Myofascial release is a type of physical therapy often used to treat myofascial pain syndrome. Myofascial pain syndrome is a chronic pain disorder caused by sensitivity and tightness in your myofascial tissues. These tissues surround and support the muscles throughout your body. (Source: https://www.healthline.com/health/chronic-pain/myofascial-release)
The approach here is unique in that the therapist does not actually use oil, lotion, and such other artificial emollients during the treatment (contrast to what you would experience in a Swedish or Deep Tissue Massage). The science behind this is fascinating for some, mind numbing for others, but beneficial for all.
The method of action in myofascial release is maintaining some sort of traction with the tissues and creates an environment that can actually stretch and manipulate the fascia. The results are incredibly more effective than your typical massage at a local franchise.
When is myofascial release used in massage therapy?
Rolfing, Structural Integration, Active Release Techniques… they all use some form of myofascial release. The philosophies might differ between each of the organizations but each accepts that you cannot have myofascial release when you add lotion. As soon as some sort of lotion is applied, you lose any form of traction or friction with the body and it creates a barrier to treatment. That’s not to say that Swedish Massages aren’t effective, they just aren’t as effective when you have a different goal you are trying to achieve.
What could prevent someone from receiving myofascial release?
Contraindications like open sores, acute trauma and inflammation are universal to bodywork but, in myofascial release, we also have to consider the quality of recipient’s skin. Sometimes, if the body is dehydrated, there may be an uncomfortable stretch felt on the surface (similar to a friction burn) and it is very uncomfortable. Most of the time, this can be remedied by splashing a little bit of water onto the skin but other times, a cautionary amount oil or lotion can be used (being careful not to add too much and risking losing all of the traction).
Who might benefit from myofascial release?
The massage therapy and bodywork community uses a variety of modalities to treat and manage soft tissue pain. Swedish Massage is very effective with calming the nervous system and increasing circulation, deep tissue (sometimes confused with deep “pressure”), Lymphatic Drainage is popular for increasing lymph flow after surgeries… and so on.
Myofascial release would be ideal for athletes or even the general population that struggle with specific pains that Swedish Massage or Deep Tissue Massage fail to resolve. This includes, but is not limited to, the following:
- Carpal tunnel syndrome
- Temporomandibular joint (TMJ) disorder
- Muscle and joint pain
- Migraine headaches
- Back pain
- Frozen Shoulder (or Adhesive Capsulitis)
- Injuries due to poor shoulder or hip alignment
Combining myofascial release with cupping, IASTM, Rock Tape (kenisiology taping) and corrective exercises is the best way to get the most out of your massage. If you’re fighting to resolve your pain, a Clinical Sports Massage could be the solution.
Identifying and Correcting Perpetuating Factors
Shoulder pain doesn’t just happen. There are numerous perpetuating factors that can set up a condition of muscular imbalance and overload. Some of these, such as dysfunctional breathing, may seem unrelated but are actually extremely important (and common). Identifying and correcting perpetuating factors is what makes the difference between fixing the same problem each week and setting your client on a new, pain-free direction.
Possible perpetuators are very numerous. Some of the most common include:
Muscles are made to collaborate in an environment of relative balance and stability in the body. Postural distortion may occur due to anatomical variations such as a leg length discrepancy. Actual leg length differences are estimated to occur in approximately 18% of the general population, so this situation is not uncommon. LLD may cause issues with the QL, spinal erectors, glutes and shoulders, and any persistent patter of unilateral pain could be due to this situation.
Individuals with hypermobile ankles may exhibit an extreme tendency to pronate. This causes the ankle to collapse medially and tends to cause anterior (head forward) posture in the upper body. This situation can be corrected with extra support in the midfoot and forefoot.
Chest breathers overuse small muscles such as the pectoralis minor and scalenes to assist in expanding the rib cage. This causes many problems, and can set up shoulder and head neck pain.
There are many other factors that must be considered in a person’s lifestyle. Workstation ergonomics, sleep position, nutrition, stress must be considered. Be observant and read the Apropos of All Muscles chapter in Travell & Simons for extensive coverage of these issues.
