Myofascial Release: An Evolving And Simple Definition

 

Urged on my peers on both sides of the argument, here is an initial version of what I hope becomes a more permanent way to describe the work I use and teach. Comments, suggestions, and criticisms are always welcome (post below). Edits will be made to this post as comments come forward, both here as well as from social media.

Myofascial release (MFR) is one style of manual therapy that uses slow, still, prolonged stretching through clothing or directly on the skin to facilitate change in the patient. Whether having its primary effects on fascia, as historically believed, or on skin, muscle, other tissues, or the nervous system in general, it is realistically a more complex direct and indirect interrelationship of overlapping systems. The goal of MFR is most often to reduce the feeling of tightness and to lessen pain, allowing for more freedom of movement and improvement in functional abilities. While other forms of MFR vary, The Walt Fritz, PT form of MFR relies on direct patient feedback to drive evaluation and treatment, assuring that interventions are patient-specific. (edit 5/13/18)

Myofascial release (MFR) is a style of manual therapy most typically associated with its historical roots, which relied on perceptions that one could label pain and various movement disorders a result of tightness/restriction within the fascia/connective tissue. Most therapists using MFR were taught that they were able to selectively and singularly impact these fascial restrictions to the exclusion of other tissues, with the goal of reducing pain and restoring more normal movement patterns, with any mention of the nervous system added as afterthoughts. While MFR has been a popular and effective form of manual therapy for decades, the claims made by its proponents have yet to be proven, though these issues exist for nearly all forms and brands of manual therapy and massage.

Most brands of MFR, manual therapy, and massage claim that pain/movement problems are due to one specific tissue and make claims to be able to specifically impact that particular problem, all while having remarkably similar styles of engagement as the next type of therapy.

While it may be possible to be able to target one tissue under the skin for intervention, more plausible explanations come from neuroscience-based explanations, as well as the potential impact of contextual factors. These models look at more central mechanisms to explain the local effects of manual therapy, including MFR. Using such principles as neurodynamic technique, where nerve tension is reduced, allowing more freedom of movement and less pain, as well as skin/superficially embedded receptors that can signal the effects of MFR at the local level, with changes in pain/movement problems being an outcome of brain output via the central nervous system. These ideas work from the knowledge that the nervous system is in ultimate control, though in partnership with, the remainder of the soft and bony structures in the body. Though neuroscience-based models also lack full proof, they may be “less wrong” than many of the various other models.

Briefly, MFR has a typical style of engagement that uses slow, still, prolonged stretching to facilitate change in the patient. Whether having its primary effects on skin, fascia, muscle, nerves, or other tissues, its goal is to reduce the feeling of tightness and to lessen pain, allowing for more freedom of movement. I call my work MFR in reference to a very recognizable style of hands-on engagement typically associated with myofascial release, rather than due to thoughts that it is fascia that I am selectively engaging.

With such uncertainty, where does that leave the therapist and consumer? Therapists still treat in the manner they were taught, with hands-on interventions typically very helpful. The best choice may be to keep explanations simple. While it may be the fascia, muscle, joints, knots, trigger points, or a host of other tissues and pathologies are responsible for our problems, we can only work through the skin. Everything else is a stretch (pun intended!).

Pathologizing: Our Words Matter

As a physical therapist trained in the 1980’s, biomechanical explanations for pain and movement disorders were the norm.

As I drifted into a myofascial release manual therapy in the early 1990’s, the biomechanical model was reinforced and made more narrow through the beliefs that pain and movement dysfunction stem from issues of fascial tightness/restriction. All had evidence to support their views, as well as well-presented logical assumptions.

Myofascial suffered from testimonial-type of evidence, which seemed very compelling to a casual scientific observer (me), who was unwilling to question the sources of presented information.

Biomechanical still are well represented throughout the manual therapies, as evident by the daily squabbles regarding the importance, or lack of, with such issues as posture, weakness, and asymmetry when it comes to both pain as well as movement disorders.

This post is not intended to address these issues, but to briefly discuss the language we use when conversing with our patients/clients. 

The Power Of Our Words

Patients pay us to help them.

This help is most often accompanied by the thorough evaluation, after which we proclaim our findings on both what is wrong with them and what should be done to rectify the situation.

We may call this our assessment or diagnosis, depending on the scope of practice allowances and limitations of your profession. Patients expect it and we feel it necessary to give them what they want and deserve, but is it always in their best interest, especially when there is a lack of consensus on the validity of our assessment’s claims?

Biomechanical factors and judgement, such as poor posture being the cause of pain, are popular and logical assumptions which many of our patients believe and you may believe it to be true as well, but is it always true?

While at the computer, I leave my Facebook notifications turned on, which is probably one reason I am so easily distracted. As I was writing this post a notification came in that I will sanitize and post here:

I’m new to this group, but curious as to many issues a (named surgical procedure) could help with. My biggest issues are forward head posture – my (type of) therapist once told me it was the worst she had ever seen – neck/shoulder/upper back tension that my chiropractor gave up on treating because he didn’t understand why he couldn’t fix it, jaw clenching, anxiety, etc). Anyway, does anyone have a recommendation for a practitioner in (certain city)?”

