Treated a client today who came in barely able to internally rotate her right shoulder girdle and had given up doing even light exercise due to stiffness all the way down the back as well pain next to the shoulder blade which onsets when reaching her arm up.
We worked on the major shoulder girdle muscles, in particular worked on Teres Minor which was very tense and tender at both attachment points (i.e. outside edge of shoulder blade half way down and top of the arm – to use non technical anatomical descriptions) . Also did fascial release work on serratus anterior muscle on the side of the rib cage. Client was feeling slight burning or crackling sensations as the taught and dehydrated connective tissue (fascia) began to yield and begin to give us back some flexibility to allow movement to happen more freely. We ended up with greatly improved range of movement afterwards.
Wondered and asked client if she suffered with asthma as the intercostal muscles in-between the outside surface of the ribs seemed very restricted from what I was able to palpate (feel) during the time that we were working on serratus anterior, she confirmed that she did have asthma. I explained that there is a set of techniques I can perform on her during a series of future sessions in order to free up the currently restricted muscles and soft tissues of the rib cage which will help ease the asthma and help free up the breathing making it become less shallow.
Myofascial and fascia released related work is a very subtle yet deeply penetrating style of soft tissue manipulation therapy, it unravels those physical knots that standard deep tissue massage is not able to effectively deal with as well as sometimes also having the effect of releasing deeply held emotional pain that can also get locked into the cell memory of the associated body tissues. It’s a form of alternative therapy work that is rarely practiced here in the UK due to the small numbers of trained practitioners, but is a tool I find to be the most effective in such a wide variety of chronic scenarios and along with trigger point therapy I would find hard to get as effective a treatment outcome as I’m able to with my clients.
So what exactly is myofascial release? Myo means muscle, and fascia is a commonly occurring type of connective tissue that envelops and pervades all structures within the body starting from just below the surface of skin. Myofascia is therefore the fascia that surrounds and permeates the individual fibres of a muscle’s structure. Fascia can be found just about everywhere under the surface of the skin, it not only envelops muscles but also nerves, blood vessels, organs, ligaments, tendons and other soft tissues in the body. If you took away everything else in the body and just left the fascia behind you would see a 3 dimensional mesh like sculpture showing you the shape of the body complete from outside to deep within.
Due to the very much interconnected nature of fascia within your body, you may be able to appreciate how fascia related tension or restrictions in one area of the body can affect the mobility of fascia in another part of the body which might be very far apart e.g. neck and hip. Severe restriction and bunching up of the fascia in any part of the body can result in pain or movement restriction locally in that part of the body or possibly somewhere else. Fortunately there are maps of the main fascia connection routes that run the length of the body which have been drawn up and backed up by cadaver dissections to prove their physical correlations which help us tremendously during therapy sessions. These myofascial train lines as they are called interestingly correlate very well with the meridian lines which have been used for thousands of years in traditional Chinese acupuncture.
I attended 2 post graduate courses for qualified bodywork therapists recently collectively spanning an entire week for practitioners who have existing hands on experience of working with fascia. The first course focused on specific myofascial techniques for pelvis, sacroiliac spine, rib cage and neck areas. The second course looked at techniques for helping release constricted fascia surrounding the organs in the abdominal cavity, which in practice isn’t as invasive as it might sound as we were just making light (but sometimes deep yet non pain causing) contact with the surface fascia and suspensory ligaments of an organ to help free it up. The idea being that working on the surface in turn contacts and pulls at the interconnected deeper fascia within, think of a big dust sheet or beach towel laid out flat and how pulling on one section causes a disturbance elsewhere, not forgeting that this work in all 3 dimensions so allowing movements to penetrate deep downwards too as well as side to side.
