27 years experience with chronic pain relief.
Frequently asked questions and answers:
What is causing my pain?
Muscle, nerve and joint pain is usually caused from impingement or entrapment of a nerve. Nerve entrapment can be driven by various factors - a common one being postural / structural imbalance and the resulting mechanical compensation issues ( ie., loss of vertical axis, such as the common "forward head posture"). Stress, repetitive use, and injury are some of the other factors that can be involved in structural pain and nerve irritation. Pain is often "referred", meaning that the source of the pain is not limited to the place where the client is feeling the pain, and is often the result of a systemic imbalance. Sometimes, in order to completely resolve the pain, the entire system needs to be brought back into alignment and balance. This is why the localized surgery for carpal tunnel does not often result in long-term relief, and why a localized cortisone shot also does not often result in a permanent relief.
What is fascia?
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together like plastic sandwich wraps. It consists of several layers: a superficial fascia, a deep fascia, and a subserous (or visceral) fascia and extends uninterrupted from the head to the tip of the toes.
Like ligaments, aponeuroses, and tendons, fasciae are dense regular connective tissues, containing closely packed bundles of collagen fibers oriented in a wavy pattern parallel to the direction of pull. Fasciae are consequently flexible structures able to resist great unidirectional tension forces until the wavy pattern of fibers has been straightened out by the pulling force. These collagen fibers are produced by the fibroblasts located within the fascia.
Fascia is thin, but very fibrous and strong. Anyone who has trimmed meat has encountered fascia, the whitish colored thin sheets of tissue between the skin and muscle of the meat. Fascia forms directly under the skin and serves as a strong layer of connective tissue between the skin and muscles underneath it. Gristle is what we call a build up of collagen fiber in a cut of meat.
The top layer of fascia is superficial fascia, which may be mixed with varying amounts of fat, depending on where it is on the body. The skull and hands have a particularly noticeable layer of superficial fascia which connects the skin to the tissues and bone underneath it. By wriggling your scalp, you can see that superficial fascia is strong but flexible, keeping the skin firmly anchored while allowing its owner to move freely.
Underneath the superficial fascia lies deep fascia, a much more densely packed and strong layer of fascia. Deep fascia covers the muscles in connective tissue aggregations which help to keep the muscles divided and protected. On occasion, this fascia can create tight knots or connective adhesions which act as trigger points which can cause pain. A variety of treatments including myofascial release and stretching are used to treat this condition, which can be debilitating and extremely painful. If a patient is diagnosed with a condition like myofascial pain syndrome, it may be useful to know that the term myofascial means “fascia related to the muscles,” and that these conditions do not necessarily involve the superficial and subserous fascia.
In my own words:
Fascia is a type of connective tissue that forms a matrix or web throughout the body. It has 2 primary functions. #1. Connecting, containing, relating and supporting all of the various "parts and structures" of the body -- muscles, bones, and organs. #2. It provides a "lubricating layer" between the muscles, preventing friction during movement.
The fibers that make up fascia are hollow tubes of collagen, that contain cerebrospinal fluid inside. It is the only tissue of the body where the fibers run in all directions, making it the strongest tissue of the body, even stronger than bone. Chronic tension in the soft tissue can pull bones out of alignment, and can even change the shape of bones over time! (see bone spurs below) The denser, deeper, longer, more continuous bands of fascia in our body act as structural supports that hold our skeletal structure in alignment through a state of balanced tension. Fascia contains 10 times more nerve endings than muscle, and as a "sensory organ", it relays information to our brain about our position relative to gravity, the relative alignment of our body parts with each other, our movement through space, as well as load and stretch sensations.
What is a fascial adhesion or contracture? Fascial adhesions (often referred to as "knots") form in response to chronic tension, repetitive use injuries, and various other factors. When a muscle is strained, injured or overworked, cells called fibroblasts begin to build denser layers of connective tissue in and around the muscle, to help support the muscle. They can also “bind” the fascial layers down to other surrounding tissue, creating an area that is dense, contracted and immobile. Often this leads to inflammation (-itis) and loss of joint mobility. When a muscle is at rest, the soft tissue should be completely soft, and movable in all directions. When a muscle feels hard, dense and immobile, that is an indication of fascial adhesions or contractures.
What is myofascial release? MFR is a manual therapy that focuses on releasing constrictions and adhesions in a specific type of tissue, called fascia. Often, if the client has pain that is difficult to locate or palpate, then the problem may be with restrictions or adhesions in the fascia. Manually releasing or "mobilizing" the fascia requires getting a grip on the restricted tissue with both hands, and pulling and twisting in various directions. Sometimes the restriction is a large "sheet" of fascia, other times it may be a tiny "band" or "chord". The sensation that accompanies the release of this tissue varies from pleasant stretch to a mild "burning" sensation.
How can myofascial release resolve chronic pain? MFR releases the nerve compression caused by stress, postural compensation, and repetitive use injury by manually releasing the restriction in the fascia, and restoring mobility and circulation in the process.
