechanical relationships of the skeletal structure
and the soft tissues.
 7.The patient has frequent headache that are
trigger by varying stimuli
 8. The patient has impaired mouth closure,
swallowing, and phonation resulting in tightness
and restriction of hyoid and the muscle of
mastication

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 9.The patient experience non-labyrinthine
induced vertigo and dizziness secondary
to active facial Trigger Point .
 10. The patient is a competitive athlete or
performer who need subtle stretching to
increase speed or accuracy and to
prevent injury at the extreme rang of
motion.

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 Conditions
 Headaches and migraines
 Trauma - physical/psychological
 Fibromyalgia
 Neck and back pain
 Chronic fatigue syndrome
 Carpal tunnel syndrome
 TMJ syndrome
 Restriction in motion
 Stress and tension
 Scoliosis
 Parkinson’s disease and other neurological disorders
 Post-surgical dysfunction and scar tissue
 Pain in the arms or legs
 Orthopedic problems
 Sports injuries
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contraindication
• Malignancy
• Febrile state
• Acute circulatory condition
• Aneurysm
• Acute rheumatoid arthritis
• Sutures
• Healing fracture
• Osteoporosis or advanced degenerative changes
• Systemic or localized infection
• Open wounds
• Anticoagulant therapy
• Advanced diabetes

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Precautions
 1. Myofascial Release consistently lowers blood
pressure. All patients must rest in a horizontal
position for 10-15 minutes following treatment.
the patient should get up slowly and not get off
the treatment table until any dizziness has
resolved
 2. myofacial release may lower blood sugar levels,
particularly when deep Trigger Point Releases are
performed. Individuals who are diabetic should
check their blood glucose level prior to
treatment.
 Individuals who are prone to hypoglycemia should
have a snack prior to treatment.

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 3. Individuals with healing fractures or wounds may
receive myofascial release to uninvolved areas.
 4. Individuals with compromised circulation may be
treated with MyofasciaL Release to the uninvolved
areas and to the area of compromise while being
closely monitored
 5. The patient is taking medication that increases
blood-clotting times and causes the patient to bruise
easily.
 6.When treating a child or a mentally incompetent
adult, the caregiver or other responsible adult should
always be present. The therapist should carefully
explain the treatment to the chaperon.

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 Pre-Treatment Protocols
 1. Establishing the Therapeutic Environment
• Quiet room
• Approprlate l1ghtl g
• Proper height of equipment
• Minlmal patient clothing
• No extraneous objects
• Position of patient
• Body mechanls of tharapist

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 Technique of Application

 The physical therapist finds the area of tightness.

 A sustained pressure over time is applied to the tight
area.
 The physical therapist waits for the tissue to relax
and then increases the stretch.
 The process is repeated until the area is fully relaxed.
 Then, the next area is treated.

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 Cross hand release
 With relaxed hands, using cross hand technique,
slowly apply gentle pressure and slowly open
your hands to slowly stretch out elastic
component of fascia until reach a barrier.
 At this point, maintain sufficient pressure to hold
the stretch at the barrier and wait a minimum of
2 minutes, usually longer (approximately 3-5
minutes).
 Wait for release to occur and follow along the
direction of ease of tissue, barrier after barrier.

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 2. Testing for Vascular Integrity
 Assess the patient‘s vascular status before
beginning treatment with Myofacial
Release.
 Palpation of arterial pulse.

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Post treatment protocole
1.Drink…drink….drink…
 Following the treatment with MFR the patient should
be instructed to drink beyond his normal intake to
avoid excessive soreness.
 2. Be Kind to Your Hands
 Decompress your finger joints periodically during
each treatment session, following every Trigger Point
and Scar Release and at the end of each treatment
session.
 To decompress your finger joints, firmly grip a finger
proximal to the metacarpophalangeal (MCP) joint
with the thumb and first finger of your other hand.
Maintain a firm grip while slowly stroking the length
of the finger several times

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 Hand muscle fatigue can be relieved in a
variety of ways, including decompression of
the finger joints which also stretches the soft
tissues of the fingers. Periodically shaking
your hand, stretching your palm or
massaging your palm and fingers can reduce
hand fatigue.
 Superficial heat supplied by a paraffin bath or
whirlpool can also be used.
 Self-stretching of individual hand muscles or
gross stretching may be necessary to
maintain muscle balance.
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 Procedures
 The therapist will first ask about the patient’s
complaints
 The therapist closely examine patient first by
inspection of posture as you sit, stand, walk, and lie.
 Then By palpation of neck, chest, pelvis, back, or other
areas will be felt
 The skin is palpated and stretched or moved in all
direction to feel for areas of tightness.
 Using the fingertips, knuckles, heel of the hand, or arm,
the therapist then feels, or "palpates," deeper layers.

