MYOFASCIAL RELEASE

An Audiovisual Presentation of the Science Behind The Rehabilitation Phenomenon

and Live Demonstration of the Technique and its Nuances

Conducted byPaul Sholander

Making Your Skin Crawl

OR

Excellent flexibility to achieve positionExcellent muscle control to hold positionExcellent joint mobility to allow position

If top layer restricts…Can’t achieve position

MYOFASCIA1,2 Viscoelastic layer of dense connective

tissue underneath the skin Covers all structures within the body

Muscles, bones, vasculature, nerves, organs One continuous sheath from head to toe Trauma to the body causes restrictions

Injuries, inflammation, habitual poor posture, surgery, scarring, emotional stress

Can produce tension up to 2,000 lbs/inch2

FASCIAL WEB1,2,3

Spider Web Tension at one point

produces tension throughout the web

Fascia Tension at one point

produces tension throughout the body

Lumbosacral fascia restriction tension headaches!

IDA PAULINE ROLF, PHD3

Originator of Structural Integration and “Rolfing”

Explored concepts of biomechanics (PhD) osteopathics sensorimotor somatic psychotherapy

“Equipoise” of fascial tissues through manual techniques allow better alignment with gravity

Dr. Rolf’s “Little Man3”

LEFT: Random Body, poor alignment with gravity, struggle and eventual collapse

RIGHT: Proper alignment with gravity, reinforced structure, more biomechanically efficient, relaxed fascia, good tensegrity

JOHN F. BARNES, PT4

Treating patients since the 60’s

Developed Myofascial Release Approach® in the 70’s

Trained 100,000+ therapists

Owner/Director/Chief PT “Sanctuary” Malvern, PA “Therapy on The Rocks”

Sedona, AZ

BARNES’S HOW TO5,6

Slowly stretch out fascia with relaxed hands

Find area of restriction and hold stretch with light pressure

90-120 second hold minimum Will vary based on

patient presentation Don’t force, go with the

flow, no real time limit Move from restriction to

restriction

May feel “heat” or a tingling in your hands Pizioelectric

phenomenon “Low load applied

slowly allows a viscoelastic medium to elongate”

Release metabolites as tissue lengthens

CASE STUDY: A. Z. 26 year old PT student with very, very

poor hamstring flexibility Sit and reach test: -8 inches

Following 2 min. hamstring stretching: -7 Professor performs 2 min myofascial

release at low back restriction Re-test sit and reach: -3 inches Released restriction along the fascial

plane improved flexibility

Superficial Front:-Knee/ankle ext.-Tensile support of ribs/face/pelvis-Protection of organs

Superficial Back:-Maintain standing

Spiral Line:-Balances/maintains rotation-Keeps spinal length-Connects side of head with opposite shoulder and ipsilateral hip/knee/foot arch

Functional/Tanden/Koshi/Hara Lines:-Opposite arm/leg movements-Rotational movements-Limited use for posture

Arm Bridges:-Articulation-Control/Stabilize arm position

Lateral Line:-Lateral flexion-Hip abduction-Foot eversion-Control lateral flex/ext/rotation

Deep Front Line:-Autonomic balance-Lumbar support-Arch support-Respiratory

Fascial lines:7

-Work as one unit-One out of balance affects others-Treat fascial impairments like joint impairments

Treating the problem

vs.Treating the cause

Yawara-Taiso: Specific exercises to activate each body line

“CHASING THE RABBIT” Some tightness

disperses, some travels down fascial plane

Planes overlap, especially in thoracolumbar

Ask patient where they feel the tingling traveling (up, down, left, right, diagonal)

Try to disperse as much tightness each session

SELF-MYOFASCIAL RELEASE Patient can perform fascial release using:

Foam roller – larger areas (ITB, quad, pec) Ball – discrete areas (Foot, neck)

Tennis, lacrosse, golf Fascial areas where manual pressure

Too light - ITB Too intense – Plantar Fascia

Patient can easily adjust pressure/time to their tolerance

Perform at home or free-up clinic time

NUANCES Friction is your friend

Limit creams/lotions for maximum contact

Constant patient feedback Easy to find areas of restriction Is this where patient feels most restricted? “Chasing the rabbit”

How much pressure? Hydration, adipose, elasticity of skin Every body feels different, patient feedback Adjust until you find sweet spot More hands-on experience, the better

WHAT MYOFASCIAL RELEASE HELPS TREAT8

Back Pain Headaches Whiplash Pelvic Pain Neck Pain Sports Injuries Chronic Pain Disc Problems Migraines Pelvic Floor Dysfunction Neurological Dysfunction

Fibromyalgia Chronic Fatigue Syndrome Adhesions Carpal Tunnel Jaw Pain (TMJ) Painful Scars Scoliosis Infants/Children Sciatica Myofascial Pain Syndrome Women's Health Issues

EFFECTIVENESS OF MYOFASCIAL RELEASE: SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS9

19 RCTs included All 5-8/10 PEDro 5 1B, 14 2B rank Avg. Sample: 65

SLR, hamstring flex PNF > MFR > sham

10 min pelvic MFR Improved alignment

MFR vs. Hot Packs As effective for ROM ↑

LBP Manip = MFR > sham

Plantar Fascia Improved pain, function,

pressure threshold Lat. Epicondylitis

Improved pain, function, grip strength

Venous Insufficiency MFR + PT = improved

venous return/pain/QoL

Drawbacks Avg. treats: 30-40 min Long term effects (?)

