Koda Integrative Therapy Group

Therapeutic Massage and Health Partners for Recovery and Performance

Myofascial Therapy and Stretching: Part of a Recipe for Fascial Release

Myofascial Therapy is a type of technique used to release muscle tissue and focus on reducing muscular shortness and tightness. There are a number of conditions and symptoms that myofascial therapy addresses effectively. Because many of my patients seek myofascial treatment after losing flexibility, or function following a surgery or injury the focus is on returning the muscles around the joint to a more ‘neutral’ place. If you are experiencing ongoing back, shoulder, hip, or virtually pain in any area containing soft tissue - myofascial therapy will help release the adhesion, tension and pain.

Other conditions can also be treated by myofascial therapy include Temporo-Mandibular Joint (TMJ) disorder, Plantar Fasciitis, Carpal Tunnel Syndrome, or symptoms of fibromyalgia or migraine headaches.

A patient’s symptoms can be defined in several ways to include:

  • Tightness of the tissues that restricts motion or pulls the body out of alignment, and this causes individuals to favor and overuse one hip, ankle or shoulder, for example.

  • Pain and tightness that does not allow normal strength or unexplained weakness around a specific joint

  • A sense of excessive pressure on muscles or joints that produces pain and discomfort when moving

  • Pain in any part or parts of the body on a regular basis - this includes headaches or back pain and plantar fascia pain.

Causes of Myofascial Pain

Myofascial pain can have two sources: Pain can be generated from the skeletal muscle or connective tissues (1), because they are 'bound down' by tight or short fascia fibers; or the pain can also be generated from damaged myofascial tissue itself, where a 'trigger point' (2) contracts the muscle fibers over a longer period. In either case, the restriction or contraction inhibits blood flow to the affected structures, thus accentuating the contraction further, and unless the area is treated the constant shortness will create extreme sensitization. Research shows that the most common sport injuries occur connective tissues - joint capsules, ligaments, tendons and other 'fascial structures' can also have this constant tightness and pain. This is everything OTHER than muscles and bones (Schleip 2015a, 2015b). Funny thing is that they are composed basically of the same components as muscles. 

Recent proposals in the sports medicine industry have begun to make fascia a specific target of training, and research. This focus would not only help prevent many injuries but also contribute to longer athletic careers - if the extent of the impact of fascial connections and transmissions of tension between joints and muscles were possible. Continuous participation in fitness activities that many people stop due to injury and aging, would no longer be a decision. When focusing only on the athlete's strength, cardiopulmonary conditioning - for fitness plans, the recovery should focus on increased neuromuscular ability after workouts.

Fascial tissues are getting more deserved attention in the field of sports medicine, because a better understanding of their adaptive dynamics and how they impact mechanical loading is invaluable when making recommendations for bio-mechanical improvements to injury prevention, athletic performance and sports-related rehabilitation. The role of fascial tissues in sports medicine, aims to (1) provide an overview of the contemporary state of knowledge regarding the fascial system from the microlevel (molecular and cellular responses) to the macrolevel (mechanical properties), (2) summarize the responses of the fascial system to altered loading caused by physical exercise, examine (3) the long term changes that lead to injury and other physiological challenges including ageing, (4) outline the methods of interventions that target fascial tissue in sport and exercise medicine.

A comprehensive approach to treating fascial structures in sport training is different than traditional training techniques. The following are examples that show differences (Schleip and Muller 2012; Schleip 2015a, 2015b)

  • Movement to improve elastic recoil

  • Landing as quietly and as softly as possible in jumping activities

  • Controlled bouncing at varied frequencies

  • Emphasis on undulating and rhythmic movement

  • Sensory and proprioceptive refinement in all movement (external methods like 'skin taping,' scraping, rolling, brushing, and including internal methods such as 'breath-initiated' movement).

