Myofascial Release

@Physiocouk #manchesterphysio facebook.com/physiocouk

Welcome
Myofascial Release (MFR) workshop
With Katie Emmett

Who are we?
Website: www.massage.physio.co.uk
Twitter: @physiocouk
Facebook: www.facebook.com/physiocouk
Katie’s LinkedIn: www.linkedin.com/katieemmett
Twitter: @KatiePhysiocouk

Aims of today
✓ Learn and understand fascia structures and it's anatomy
✓ Learn the indications and contraindications to myofascial
release techniques
✓ Learn different myofascial release techniques and how to
perform them safely
✓ Learn which outcome measures and other treatment
techniques to use with myofascial release.

Itinerary
10.00 - 10.30 - Induction / Arrival
10.30 - 11:15 - Theory: MFR
11.15 - 12:15 - Practical: MFR (Upper Limb)
12:15 - 12.45 - Lunch
12:45 -13:45 - Practical: MFR (Lower Limb)
13.45 - 14.30 - Treatments alongside MFR
14.30 - 15.00 - Evidence and Case Studies

Theory:
Myofascial Release

Definition
Myo= Muscle
Fascia = a band / sheet of connective tissue
Release = relaxation / stretching of tight structures

What is fascia?
Where is it found?
• Fascia is a layer of fibrous tissue that surrounds groups of muscle,
bone, blood vessels and nerves.
• It binds structures together, whilst permitting other structures to glide
smoothly over each other.
• Fascia is dense, regular connective tissue, which contains closely
packed bundles of collagen fibres aligned in a wavy pattern parallel to
the direction of pull.

Layers of Fascia
Fascia is classified depending on it’s distinct layers, functions and
anatomical position:
Superficial, deep and visceral

Muscle anatomy
•All muscle tissues have a superficial covering of
varied thicknesses of fascia, made of connective
tissue and laced with adipose tissue.
A singular muscle fibre is referred to as a myofibril
and contains thick and thin myofilaments.

Function of Fascia
● Reduce friction during a muscular
contraction
● Support the nerves and blood vessels as they
glide through the muscle.
● The fascia holds the muscle together and
keeps it in the correct place.
● The fascia separates the muscles so they can
work independently of each other.

Fascia- why does it go wrong?
Age and injury can cause an increase of laying down of collagen,
increased cross linkages and restrictions (adhesions)
Fascia increases its density and decreases its ability to slide freely
following:
• Trauma and injury
• Poor posture
• Infections or disease
• Over and under use
• Ischaemia
• Local and systemic inflammation
• Tissue dehydration
• Emotional stress and centralised pain

How can we treat fascia?
• Theory of fascial lines.
• Structures are grouped together in recognised fascial lines and
when one structure is released the benefits may be present further
along the line.
• The point of restriction may be away from the point of pain.

Anatomy Trains
Superficial Back Line (SBL)
• Function is to support the body in full upright extension
• With the knees extended the line is continuous
• It has a higher degree of slow twitch endurance muscle fibres
and extra heavy sheets of fascia to overcome the postural
demands.
• There is no deep back line although some aspects of the SBL
are deeper than others. There is no consistent and connected
layer deeper than the SBL

Anatomy Trains
Superficial Front Line
• Function is to balance the SBL and provide tensile
support from the top to lift those parts of the
skeleton which extend forward of the gravity line
(pubis, ribcage and face)
• Viewing the patient from the side reveals the state
of imbalance between the SFL & SBL

Anatomy Trains
Deep Front Line
• Infused with slow twitch endurance muscle fibres, the DFL
provides stability and subtle positioning changes to core
structure.
• Failure of the DFL does not cause an acute change but more
functional restriction over a period of time which may appear
in another line.
• Its role in surrounding the heart and lungs has a significant
effect upon respiration.

Anatomy Trains
Demonstration of Theory

What is Myofascial
Release?
Myo = muscle
Fascia = a band or sheet of connective tissue
Release = the relaxation and/or stretching of tight
structures

What is Myofascial
Release?
“Myofascial Release is a specialised physical
and manual therapy used for the effective
treatment and rehabilitation of soft tissue and
fascial tension and restrictions”
Myofascial Release UK

What is Myofascial
Release?
•Safe and effective hands-on technique that works on the fascia to
release restrictions.
• Applied with prolonged pressure to restricted tissue.
• Aims to release tension and stretch out restricted parts of the
fascia.