EFFECTIVENESS OF MYOFASCIAL RELEASE THERAPIES ON PHYSICAL PERFORMANCE MEASUREMENTS: A SYSTEMATIC

REVIEW10

10 studies All 4+/10 on PEDro scale 6 with 6+/10

9 studies looked at ROM 4 Hams, 1 Quad, 1 Triceps,

3 Cervical 7 found significant

improvements 2 hamstring studies found

no improvements 1 had high level athletes,

ceiling effect Both had only 1 session,

multiple sessions may be required for improvements

3 studies looked at EMG No +/- change in activation Improved spontaneous/basal

electrical activity Doesn’t help

performance, but won’t hurt

3 studies looked at self-myofascial release As effective as clinician

performed MFR, patient education

Time Average 90 sec-3 mins One found results with 20

seconds

EFFECTS OF SELF-MYOFASCIAL RELEASE:A SYSTEMATIC REVIEW11

22 studies included PEDro 4-8 Majority used foam rolling

Acute Systemic changes Improved

arterial/endothelial function

Decreased smooth muscle tension

Increased plasma nitric oxide

Improved parasympathetic response

Drawback: Only 1-2 studies, further research needed

ROM 11 studies: Improved

acutely (10 minutes) w/o performance dropoff w/1-2 min. treatment

4 studies: Conflicting evidence for long-term improvements, further research needed

DOMS 3 studies: Acute relief

across different pop. 1 study found more pain

with fascial vs. muscle injections post eccentric activity, further research for fascial role in DOMS

SELF-MYOFASCIAL RELEASE Peacock et al.12

11 male athletes 1 week between 2 treats

10 min Dynamic Warm Up Foam Rolling + Warm up

Thoracolumbar, Glutes Hams, Calves, Pecs, Quads

5 x 30 sec bilaterally Tests

Sit-Reach, Vert/Broad Jump, Shuttle Run, 1RM Bench, Sprint

Foam Rolling Significant improvement

(4-7%)in all but Sit-Reach

MacDonald et al.13

11 healthy males in early 20s

1 min. quad foam-rolling vs. control

Foam rolling: 10°↑ 2 minutes post 8°↑ 10 minutes post No significant decrease in

muscle performance

Foam rolling good for acute ROM increase

SELF MYOFASCIAL RELEASE II: THE SEQUEL

Grieve et al.14

RCT, 24 20-30s M/F Experiment

Pre-Sit and reach 2 min tennis ball self-

MFR/foot “Discomfort, not

pain” Post-Sit and reach

Control: No treat Self-MFR

Increased hamstring/lumbar flex

Morton et al.15

RCT, 19 males, early 20s, decreased ham ROM

Each leg randomized Control: 4x45 sec static Exp: 4x60 sec self MFR

+ Control BID/4weeks

Self-MFR No more effective for

PROM/torque/MVC

COMPARISON OF MYOFASCIAL RELEASE AFTER PASSIVE MUSCLE STRETCHING AND NEURAL MOBILIZATION ON

ROM OF THE HIP16

57 students 18-32 y.o. Neural/MFR/control M/W/F for 1 week

MFR group 30 sec posterior fascial

mob of hamstring in prone 30 sec PROM hamstring

stretch in supine Neural

Supine PROM hip flexion with knee held extended

1 min sciatic nerve glides PF/DF

Results MFR: 7.53° Neural: 8.37°

Both had ROM improvements

Neural slightly better, affects underlying neural tension

FIBROMYALGIA Altindag and Ozaslan17

36 subjects Late 30s Avg. symptoms 3.5 years

45 min/5 days/3 weeks Neck, back, arms, legs

Improvements in: FIQ – QoL VAS - Pain HDRS – Depression

MFR easier to tolerate than deeper massage

Castro-Sanchez et al.18

86 subjects, RCT 10 points: Head Sacrum 1 hr/2x week/20 weeks

Significant improvements 20 weeks + 6 months post

FIQ, # good days, pain, fatigue, tiredness on waking, stiffness

1 year post # good days only

No postural improvements

A PILOT STUDY OF BALANCE PERFORMANCE BENEFIT OF MYOFASCIAL RELEASE, WITH A TENNIS BALL, IN CHRONIC

STROKE PATIENTS19

Significant balance improvements Berg at 4 and 8 weeks

Only turn 360° didn’t improve

TUG at 4 and 8 weeks compared to baseline

Performance leveled off after 4 weeks, ceiling (?)

