UNDERSTANDING MYOFASCIAL RELEASE

The following is a condensed version of an article written by John F. Barnes, P.T., Founder of the Myofascial Release Treatment Centers and International Instructor of the Myofascial Release technique, as printed in PT Today, January 16, 1995.

The New England Journal of Medicine reported a study of the volume of people and amount of money spent on traditional therapy and medicine vs. alternative therapy. The stunning news was that as much money was spent (over thirteen billion dollars last year) on traditional therapy as was with traditional therapy and medicine. The study also demonstrated that people were willing to pay cash for alternative therapy that produced the results that they needed and that this trend continues to grow daily.

What Is Happening?

The health professions had ignored the importance of an entire physiological system, the fascial system that profoundly influences all other structures and systems of the body. Fascial restrictions can exert tremendous tensile forces on the neuromuscular-skeletal and other pain sensitive structures. This enormous pressure (more than 2,000 pounds per square inch) can create the very symptoms that we have so long been trying to eliminate. Myofascial Release techniques are utilized in a wide range of settings and diagnoses; pain, movement restriction, spasm, spasticity, neurological dysfunction, i.e., cerebral palsy, head and birth injury, CVA’s, scoliosis, menstrual and pelvic pain and dysfunction, headaches, temporomandibular pain and dysfunction, geriatrics, sports injuries, pediatrics, chronic fatigue syndrome, fibromyalgia, traumatic and surgical scarring, acute and chronic pain.

The Anatomy and Physiology of Fascia

Fascia is a tough connective tissue which spreads throughout the body in a three dimensional web from head to toe without interruption. The fascia surrounds every muscle, bone, nerve, blood vessel and organ of the body, all the way down to the cellular level. Therefore, malfunction of the fascial system due to trauma, posture, or inflammation can create a binding down of the fascia, resulting in abnormal pressure on nerves, muscles, bones or organ. This can create pain or malfunction throughout the body, sometimes with bizarre side effects and seemingly unrelated symptoms, not always following dermatomal zones. It is thought that an extremely high percentage of people suffering with pain and/or lack of motion may be having fascial problems; but most go undiagnosed, as the importance of fascia is just now being recognized. All of the standard tests, such as x-rays, mylelograms, CAT scans, electromyography, etc, do not show the fascial restrictions.

The fascia can be broken down into three divisions; superficial fascia lies directly below the dermis; deep fascia surrounding and infusing with muscle, bone, nerves, blood vessels, and organs of the body, all the way down to the cellular level, and the deepest fascia within the dura of the cranial/sacral system. Fascia at the cellular level creates the interstitial spaces and has extremely important functions of support, protection, separation, cellular respiration, nutrition, elimination, metabolism, fluid and lymphatic flow. In other words, it is the immediate environment of every cell of the body.

This means that any trauma or malfunction of the fascia can set up the environment for poor cellular efficiency, necrosis, disease, pain and dysfunction throughout the body.

Other important factors concerning fascia are: It supports and stabilizes thus enhancing the postural balance of the body. It is vitally involved in all aspects of motion and acts as a shock absorber. It aids in circulatory economy, especially in venous and lymphatic fluid. Fascial change will often precede chronic tissue congestion.

Such chronic passive congestion creates the formation of fibrous tissue, which then proceeds to increase hydrogen ion concentration of articular structures.

Fascia is a major area of inflammatory processes. Fluid and infectious processes often travel along fascial planes. The central nervous system is surrounded by fascial tissue (dura matter) which attaches to the inside of the cranium, the foramen magnum and at the second sacral segment. Dysfunction in these tissues can have profound and widespread neurological effects.

Myofascial Pain and Dysfunction by Janet Travell, M.D. beautifully illustrates that there is a myofascial element; for every muscle of the body is surrounded by a smooth fascial sheath, every muscular fasciculi is surrounded by fascia, and every microfibril down to the cellular level is surrounded by fascia that can exert pressures of over 2,000 lbs. per square inch. Therefore, it is the fascia that can ultimately determine the length and function of its muscular component.

We must be clear that medicine, modalities, muscle energy techniques, mobilization/manipulation, massage and flexibility and exercise programs do not alter the powerful fascia restrictions that occur in a high percentage of our patients. These restrictions are only altered via Myofascial Release.

Myofascial release is a whole body “hands-on” approach to the evaluation and treatment of the human structure. The therapist is taught to evaluate the fascial system through visual analysis of the human frame three-dimensionally in space, by palpating the tissue texture and various fascial layers and observing the symmetry, rate, quality, and intensity of strength of the cranial/sacral rhythm. Proper Myofascial Release requires ongoing re-evaluation, including the above procedures and observance of vaso-motor responses and their location as they occur after a particular fascial restriction has been released. This provides instantaneous and very accurate information enabling the therapist to proceed intelligently and logically from one treatment session to the next, to the ultimate resolution of the patient’s dysfunction.