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 The stretch may be held for one to two minutes,
and sometimes for up to five minutes, before
"release" is felt (creep). The release indicates that
the muscle is relaxing, or the fascia has been
realigned to its proper orientation.

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• The process is then repeated until the tissues are
fully elongated.
• The patient should feel less pain and move more
easily than you did before.
• Sessions typically last 30 minutes to an hour and
may be given one to three times a week depending
on your condition.

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Cervical muscles release

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Para-spinal muscles release

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Neck muscles release

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Self- Myofacial Release Techniques
using form roller
 It’s important to understanding two key terms in
order to appreciate how self myofascial release
technique acts favourably on the body. They are
’fascia’ and ’trigger points’.

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Fascia & Trigger Points
 Fascia is a specialized connective tissue layer
surrounding muscles, bones and joints and gives
support and protection to the body.
 It consists of three layers - the superficial fascia, the
deep fascia and the subserous fascia.
 Fascia is one of the 3 types of dense connective
tissue (the others being ligaments and tendons)
and it extends without interruption from the top of
the head to the tip of the toes

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 Fascia is usually seen as having a passive role in the
body, transmitting mechanical tension, which is
generated by muscle activity or external forces.
 Recently, however some evidence suggests that
fascia may be able to actively contract in a smooth
muscle-like manner and consequently influence
musculoskeletal dynamics

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 Trigger points have been defined as areas of muscle
that are painful to palpation and are characterized
by the presence of taut bands. Tissue can become
thick, tough and noted.
 They can occur in muscle, the muscle-tendon
junctions, bursa, or fat pad (3). Sometimes, trigger
points can be accompanied by inflammation and if
they remain long enough, what was once healthy
fascia is replaced with inelastic scar tissue.

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 It has been speculated that trigger points may lead
to a variety of sports injuries - from camps to more
serious muscle and tendon tears.
 The theory, which seems plausible, is that trigger
points compromise the tissue structure in which
they are located, placing a greater strain on other
tissues that must compensate for its weakness.
 These in turn can break down and so the spiral
continues.

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 According to many therapists, trigger points in the
fascia can restrict or alter the motion about a joint
resulting in a change of normal neural feedback to
the central nervous system.
 Eventually, the neuromuscular system becomes less
efficient, leading to premature fatigue, chronic pain
and injury and less efficient motor skill
performance.

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 causes includes acute physical trauma, poor
posture or movement mechanics, over training,
inadequate rest between training sessions and
possibly even nutritional factors
 Self myofascial release is a relatively simple
technique that athletes can use to alleviate trigger
points. Studies have shown myofascial release to be
an effective treatment modality for myofascial pain
syndrome (6,7,8), although most studies have
focused on therapist-based rather than self-based
treatment.

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Self Myofascial Release Exercises

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 Adductor Self Myofascial
Release
 1. Extend the thigh and
place foam roll in the groin
region with body prone
(face down) on the floor.

 2. Be cautious when rolling

near the adductor complex
origins at the pelvis.

 3. If a “tender point” is
located, stop rolling, and
rest on the tender point
until pain decreases by
75%.

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 Hamstring Self Myofascial
Release
 1. Place hamstrings on the
roll with hips unsupported.

 2. Feet can be crossed so that

only leg at a time is one the
foam roll.

 3. Roll from knee toward

posterior hip.

 4. If a “tender point” is
located, stop rolling, and rest
on the tender point until pain
decreases by 75%.

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 Quadriceps Slef Myofascial
Release
 1. Body is positioned prone
(face down) with quadriceps
on foam roll
 2. It is very important to
maintain proper core
control (abdominal drawn-in
position & tight gluteus) to
prevent low back
compensations
 3. Roll from pelvic bone to
knee, emphasizing the
lateral (outside) thigh
 4. If a “tender point” is
located, stop rolling, and
rest on the tender point
until pain decreases by 75%.

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 Iliotibial Band Self Myofascial
Release
 1. Position yourself on your side
lying on foam roll.
 2. Bottom leg is raised slightly off
floor.
 3. Maintain head in “neutral”
position with ears aligned with
shoulders.
 4. This may be PAINFUL for many,
and should be done in
moderation.
 5. Roll just below hip joint down
the outside thigh to the knee.
 6. If a “tender point” is located,
stop rolling, and rest on the
tender point until pain decreases
by 75%.

