Pinnacle Performance

The physical therapists and massage therapists at Pinnacle Performance will use a variety of myofascial techniques during your treatment session. We find that these techniques are a powerful adjunctive therapy when used in combination with Intelligent Movement and bony manipulative Manual Therapy techniques.

The following information is taken directly from Webster and will provide you with helpful information about the origin, history, and definition of myofascial release. Myofascial release techniques are valuable skills within Manual Therapy.

What is fascia?

Fascia is the soft tissue component of the connective tissue that provides support and protection for most structures within the human body, including muscle. 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 affected as well, including other connective tissue.[2]

As in most tissue, irritation of fascia or muscle causes local inflammation. Chronic inflammation results in fibrosis, or thickening of the connective tissue, and this thickening causes pain and irritation, resulting in reflexive muscle tension that causes more inflammation. In this way, the cycle creates a positive feedback loop and can result in ischemia and somatic dysfunction even in the absence of the original offending agent. Myofascial techniques aim to break this cycle through a variety of methods acting on multiple stages of the cycle. According to John F. Barnes, PT, LMT, NCTMB and his Myofascial Release Approach® (MFR).

Fascia is a specialized system of the body that has an appearance similar to a spider’s web or a sweater. Fascia is very densely woven, covering and interpenetrating every muscle, bone, nerve, artery and vein, as well as, all of our internal organs including the heart, lungs, brain and spinal cord. The most interesting aspect of the fascial system is that it is not just a system of separate coverings. It is actually one continuous structure that exists from head to toe without interruption. In this way you can begin to see that each part of the entire body is connected to every other part by the fascia, like the yarn in a sweater.

Trauma, inflammatory responses, and/or surgical procedures create Myofascial restrictions that can produce tensile pressures of approximately 2,000 pounds per square inch on pain sensitive structures that do not show up in many of the standard tests (x-rays, myelograms, CAT scans, electromyography, etc.) A high percentage of people suffering with pain and/or lack of motion may be having fascial problems, but are not diagnosed.

Origin and history

In medical literature, the term myofascial was historically used by Janet G. Travell, M.D. in the 1940s referring to musculoskeletal pain syndromes and trigger points. In 1976 Dr. Travell began using the term “Myofascial Trigger Point” and in 1983 published the reference “Myofascial Pain & Dysfunction: The Trigger Point Manual”.[3] 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, structural integration and strain-counterstrain techniques. However, in current medical terminology, myofascial release refers mainly to the soft tissue manipulation techniques described below.

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 works through engaging the myofascial tissue restrictive barrier, the tissue is loaded with a constant force until tissue release occurs. Practitioners use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a few killograms-force or tens of newtons. 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.

Robert Ward, D.O. 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 (Bindegewebsmassage) in the 1920s, which involved superficial stretching of the myofascia. Dr. Ida Rolf developed structural integration in the 1950s, an 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 discovered 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 evolved her theory and methods.

Different practitioners bring their own sensibility, style, level of maturity, and awareness to their work with clients which can have a significant effect on the clients 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 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.

The indirect technique originated in osteopathy schools and is also popular in physiotherapy. According to Robert C. 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. Robert 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. It was popularized and taught to physical therapists, massage therapists, occupational therapists and physicians by John F. Barnes, PT, LMT, NCTMB through his Myofascial Release Approach® (MFR) seminar series.