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Myofasical Release And Massage Therapists

Myofasical Release And Massage Therapists

Anyone who has spent long hours engaged in a heated discussion over Facebook knows the frustration that comes along with it. These discussions have forced me to question many of my long held beliefs about the fascial system and myofascial release. There is evidence that myofascial release is an effective technique for a number of injuries.

However, when it comes to anything fascia related the professional community is divided with fundamentalist views on both sides.

To some myofascial release is a panacea and others regard  fascia as ‘dead tissue’ with no clinical significance.

With some of the research and reading I’ve done, I have wanted to dispel myths and simplify research.

Fascial Anatomy For Massage Therapists

Andreas Vesalius (1514-1564) is often considered to be the first anatomist and is best remembered for publishing the famous anatomy text, De humani corporis fabrica in 1543.

If you look at these early illustrations they present the fascia and muscles as one continuous soft tissue structure.

Fast forward to the 20th century (texts we study) most opt  to omit fascial structures in order to depict muscles in a cleaner fashion. Recently there has be a resurgence of this ‘forgotten tissue’ and anatomy textbooks have made an effort to include fascial structures in their depictions and descriptions.

An example of this is The Functional Atlas of the Human Fascial System by Carla Stecco, an Orthopedic surgeon and a professor of human anatomy at the University of Padua in Italy, the same University that once employed Andreas Vesalius in the early 1500’s.

Another example is Anatomy Trains by Thomas Myers, in this book Myers presents conceptual ‘myofascial meridians’, a recent systematic review confirmed a number of these continuous soft tissue structures.

What is Fascia?

To better understand the possible actions of myofascial release, there is a need to clarify the definition of fascia and how it interacts with various other structures: muscles, nerves, vessels.

Simply speaking all fascial tissue is connective tissue, but all connective tissue is not fascial tissue.

The primary job of connective tissue is to support, connect or separate different types of tissues and organs in the body. For the purpose of brevity, connective tissue proper can be divided into dense connective tissue and loose connective tissue. Simply put fascia is a combination of dense and loose layers of connective tissue. As, for the definition of fascia, there are many different ways that fascia is defined, see What is ‘fascia’ A review of different nomenclatures. In this article the definitions of fascia that I use is “Fascia is fibrous collagenous tissue which are part of a body wide tensional force transmission system”

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What Are Massage Therapists Doing With Myofascial Release?

The thing is, myofascial release is not well defined, it is a broad term covering a wide variety of techniques.

This includes osteopathic techniques, rolfing, structural integration, massage therapy, cupping and IASTM. My interpretation of myofascial release may differ from others, but in this post I am referring to myofascial release as a manual technique that tensions soft tissue structures and is accompanied by active or passive movement, to promote relative tissue motion.

I have divided the response to myofascial release into three categories, in reality the response likely represents a response of multiple overlapping systems:

  • Contextual Responses to Myofascial Release
    • This is likely to play a role in any therapeutic intervention, the way we present ourselves and present our techniques has influence on the treatment. The magnitude of a  response may be influenced by mood, expectation, and conditioning.
  • Neurological Responses to Myofascial Release
    • Fascia is highly innervated by mechanoreceptors, this was document by Robert Schleip in 2003. His article Fascial plasticity – a new neurobiological explanation Part 1 Part 2, this is an interesting and very readable two-part article laying out a possible neurological explanation for the beneficial effects of myofascial release.
  • Mechanical Responses to Myofascial Release

Any type of massage therapy is actively engaging the nervous system by stimulating mechanoreceptors at the level of the skin, as well as at deeper level fascial layers. Deep slow myofascial release techniques stimulate sensory ending known as the ruffini endings. Stimulating these slow adapting sensory receptors has the ability to alter the motor output and the experience of pain.

“Fascia and the autonomic nervous system appear to be intimately connected. A change in attitude in myofascial practitioners from a mechanical perspective toward an inclusion of the self-regulatory dynamics of the nervous system is suggested.”

-Fascial plasticity – a new neurobiological explanation: Robert Schleip

Are Massage Therapists Breaking Adhesions?

With such a lengthy post on myofascial release I would be remiss if I did not address the notion of breaking down adhesion. “An adhesion is an attachment of tissue at unusual non-anatomic sites which can be, vascular or avascular, innervated or not innervated.” 

There is little to no research that I am aware of that would indicate that massage therapy can manually break down mature adhesions. There is however literature to support the idea that massage therapy may be able to break down immature  postoperative adhesions.

Research by Geoffrey Bove and Susan Chapelle has demonstrated that manual therapy has the ability to break down immature adhesions. A recent case study demonstrated the effect of manual therapy on immature postoperative adhesions. Susan Chapelle has posted a well put together summary of the latest evidence of massage therapy and the effect on scars and adhesions Susan Chapelle- Understanding and Approach to Treatment of Scars and Adhesions.

What is the Clinical Relevance Of The Fascial System In Massage Therapy?

The “fascial system” serves to provide a conceptual model by which to explain the function of the global fascial net during movement, including the interconnections of fascial tissues with joint capsules, nerves and intramuscular connective tissues.

One of the proposed dysfunctions is an alteration of  loose connective tissue that may adversely affect the sliding motion of fascial layers, this may be due to age, trauma or inflammation. This alteration of loose connective tissue is described as a densification In The Functional Atlas of the Human Fascial System.

Is a fascial densification the same thing as fibrosis?

Stecco makes a distinction between a pathological fibrosis and densification:

  • Densification refers to an alteration of the loose connective tissue (adipose cells, glycosaminoglycans and hyaluronic acid) Densification can involve an alteration in the quantity or quality of the components of loose connective tissue and an alteration in fascial viscosity.