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 Upper Back Self Myofascial
Release
 1. Place hands behind head or
wrap arms around chest to clear
the shoulder blades across the
thoracic wall.

 2. Raise hips until unsupported.

 3. Stabilize the head in a “neutral”

position.

 4. Roll mid-back area on the foam

roll.

 5. If a “tender point” is located,

stop rolling, and rest on the
tender point until pain decreases
by 75%.
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General Guidelines
 Spend 1-2 minutes per self myofascial release
technique and on each each side (when applicable).
 When a trigger point is found (painful area) hold
for 30-45 seconds.
 Keep the abdominal muscles tight which provides
stability to the lumbo-pelvic-hip complex during
rolling.
 Remember to breathe slowly as this will help to
reduce any tense reflexes caused by discomfort.
 Complete the self myofascial release exercises 1-2
ex daily.
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 CONTRAIDICATIONS: Please discontinue exercises
and consult your phycisian if you are experiencing
sharp pains during foam rolling.
 Also consult your doctor if you are pregnant,
healing from fractures or surgery, have been
diagnosed with osteoperosis, rhumatoid arthritis,
varicose veins or other chronic conditions.

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 Review of literature
1. Ratan Khuman et al (2013) conducted study on Comparative Study
of Myofascial Release and Cold Pack in Upper Trapezius Spasm
 Study design: Comparative Cross sectional Study.
Study setting: Outpatient Orthopedic Physiotherapy department.
Outcome Measures: VAS, Pain Pressure Threshold (PPT), ROM
Materials & Method: 45 subjects with upper trapezius spasm were
randomly assigned into 3 groups. Group A (n=15) underwent MFR +
exercises, Group B (n=15) Cold pack + exercises and Group C (n=15)
only exercises once daily for 5 days. The outcome measures were
recorded at baseline and after 5 treatment session.
Results: Post treatment analysis suggests significant difference among
groups (p<0.05). The MFR group shows greater significant
improvement in VAS (p=0.000), PPT (p=0.000) and ROM (p=0.000)
compared to cold pack and only exercises group.
Conclusion: The MFR and Cold pack along with exercises are
effective interventions in upper trapezius muscle spasm. But MFR
shows greater effectiveness as compared with cold pack and exercises
in treatment of upper trapezius spasm.
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2. Anne Walton, BA, RMT et al conducted a study on
Efficacy of myofascial release techniques in the treatment of
primary Raynaud's phenomenon

 Methods: Five treatments were administered over a 3-week

treatment period on a 35-year-old female experiencing
primary Raynaud's phenomenon for the past 12 years. A log
was kept documenting frequency, duration and severity of
pain. The myofascial work targeted the upper back, neck and
arms according to hypothetical fascial meridian lines.

 Conclusions: The results suggest that by releasing

restricted fascia, myofascial techniques may influence the
duration and severity of the vasospastic episodes
experienced in primary Raynaud's phenomenon.

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3. Adelaida Maria castro sanchez et al (2011)
conducted a study on effect of myofacial release
technique on pain, physical functional and
postural stability in a patients with fibromyalgia: a
randomized controlled trial.

Conclusion: Myofacial Release Technique can be a

complementry theerapy for pain sumptoms,
physical function and clinical severity but do not
improve postural stability in patients with
fibromyalgia syndrome.

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References
 1) Scanlon, V.C., and Sanders, T. Essentials of anatomy and
physiology, 3rd edition. Canada: F.A. Davis Company. 2002
 2) Schleip R, Klingler W, Lehmann-Horn F. Active fascial
contractility: Fascia may be able to contract in a smooth
muscle-like manner and thereby influence musculoskeletal
dynamics. Med Hypotheses. 65(2):273-7. 2005
 3) Borg, S. et al. Trigger points and tender points. One and
the same? Does injection treatment help? Rheum. Dis. Clinics
of North America. 22(2). 1996
 4) Vecchiet, L., Giamberardino, M.A., Saggini, R. Myofascial
pain syndromes: clinical and pathophysiological aspects. Clin
J Pain. 7 Suppl 1:S16-22. 1991
 5) Saggini, R., Giamberardino, M.A., Gatteschi, L., Vecchiet,
L. Myofascial pain syndrome of the peroneus longus:
biomechanical approach. Clin J Pain. Mar;12(1):30-7.1996

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