Myofascial therapy to treat acute and chronic pain

Myofascial therapy relieves soft tissue restrictions that cause pain

Some causes of chronic pain or low back pain are easier to diagnose than others: trauma (such as a car accident or fall), cumulative posture misalignment or mechanical deficits, a compressed nerve from a herniated disc, or inflammatory conditions. When pain is caused by tightness within the fascial system (the web of connective tissue that spreads throughout the body and surrounds every muscle, bone, nerve blood vessel and organ to the cellular level) the diagnosis is more difficult, as fascial restrictions do not show up on MRI scans or x-rays. Yet, those restrictions can play a significant role in creating pain and malfunction in the structure of the spine, extremities and organs.

Myofascial Release (MFR) Therapy is a type of safe, low load stretch that releases tightness and the pain caused by these restrictions throughout the body. This article provides an overview of the treatment technique, including:

• What the myofascial system consists of

• Conditions and symptoms myofascial therapy can treat

• A description of the treatment and who typically provides it

• Results and outcomes of a course of myofascial therapy

Fascia is a three-dimensional web that permeates the whole body

The best way to envision the expanse of the fascial system is to think of it as a layer of connective tissue (similar to a tendon or ligament) that starts with the top layer directly below the skin, and extends to two deeper layers. When the fascia is in its normal healthy state it is a relaxed and supple web—like the weave in a loose-knit sweater. When it is restricted, it is more rigid and less pliable, and can create pulls, tensions and pressure as great as 2,000 pounds per square inch. The fascia is a continuous system, running from the bottom of the feet through the top of the head and has three layers:

• Superficial fascia, which lies directly below the skin. It stores fat and water, allows nerves to run through it, and allows muscle to move the skin.

• Deep fascia, which surrounds and infuses with muscle, bone, nerves and blood vessels to the cellular level

• Deepest fascia, which sits within the dura of cranial sacral system.

Restrictions can occur within any or all of the layers.

Myofascial therapy focuses on releasing muscular shortness and tightness

There are a number of conditions and symptoms that myofascial therapy addresses. Many patients seek treatment after losing flexibility or function following an injury or if experiencing ongoing back, shoulder, neck, hip or virtually pain in any area containing soft tissue. Other conditions treated by myofascial therapy include Temporo-Mandibular Joint (TMJ) disorder, carpal tunnel syndrome, or possibly fibromyalgia or migraine headaches. Patient symptoms usually include:

• Tightness of the tissues that restricts motion or pulls the body out of alignment, causing individuals to favor and overuse one hip or shoulder, for example

• A sense of excessive pressure on muscles or joints that produces pain

• Pain in any part or parts of the body, including headache or back pain

Myofascial pain can have two sources. Pain can be generated from the skeletal muscle or connective tissues that are ‘bound down’ by tight fascia. In addition, pain can also be generated from damaged myofascial tissue itself, sometimes at a ‘trigger point’ where a contraction of muscle fibers has occurred. In either case, the restriction or contraction inhibits blood flow to the affected structures, thus accentuating the contraction process further unless the area is treated.

Myofascial therapy is provided by several types of health professionals

The goal of myofascial therapy is to stretch and loosen the fascia so that it and other contiguous structures can move more freely, and the patient’s motion is restored. For this reason, myofascial therapy is sometimes referred to as ‘myofascial release’ therapy.

Many different types of health professionals can provide myofascial therapy, including appropriately trained osteopaths, chiropractors, physical or occupational therapists, massage therapists or sports medicine/injury specialists. Specific training and courses in Myofascial Release Therapy are generally necessary and can be extensive to attain a high level of competency. Therapy sessions follow a pattern similar to physical therapy for post-operative rehabilitation. An initial appointment will be devoted to locating the areas of the fascia that appear to be restricted, and measuring the level of loss of motion orloss of symmetry in the body. Subsequent treatment sessions may:

• Last at least 30 but optimally 50 minutes or more per session

• Be conducted daily or every few days

• Take place at outpatient clinic or health center

• Have a trained therapist provide hands-on treatment in a relaxing, private therapy room

• Take place over a few weeks or months, depending on the nature and intensity of disability

The specific releases to different parts of the body vary, but generally include gentle application of pressure or sustained low load stretch to the affected area. Progress is gauged by the level of increased motion or function experienced, and/or decrease in pain felt by the patient.

Myofascial therapy can be a precursor and complement to other treatments

Patients who engage in myofascial therapy also may benefit from other forms of conservative care that aim to control pain and keep muscles and joints warm and loose. These include:

• Using non-prescription pain relievers such acetaminophen or non-steroidal anti-inflammatories

• Applying heat to soothe constricted muscles or using ice to calm inflamed areas

• Performing self-stretching exercises to maintain flexibility and increase range of motion or aerobic exercise to increase blood flow to the affected areas

Myofascial therapy can also enhance or assist other treatments to increase their effectiveness such as acupuncture, manipulation, physical therapy or occupational therapy. Myofascial release therapy can also improve skeletal and muscular alignment prior to a surgery, or help athletes achieve better alignment prior to sports competitions.

By targeting specific areas of the fascial system, myofascial therapy can help prepare patients for more aggressive forms of strengthening, or provide pain relief for patients with restricted flexibility and movement, thus allowing patients to return to normal movement and greater function.

By: Lisa Ganfield, OTR/L, CHT
February 20, 2007