    “Densification may affect the sliding and gliding of tissue. The different layers of the body contain viscous loose connective tissues that allow a gliding, sliding function, protecting sensitive neural structures, as well as facilitating pain-free, efficient movement and force transmission. Gliding function may be lost because of trauma, inflammation or aging, resulting in fibrosis, thickening, densification.” -Pavan et al 2014

  • Fibrosis is defined as an alteration of dense connective tissue, specifically a rearrangement of the composition and structure of the dense connective tissue.

Nerve Entrapment

Many cases of peripheral nerve entrapment occurs following a traumatic injury, this is often the case with the sciatic nerve in proximal hamstring syndrome. It could be argued that this thickening and entrapment of peripheral nerves is a development process, could manual therapy play a role in slowing or reversing this progression?

Conclusion
Over the last couple of months I have spent a lot of time reading and reviewing fascial research, this has changed the way I that I communicate with therapists and patients. Myofascial release is an effective treatment technique, the catch is that it may not work in the way some were taught. Over time the supportive theories behind techniques evolve or change completely, myofascial release is an example of this. Is the name myofascial release better used as an analogous term to describe a palpable change in tissue that is likely due to many overlapping responses? Namely:

  • Contextual Responses
  • Neurological Responses
  • Mechanical Responses

These combined responses results in an increased pliability of soft tissue structures that often translates clinically into improved proprioception, increased range of motion and decreased experience of pain.

I am no longer frustrated when I get in heated discussions on Facebook, if someone can present a convincing argument I am willing to change some of my long standing views. Something I am still frustrated with is that there is a lack of resources available for massage therapists, hopefully this will change over time.

I work at The Fowler Kennedy Sports Medicine Clinic at Western University in London, Ontario. As an educator and clinician my primary focus is helping people manage sports injuries, my professional mission is to translate the latest research into clinically useful information for massage therapists and patients. My free time is spent camping, hiking and kayaking all around the great lakes region.

Richard Lebert

I work at The Fowler Kennedy Sports Medicine Clinic at Western University in London, Ontario. As an educator and clinician my primary focus is helping people manage sports injuries, my professional mission is to translate the latest research into clinically useful information for massage therapists and patients. My free time is spent camping, hiking and kayaking all around the great lakes region.

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18 Comments

  1. Til Luchau December 9, 2015

    Thanks Richard. Nice overview and summary of some of the questions facing those of us who do “myofascial” work. Well done.

    reply
    • Richard Lebert December 9, 2015

      Thank you Til!

      I just started reading your new book this week!
      I’m looking forward to volume 2!

      reply
  2. Don Dillon December 12, 2015

    Excellent article Richard.

    Well structured, clear, and memorable by the way you’ve organized it.

    “Densification” is not a word I’ve heard to describe the palpable changes, but it’s a great descriptive term.

    Thank you for presenting the subject in the spirit of curiosity and openness. I hope to see this article referenced many times over social media. Warm regards, d

    reply
    • Richard Lebert December 12, 2015

      Thank you for the input Don, I am glad you enjoyed the article. I have read a lot of you work, you have motivated me to continually up my game over the years, thank you!
      Richard

      reply
  3. Kathy December 12, 2015

    Very informative! Thanks for the comprehensive review, complete with links. Great job!

    reply
  4. Malcolm Innes December 12, 2015

    Great piece Richard & really enjoyed reading it. Looking forward to having a browse at your other posts 🙂

    reply
    • Richard Lebert December 12, 2015

      Thank you Malcolm, I’m glad you enjoyed it. Just started writing, it is encouraging to have positive feedback.

      reply
  5. Cara January 8, 2016

    Thanks for the article! It was very informative. I have known about myofascial release and its benefits for about 15 years not but only recently became a massage therapist mainly for the purpose of using myofascial release to help those with chronic pain and many other issues. Since I started learning about it, I have realized that fascia is hard to study because it is only fully functional in the living human body. I have also realized that sometimes, even if you do not fully know what is happening or how the body is doing it, it works and it is very effective. Keep up the good work!

    reply
    • Richard Lebert January 8, 2016

      I agree with you Cara.

      Even though we still have more to learn about what is going on in a living body, we are still able to provide our patients with excellent healthcare. As time goes on and we learn more about the body, I can only hope that this will improve our clinical outcomes with patients.

      Richard

      reply
  6. Deborah Bruce April 21, 2016

    I am really gratified to read your overview and the sober tone is a welcome change from over-emotional “heat” in some places. Your article is a good foundational piece that can help clinicians and researchers. It certainly helps me. Thank you.
    Deborah

    reply
    • Richard Lebert April 21, 2016

      Deborah,

      Thank you for the kind words. I am glad you enjoyed the post.

      Richard

      reply
  7. Melissa April 29, 2016

    Yes very good information Richard! John Barnes here in the US is the master of Myofascial Release. Have you heard of him?
    Check him out on Google 🙂

    reply
    • Richard Lebert April 29, 2016

      Thank you Melissa, I am glad you enjoyed the article.

      I have seen John Barnes all over the internet and in magazines, but I have never taken a course with him.

      Richard

      reply
  8. Jaclyn March 14, 2017

    This was a great article. I’m a current massage therapy student and have just learned about myofascial release this term. I found your article informative regarding different information/debates that I had not heard of prior. I’m sure this new knowledge will only benefit me ask I open my own practice later in life. Thank you

    reply
    • Richard Lebert March 16, 2017

      Thank for taking the time to read Jaclyn.

      All the best,
      Richard

      reply
  9. Marcus December 6, 2017

    Great read!

    Myofascial release has been an important part of treating a bad injury I got from weight training.

    I am having some problems with my right leg now, and trying to learn and understand what could be the problem. Massage, foamrolling, and stretching have not made it better, but reading this helped me understand things better – thanks!

    reply

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