What is Myofascial Release?
A Review of The Literature
A Look at Fascial Anatomy
Andreas Vesalius (1514-1564) is often considered to be the first anatomist and is best remembered for publishing the famous anatomy text, De humani corporis fabrica in 1543. If you look at these early illustrations they present the fascia and muscles as one continuous soft tissue structure.
Fast forward to the 20th century (texts we study) most opt to omit fascial structures in order to depict muscles in a cleaner fashion. Recent anatomy textbooks have made an effort to include this ‘forgotten tissue’ in their depictions and descriptions.
An example of this is The Functional Atlas of the Human Fascial System by Carla Stecco, an Orthopedic surgeon and a professor of human anatomy at the University of Padua in Italy, the same University that once employed Andreas Vesalius in the early 1500’s.
Another example is Anatomy Trains by Thomas Myers, in this book Myers presents conceptual ‘myofascial meridians’, a recent systematic review confirmed a number of these continuous soft tissue structures (Wilke et al. 2016).
To better understand myofascial release, there is a need to clarify the definition of fascia and how it interacts with various other structures: muscles, nerves, vessels.
Fascia has Been Used as an Ambiguous Term by Many, Myself Included.
Inconsistent definitions in the literature has lead to confusion for researchers and therapists. A definition put forth by the Fascial Research Society hopes to provide some guidance. These researchers suggest making the distinction between A Fascia and The Fascial System (Adstrum et al. 2017).
What is a Fascia?
The Fascial Research Society describes A Fascia as follows "fascia is a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs."
What is the Fascial System?
The Fascial Research Society describes The Fascial System as follows "The fascial system consists of the three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissues that permeate the body. It incorporates elements such as adipose tissue, adventitiae and neurovascular sheaths, aponeuroses, deep and superficial fasciae, epineurium, joint capsules, ligaments, membranes, meninges, myofascial expansions, periostea, retinacula, septa, tendons, visceral fasciae, and all the intramuscular and intermuscular connective tissues including endo-/peri-/epimysium."
Myofascial Release in Various Forms Stimulates Mechanoreceptors
Ascribing patient’s pain solely a tissue-driven pain problem is often an oversimplification of a complex process. This insight provides us with an opportunity to re-frame our clinical models.
When it comes to myofascial release a biopsychosocial framework helps put into context the interconnected and multidirectional interaction between a number of proposed mechanisms of action, including but not limited to: contextually aided responses, neuromodulation and mechanotherapy.
Neurologically myofascial release may be used to stimulate mechanoreceptors, which in turn, trigger tonus changes in skeletal muscle fibers. Further more, input from sensory neurons may prevent the spinal cord from amplifying nociceptive signaling.
Myofascial Release in Various Forms Influences Tissue and Cell Physiology
Along with the neurological response a number of researchers have investigate the effect of manual therapy on cellular signaling and tissue remodeling.
Researchers at the University of Kentucky suggest that the application of massage prompts a phenotype change of M1 macrophages into the M2 macrophages (Waters-Banker et al. 2014). Another group of researchers propose that mechanical stimulation can trigger fibroblasts to express anti-inflammatory cytokines (Zein-Hammoud et al. 2015). Taken together this reduction in inflammatory signalling may play a role in tissue remodeling.
Another study from Geoffrey Bove published in The Journal of Neurological Sciences looked at the effect of modeled massage therapy on TGF-β1 induced fibroblast to myofibroblast transformation (Bove et al. 2016). This is potentially impactful in postoperative rehabilitation because TGF-β1 plays a key role in tissue remodeling and fibrosis.
Furthermore, a recent study published in The Journal of Physiology found that massage enhanced satellite cell numbers (Miller et al. 2018). This may again effect tissue remodeling and improve the bodies ability to respond to subsequent rehabilitation.
Does Myofascial Release Break Adhesions?
Following trauma there are often a number of pathological adaptations which may impair the bodies ability to respond to subsequent rehabilitation. Traditionally when soft tissue structures have a reduced ability to glide adhesions are blamed. Currently there is a paucity of research to support the claim that manual therapy can break mature adhesions. However, in the developmental phase manual therapy may be able to attenuate the development of post-surgical adhesions (Bove et al. 2017).
In the remodeling phase the mechanisms by which myofascial release interrupts the sequelae of pathological healing is most likely not in a single unified response.
So, What is Myofascial Release?
This post is set up in a Cole's note format, I have left our many nuanced subjects which I will address in future posts. In the interest of brevity I will now address the original question.
Myofascial Release is a hands on treatment approach that stimulates mechanoreceptors and influences tissue and cell physiology. Clinically this translates into improved proprioception, increased range of motion and pain management.
More to Explore
Adstrum, S., Hedley, G., Schleip, R., Stecco, C., Yucesoy, C.A. (2017). Defining the fascial system. J Bodyw Mov Ther.
Berrueta, L., Muskaj, I., Olenich, S., Butler, T., Badger, G. J., Colas, R. A., . . . Langevin, H. M. (2016). Stretching Impacts Inflammation Resolution in Connective Tissue. Journal of Cellular Physiology.
