MYOFASCIAL

RELEASE
 BIOMEDICAL VS INFOMEDICAL
MODEL
Biomedical Model Infomedical Model
Quantum Physics
Newtonian Physics Patient (Process)
Pathology Oriented Oriented
Reductionistic lnterdependency
Cartesian Mind/Body
Clinician Awareness
Responsibility Patient Responsibility
Biological Outcomes Functional Outcomes

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 DEFINITION
Myofascial therapy can be defined as
"the facilitation of mechanical, neural, and
psychophysiological adaptive potential as
interfaced via the Myofascial system.“
The word "Myofascial" is derived from the
Greek word "myo", which means "muscle,"
and the word fascial.
 Myofascial release is the application of
the gentle manual application of sustained
pressure to release fascial restriction.

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 HISTORY
The first description of the myofacial pain
syndrome was published in the German
literature in 1843.
 As early as 1843,Froriep labeled the
condition involving tender bands or cords
within muscles as “Rheumatism” and he
considered these tender palpable bands to
be deposits of connective tissues.

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 HISTORY(CONT…)
Shortly thereafter, in 1890 Grauhan
histologically described these bands as
fibrous tissues that surrounds muscles
fibers and that is infiltrated with
lymphocytes.
Steindler and luck term these “Trigger
Zones” and considered the sites to be
within the ligaments or a muscle.
Since 1942,Travell conducted many studies
on trigger points.

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 TENSEGRITY MODEL-
BUCKMINSTER FULLER

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 TENSEGRITY MODEL VS
BIOTENSEGRITY

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 FASCIA

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 MYOFASCIAL RESTRICTION
Fascia, according to Calliet, is a type of
connective tissue along with tendons,
ligaments, cartilage, muscle, and bone.
Fascia covers every muscle and every fiber
within each muscle.
When muscle fibers are injured, they heal
by forming adhesions, the fibers and the
fascia which surrounds it become short and
tight.

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 MYOFASCIAL RESTRICTION( CONT…)
In scaring and adhesion the ground
substance of fascia is converted from gel
state to solid state.
Scarring or injury to this network of
connective tissue is a major cause of pain
and limitation of motion.
This impose uneven stress, because the
fascial system is interconnected, this
stress can be transmitted through the
fascia to other parts of the body, causing
symptoms may appear in areas of the body
that unrelated to the actual restricted area.
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 CONCEPTUAL MODELS
1. Fascia as a balloon
2. Fascia as plastic wrap
3. Fascia and muscle as red elastic bands

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 HOW MYOFASCIAL RELEASE WORK?
The gentle and sustained Myofascial
release is believed to supply mechanical
and thermal energy which converts the
ground substance into gel state again
which allow facilitation of sliding movement
of collagen and elastin fibers.
The gentle and sustained pressure and
stretch of myofascial release is believed to
free these adhesions and soften and
lengthen the fascia.
By freeing up fascia that may cause
compression on blood vessels or nerves,
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myofascial release is also said to improve
 TRIGGER POINTS
A hyperirritable spot, usually within a taut
band of skeletal muscle or in a muscle
fascia.
The spot is painful on compression and can
give rise to characteristic referred pain and
tenderness.
Each muscle has its own characteristic
pattern of referral. Often this can produce
another trigger point to become active in
another muscle within the zone of radiation
of the original trigger. These are called
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“SATELLITE” trigger points.
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 TECHNIQUES

1. Direct Myofascial
Release
2. Indirect
Myofascial Release
3. Self Myofascial
Release

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 TECHNIQUE OF APPLICATION

The physical therapist finds the area of

tightness.
A sustained pressure over time is applied
to the tight area.
The physical therapist waits for the tissue
to relax and then increases the stretch.
The process is repeated until the area is
fully relaxed.
Then, the next area is treated.

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 DIRECT MYOFASCIAL RELEASE
 The direct myofascial release (or
deep tissue work) method works on
the restricted fascia.
Practitioners use knuckles, elbows,
or other tools to slowly stretch the
restricted fascia by applying a few
kilograms-force.
Direct myofascial release seeks for
changes in the myofascial
structures by stretching, elongation
of fascia, or mobilising adhesive
tissues.
The practitioner moves slowly
through the layers of the fascia
until the deep tissues are reached.
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 DIRECT MYOFASCIAL
RELEASE(CONT…)
Direct myofascial release technique:
Land on the surface of the body with the
appropriate 'tool' (knuckles, or forearm
etc).
Sink into the soft tissue.
Contact the first barrier/restricted layer.
Put in a 'line of tension'.
Engage the fascia by taking up the slack in
the tissue.
Finally, move or drag the fascia across the
surface while staying in touch with the
underlying layers.
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Myofascial
gracefully. 29/10/2024
Direct myofascial release on plantar fascia

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 Direct myofascial release on the thigh

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 H
E
A
D
&
F
A
I C
N E
T
R
A
-
O
R
Myofascial Release
A
21 L 29/10/2024
 Direct release myofascial technique - the
trunk

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 Direct release myofascial technique - the
cervical region

REGION
CERVICAL

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Direct release myofascial technique - thigh

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 INDIRECT MYOFASCIAL RELEASE
The indirect method involves a gentle
stretch, with only a few grams of pressure,
which allows the fascia to 'unwind' itself.
The gentle traction applied to the restricted
fascia will result in heat and increased
blood flow in the area. This allows the
body's inherent ability for self correction to
return, thus eliminating pain and restoring
the optimum performance of the body.

