Medication Use A common cause to modify treatment, or at the very least monitor it,…
1. MYOFASCIAL RELEASE
What is Myofascial Release (MfR)?
The person who is credited with founding the Myofascial Release (MfR) techniques is a Physical
Therapist named John F. Barnes. He has been treating patients since the 1960s and started to
establish teaching seminars for the Myofascial Release Approach in the 1970s, having trained
over 50 000 therapists in this exceedingly successful technique. Earning his degree from the
University of Pennsylvania, John has also published a couple of books in which the contents
discuss his experience with the myofascial release – many of which are well recognized in
several medical journals.
Myofascial Release (MfR) is considered to be a safe and greatly effective manual, hands-on
massage therapy technique. It involves the administration of gentle sustained pressure to
myofascial connective tissue restrictions to eradicate pain symptoms, increase active range of
motion, and maintain movement. Myofascial restrictions are caused by trauma, poor posture,
inflammatory response, surgical procedures, or repetitive motions.
What is Fascia?
Fascia is a very thin, elastic-like connective tissue that covers all muscles / muscle groups,
bones, and organs, keeping them in place. This continuous sheet of tissue surrounds the whole
body and is durable and mobile. Fascia comes in three categories: superficial, deep, and
subserous. The superficial fascia, which is located just beneath the skin, also consists of fat,
vascular structures, and nerve receptors. Below this, the denser and tougher deep fascia aids in
the body’s contours and functions, as well as enveloping the muscles and viscera (internal
organs). The subserous fascia surrounds the viscera, supports organs, and provides adequate
lubrication to allow gliding against one another. Typically fascia is situated in a longitudinal
direction, with some exceptions. These exceptions include the layers which cover the lower
opening of the pelvis (pelvic diaphragm), the thoracic diaphragm, and at the junction of the
thorax and cervical regions (either thoracic inlet or outlet). Fascia covers and penetrates every
muscle, bone, nerve, vein, artery, and the internal organs including the heart, lungs, brain, and
spinal cord and holds a tensile strength of up to 1200 lbs before breaking.
Fascial techniques can generally be categorized into two types, called Direct and Indirect.
Direct Fascial techniques engage the soft tissue barrier by taking the fascia towards the
restriction / adhesion, and then beyond the barrier. This breaks down the bonds between the
connective tissue fibers. Typically, direct techniques are based on several concepts, including
● The pressure applied to the tissue will affect the appropriate fascial level & the amount of
pressure is varied within the depth of fascia
● Elastic slack is removed from the tissue by a stretch to the affected fascia
● Holding this stretch keeps the tissue engaged
● The goal of this is to maintain this stretch for a period that is sufficient enough to break
the bonds between the individual connective tissue fibers. This may require several
minutes to achieve a successful tissue release, and the patient should experience a
● Signs of a successful release include hyperemia (increased local blood flow), a palpable
release of heat, a decrease in pain symptoms, and a softening / lengthening of the
tissue. The pressure should be moderate to deep with slow speed and requires little to
no oil / lotion when administering the technique.
Types of Direct Fascial Techniques
1. Skin rolling
This technique uses the fingers and thumb to lightly grasp and gently raise the skin
above and away from the underlying layer. The therapist can move the thumb to guide
the direction of movement, as well as slowly engage the tissue. This is generally
performed at a slow rate, and if oil is used it would be considered petrissage.
2. Cross-Hand Fascial Stretch
This technique is performed with the palms of the therapist’s hand flat and positioned
where the fingers are pointed away from each other. The tissue is engaged in the
opposite direction where this fascial stretch is then held until the tissue releases.
3. Fascial Spreading
By using the fingertips or thumbs of both hands, one hand stabilizes the tissue for
support while the other glides away to take up the slack. The stroke can be either short
or long, either moving further away from the other hand, or both hands moving in the
opposite direction of the therapist.
4. Cutting Technique
While the therapist maintains slightly flexed fingers, both hands are held together and
then placed into the necessary fascial depth. This technique is performed when the
engaged tissue is pulled towards the therapist in a “cutting” motion.
5. Fascial Torquing
This technique is performed by lifting tissue between the fingertips and thumbs of both
hands to take up the slack, raised further away from the underlying tissue, and is then
engaged by “twisting” it.
6. S-Bowing Fascial Technique
The therapist positions both hands side by side so that the thumbs – which are pointing
towards each other – manipulate the tissue into an S-shape when it is engaged. This is
normally held for varying amounts of time, as per the general concepts of engaging and
then holding the technique until there is a release. When this technique is used on a
tendon instead of fascia, then it is referred to as S-Bowing Golgi Tendon Organ Release.
7. C-Bowing Fascial Technique
The thumbs are positioned side by side so that when the tissue is grasped and then
lifted away to form a line, the therapist can then push both thumbs forward to manipulate
the fascia into a C-shape. Engaging and holding this position to a release is important to
ensure the accurate execution of this technique. When it is performed on a tendon, it is
called C-Bowing Golgi Tendon Organ Release.
This is usually introduced after superficial fascial techniques have already been applied,
as this is characterized as the deepest and most destructive fascial technique. The
therapist will make a fist and then use the big knuckle on the index finger to draw a small
J-shape into the tissue.
Indirect Fascial Techniques take the fascia in the direction of ease, which is generally away
from the restriction/adhesion. When the fascial slack is taken up, this position is held for varying
periods until the tissue stops resisting the therapist’s pressure and a new slack has developed.
This slack is taken up again, held until a new slack evolves, and repeated through this cycle
until the tissue has been adequately released. The pressure for indirect fascial techniques also
requires a slow rate and is light to moderate with no necessity for oil / lotion.
This manual technique can be exceptionally helpful with the treatment of several medical
conditions including Fibromyalgia, Chronic Fatigue Syndrome, Temporomandibular Joint (TMJ)
Dysfunction, Cervicogenic Headaches and Migraines, Carpal Tunnel Syndrome, Scars and
adhering scar tissue, Back and neck pain, Chronic Pain Syndrome, Postural Issues, Whiplash,
and Disc Dysfunction.
Christina Sharma, RMT
(Massage Therapy Vancouver)