Which pain syndromes can be treated successfully with MFR?
Here is a partial list of pain syndromes that I have treated successfully using MFR:
plantar fasciitis tension and sinus headache low back pain sciatica carpal tunnel syndrome
thoracic outlet syndrome frozen shoulder neck and shoulder pain
hip, knee or ankle pain TMD / TMJ disorder bursitis pinched nerve fibromyalgia
osteoarthritis pain tennis elbow (lateral or medial epicondylitis) tendonitis costo chondritis
pain syndromes associated with scoliosis, lordosis, and kyphosis sports injuries
injuries from car accidents and other impact injuries, (ie., whiplash)
I have tried massage before, and while it was relaxing, it did nothing for my pain issues. How would this treatment be different, and why would it be more effective? Most massage therapists focus primarily on relaxation or "spa" massage, where the primary objective is to soothe the nervous system, not to resolve structural problems. My focus is more about working with the structural problems and dysfunction. A relaxation massage feels nice at the time, and provides no noticeable or lasting improvement with chronic pain conditions. When I work on someone, often the therapy is not exactly comforting or soothing at the time, but the client quickly learns to appreciate the effectiveness and immediate and lasting relief. Relaxation massage is characterized by the use of lubrication, and long, slow strokes that focus on the muscles. I tend to focus more on the underlying fascia in and around the joints, and the origins and insertions of muscles, where they attach to the bones. Myofascial release, unlike massage, requires traction in order to release the gluey collagen fibers, so lubrication isn't used until after the problem area has been successfully treated.
Is the treatment painful? There are many different sensations that are part of a typical treatment. what I tell the client is that at no time should they experience a discomfort that causes them to "tense up", that they should always be able to breathe and relax with the sensation. If it is more than they want to feel, then they should tell me to back off or modify my pressure until it is tolerable. The sensations must always be tolerable for the client in order to be effective. Sensations can include mild burning, pleasant stretch, sharp, "prickly" or radiant, etc.
What is bodywork? Bodywork is a term that is often used to indicate an approach that includes many different manual therapies in the treatment of acute and chronic pain issues, and is often used to differentiate between relaxation and rehabilitative therapy.
What is acupressure? Acupressure is an oriental modality, using the same system of meridians as acupuncture. Often, if the pain is very specific, for example, "It hurts when I press here", then Acupressure may be an effective remedy. In the application of acupressure, the practitioner holds one or several "points", with steady pressure or pressure with some movement. The amount of pressure varies from person to person, some people requiring a fairly deep pressure and others barely tolerating any pressure at all. While there may be a "sharp" sensation, the sensation should not be so intense that the client is tensing up or gripping. The pressure is modified according to the needs of the client. Within a minute or two of holding, the tissue should release, and the sensation fades away. If the point does not release within a few minutes, this usually indicates that there are other points elsewhere that need to be released first.
What is yoga? Yoga is a mind-body practice that involves various breathing exercises and observances, with movements, isometric exercises and static positions that release restrictions in the soft tissue and strengthen the muscles all over the body. It brings balance and alignment to the posture, and calms and energizes the nervous system. The proper yoga practice can help to maintain and integrate any progress made with Myofascial release or acupressure.
How can yoga relieve my pain? By releasing tension from the system, relaxing tight muscles, calming the nervous system, which often "grips" when we are in pain. On the other hand, yoga can strengthen and stabilize weaknesses in the structure that lead to compression, and the practice of yoga over time restores balance and postural integrity, and develops healthier body mechanics.
What causes a bone spur? A bone spur is an outgrowth of bone, that often is blamed for chronic pain. Two common areas are in the neck and the heel. The relationship between the spur and fascia is as follows: Bones have a covering of fascia, called periosteum. Other soft tissues attach to the periosteum, and when there is a chronic tension, can actually pull the periosteum away from the surface of the bone. Special bone-building cells called osteoblasts are triggered by the space created, as they build bone according to the boundaries of the periosteum. The osteoblasts fill in the space with new bone growth, and that is the bone spur. By releasing the chronic tension that distorted the periosteum, often the bone spur will over time may shrink back to a smaller size. The releasing of the soft tissue around the spur often immediately relieves the pain.
There are 3 types of assessment I utilize with clients: visual, palpation and range of motion. With visual assessment, I look at the posture for visible misalignment, ie. kyphosis, lordosis, scoliosis, etc. Palpation involves using specific finger pressure, usually at the origin and insertion points of muscles (where a muscle attaches to a bone). I test for pain, as well as density and immobility of the soft tissue.
What to expect post-treatment
If we're working to resolve a chronic pain issue, it is common to experience a day or two of mild, generalized soreness at the site of the deep tissue work. This is most common after the first few sessions and decreases with each successive treatment. Drinking lots of water may help to minimize this effect.
Occasionally, a client may experience post-treatment what's known as a "healing crisis", which may include certain unpleasant symptoms such as headache or cold or flu-like symptoms. This also will pass, and its important to let the therapist know whatever you experience.