Hands On Therapy | The Myofascial Component
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The Myofascial Component

15_Post Fascia Man Full Injury
Any discussion of the conditions or dysfunction of the soft tissue would be incomplete and limited in scope without an exploration of the fascial system. Restrictions and dysfunction in the fascial system may be the underlying component to a multitude of conditions that cause pain, limited range of motion (ROM) and postural aberrations. Before we discuss the particular conditions that are affected by these fascial restrictions, let us review some of the basic information about fascia, its function and its importance.

Fascia, as a tissue, is composed of elastin, collagen and a polysaccharide complex called ground substance. A tough yet flexible connective tissue matrix that resembles a spider web is formed with these components, providing a contiguous connection from muscle to bone, bone to bone and organs to their supporting structures. Fascia is present even at the cellular level and is active in cellular nutrient transport and communication. Examining the components of fascia, we find that collagen is the component that provides strength and protection from over-stretching of the fascia. Elastin, then, provides the flexibility of fascia through its rubbery structure. The ground substance is composed of polysaccharides, namely hyaluronic acid and proteoglycans. This ground substance lubricates the other two components of fascia and provides shock-absorption for the entire body through its viscosity. The ground substance and therefore the entire fascial unit/body can exist in states that range from near-solid to near-fluid. Tissues of this type are called colloidal tissue. Discussion of the importance of this tissue will be addressed later in our exploration of the fascial system.

If fascia were only present at the junction between muscle and bone, it would rightfully be relegated to its current level of understanding and treatment in the allopathic world. However, the fascial system creates a 3-dimensional web that surrounds and infuses every muscle, bone, nerve and organ in the body and is present even at the cellular level. Therefore, fascia should be treated and thought of not just as a tissue, but as a complex living system. This living system provides structure, stability, communication and protection and can be adversely affected by injury, inflammation, postural abnormalities and emotional trauma. As restrictions are formed in the fascial system by the aforementioned causes, pain, reduced ROM, local dysfunction, systemic dysfunction, postural imbalances and fatigue may begin to occur. These symptoms can occur locally or in areas remote from the original restriction because of the 3-dimensional structure of the fascial system and the propensity for fascial restrictions to spread along lines of tension.

When we refer to restrictions in the fascial system, we are referring specifically to areas that have lost their malleability due to processes that harden the fascial component and solidify the ground substance. Fascia has a tensile strength of up to 2000 lbs per square inch, so it is not difficult to imagine why therapists often hear complaints of severe pain in areas where restrictions are present. These restrictions can entrap pain-sensitive areas and decrease ROM locally. As the body adapts to this restriction, other restrictions may form due to compensatory postures or movements that are not biomechanically correct. This again may lead to pain in that region, reduced ROM and still more compensatory restrictions and dysfunction in yet another area and then throughout the entire body.

09_Elastocollagenous Complex
18_MFR Reduces Injury
In order to release these restrictions, the therapist cannot expect to find full or permanent resolution by addressing muscle tension, muscle length or other soft tissue manipulation. A specific means of addressing the fascial system must be employed in addition to these modalities in order to sufficiently reduce or eliminate the restriction. We address these restrictions with techniques developed by John F. Barnes, P.T. and call them Myofascial Release techniques .

By employing these Myofascial Release techniques, we can improve and restore function, increase ROM and allow proper cellular function in restricted areas. The techniques discussed will have commonalities that aid in increasing fluidity in the ground substance which will lengthen the fascia and reduce or eliminate pressure on pain-sensitive areas. One such common concept will be the length of time that these techniques are held. For stretches aimed at lengthening the muscular unit, stretches typically last from 2 seconds to a minute. During a Myofascial Release technique, the minimum length of time the release should be held is between 1-3 minutes and may last as long as 5-10 minutes for a complete softening of the restriction. Whenever a force (i.e. pushing, pulling, twisting) is applied to the fascia, the ground substance will begin to change its viscosity due to the piezoelectric make-up of its matrix. The gentle traction forces will elicit heat, a vasomotor response that increases blood flow to the affected area, enhance lymphatic drainage of metabolic waste, realign fascial planes and reset the soft tissue proprioceptive sensory mechanism which reprograms the Central Nervous System, enabling a normal, functional ROM without eliciting old pain patterns.

While a holding time of 5 to 10 minutes may seem like a long time, it is pertinent to give the fascia enough time to change its viscosity, allow cross restrictions to degrade and permit a complete release of the restricted area. Subjective descriptions of this release are often reported as feeling like taffy being pulled or like glue stretching. A properly trained Myofascial Release therapist does NOT try to force through barriers where the tissue is hardened or painful, but allows the barrier to “melt”, thereby allowing the release to continue.

As layer after layer of these restrictions are released, fascia and the surrounding tissue, organs, bones, blood vessels and nerves can return to a more functional state and the client will report a decrease in pain, an increase in ROM and a decrease in dysfunction. Time after time it occurs that, once the fascial system is addressed, clients begin to make progress and in a matter of weeks, with Myofascial Release treatment, they are on their way to a pain-free, active lifestyle again.

14_Trauma Spreads
1*Barnes, J. Myofascial Release: Search for Excellence. John F. Barnes PT and Rehabilitation Services, Inc.
2*See Footnote 1.
4*Barnes JF, Smith G. The body is a self-correcting mechanism. Physical Therapy Forum, July 8, 1987