Myofascial mobilization for pain relief

 

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Myofascial Release Therapy

Myofascial Release is one of the terms used to describe a manual therapy used to mobilize a type of connective tissue, called fascia, that has become immobile due to excessive collagen formation and adhesion.  Fascial contracture and adhesion is one of the main causes of joint pain, disc problems, and nerve impingement and other pain syndromes.   At the beginning of a session, I start with a palpation evaluation, to locate and assess soft tissue that has become harder, denser, more rigid and fixed than the surrounding tissue, and mobilizing it through direct manual pressure with traction, in a specific direction.   While the treatment is not quite pleasant and relaxing, like a relaxation massage, it can provide lasting relief from chronic pain and immobility, which a relaxation massage generally does not.   

 

Unlike relaxation massage, myofascial release can only be applied if there is a fascial adhesion or contracture present that would benefit from this type of treatment.   It is quite easy to assess or evaluate a body to determine if there are fascial contractures or adhesions through a palpation assessment.   If I don't find any fascial contractures or adhesions, there is no point in scheduling any further appointments, and I will make a recommendation for PT or other therapy. 

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What is Fascia?

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A fascia is a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs. 

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The fascial system consists of the the three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissues that permeate the body.  The fascial system interpenetrates and surrounds all organs, muscles, bones and nerve fibers, endowing the body with a functional structure, and providing an environment that enables all body systems to operate in an integrated manner.     (Adstrum, Hedley, Schliep, Stecco & Yucesoy, 2017)

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Fascia is a term used to describe the connective tissue that is the underlying substrate for all the other tissues of the human body.   Fascia forms first in the developing embryo, and bones and muscles form and develop as structures within the fascia.  Fascia is composed primarily of collagen fibers, with some nerve tissue, and in a few areas of the body, immune system cells called macrophages.  It can vary widely in density and tensile strength in different areas of the body.   

 

Fascia serves a number of functions, including supporting the alignment of the skeletal structure, providing a slippery film between all of the various muscle groups.  As a whole, the fascial system is a sensory organ providing the brain with proprioceptive intelligence.  

 

Proprioception includes our position in space relative to gravity, our various body parts relative alignment with each other, as well as the sensing of stretch and load bearing.  When our proprioceptive intelligence is working properly, we are more graceful, with a greater sense of balance and stability. 

 

There are certain fascial structures that have been named: 

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Periosteum is the fascial wrapping of the bones, and is the tissue that tendons attach to.   

A retinaculum is a lateral band of fascia that wraps around the outside of tendons above and below a joint, and serves to hold tendons in place and to give muscles and tendons much more power in contraction and movement.  

The mesentery is a fascial organ in the abdomen that interfaces with the small and large intestine and contains macrophages.  This organ is still a mystery as to its exact function. 

Myofascial refers to the fascia that surround individual muscle fiber bundles, as well as the fascial membranes that divide muscle groups.  

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It's also useful to think of fascia as "rigging":  bands, straps, sheaths, membranes, wrappings, etc.

 

 

What is Collagen?

Collagen is a fibrous protein, is the strongest tissue (highest tensile strength) in the body, and is also highly adhesive.  Hide glue, an adhesive used in most stringed instruments such as violins, cellos, guitars, and pianos, etc. is made from the collagen of rendered livestock.   

 

Our body uses collagen where tensile strength is needed, such as tendons, ligaments, bones, muscles and connective tissue. Our body also uses collagen as a stop-gap measure where there is mechanical stress or injury, or where more support is needed.   Scar tissue is one example of this feature of collagen, where the collagen fibers knit together and bind the area, holding the tissue together while the body heals.

 

Collagen production

Fibroblasts are the cells that produce collagen.  When any soft tissue area of our body is under stress or strain, the fibroblasts may be stimulated into collagen production.   The resulting contracture, adhesion, or immobility can trap or impinge nerves, causing pain and other symptoms.

 

Fibroblast activity in the human body varies widely along a spectrum, and it's causes are not very well studied or understood at this point.   At the underactive end, there are syndromes such as Ehlers-Danlose syndrome where the body doesn’t produce enough collagen to maintain joint stability.  At the overactive end of the Fibroblast spectrum, the fibroblasts over-react to repetitive use injury, compensation injury, muscle strain injury, impact injury, and everyday postural or occupational stresses.  At this end of the spectrum, the symptoms include osteoarthritis, degenerative joint disease, chronic pain syndromes, neuralgia, inflammation, immobility, herniated or ruptured disks, and other musculoskeletal pain syndromes and dysfunctions.

 

 

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