Aims and benefits
Myofascial Release can decrease pain:
Endorphin release/ increased temperature/ pain gate theory.
Myofascial release can help the immune system.
Increased lymphatic flow.
Myofascial Release promotes healing
Increased blood flow and cell nutrition
Myofascial release can reduce tension
Stretching/ elongation of fascia/ Increased heat in tissues

How is myofascial release
applied?
• Direct, gentle and sustained, pressures applied for a prolonged periods of
time
• This amount of time permits fascia to naturally elongate and return to
normal resting length which will restore the healthy status quo, giving
greater flexibility, mobility and eliminating pain.
• Techniques applied for shorter periods will temporarily
lengthen the elastic fibres in the muscles and fascia and
the tissues will feel looser for a while but could gradually
tighten up again.

applied?
Direct techniques
The direct myofascial release method works directly on the
restricted fascia
The use of knuckles, elbows or other tools can be used into
restricted fascia.
- referred to as deep tissue work.

applied?
Indirect techniques
The indirect technique focuses on gentle stretching. Pressure applied through
hands tend to go with the restricted fascia, hold the stretch, and allow the
fascia to “unwind” itself.
The gentle traction applied to the restricted fascia will result in heat, increase
blood flow in the area.
The intention is to allow the body to self correct, eliminating pain and restoring
optimal function.

Manual handling and body
position
Posture
• Bed height
• Stance
• Patient position
• Use different parts of your hands/ arms to apply pressure
• Keep arms straight to utilise body weight when applying
pressure/resistance.
• Move from the hips and knees as much as possible
• Oil (or cream)- only needs to be a little bit - some advise not to be able to
tack and pin effectively.
Look after yourself before you look after the patient!

Post Rx soreness?
Very common for people to experience post rx soreness for up to 72
hours after treatment.
Side effects can include:
• Bruising
• Redness
• Tenderness/Increased Sensitivity
• Increased symptoms
• Aching similar to DOMS

Post Rx soreness?
Causes
• The release of toxins/waste products from muscular tissue
• Neurological sensitisation
• Increased blood flow and micro trauma can lead to bruising and
redness
Advice
• Reassure the patient it's a normal response to be sore after soft
tissue treatment
• Advise them to use ice (safely)
• Recommend they drink water to keep hydrated

Indications for Rx
• Loss of mobility and range of motion
• Increased amounts of scar tissue and adhesions
• Increased tone of overactive muscles
• Poor quality of movement

Specific Pathologies treated
with myofascial release
● Whiplash associated conditions
● Fibromyalgia / Non- specific chronic pain
● Lower back pain
● Individuals with reduced ROM
● Postural Tension
● Reduced blood flow from trauma or post surgery
● Reduced immune system

Contraindications for Rx
Local Systemic
Broken skin/Open cuts Active cancer (Malignancy)
Skin conditions Acute Circulatory disorders
Haematoma Blood Thinning Medications (e.g.
Warfarin)
Healing Fracture Bleeding disorders (e.g.
Haemophilia)
Active infections Systemic Infection
Obstructive Oedema
Acute RA
Uncontrolled Diabetes

Precautions to Rx
• Pregnancy
• Hypersensitivity
• Hyper or Hypo-tension
• Patient Anxiety
• Acute injury/ Inflammatory stages of healing

Practical

Back
• Direct
- Knuckles
- Thumb kneading
- Skin rolling
• Indirect
- Longitudinal stretch
- Cross over

Shoulder/ Upper Traps
• Direct
- Stripping
- Isolated MFR over trigger points
- Supine UFT
Indirect
• Glides
• Stretches
• Limb pulls

Lunch

Quadriceps
• Direct
- Knuckles
- Elbows
- On stretch
- Skin rolling
• Indirect
- Cross over

Hamstrings
• Indirect
- Gliding
Direct
• Skin rolling
• Stripping
• Tack and stretch/ active release techniques

Calf's
• Gliding
• Gliding on stretch
• Tack and stretch
• Release on stretch

Glutes
• Side lying position with muscles on a stretch
• Towel for pt comfort and dignity
• Communication!
• Pin under great trochanter

Treatments that work
well alongside MFR

Taping

Trigger pointing/ Soft
tissue release

Exercise

Foam Rolling

Outcome measures
● Pain scores (VAS)
● (Pre/ Post) Muscle length / stretching /
special testing
● Quality of Sleep (Quality of Sleep Index
Questionnaire)
● Quality of Life Questionnaire

Case study 1
Subjective:
40 year old male reports 4/10 dull ache pain into lower back. No neurological
symptoms or red flags. Aggs- desk based job. Eases- hot baths, lying down.
24hr- stiffness in AM.
Objective:
Anterior tilted pelvis
Excessive lumbar lordosis
Reduced range into lumbar flexion/ side flexion bilaterally
Positive modified thomas test
Tender to palpate on Lx paraspinals and quads.

Which myofascial release techniques could you use?
What outcome measures could be used to check it is
effective?
Any other treatments alongside MFR?
Case study 1

Case study 2
Subjective:
25 year old female reports 5/10 dull ache pain into calves and
hamstrings following an increase in the frequency of running while
she is training for a marathon. No neurological symptoms or red
flags. Aggs- running Eases- rest, heat and stretching.
Objective:
Posterior tilted pelvis.
Reduced range into lumbar flexion
Limited range into ankle dorsiflexion bilaterally
Restrictive 90/90 hamstring length test 120 bilaterally.

Case study 2
Which myofascial release techniques could you
use?
What outcome measures could be used to check it
is effective?
Any other treatments alongside MFR?

Thanks for coming!
Don’t forget to follow us on Twitter: @physiocouk

Myofascial Release

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