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 INDIRECT MYOFASCIAL
RELEASE(CONT…)
The indirect myofascial release
technique(eg. Cross hand technique):
Lightly contact the fascia with relaxed hands.
Slowly stretch the fascia until reaching a
barrier/restriction.
Maintain a light pressure to stretch the
barrier for approximately 3-5 minutes.
Prior to release, the therapist will feel a
therapeutic pulse (e.g. heat).
As the barrier releases, the hand will feel the
motion and softening of the tissue.
The key is sustained pressure over time.

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 Cross hand longitudinal stretching of the
lumbar and thoracic erector spinae musles

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 Cross hand longitudinal stretching of the
middle trapezius musles

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 Cross hand sretching of the quadriceps
femoris muscle

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 SELF MYOFASCIAL RELEASE
 Self myofascial release(SMR) is when the
individual uses a soft object to provide
myofascial release under their own power.
 Usually an individual uses a soft roll, or ball on
which to rest one’s body weight,then,by using
gravity to induce pressure along the length of
the specific muscle or muscle groups, rolls their
body on the object, slowly allowing for the
fascia to be massaged.

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 ILIOTIBIAL
UPPER BACK BAND

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 CALF COMPLEX ADDUCTORS

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 HAMSTRING
COMPLEX HIP FLEXORS

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 THE PRINCIPLES OF MYOFASCIAL
RELEASE:
Fascia covers all organs of the body,
muscle and fascia cannot be separated.
All muscle stretching is myofascial
stretching.
Myofascial stretching in one area of the
body can be felt in and will affect the other
body areas.
Release of myofascial restrictions can affect
other body organs through a release of
tension in the whole fascia system.
Myofascial release techniques work even
though the exact mechanism is not yet fully
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understood.
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 EFFECT OF MYOFASCIAL RELEASE
oRelieve pain
oRestore function
oIncrease range of motion
oImprove motor performance
oRestore body equilibrium

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 EFFECT OF MYOFASCIAL
RELEASE(CONT…)
Myofascial Release is highly effective in
treating patients with the following
diagnoses:-
Back strain, chronic back pain, low back
pain, thoracic pain.
Carpal tunnel syndrome
Chronic cervical pain

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 INDICATION
1.The patient's pain complaint has not been
alleviated by traditional physical therapy
treatment.
2. The patient has a complex, global, or specific
pain complaint that does not follow dermatomes,
myotomes, or visceral referral patterns.
3. The patient has an underlying chronic condition
that causes tightness and restrictions in the soft
tissues (e.g., fibromyalgia and post-polio
syndrome).
4. The patient has painful complex postural
asymmetries.

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 INDICATION(CONT...)
5. The patient has asymmetrical muscle
weakness due to an acute or chronic
peripheral or central neuropathy.
6. The patient has impaired respiration and
an inflexible rib cage due to chronic
respiratory disease, central nervous system
injury, or faulty mechanical relationships of
the skeletal structure and the soft tissues.
7.The patient has frequent, intense
headaches that are triggered by a variety
of stimuli including myofascial trigger
points, tension in posterior cervical
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musculature, TMJ dysfunction &
 INDICATION(CONT...)
8. The patient has impaired mouth closure,
swallowing & phonation resulting in
tightness & restriction of hyoids & muscles
of mastication.
9. The patient experiences non-labyrinthine
induced vertigo & dizzziness secondary to
active myofascial trigger points.
10.The patient is a competitive athlete or
performer who needs subtle stretching to
increase speed or accuracy & to prevent
injury at extreme range of motion.
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 CONDITIONS THAT CAN BE TREATED
WITH MFR
Dizziness and vertigo .
Fibromyalgia.
Headache.
Myofascial pain dysfunction.
Trigger points, tender points.

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 CONTRAINDICATION
1.The patient does not understand or respect
boundaries.
2. The patient does not tolerate close
physical contact or touch.
3. The patient has an unstable medical
condition, e.g., unstable angina.
4. The patient has a dermatitis.
5. The patient has a contagious or infectious
disease that is transmitted by the upper
respiratory tract or by direct contact with
the skin.
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 CONTRAINDICATION(CONT...)
6. The patient does not understand the concept of
the "Good Hurt."
7. The patient does not trust the therapist.
8. The patient is under the influence of drugs or
alcohol.
9. The patient is unable to give informed consent
to treatment due to his mental status.
10. The therapist does not feel comfortable with
the patient (i.e., after the initial interview and
evaluation, the therapist's "gut response" says
not to treat this patient with Myofascial Release
or not to treat this patient at all).

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 PRECAUTION
1.Myofascial Release consistently lowers blood
pressure. All patients must rest in a horizontal
position for 10-15 minutes following treatment.
The patient should get up slowly and not get off
treatment table until any dizziness has resolved.
2.Myofascial Release may lower blood sugar
levels, particularly when deep Trigger Point
Releases are performed. Individuals who are
diabetic should check their blood glucose level
prior to treatment. Individuals who are prone to
hypoglycemia should have a snack prior to
treatment.

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 PRECAUTION(CONT...)
3. Individuals with healing fractures or wounds may
receive Myofascial Release to uninvolved areas.
4.Individuals with compromised circulation may be
treated with Myofascial Release to the uninvolved
areas and to the area of compromise while being
closely monitored.
5.The patient is taking medication that increases
blood-clotting times and causes the patient to
bruise easily.
6.When treating a child or a mentally incompetent
adult, the caregiver or other responsible adult
should always be present. The therapist should
carefully explain the treatment to the chaperon.
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 THERAPEUTIC ENVIRONMENT
• Quiet room
• Appropriate lighting
• Proper height of equipment
• Minimal patient clothing
• No extraneous objects
• Position of patient
• Body mechanics of the therapist

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 REFERENCE
The myofascial release manual 3rd edition
by Carol J. Manheim
Myofascial Pain & dysfunction the trigger
point manual volume 1 by Janet Travell
Images taken from Google images &
Wikispace

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