Fascia is fixotropic in nature which means that it can interchange between a solid state and a flowing liquid state according to prevailing conditions, press too hard against it and it gets tougher, but work with just the right amount of pressure against it (not too light either) and it begins to flow like a viscous fluid. Try mixing cornflower starch and water together in a big bowl, this gives you a fixotropic substance to play around with, try and stab your fingers straight in very fast to get below the surface of the mixture as if you were trying to poke at a fast moving small object just below the surface, and then as a contrast try sinking you finger(s) in very slowly as if you were putting your fingers into a still pond trying not to make any ripples appear on the surface of that still pond. This explanation should hopefully inform you of how specific one needs to be in order to get the fascia to unlock and release, too much or too little pressure either way and the fascia remains rigid in its pre-existing shape, but just right and the fascia begins to stretch and flow by more than just subtle amounts which both practitioner and client can detect.
Myofascial and fascial work is often the missing link when it comes to easing chronic muscular pain or soft tissue constrictions including scar tissue. In fact, early release of scar tissue helps in preventing the severity of long term scaring as the connective tissue that was laid down during the initial scaring was done as a time is of the essence emergency slap dash way by the body, but once that emergency is over fascia release breaks down the scar tissue bit by bit and allows the body to do the repair again, this time with much more precision and craft as we are now in a non emergency repair situation. The teachers I’ve trained with who also concurrently run their own therapy practices have been successfully using these techniques for over 9 years. I have also had success in the time that I have been working with these techniques with clients who have completed enough sessions for their bodies to be re-educated and for the physical adaptations to be gradually taken on piecemeal as each session goes by.
As a closing thought to play us out of this particular topic, here is a video from one of the foremost proponents of fascia based bodywork therapy Tom Myers. Tom trained with among others Dr Ida Rolf, the originator of rolfing, a deep tissue style of bodywork that re-aligns a person’s entire body posture over a series of 10 session starting from the feet and working gradually upwards with each successive session. In this video Tom explains the concept of tensegrity and how torsioning in the myofascia of the body causes seemingly unrelated or unresolved soft tissue related pain often not diagnoseable by conventional x-ray or MRI means:
A study into the prevalence of significant physical aches, pain and discomfort among the general population showed that…
60% are relatively “pain free” on a day to day basis;
30% experience some kind of accute or regional / local pain;
10% suffer with some degree of widespread distributed pain everyday.
Therefore 40% of the general population experiences some kind of on-going physical pain on-going in their bodies.
Within that 40% group, between 70% – 80% of pain has been found to be soft tissue related in nature. Soft tissue includes the muscles, tendons, ligaments and all pervading connective tissues (known as the “fascia”) of the body.
Massage therapists who have had specalist (usually extended) training in remedial massage and soft tissue manipuation techniques are particuarly well placed to provide effective assistance in the addressing or easing of soft tissue pain. Suitably qualified therapists will usually advertise their skills by using any one of the following modality descriptions in order to differentiate themselves from those who are just offering non-remedial general relaxation massage or spa type treatments: remedial massage, remedial bodywork, sports massage, soft tissue manipulation, soft tissue therapy, myofascial release, fascial bodywork, structural bodywork, structural integration, Rolfing, neuromuscular therapy, neuromuscular technique, neuromusuclar massage, deep tissue massage, trigger point therapy, medical massage and clinical massage. Also related are the modalities of visceral manipulation, craniosacral therapy and physical therapy.
This type of therapy involes various types of postural, visual and functional assessment procedures which help the therapist identify the issue. The work is often concentrated on a particular area with precision focus for an extended amount of time involving interactive feedback with the client, whilst other areas of the body which may seem unrelated to the presenting issue can also be worked on in the same session or in future sessions. Finally the client is given useful exercises to do in-between visits in order to maintain, supplement and enhance the effectiveness of the work done durinig each session.
The video below is aimed at therapists but still will be very much of interest to a lay person such as maybe yourself who may be looking for a proven alternative or complementary approach to relieving their soft tissue related pain, it expalins the physiological mechanism of pain and how remedial massage modalities can help:
Over the next few days, I’ll be publishing a series of articles defining some of the soft tissue modalities and techniques (mentioned above) that I use in my own clinical massage clinic here in Exeter (UK) and how in practical terms they have worked successfully on real world clients.
Henry's Natural Health & Personal Development Blog 