Author: Aikaterini Karagianni, Registered Clinical Massage Therapist

Revised: August 22 2023

Myofascial release focuses on reducing pain by easing the tension and tightness in these trigger (stuck/tight) points. Myofascial release techniques are often used over a broad area of muscle and tissue rather than at single points, called Myofascial Lines.

It's an intense and very effective treatment, but let's explore it's mechanism and science behind its effectiveness a little bit more.

What is Fascia?

Fascia is comprised of connective tissue and, along with the skeletal system, is the structural support system of the body. Connective tissue is one of the four main tissue types in the body alongside epithelial, muscle, and nervous tissue.

Fascia has long been ignored as just a wrapping for other organs, but now is seen as one of the major sensory organs in the body. 

Fascia is classified based on its physical location as:

• Superficial Fascia

• Deep Fascia 

• Visceral Fascia

Some trained massage therapists primarily work with superficial fascia and deep fascia. The third type of fascia, visceral fascia, which surrounds the organs, can be treated, but requires specialized training of the therapist.

It is worth noting that once fascia is aligned and has a specific direction, when the body produces more collagen, it will often deposit it in line with existing fascia. Even so, without movement, this new collagen is usually dysfunctional

How Fascia works

When myofascia contracts, which is to say the muscle contracts and brings the fascia with it, it is called fascial loading and it is a regular occurrence in the body. Fascial loading is what allows a gazelle to leap straight in the air to avoid an alligator, or what allows a human to suddenly explode into action from a stand still when they see a spider. When fascia is loaded, it acts like a spring by releasing a large amount of potential energy all at once. This spring effect is experienced when we walk. As we pivot forward on the weight-bearing leg, the fascia on the anterior aspect of the leg is put under tension. The opposite leg that is swinging forward is also put under tension on the posterior aspect of the leg. This tension has potential “energy” and when the fascia unloads, the leg is swung forward with minimal muscle effort, relying instead on the elastic recoil of the fascia.

Research has found that 93% of the energy stored in fascial loading is returned to the system, which greatly reduces the active participation of muscles and the use of oxygen. For example, it has been hypothesized that 16% of the energy required for walking is derived from fascial loading of the Achilles tendon, which minimizes the load on the plantar flexors, gastrocnemius, and soleus. Also, 17% of the energy required to run is derived from fascial loading of the arches of the foot and the plantar fascia, which absorb the load, then recoil as we push off.

The energy released is called “free energy”, but still requires some muscular input, ATP and oxygen. One of the reasons why regular walking is easy for us is because of the “free energy” release from the fascia. On the other hand, if we are walking but stopping and starting repeatedly, the fascia unloads it’s “free energy”, which requires more muscular input in order to continue walking again. Therefore, this type of walking (called “museum walking”) is harder and more tiring.

Throughout the body, the collagen within fascia tends to line up in parallel. This increases the strength of fascia considerably. In fact, plantar fascia, some of the densest fascia in the body, can withstand up to 2000 pounds per square inch! An important part of this consideration is that the collagen fibers must be aligned in the same direction.

The question then becomes:  What tells the collagen to line up parallel?

The answer is:  Movement.

When we apply force to the body of any kind (lifting objects, running, sitting, etc.), the fascia will align with the direction of force. This is a fundamental idea in fascia; movement and stress is what aligns the fibers.

Thomas(Tom)Myers is the author of Anatomy Trains(2001) and has played a major role in our current understanding of fascia and myofascial release. Having studied directly under Dr. Ida Rolf, many of Tom Meyers’ techniques refer to her methodology. The main concept that Tom Myers works toward is an integrative system in which we consider the wholebody’s condition as opposed to a specific region. He has spent a large portion of his career researching what he calls ‘anatomy trains’ and has proven his theory successfully.

Fascia's roles in the body function

Fascia is an incredibly diverse and adaptable tissue. It has a large number of roles in the body, however it can be summarized as follows:

Stability

A tight wrapping around the whole body helps stabilize joints and maintain stability during motion.

Mobility

Allows for highly efficient movements.

Proprioception

Many mechanoreceptors are nestled within fascia. For a detailed outline of the various mechanoreceptors in fascia, refer to the chart below.

Ida Rolf (1896-1979) started her career as a biochemist and, at about the age of 20,graduated from Barnard College in New York in 1920. Hungry for knowledge and personal development, in 1927 Dr. Rolf left the US and travelled to Europe. She studied mathematics and physics in Switzerland – and furthered her interest in homeopathy by studying homeopathic medicine in Geneva. After many years of study and research, Dr. Rolf finally developed Structural Integration. Her ambition to introduce Structural Integration to as many people as possible took her all over the world. Her desire was not simply to help others, but to teach future generations the fruit of her life’s work.

Fascia Adhesions

Whenever fascia is spoken of or referred to in the context of massage therapy, it is inevitably followed by the word ‘adhesion’. In order to understand the effect of myofascial adhesions, it helps to start with a demonstration.