Further study required Long-term gait effects Underlying

mechanisms

8 CVA subjects Hemiplegia, s/p 6

months, modified Ashworth >1, ambulatory

PT assisted MFR with tennis ball 10 min plantar fascia 20 min calf/hams/

sacrotuberous ligament

3x/week for 8 weeks

EFFECTIVENESS OF MYOFASCIAL RELEASE IN THE MANAGEMENT OF CHRONIC LOW BACK PAIN IN

NURSING PROFESSIONALS20

74 nursing professional with LBP 38 MFR + exercise 36 Sham MFR + exercise

40 minute MFR (4 min/side) Glute max, piriformis,

thoracolumbar fascia, deep paraspinals, sides of trunk

20 min Exercises 12 total 4 stretches, 4 self-correcting,

4 strengthening 3x/week, 8 weeks

Measures Pain-McGill Pain

Questionnaire Function-Quebec

Back Pain Disability Scale

Sig. Improvements with MFR at weeks 8: P=53% F=29% 12: P=44% F=23%

MFR clinicians 100 hours training Avg. 12 months

experience

LAST WORDS Good for acute

pain/ROM/performance improvements

Not a PRIMARY treatment option Can’t address underlying

joint mobility/muscular imbalances, but can supplement those treatments

“This approach to the body is not intended to replace…It is an added dimension.” –John Barnes5

Educate patients on posture!

90 second stretch minimum, no time limit for total treatment

Follow up with activity to take advantage of gains (think METs/Jt. Mobs)

Self-MFR10-15

Conflicting evidence flexibility/performance

PATIENT EDUCATION!

Hands-on: Technique comes with experience!

REFERENCES 1) What is Fascia? (- Myofascial Release)

https://www.myofascialrelease.com/about/fascia-definition.aspx

2) What is Myofascia? (What is Myofascia?) http://jenings.com/what-is-fascia.html

3) Jacobson, Eric. "Structural integration: origins and development." The Journal of Alternative and Complementary Medicine 17.9 (2011): 775-780.

4) John F. Barnes, PT (- Myofascial Release -) https://www.myofascialrelease.com/about/johnfbarnes.aspx

5)https://www.myofascialrelease.com/downloads/articles/InnerJourney_MNB_JA_12.pdf

6) What is Myofascial Release? (- Myofascial Release) https://www.myofascialrelease.com/about/definition.aspx

7) 005A Exercises to activate body-lines (muscle-tendon-fascia) (Study-Group-Tomiki-Aikido -) https://study-group-tomiki-aikido.wikispaces.com/005A+Exercises+to+activate+body-lines+%28muscle-tendon-fascia%29

8) Problems MFR Helps (- Myofascial Release) https://www.myofascialrelease.com/about/problems-mfr-helps.aspx

9) Ajimsha, M. S., Noora R. Al-Mudahka, and J. A. Al-Madzhar. "Effectiveness of myofascial release: Systematic review of randomized controlled trials." Journal of bodywork and movement therapies 19.1 (2015): 102-112.

10) Mauntel, Timothy C., Michael A. Clark, and Darin A. Padua. "Effectiveness of Myofascial Release Therapies on Physical Performance Measurements: A Systematic Review." (2014): 189-196.

2 REFERENCES 2 FURIOUS 11) Beardsley, Chris, and Jakob Škarabot. "Effects

of self-myofascial release: A systematic review." Journal of Bodywork and Movement Therapies (2015).

12) Peacock, Corey A., et al. "An acute bout of self-myofascial release in the form of foam rolling improves performance testing." International Journal of Exercise Science 7.3 (2014): 5.

13) MacDonald, Graham Z., et al. "An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force." The Journal of Strength & Conditioning Research 27.3 (2013): 812-821.

14) Grieve, Rob, et al. "The immediate effect of bilateral self myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility: A pilot randomised controlled trial." Journal of Bodywork and Movement Therapies (2014).

15) Morton, R. W., et al. "Self-Myofascial Release Does Not Improve Functional Outcomes in'Tight'Hamstrings." International journal of sports physiology and performance (2015).

16) Mendes, Alan Campelo, et al. "Comparison of myofascial release after passive muscle stretching and neural mobilization on ROM of the hip." Manual Therapy, Posturology & Rehabilitation Journal 12.x (2014): 149-154.

17) Altindag, O., and S. Ozaslan. "Efficacy of Myofascial Release Method on Pain and Disease Severity in Patients with Fibromyalgia." J Pain Relief 3.161 (2014): 2167-0846.

18) Castro-Sánchez, Adelaida María, et al. "Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial." Clinical Rehabilitation 25.9 (2011): 800-813.

19) Park, Du-Jin, and Young-In Hwang. "A pilot study of balance performance benefit of myofascial release, with a tennis ball, in chronic stroke patients." Journal of Bodywork and Movement Therapies (2015).

20) Ajimsha, M. S., Binsu Daniel, and S. Chithra. "Effectiveness of Myofascial release in the management of chronic low back pain in nursing professionals." Journal of bodywork and movement therapies 18.2 (2014): 273-281.