by Tonya Juge, PT, MSPT, CFMT
Fascia is a fundamental component in the assessment and treatment of performance, pain and dysfunction. Patients of all age groups and fitness levels may benefit from myofascial release techniques when applied as a part of a complete treatment program.
Fascia is an interconnected web of collagenous tissue that runs under the skin and surrounds muscles, nerves, and joints at both superficial and deep levels. It is important because it affects motion, coordination and the stability of our bodies. The myofascial system absorbs shock, stores energy, and allows for normal “slide and glide” of the body’s gears beneath the surface. It is even responsible for the exchange of metabolites, and may provide protection against the spread of infection (Johnson 2009).
Fascia may adhere or bind after injury or surgery. Research shows that treating dysfunctional fascia with manual therapy may significantly improve function (Threlkeld 1992). The controlled mechanical stress of soft tissue mobilization has been shown to maintain viscoelasticity and homeostasis of connective tissue (Cyr Lisa 1998) One study involving a 28-year old woman experiencing pain after 5 abdominal/pelvic surgeries, showed the effects that manual therapy may have on function. She experienced improvement in abdominal and hip pain and was able to return to active duty in a military setting following 5 sessions of physical therapy that included soft tissue mobilization followed by 5 sessions of therapeutic exercise (Wong 2015). According to Kobesova (2007), assessment and treatment of active scar tissue is an important component of managing locomotor dysfunction and associated pain syndrome.
Fascia is richly innervated and plays a role in proprioception and coordination. Proprioception is the awareness of our bodies as we move through space. (Jaap van der Wal 2009). When our fascial gears are gliding properly we have improved sensory awareness and coordination and experience fewer accidents and injuries. Some recent studies are suggesting that fascia may have contractile properties and influence musculoskeletal dynamics more than previously thought.(Schleip 2005)
The myofascial system plays an important role in musculoskeletal dysfunction (Stecco 2011). Improper fascial tone has the potential to cause compartment syndromes, and hypermobility issues. When fascia is injured or cut after surgery, STM (soft tissue mobilization) may serve as a catalyst to increasing fibroblast activity and lead to repair of fascia (Gehlsen 1999).
Another study showed the importance of active scar tissue treatment for improving mechanics, dysfunction and pain. (Kobesova 2007) A case study of a man with an appendectomy scar detailed significant improvement in right lower hip pain after the superficial and deep layers of scar tissue were treated using myofascial release techniques.
The research above implies that pain, coordination, and contractile issues may be positively influence by myofascial release. STM may improve mechanics by releasing restrictive adhesions and altering the scar tissue matrix. Mechanical elongation of fibers may occur as well as improved lubrication, hydration and interstitial fluid distribution through ground substance normalization. (Johnson 2009)
There are many DIY fascia tools on the market, but no tool can take the place of a skilled therapist who possesses an intricate knowledge of anatomy. These individuals are trained to trace and isolate precise layers of fascia in the specific direction of restriction as well as advise on the proper functional exercise pairing.
Occasionally a skilled fascia release session will bring dramatic improvements to a client’s level of discomfort, but more often than not, what is needed is a complete program of treatment that assesses the entire system. Find a skilled physical therapist who gives you focused attention. They will evaluate joint mechanics, muscle strength, reciprocal patterning in the trunk, sitting and standing posture, repetitive movement patterns, ergonomics, functional strengthening, and motor control.
When precise fascial release techniques are combined with proper movement pattern retraining, posture and function is restored, small pathologies are interrupted before they become big pathologies, and the long term consequences of injury are thwarted. We can achieve a balanced system that distributes weight evenly, absorbs and transfers shock, and functions with ease. It is possible to improve as we age.
The contents of this blog are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment.
Johnson, G., Johnson V., Course Presentation: Institute of Physical Art: Functional Orthopedics I (FOI) at Long Island University;1982 revised March 2009: Brooklyn,NY
Threlkeld AJ. The effects of manual therapy on connective tissue. Phys. Ther. 1992;72:893-902
Cyr LM and Ross RG. How controlled stress affects healing tissues. J Hand Ther. 1998;11:125-30.
Wong et al, Soft Tissue Mobilization to Resolve Chronic Pain and Dysfunction Associated With Postoperative Abdominal and Pelvic Adhesions: A Case Report. J Orthop Sports Phys Ther 2015 Dec; 45(12):1006-16
Kobesova A, Morris CE, Lewit K, Safarova M. Twenty-year old pathogenic “active” postsurgical scar: a case study of a patient with persistent right lower quadrant pain. J Manipulative and Physiological Ther. 2007;30:234-238.
Jaap van der Wal, The Architecture of the Connective Tissue in the Musculoskeletal System-An Often Overlooked Functional Parameter as to Proprioception in the Locomotor Apparatus. Int J Ther Massage Bodywork. 2009; 2(4): 9-23
Schleip, R., Klingler, W., Lehmann-Horn, F., Active fascial contractility: Fascia may be able t contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Med Hypotheses. 2005;65:273-277.
Stecco C, Macchi V, Porzionato A, Duparc F, De Caro R. The fascia: the forgotten structure. Ital J Anat Embryol. 2011;116(3):127-38.
Gehlsen G.M., Ganion L.R., Helfst R., Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999 Apr; 31(4): 531-5.