The writer of this post was speaking from genuine self-concern and must have found some solace in her therapist’s statement about the severity of her forward head, but what does she now do with that?

If she is the worst case her health professional has ever seen, it would seem to me that makes it less likely that she can be helped. There is information easily available that casts doubt on the degree of forward head posture and neck pain, but that therapist has planted a seed in the patient’s brain that she is one of the worst out there, at least from her therapist’s perspective.

Do we really need to say things like this?

Below are some studies that were recently posted to a thread on one of the many groups there, all speaking to the effect of the power of our words. If you’ve never given this much thought, please read through some of the abstracts and papers.

Our words have power, and often the message conveyed negatively impacts outcomes.

Easy to Harm, Hard to Heal: Patient Views About the Back.

CONCLUSION: Negative assumptions about the back made by those with LBP may affect information processing during an episode of pain. This may result in an attentional bias toward information indicating that the spine is vulnerable, an injury is serious, or the outcome will be poor. Approaching consultations with this understanding may assist clinicians to have a positive influence on beliefs.

The enduring impact of what clinicians say to people with low back pain. (Full-text link)

CONCLUSIONS: Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.

Importance of psychological factors for the recovery from a first episode of acute non-specific neck pain – a longitudinal study. (Full-text link)

CONCLUSIONS: Psychological factors emerged from this study as relevant in the early phase of acute neck pain. Particularly persistent anxiety and depression at baseline might be risk factors for a transition to chronic pain that should be addressed in the early management of neck pain patients.

‘Talking a different language’: a qualitative study of chronic low back pain patients’ interpretation of the language used by student osteopaths. 

CONCLUSIONS: The language used by student osteopaths’ influences patient beliefs about LBP in a variety of ways. The current study furthers understanding of how language contributes to these beliefs, identifying ways through which communication can contribute to improved healthcare through enhancing patient engagement.

Words That Harm, Words That Heal. (Full-text link)

Both positive and negative beliefs are important in patients with spine pain: findings from the oioc registry.

CONCLUSIONS: Our study demonstrates that both negative and positive beliefs are associated with perceptions of disability, however, in this study only positive beliefs were associated with treatment outcome.

Do you have any studies to share regarding this topic? I’d love to have a look!

5 Habits To Have To Have Before Disconnecting For The Weekend

Success is determined by what you do after you do what is expected of you.

1. Celebrate Your Wins And Reflect On Your Future

Develop the Habit of reviewing what went well and celebrate it. It reminds you to focus on your growth, to focus on the positive influences you’ve had, the contributions to improving your patients’ quality of life and helps you begin your weekend in an enthusiastic frame of mind.

Now is the time to take 5 minutes, at the end of your day, and really reflect on the good work you are doing and the lives you are touching (pun intended!) I guarantee that along the way, you helped quite a few people. I have no doubts that you changed a few lives by improving the quality of life of some people.

If your weeks are like mine, this week went by so fast, you were so busy with treating patients, you don’t even know what you did, but you got here somehow.

Ask yourself a few key questions: What did I accomplish this week? What do I want to accomplish next week? Next month? Next year? A businessperson should always be aware of his or her recent accomplishments and reflect on them to better plan for his or her future success.

2. Develop The Habit Of Sending Two “Thank-You” Notes!

As a businessperson, you rely on a lot of people; your team, mentors, partners, and Patients to support you each week. All play an important role in our lives, yet in today’s world, thankfulness seems to be on the downslope.

Before you leave the office, recognize at least two people for their continued offerings, positive influences, and referrals with simple notes of appreciation. Doing this shows you care about “your team” and that you recognize their support.

3. Develop The Habit Of Reviewing Your Contacts List For The Week

Before you leave your practice, reflect upon your contacts list and review your calendar (see below).

Throughout the week you may have had certain people you came into contact with that can and possibly will influence the direction of your professional and or personal path. Think about the NEW patients you had. Make a couple of quick notes about what the next step in their treatment may be. This doesn’t have to be a concise treatment plan, just a couple of points to think about and get you started in a direction.

Add any business contacts to your LinkedIn, Twitter and other social media accounts. Doing this now makes sure no one slips through the cracks.

Photo by: Pixelkult

Photo by: Pixelkult

4. Develop The Habit Of Having A Clean Desk

Make sure you have all your daily patient files charted. Ultimately you should have the habit of charting your files as part of your treatment time, but for those of us who chart at the end of the day… get it done now!

If you have any clinical records waiting to be copied and sent to lawyers or insurance companies…get them done and mailed.

Clearing your desk of these tasks is a weight off your mind. You now have the freedom to focus on more important weekend activities, friends, and family.

5. Develop The Habit Of Reviewing Next Week’s Calendar

Make note of any business contacts you met with over the past week and how and when you’ll follow up with them. Review or enter times and dates on your calendar for next week of when you may want to contact them again. Make a short list of who needs to be contacted next week and set a tentative date and time to do so.

Don’t feel bad if you don’t get through all of these. The exercise is to get you into the Habit of ending your week productively and positively!