December 26, 2013

Myofascial mobilization is as old as human history itself. The current schools of myofascial manipulation are influenced not only by the most current evidenced based science, but what has been learned from in the past, as well. There are early recordings of myofascial manipulation dating back to Hippocrates and the work has continued in the present.

What is myofascia? It is a strong and elastic connective tissue that provides support for many structures of the body including organs, blood vessels, nerves and muscles. It is best described as a body suit of connective tissue that starts at the top of your head and continues to the bottom of your feet.

There are multiple classes of myofascia, including dense irregular and loose irregular tissue types. Dense irregular is the connective tissue that is under high degrees of mechanical stress, such as the lambar fascia, where it is relied upon to provide strength and elasticity for the lumbar spine structures. There is also loose irregular tissue which consists of a multidirectional arrangement of the collagen fibers with a high percentage of a compound elastin, which allows for increased elasticity. This type of tissue also has a high percentage of water, increasing the ability of the tissue to slide over other structures such as muscle, bone, and ligaments. This second type is best affected by myofascial manipulation.

When the fascia is in a normal healthy state is it quite flexible and soft with great ability to move without restrictions. When there is an injury or inflammation, the myofascia no longer has the same elasticity and can become less pliable. Not only can direct physical trauma alter the mobility of the myofascia, habitual poor posture can have the same cumulative effect.

Physical therapists have been implementing myofascial manipulation in many different forms and it is frequently added to a patient’s plan of care. When conducting an evaluation, the mobility of the musculature as well as the fascia are performed and treatments are selected that would best effect these tissues. Frequently, a direct myofacial release is performed where the tissue is loaded with a constant force into a restriction until a release occurs. This is performed slowly from superficial through the deeper layers. The pressure can range from quite light tough to a deeper pressure but is not given beyond the tolerance of the patient. Myofascial release is performed to lengthen the tissues and allow for improved movement and better health of the fascia.
Research has shown that Myofascial mobilization can reduce pain perception as well as increase the mobility of facial layer sliding. It has also been shown that soft tissue mobilizations have a positive effect on chronic low back pain as well.

Treatment is used effectively for
• Neck and low back pain
• Shoulder pain
• Headaches
• Knee and hip pain
• Sports injuries
• Many other conditions
In conclusion, Myofascial Release can be a very effective treatment option to improve soft tissue and orthopedic conditions.
-Dan Bodkin, PT