When the therapist has determined where the fascial restrictions lie, he or she will apply gentle pressure into the direction of the restriction. At first, the elastic component of the fascia will release, and at some point in time the collagenous barrier will be engaged. This barrier cannot be forced (it is too strong). One waits with gentle pressure, and as the collagenous aspect releases, the therapist follows the motion of the tissue, barrier upon barrier until freedom is felt.

It is felt that each time we experience a trauma, undergo an inflammatory process. Or suffer from poor posture, over time that the fascial system becomes restricted. These restrictions act like the concentric layers of an onion. These adaptive layers slowly tighten until we begin to lose our physiologic adaptive capacity (our margin of error). Therefore, we slowly tighten, losing our flexibility and spontaneity of motion, setting us up for trauma, pain or restriction of motion. These powerful restrictions begin to pull us out of our three-dimensional orientation with gravity. The goal of Myofascial Release is to help return the individual’s physiological adaptive capacity by increasing space and mobility and restoring three-dimensional balance and returning the structure to as close as potentially possible to its vertical orientation with gravity. This equilibrium allows the individual’s self-correcting mechanisms to come into play and alleviate symptoms and restore proper function.

A comprehensive treatment program should also include appropriate modalities, exercise and flexibility programs, movement awareness facilitation techniques, instruction in body mechanics, mobilization and muscle energy techniques, nutritional advice, biofeedback and/or psychological counseling.

This is a total approach incorporating a physiological system, that when included with traditional therapy, acts as a catalyst yielding impressive, clinically reproducible results.

A New Era

It is important for those providing treatment to realize that the body is a repository of information. The body can be used as a biofeedback system for the master therapist’s finely trained, sensitive hands. It can then be used as a handle or lever to provide access to emotions and belief systems and allow for structural and biomechanical change.

Tell your patients not to view the cause of their dysfunction as a defeat but rather to see it as a lesson. By looking for the positive, they can see its value, learn from it, and allow themselves to heal. Help them to understand that one of the best lessons is that they may not be able to change the circumstances of their life, but they can change their reaction to their circumstance. They can move from being passive, helpless recipients to active participants. This important change in perspective creates a partnership between you and your patient where you can help them help themselves.

MYOFASCIAL UNWINDING – THE BODY REMEMBERS

This is an article written by John F. Barnes, P.T., Founder of the Myofascial Release Treatment Centers and International Instructor of the Myofascial Release technique, as printed in PT & OT Today Vol.4, No 40.

To ask how the mind communicates with the body, or how the body communicates with the mind assumes that the two are separate entities. My experience has shown me that they are a single unit. The body is not just a reflection of the personality, it is the personality.

Mind/body awareness encompasses two different aspects of the same spectrum, immutably joined, inseparable and in constant communication. Myofascial release techniques and myofascial unwinding allow for the complete communication necessary for healing and true growth. I believe that the body remembers everything.

The link between mind/body awareness and healing is the concept of state-dependent memory, learning and behavior. A certain smell, or the sound of a particular piece of music creates a flashback phenomenon, producing a visual, sensorimotor replay of a past event or important episode in our lives. All of us have experienced this. The vividness of the recall is as if it were happening at that moment. I would like to expand this theory to include position-dependent memory, learning and behavior, where the structural position of the body in space is the missing component in the state-dependent theory.

Studies have shown that during periods of trauma, people sustain indelible imprints that have high levels of emotional content. The body can hold information below the conscious level as a protective mechanism, so these memories tend to become dissociated. Memories are state and position dependent and can therefore be retrieved when the person is in a particular state or position. The information is not available in the normal, conscious state, and the body’s protective mechanisms keep us away from the positions that our mind/body awareness construes as painful or traumatic.

It has been consistently demonstrated that when a myofascial release technique takes the tissue to a significant position, or when myofascial unwinding allows a body part to assume a significant position three-dimensionally in space, the tissue not only changes and improves, but also raises memories, associated emotional states and belief systems to the conscious level. This awareness allows the individual to grasp the previously hidden information that may be creating or maintaining symptoms or behavior that deter improvement. With the information now at a conscious level, the individual is in a position to learn what holding or bracing patterns have impeded progress. This release of the tissue, emotions and hidden information creates and environment for change that is both conscious and effective.

The therapist, using the myofascial unwinding process, acts as a facilitator, following the body’s inherent motions. When a significant position is attained, the craniosacral rhythm will shut down to a still point. During the still point, a reversible amnesia surfaces, replaying all of the emotional states that occurred during a past traumatic event. This dissociation, or reversible amnesia, is a “double-conscious” state. In other words, what is learned or remembered at the time of trauma is dependent on the psycho-physiologic state of the individual at the time of the experience. The block between the conscious and subconscious minds is the source of many poor or temporary therapy results.