Bijlard, E., Uiterwaal, L., ... Huygen, F.J. (2017). A Systematic Review on the Prevalence, Etiology, and Pathophysiology of Intrinsic Pain in Dermal Scar Tissue. Pain Physician.
Bordoni, B., Bordoni, G. (2015). Reflections on osteopathic fascia treatment in the peripheral nervous system. J Pain Res. (OPEN ACCESS)
Bove, G., Harris, M., Zhao, H., & Barbe, M. (2016). Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. Journal of the Neurological Sciences.
Bove, G.M., Chapelle, S.L., Hanlon, K.E., Diamond, M.P., Mokler, D.J. (2017). Attenuation of postoperative adhesions using a modeled manual therapy. PLoS One. (OPEN ACCESS)
Chaitow, L. (2017). What's in a name: Myofascial Release or Myofascial Induction? J Bodyw Mov Ther.
Chamorro Comesaña, A., Suárez Vicente, M.D., ... Pilat, A. (2017). Effect of myofascial induction therapy on post-c-section scars, more than one and a half years old. Pilot study. J Bodyw Mov Ther.
Chaudhry, H., Bukiet, B., Ji, Z., Stecco, A., Findley, T.W. (2014). Deformations experienced in the human skin, adipose tissue, and fascia in osteopathic manipulative medicine. J Am Osteopath Assoc.
Chen, Q., Wang, H., Gay, R. E., Thompson, J. M., Manduca, A., An, K., . . . Basford, J. R. (2016). Quantification of Myofascial Taut Bands. Archives of Physical Medicine and Rehabilitation. Archives of Physical Medicine and Rehabilitation.
Dischiavi, S.L., Wright, A.A., Hegedus, E.J., Bleakley, C.M. (2018). Biotensegrity and Myofascial Chains: A Global Approach to an Integrated Kinetic Chain. Medical Hypothesis.
Freitas, S.R., Mendes, B., Le Sant, G., Andrade, R.J., Nordez, A., Milanovic, Z. (2018). Can chronic stretching change the muscle-tendon mechanical properties? A review. Scand J Med Sci Sports.
Klingler, W., Velders, M., Hoppe, K., Pedro, M., & Schleip, R. (2014). Clinical Relevance of Fascial Tissue and Dysfunctions. Current Pain and Headache Reports.
Langevin, H. M., Keely, P., Mao, J., . . . Findley, T. (2016). Connecting (T)issues: How Research in Fascia Biology Can Impact Integrative Oncology. Cancer Research. (OPEN ACCESS)
Miller, B.F., Hamilton, K.L., ... Butterfield, T.A., Dupont-Versteegden, E.E. (2018). Enhanced skeletal muscle regrowth and remodelling in massaged and contralateral non-massaged hind limb. J Physiol.
Nordez, A., Gross, R., Andrade, R., Le Sant, G., Freitas, S., Ellis, R., McNair, P.J., Hug, F. (2017). Non-Muscular Structures Can Limit the Maximal Joint Range of Motion during Stretching. Sports Med.
Parravicini, G., Bergna, A., (2017). Biological effects of direct and indirect manipulation of the fascial system. Narrative review. Journal of Bodywork & Movement Therapies.
Queiroz, B.Z., Pereira, D.S., ... Pereira, L.S. (2017). Inflammatory Mediators and Pain in the First Year After Acute Episode of Low-Back Pain in Elderly Women: Longitudinal Data from Back Complaints in the Elders-Brazil. Am J Phys Med Rehabil.
Stecco, A., Meneghini, A., Stern, R., Stecco, C., & Imamura, M. (2013). Ultrasonography in myofascial neck pain: Randomized clinical trial for diagnosis and follow-up. Surgical and Radiologic Anatomy.
*This article is the first that show the modification of the fascia in patients before and after treatment.
Stecco, A., Stern, R., Fantoni, I., Caro, R., & Stecco, C. (2016). Fascial Disorders: Implications for Treatment. Pm&r.
Waters-Banker, C., Dupont-Versteegden, E. E., Kitzman, P. H., & Butterfield, T. A. (2014). Investigating the Mechanisms of Massage Efficacy: The Role of Mechanical Immunomodulation. Journal of Athletic Training.
Webb, T.R., Rajendran, D. (2016). Myofascial techniques: What are their effects on joint range of motion and pain? - A systematic review and meta-analysis of randomised controlled trials. J Bodyw Mov Ther.
Wilke, J., Schleip, R., Yucesoy, C.A., Banzer, W. (2018). Not merely a protective packing organ? A review of fascia and its force transmission capacity. J Appl Physiol.
Wilke, J., Krause, F., Vogt, L., & Banzer, W. (2016). What Is Evidence-Based About Myofascial Chains: A Systematic Review. Archives of Physical Medicine and Rehabilitation.
Wong, K., Chai, H., Chen, Y., Wang, C., Shau, Y., & Wang, S. (2017). Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: A study of dynamic ultrasound. Manual Therapy.
Zein-Hammoud, M., & Standley, P. R. (2015). Modeled Osteopathic Manipulative Treatments: A Review of Their in Vitro Effects on Fibroblast Tissue Preparations. JAOA.