Myofascial Release Lecture PDF

MYOFASCIAL RELEASE DR. FAIROUZ HATEM AMEEN BASIC SCIENCE DEPARTMENT ◦Myofascial release: Myo means ‘muscle’, and fascia means ‘band’. ◦Fascia, is a single uninterrupted three-dimensional sheet of tissue that overlap, surrounds, protects and supports every structure of the human body. ◦It exte...

MYOFASCIAL RELEASE DR. FAIROUZ HATEM AMEEN BASIC SCIENCE DEPARTMENT ◦Myofascial release: Myo means ‘muscle’, and fascia means ‘band’. ◦Fascia, is a single uninterrupted three-dimensional sheet of tissue that overlap, surrounds, protects and supports every structure of the human body. ◦It extends from the skull down to the soles of the feet. ◦and from the exterior to the interior of the body. ◦ It is dynamic, ever-changing and adapting fluid- filled network present in and around every structure. ◦It is described as the largest system in the human body.  The myofascia possesses 10 times more sensory nervereceptors than its muscular counterpart.  It is considered a mechanosensitive system that adapts its fibers arrangement and density according to the local and tensional demands placed on it. fascia as a fluid-filled network.  The term fascia describes all of the soft tissue components of the connective tissue system in the human body.  Therefore, fascia also includes the aponeurosis, ligaments, tendons, joint capsules, and certain layers of bone, organs and nerves, as well as the dura mater surrounding the central nervous system, the epineurium (i.e., a fascial layer around peripheral nerves) and bronchial connective tissues and the mesentery of the abdomen.  It forms supportive structures to maintain hydrostatic pressure, promoting the visceral function, and protecting, the vital organs.  Like muscles, fascia also is sensitive to mechanical loads that stimulates mechanoreceptors of fascia (receptors that responds to mechanical load or distortion).  Loading the fascial network: Muscles transmit only a little force of their strength through their tendons onto bone attachments.  Rather, they distribute their contractile tensional forces onto the fascial network, distributing this force along its interconnected matrix (fascial sheaths) to synergistic and antagonistic muscles, nearby joints and other structures along its tensional lines.  Fascia is dynamic because it is constantly undergoing change. It is continually morphing in response to the demands of both the internal and external tension imposed on it.  Elements of fascia The three main elements of fascia are as follows:  Collagen  Elastin  Ground substance  COLLAGEN is the most abundant protein in the body.  ELASTIN is another type of protein.  Both collagen and elastin, are the main fibers within fascia.  Together they exist within a viscous, gel-like fluid called ground substance. Role of collagen and elastin  - The specific composition of fascia is depending on its function.  -Collagen provides strength and stability when mechanical stress is applied, to guard against over extension.  -Elastin provides an elastic quality that allows the connective tissue to stretch to the limit of the collagen fibers’ length whilst absorbing tensile force.  Ground substance: Surrounding the collagen and elastin fibres is a viscous, gel-like ground substance (a polysaccharide gel complex) composed of hyaluronic acid (hyaluronan) and proteoglycans that lubricate the fibres and allow them to glide over each other. Role of the ground substance  The ground substance is the environment medium for all the cells in the body.  The proteoglycans form this gel-like medium, and the presence of the hyaluronan makes it hydrophilic (water loving), drawing water into the tissue.  This provides a cushioning effect and aids in maintaining space between the collagen fibres.  The gel absorbs shock and disperses it throughout the body.  Fascia’s ground substance provides the medium in which other elements are exchanged (gases, nutrients, hormones, cellular waste, antibodies, and white blood cells).  The condition of the ground substance can affect the rate of diffusion and therefore the health of the cells it surrounds. Fascia is a colloid. A colloid comprises particles of solid material suspended in fluid.  Colloids are not rigid; they conform to the shape of their containers and respond to pressure even though they are not compressible. Note:  The amount of resistance colloids offer increases proportionally to the velocity of force applied to them.  The more rapidly force is applied, the more rigid the tissue becomes.  This is why a gentle, light, sustained touch is essential to avoid resistance and viscous drag when releasing fascial restrictions. Elastic Properties and Force Transmission within fascia  Fascia, has variable degree of elasticity that allows it to withstand deformation when forces and pressures are applied to it.  It can then recover and return to its starting shape and size.  Because fascia contracts and relaxes, it responds to load, compression and force.  At the beginning of loading, fascia has an elastic response in which a degree of slack is taken up.  - Over time, if loading persists in a slow and sustained manner, creep develops, which is a slow, delayed yet continuous deformation.  Then, volume change occurs as water is forced from the tissue (i.e., the ground substance becomes less gel-like).  -When the applied force, or loading, ceases, fascia should return to its original non-deformed state.  -The restoration of shape occurs through elastic recoil.  The time needed for tissue to return to normal via elastic recoil depends on the uptake of water by the tissue and whether its elastic potential has been exceeded or not.  - When loading occurs, tissues lengthen and distort until they reach a point of balance.  - If loading is sustained, over time, chronic deformation will result. The three primary conditions that affect fascia are as follows:  Injury or trauma (anything physical or emotional)  Inflammatory processes  Habitual poor posture Injury or Trauma could be:  - Fall  - Blow  - Cut  - Burn  -Surgery of any kind  -Medication  -Overuse and underuse of the tissues as in a sporting injury.  -General stresses of daily life. Inflammatory Processes : -Imbalance in cellular fluids. -Scar formation. -Fascial adhesions. Function and importance of fascia In addition to providing support, protection and the separation of structural elements fascia plays a vital role in the following:  1- Fascia provides a course for interstitial fluid and thus provides lubrication between structures to allow for movement and the delivery of nutrition.  2-Connective tissue has a nutritive function and houses nearly a quarter of all body fluids.  3-The anatomical barrier presented by fascia has important defensive functions in case of infections.  4-Cellular respiration  5-Elimination  6-Metabolism  7-Fluid and lymph flow  8-Repair by deposition of repair tissue  9-Conservation of body heat  10-Fat storage  11-Cellular health and the immune system Superficial vs deep fascia The superficial and deep fascial layers can be distinguished by trained hands.  These two layers and their associated structures are enveloped within the global fascial matrix and are therefore in complete communication with each other. Role of superficial fascia Superficial fascia is loosely attached, that consists of fibroelastic, areolar tissue that has the following functions and effects:  1- Forms a thin layer of tissue beneath the skin, attaching the dermis skin to the underlying tissues.  2- Provides shock absorption.  3- Provides space for the accumulation of fluid and metabolites  4- stores fat.  5- Provides insulation.  6- Contains capillary networks and lymphatic channels.  7- Regulates fluid.  8- Contains inflammatory exudates.  9- Causes many tissue texture abnormalities. Superficial fascia aereolar connective tissue Role of deep fascia Deep fascia is tough, tight and compact; it has tough, inelastic clefts and septa; thus forming many interconnected pockets, it thickens in response to stress; thus it has the following functions and effects:  1- It contributes to the contour and function of the body.  2- Comprises the specialized elements of the peritoneum, pericardium and pleura.  3- Compartmentalizes (dividing into compartments) the entire muscular system.  4- Surrounds and separates visceral organs.  5-Functions to stabilize posture.  6-Encases the nervous system and the brain. Deep fascia Mechanism of fascial injury  Deformation and distortion of any part of the fascial network imposes negative stresses on distant aspects and on the structures it divides, envelopes, enmeshes, supports, and with which it connects.  -Over time, fascial restrictions insidiously spread like a pull in a sweater or stocking.  -Flexibility and spontaneity of movement are lost, setting up the body for more trauma, pain and movement limitation.  Abnormal forces can cause it to twist and turn increasing the tensile force on the body and leads to biomechanical inefficiency and stimulates pain- sensitive structures in the affected area as well as the adjacent and distant pain-sensitive structures.  This binding down of fascia results in unique adaptations in a faulted way. MFR procedure  MFR is a treatment approach, a therapy and a rehabilitation tool.  It is a hands-on therapy, meaning that the therapist applies pressure with the hands on the patient’s body.  It is tridimintional.  The therapist addresses the tissue barrier of resistance by feeling for tightness, restrictions and adhesions in any plane that may be causing pain or dysfunction.  The many aspects of the MFR approach depend on each other.  The manual application of the techniques is one part; another is myofascial rebounding, and a third is myofascial unwinding. MYOFASCIAL TREATMENT ◦ The Myofascial Release Approach has three major components: ◦ Myofascial Release, ◦ Myofascial Unwinding, and ◦Myofascial Rebounding. ◦Myofascial release is a tridimentional treatment approach, a therapy and a rehabilitation tool. ◦It is a hands-on therapy, meaning that the therapist applies pressure with the hands on the patient’s body. ◦The therapist searches for the tissue barrier of resistance by feeling for tightness, restrictions and adhesions in any plane that may be causing pain or dysfunction. ◦Myofascial Rebounding utilizes the fluid/energy dynamics to enhance Myofascial Release effectiveness in reducing pain, increasing function, and awareness. ◦Myofascial unwinding is a physical movement that comes from a higher intelligence which describes a “feeling” to release. ◦The therapist can see or note spontaneous movement or twitching anywhere in the patient’s body.  