Myofascial release and myofascial unwinding bring the tissue or body part into a position that allows the individual to be aware of his or her divided consciousness. Reactivating the conditions and the resulting physiologic responses during which trauma was acquired through this flashback phenomenon allow for the patient’s conscious awareness. The patient then has the option to change.

Myofascial release and myofascial unwinding techniques relieve excessive pressure on pain-sensitive structures that produce pain and limit full, fluid motion. These techniques also reeducate the central nervous system for new movement possibilities.

New neurobiological research and Han Selye’s classic work are concerned with the phenomena of state-dependent memory, learning and behavior. State-dependent memory, learning and behavior is the process of learning that takes place in all complex organisms that have a cerebral cortex and a limbic-hypothalamic system, and Pavlovian and Skinnerian conditioning are specific varieties of it.

Memory and learning of all higher organisms fall into two classes of internal responses: 1.) Memory trace on the molecular-cellular-synaptic level. 2.) Involvement of the amygdala and hippocampus of the limbic-hypothalamic system in processing and encoding, and recall of the specific memory trace may be located elsewhere in the brain. The limbic-hypothalamic system is the central core to Selye’s general adaptation syndrome, the three states – the alarm reaction, the state of resistance and the stage of exhaustion – which take on a profound significance.

The hormones responsible for the retention of memory, epinephrine and norepinephrine, are released during the alarm stage by the activation of the sympathetic branch of the autonomic nervous system. The state or position the person is in at the moment of trauma is encoded into the system as the person progresses into the stage of resistance. The system adapts and develops strategies to protect itself from further trauma, fear or memories by avoiding those three-dimensional positions. The emotions communicate this mind/body information through its network by way of the neuropeptides. This creates a vicious cycle of interplay among the endocrine, immune and autonomic neuromyofascial systems, and the neuropeptides.

If the cycle continues too long, the person enters the exhaustion stage, in which the body’s defense mechanisms expend enormous amounts of energy, thereby depleting one’s reserve and perpetuating or enlarging the symptom complex. Selye frequently described this type of resistance as being “stuck in a groove” – something we have all experienced. When something familiar happens, we react subconsciously, until these hidden memories and learned behaviors are brought to the surface. Myofascial unwinding brings this information to a conscious level, allowing patients to experience it and let go.

SUBCONSCIOUS PATTERNS

Why don’t normal body movements or daily activities reproduce these memories, emotions, and outdated beliefs? I believe that these positions represent fear, pain or trauma. In an attempt to protect itself from further injury, the subconscious does not allow them to move into positions that reenact the micro events and important micro cognitions essential for lasting change. The body then develops strategies or patterns to protect itself. These subconscious holding patterns eventually form specific muscular tone and tension patterns, and the fascial component then tightens into these habitual positions of strain as a compensation to support the misalignment that results. Therefore, the repeated postural and traumatic insults of a lifetime, combined with the tensions of emotional and psychological origin, result in tense, contracted, bunched and fatigued fibrous tissue.

A discrete area of the body may become so altered by its efforts to compensate and adapt to stress that structural and, eventually, pathological changes become apparent. Researchers have shown that the type of stress involved can be entirely physical, such as the repetitive postural strain adopted by a dentist or hairdresser, or purely psychic, such as chronic, repressed anger.

More often than not, a combination of mental and physical stresses alters the neuromyofascial and skeletal structures, creating an identifiable physical change that generates further stress, such as pain, joint restriction, general discomfort and fatigue. A chronic contraction which, if prolonged, causes energy loss, mechanical inefficiency, pain, cardiovascular pathology and hypertension.

Working in reverse, myofascial release and myofascial unwinding free the fascial tissue restriction, thereby altering the habitual muscular response and allowing the positional, reversible amnesia to surface, producing emotions and beliefs that are the cause of the holding patterns and ultimate symptoms. Thus, it is important for the therapist to quiet his or her mind and feel the inherent motions. Quietly following the tissue or body part three-dimensionally along the direction of ease takes the patient into the significant restrictions or positions. With myofascial unwinding, the therapist eliminates gravity from the system. This unloading of the structure allows the body’s righting reflexes and protective responses to temporarily suspend their influence. The body then can move into positions that allow these state- or position-dependent physiological or flashback phenomena to recur. As this happens within the safe environment of a myofascial release session, the therapist can facilitate the body’s inherent self-correcting mechanism to obtain improvement.

The myofascial release approach is not just an assembly of techniques. It creates a whole-body awareness that allows health professionals to facilitate change, growth and the possibility for total resolution of restrictions, emotions and belief systems which impede patient’s progress.