Begin by pinching the bottom right section of your shirt, then twist it a few times until you have a small bundle of fabric.

Now, lift your left arm to the side. How does it feel?

Chances are you felt a restriction and got to a point where you could no longer lift your arm. This is how fascia causes restrictions. A small adhesion can eventually lead to larger issues.

What causes Fascial Damage?

Myofascial release massage therapy is useful for treating skeletal muscle immobility and pain by relaxing contracted muscles, improving blood and lymphatic circulation and stimulating the stretch reflex in muscles.

Trauma/Surgery

When considering what causes damage to fascia, trauma is an obvious conclusion. Whenever tissue is impacted or overstretched, it can cause damage to the tissue. Surgeries are also a common cause of damage to fascia. Almost all surgeries involve cutting fascia in some way, be it large or small. When the tissue is cut, it responds similarly as if it were torn from trauma; it lays down as much new collagen as possible, and in the process adhesions form. Often during healing, one layer of fascia can heal to a deeper one. 

Hydration 

The quality of the ground substance within the extracellular matrix plays a vital role in the formation of adhesions. If there is a lack of fluid in the body as a whole, the ground substance will have less fluid as well. As the amount of fluid goes down, the viscosity of the extracellular matrix goes up. With a higher viscosity, there is less pliability and mobility to the fascia and it is far more likely to be affected by damage. 

Posture

It is difficult to determine whether fascial damage causes posture changes, or whether posture changes cause fascial damage. It is possible for fascial adhesions to cause postural deformities, but it is also possible for postural deformities to cause fascial adhesions. If there has been trauma or surgery, likely the adhesion occurred as a result, deforming the posture. However, when a person holds a poor posture for extended period of time, fascial adhesions can form, effectively gluing the posture in place. When we hold myofascia in a stretched position for long periods of time, we say the tissue is “locked long”. This indicates the tissue is tight, inhibited, and in a shortened position. An example would be medially rotated shoulders; the rhomboids are locked long, the pecs are locked short.

Inactivity

Inactivity, be it due to an injury or lifestyle, causes fascial adhesions in the same way as poor posture. The body is constantly applying new collagen in order to maintain structural integrity. If we stay sedentary for too long a period, fascial adhesions can form. 

Stress

Fascia has myofibroblasts in it, which allows a small amount of contraction to occur in fascia. This contraction is involuntary and occurs typically in time of sympathetic activation. This process is known as fascial loading as mentioned earlier. The sympathetic nervous system is stimulated in times of stress and is responsible for the fight or flight reaction. Once the stressor has either been dealt with or has been removed, the body should relax. This, however, doesn’t always happen. When a person has a significantly stressful life, fascial loading can persist, causing fascial shortening.

Myofascial Lines Conditions 

It's very crucial for the Massage therapist to be experienced in working with Fascial Lines as it's a very effective treatment for a lot common conditions. Below I mention the Conditions many of us suffer and how their relation to each Fascial Line.

Superficial Front Lines

• Anterior Shin Splints

• Knee Sprains, Quad Strains

• Patellofemoral Pain

• Low Back Conditions (due to anteriorly tilted pelvis)

• Breathing Restrictions

• Forward Head Posture

• TOS (due to HT in Ant neck)

• Cervical Facet Syndrome

Superficial Front Arm Lines

• Upper crossed Syndrome

• Costoclavicular TOS

• Forearm flexor Conditions (medial epicondylitis, pronator teres syndrome)

• Carpal Tunnel

• Cubital Tunnel

Deep Front Arm Lines

• TOS: Costoclavicular and Pec Minor

• Shoulder Impingements (due to anterior tipping of scapula)

• Bicipital Tendinopathies

Superficial Back Lines

• Headaches-Tension

• Back Pain Pathologies ie. Herniated discs, spondy, LBP

• Hamstring Strains

• Achilles Tendinopathies

• Plantar Fasciitis/ Foot Pain

Superficial Back Arm Lines

• Neck pain ie. Cervical Facet Syndrome

• Tension Headaches

• Shoulder Impingements

• Lateral Epicondylitis

Deep Back Arm Lines

• Rotator Cuff Tendinopathies, Strains

Lateral Lines

• Torticollis

• TOS at A&M scalene

• Functional Scoliosis

• Medial/Lateral Knee Sprains

• ITB friction syndrome

Spiral Lines

• Torticollis

• Scoliosis

• SIJ Dysfunction

• ITB Friction Syndrome

• Knee Sprains

LEARN MORE

References

• Myers, T. W. (2009). Anatomy trains. Edinburgh: Churchill Livingstone/Elsevier.

• Stecco, C., & Hammer, W. (2015).Functional atlas of the human fascial system. London:Churchill Livingstone.

• Schleip, R., Baker, A. (2015). Fascia in sport and movement. Pencaitland: Handspring.

• Schleip, R. et al. (2012). Fascia the tensional network of the human body. Edinburgh: ChurchillLivingstone/Elsevier.

• Images from https://Pixabay.com

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