Sequence of events during healing by MFR ◦MFR is based on squeezing out the water from the entire fascial matrix, encouraging fresh, clean water to return. ◦- At the same time, the hydrophilic nature of the collagen encourages the water molecules to organise themselves in the liquid crystalline matrix form. ◦-This matrix provides it with a high degree of viscoelasticity promoting bounce and give within the system. ◦The mechanoreceptors of the fascia respond to stimuli. ◦-MFR, through kinaesthetic awareness, stimulates the mechano-receptors by applying sustained pressure to release the restricted fascia. ◦ -As the tissue releases, it stretches, and as the patient begins to spontaneously unwind, other mechanoreceptors are stimulated by this movement. ◦In restricted fascia, however, in which the collagen and elastin fibres are drawn closer together, less bound water is present. ◦ Restricted fascia, creates a tensile force, affecting pain- sensitive structures throughout its network. ◦ ◦ Follow lines of restriction back to the origin and remove it, you can restore the entire structure to an even and equal pull, This is how MFR works on a three-dimensional level. ◦ The therapist takes note of where the pain is, he looks, feels and traces the restricted tissue back to the origin of that restriction and releases it; then work with creating balance and restoring function. ◦ The application is slow, sustained pressure held at the barrier of tissue resistance, usually for five minutes or more without slipping over the skin. ◦ The viscoelastic nature of fascia causes it to resist sudden forces. ◦ Less pressure applied to tissue results in a greater response; firmer and quicker pressure results in tissue resistance ◦-The three elements of MF treatment which work with and promote the healthy activation of all of the fascial mechanoreceptors ultimately promoting and maintaining health and function. ◦-The time needed for tissues to begin to rearrange themselves is approximately 90 to 120 seconds. ◦-The viscous ground substance determines the ease at which the release occurs. ◦-Because collagen begins to change only after 90 to 120 seconds, MFR techniques must be performed for more than five minutes to influence the entire fascial network. ◦-As the collagen and elastin fibers reorganize themselves: ◦1- Cross-linkages in these fibres are broken down. ◦2- Fascial planes are realigned, ◦3- Local circulation (waste and nutrient exchange) improves ◦4- Soft tissue proprioceptive sensory mechanisms are reset, enabling a normal functional range of motion without eliciting the old pain. ◦-Fascia responds by softening and yielding, allowing the therapist to follow that softening through barrier after barrier of restriction in any direction in a three-dimensional manner. ◦-MFR therapists feel for tissue resistance called the end-feel, or tissue barrier. The term end-feel is used to refer to where the tissue stuck and is resistive to pressure or traction. ◦Positive signs to continue the technique progression, is when the therapist determine vasodilatation, or red flare. ◦-This occurs where there is an increase in circulaton as the tissue releases along the lines of pull. ◦ The patient senses movement or softening in sites distant to where the therapist’s hands are. ◦-This is due to the release of restrictions along a line of pull ◦The protein collagen is a hydrophilic tissue. ◦ Water, which makes up approximately two thirds of fascial composition, in addition to collagen forms bound water, which promotes the bounce and give that enhances nutrient, gaseous, waste product and information exchange. Rules and principles followed when applying MFR: ◦ 1-MFR is performed without oil or lotion to prevent slippage on the skin. ◦ 2-Generally, patients are treated wearing minimal clothing with sheets or towels for drapes. ◦ 3-In most cases the MFR therapist performs a visual, movement and palpatory assessment before treatment. ◦ 4-Once the evaluation has been completed; the therapist starts treatment in areas that feel tight, hot or tender. These areas will not always be where the patient is experiencing pain. ◦ 5- Apply each technique for 5 minutes then repeat or move to the other technique. ◦ 6-The therapist obtains a patient consultation form. ◦ 7-MFR should be carried out as soon as possible after an injury to assist in the repair process and to avoid the effect of compensation. ◦ 8-Working in and around a scar site should be avoided for approximately six to eight weeks post-injury. Benefits of MFR: ◦ General increase in health due to the increase in water volume (bound water) in the ground substance (nutrient and waste exchange) ◦ Promotion of relaxation and a sense of well-being ◦ Elimination of general pain and discomfort ◦ Increased proprioception. ◦ Re-established and improved joint range of motion and muscle function ◦ Improved digestion, absorption and elimination ◦ Restored balance and promotion of correct posture ◦ Injury recovery and rehabilitation ◦ Can be used as part of an athletic or sport training routine and maintenance program to promote mobility and performance ◦ Promotion of awareness of emotional issues and how they may be resolved  Indications of MFR: ◦Fascial restrictions. ◦Muscle shortening, or imbalance. ◦Postural asymmetry, deviations and deformities. ◦Restricted joints. ◦Pain due to trauma, injury or habitual adaptations and compensations. ◦Chronic conditions and disorders ◦Headaches from a cervical origin. ◦Tightness of soft tissues.  Precautions ◦ MFR could lower blood pressure, so patients should rest for 15 minutes in a horizontal position after the session and they should get up slowly. ◦ MFR may lower blood sugar levels, so allow the patient to have a snack prior to the session. ◦ If there is an open wound or incision, apply MFR to uninvolved areas.  Contraindications of MFR: ◦ General contraindications ◦ Alcohol and recreational drug use ◦ Febrile state (high temperature) ◦ Systemic infection ◦ Colds and flus that are contagious ◦ Acute circulatory conditions and acute blood disorders ◦ Deep vein thrombosis and aneurysm ◦ Uncontrolled hypertension usually involving anti-coagulant therapy ◦ Severe undiagnosed swelling ◦ Severe undiagnosed pain ◦ Undiagnosed lumps ◦ Rapid weight loss or gain ◦ Undiagnosed breathing difficulties ◦ Undiagnosed bowel and bladder issues Local Contraindications ◦ Open wounds ◦ Sutures or stitches ◦ Healing fracture ◦ Skin hypersensitivity or inflammation ◦ Infectious skin condition or sunburn ◦ Localised infection ◦ Osteomyelitis ◦ Osteoporosis or advanced degenerative changes ◦ Rheumatological conditions ◦ Severe varicose veins. Effects of MFR on scar Tissue and Adhesions ◦ MFR has great effect on internal scarring and adhesions, the scar look much softer, releasing all the restricted vessels, nerves and organs tied up within that restriction. Be sure to wait between six and eight weeks before performing MFR over a scar; prior to that time, work can be carried out above and below the incision site. ◦ MFR release the restrictions and scarring that may be contributing to pain, it is also a relaxation tool for those who are post-surgery or postpartum. ◦ It promotes total-body softening and yielding gives more energy, flexiblility and pain free movement Effects of MFR on Increased circulation- red flare ◦ Circulation increases in the area you are treating and also distant to where the therapist’s hands are. This is because when one area releases, subsequent areas along the same line of pull release also. ◦ Red flare indicates areas that should be subsequently treated to maximize the results of the therapy.  Post-treatment effects: ◦Therapeutic pain. This is what we call body stiffness or tenderness post-treatment. ◦Better sleep due to less pain and tension. ◦Lethargy: patients can feel ‘washed out’ after treatment. Holding on to huge amounts of tension can be exhausting. As the tension releases, the body is able to show how exhausted it has been from having to hold on. 10/20/2024 Soft tissue manipulation, dr.fairouz hatem ameen Ph.D B Sc. 51  ◦Females may have less painful menstruation cycles. ◦ Old aches and pains: As layers of restriction and tension are released, old injuries that were not adequately treated become uncovered. This process of peeling back the layers reveals both the physical and emotional aspects of all injuries. ◦Energised. The client feels an increase in energy due to the release of tensional loads on their body. 10/20/2024 Soft tissue manipulation, dr.fairouz hatem ameen Ph.D B Sc. 52  ◦Normal responses that can occur from a physical or emotional release, or both, due to myofascial unwinding, during a MFR treatment session: ◦Breathing changes ◦Skin colour changes (pallor to flushed) ◦Sweating ◦Shivering, trembling, vibrating or shaking ◦Local or full-body movement (myofascial unwinding) ◦Emotional release such as laughter, crying, anger, joy or fear. 10/20/2024 Soft tissue manipulation, dr.fairouz hatem ameen Ph.D B Sc. 53  Responses to myofascial unwinding: ◦ Twitching, jumping, jerking of a limb or body part ◦ Shivering or shaking ◦ Sweating ◦ Changing facial expressions ◦ Breathing changes ◦ Full-body or local movement ◦ Emotional release (crying, laughing, fear, anger, joy) ◦ Surfacing of a memory of an event ◦ Rapid eye movement ◦ Rocking of the body (rebounding) 10/20/2024 Soft tissue manipulation, dr.fairouz hatem ameen Ph.D B Sc. 54  Techniques of MFR: ◦ 1-Cross-Hand Releases 10/20/2024 Soft tissue manipulation, dr.fairouz hatem ameen Ph.D B Sc. 55  II-Longitudinal Plane Releases 10/20/2024 Soft tissue manipulation, dr.fairouz hatem ameen Ph.D B Sc. 56  III- Compression Releases. 10/20/2024 Soft tissue manipulation, dr.fairouz hatem ameen Ph.D B Sc. 57  IV-Transverse Plane Releases 10/20/2024 Soft tissue manipulation, dr.fairouz hatem ameen Ph.D B Sc. 58