Medications can be a powerful and unsuspected perpetuator of pain in the body. Few people are aware of the extensive pain-related side effects from many drugs. Some of the most common, like the statin family of drugs, have extensive muscular side effects and patients are often unsuspecting. Take the time to look up side effects for drugs.
Serratus anterior is misunderstood and overlooked by most manual therapists, despite its central function of stabilizing the scapula during all arm movements. In CTB we have come to recognize it as the hidden key to scapular positioning and hence, shoulder pain and movement dysfunction.
When a client has rounded shoulder posture (a.k.a. upper crossed syndrome) the shoulders are protracted and the scapular stabilizers do not have normal resting length/tension. Serratus anterior is a primary scapular stabilizer and tends to adaptively shorten and defacilitate. This, along with pec minor adaptively shortening results in the chronic protraction of the scapula. This misalignment of the shoulder will alter the scapulohumeral rhythm and then also impact the glenohumeral motion.
However, unlike pec minor, serratus anterior is a broad muscle that has many digitations and the muscle fiber directions can span more than 120 degrees! Some fibers protract/abduct the scapula. The low fibers upwardly rotate the scapula. The lowest fibers attaching to the 12th rib can be very vertical and capable of depressing the scapula. In addition, the highest fibers attaching to the first rib can produce scapular elevation. There are a lot of different motions possible by this one muscle!
The serratus anterior attaches to the ribs and to the medial border of the scapula. Because of its wide span of fiber directions, it is antagonistic to many other scapular stabilizers including: low trapezius, mid trapezius, high trapezius, rhomboids, and levator scapula. It is in length/tension relationships with all these muscles. That’s why most therapists fail to get a release of taut fibers in these other scapular stabilizers, particularly in the interscapular area. They are not addressing the antagonist, serratus anterior, the hidden key.
If serratus anterior is locked into protracting the scapula, the interscapular muscles (mid/low trap, rhomboids) lock into a lengthened position. The neuromuscular system “locks down” the muscles by purposefully creating taut bands (trigger points) in the muscles to provide stability without having to expend energy. Trigger points are metabolically stagnant. No ATP is then required to keep the static posture. The body basically creates a “fake ligament” with the trigger points. It is a strategy that makes sense and has been pointed out by renowned osteopath and author, Leon Chaitow. Many massage therapists and bodyworkers endlessly strip this interscapular area with as much gusto as they can muster (and their clients can handle), to no avail. Taut bands in the antagonist muscle, serratus anterior, must be released for these interscapular muscles to change.
Another important but overlooked issue with the serratus anterior concerns its referral pain. It projects referral along the lateral border of the scapula, down the posterior arm to the last 2 fingers, but most importantly right into the belly of the low trapezius near the inferior angle of the scapula. Low trapezius referral projects upwards into the mid trap, rhomboids and upper trap. So referral pain generated by the serratus anterior reaches all its antagonists via satellite referral! This is a phenomenon (an agonist referring pain over its antagonist) Chuck Duff has termed “reciprocal referral”. Muscle dysfunction in reciprocal referral situations can quickly spiral into severity, but can be addressed effectively if one understands this relationship. Referral pain originating in the serratus anterior can also cause posterior neck pain and even migraine headaches via satellite referral through the low trapezius.
As if all that wasn’t enough, the serratus anterior is also an accessory breathing muscle. Because of its rib attachments it is recruited to assist in expanding the rib cage on inhalation. Thus dysfunction in the serratus anterior can be caused by dysfunctional breathing. If a person doesn’t adequately use their diaphragm to breathe, the serratus anterior is recruited to do more work than which it was designed. This overload causes trigger points to develop and cascades into shoulder pain and dysfunction.
Serratus anterior has so many fiber directions and relationships; to antagonist scapular stabilizers, shoulder posture, reciprocal referral and breathing. Through many years of clinical experience, we have come to see it as the hidden key to shoulder pain and dysfunction. Some of the fibers are deep to other muscles and structures and inaccessible via palpation. Even these fibers can be influenced by the penetrating vibration of the Muscle Liberator making it the perfect tool to treat serratus anterior.