  • Preparatory counter-movements before primary movements (example, deep squat before jumping; increased shoulder rotation right before you swing a bat)

  • Fascial Stretching - think Active Isolated Stretching (AIS) and Fascial Stretch Therapy (FST)

Fascial Training is included to augment other forms of training, but it is essential to the full spectrum of training possibilities - like cardiovascular, neuromuscular and hypertrophic - it is a tool for recovery. Understanding of mechanical aspects of connective tissue function is important because it depends on the result of interconnected and interwoven connective tissues beyond the sheets or bands of muscles. There is enormous potential to be gained from understanding the concepts of biology that impact the adaptation, function and pathology of the fascia and tissues.

The fascial system includes adipose tissue, adventitia, neurovascular sheaths, aponeuroses, deep and superficial fascia, dermis, epineurium, joint capsules, ligaments, membranes, meninges, myofascial expansions, periostea, retinacula, septa, tendons (including endotendon or peritendon or epitendon or paratendon), visceral fascia, and all the intramuscular and intermuscular connective tissues, including endomysium or perimysium or epimysium.

ELASTIC RECOIL

New research in fascia shows this ‘tissue’ has the ability through tendons, ligaments and aponeuroses, or ligamentous sheaths, to change the distance between muscles and skeletal attachments and allow, or impede, the body to store and release kinetic energy (Schliep, 2015b, 96).

Research evidence supports the idea that aging, injury and over training without proper preparation and recovery can result in a significant decrease in the kinetic energy potential of the body. In other words, changes to muscle tissue like the formation of additional collagen 'cross-links' in the musculoskeletal (i.e. think adhesion or trigger point) impedes the structure or reduces the ‘functional movement.’

Looking at a whole chain of muscles, throughout the body, and their shared stress can show reduction in mobility, range of motion, strength and elasticity and weakness. The adhesions in any of these tissues can reduce the ability of muscles to slide easily past each other, and the missing elasticity can increase risk of tissue tears and other injuries. Increasing stretching is designed to to stimulate and then preserve the elastic recoil enhances optimal performance.

AGING AND FLEXIBILITY

Physiological ageing is a highly individual, the process is characterized by a progressive degeneration (or loss of flexibility) of tissues. Age-related alterations in fascial tissues include densification (altered ‘laxity’ of loose connective tissue - tendons and ligaments) and the fibrosis is altered ‘adhesion’ of collagen or fibrous bundles.  Functional impact of these pathological changes can modify the mechanical properties of fascial tissues and skeletal muscle, AND their impact on the joints. This change in the relationship, whereby the muscles must work harder - or are less adaptable to environmental changes - contributes to pain-related and age-related reductions in muscle force or range of motion. These changes cannot be solely explained by the loss of muscle mass. The ECM - extracellular matrix - becomes the structure between molecules and cellular components that influences much of the connectivity throughout the body. The cross links between joints and muscles and my impact the structural, biochemical, cellular and functional changes occur during ageing.

Age related symptoms are characterized by chronic, low-grade inflammation—the so-called inflammaging most often associated with muscle pain (ie. arthritis, tendonitis, etc).19  As the ECM is the main site of inflammatory responses in tissues, it is not surprising that imflammation in the ECM can interact with immune cells to change their function. This plays an important role in growth and regeneration of tissues (specifically recovery).

Adipose tissue is also a potential source of pro-inflammatory cytokines and has been implicated in a range of musculoskeletal conditions. Osteoarthritis can result from the constant impact to the joints .69 Regardless of the underlying mechanism, fibrotic changes in the muscle have a substantial potential impact on tissue dynamics and force generation capacity.

Stretching of fascial tissues can promote resolution of the inflammation whether in vivo or in vitro. 71  Manual therapy can prevent overuse- and repetitive stress induced fibrosis at several levels of fascial tissues regardless of the age.72 In terms of muscle changes, resistance exercise is necessary to reverse fatty changes (and perhaps fibrosis) in chronic conditions,73 whereas gentle muscle activation is sufficient to reverse early muscle atrophy,74 and whole body exercise can prevent inflammatory changes in back muscles that follow intervertebral disc injuries.75

PLANTAR FASCIA STRETCHES AND RELEASE TECHNIQUES

PLANTAR FASCIA STRETCHES AND RELEASE TECHNIQUES