You may be suffering from an ongoing injury; you’ve visited various professionals in the hope of finding an answer to your ongoing pain. Painful massage, rehabilitation exercises and stretching – you’ve done it all but the pain persists.
Perhaps you’ve been suffering from chronic pain for some time; the feeling of a tightening or constriction in various parts of your body. Perhaps you are suffering from pain in your neck and shoulders, tightness around your rib cage or hips? Again, you may have tried various therapies, stretching, yoga….you’d try anything if it helped get rid of the pain?!
You’ve searched the internet looking for answers and come to the conclusion you are medically flawed and recovery is impossible…
……Well don’t give up just yet.
The answer could be right under your fingertips. About 2 millimetres under your fingertips, to be precise.
Under your skin, encasing your body is a substance known as fascia.
Manipulation of the fascial system – known as myofascial release – can be the missing link in the treatment of chronic pain and injury – particularity where previous therapies have not improved the clients condition.
In this blog I will attempt to give you a little more insight into what fascia actually is, its role in pain and injury and what we, as therapists, actually do during a myofascial release session.
Firstly, we’ll begin by looking at what fascia actually is and what it is made up of. We’ll then go on to discuss what causes fascia to become injured in the first place and the potential effects this can have on the body. It’s quite a difficult subject to explain in a short blog ( many have written whole books on the subject and still find it difficult!) so I’ve tried to keep the technical aspects of the post as brief as possible – but hopefully it gives you a good idea….hopefully!
What is fascia?
Fascia is the main connective tissue in the body, connecting everything to everything else. Fascia is one continuous sheet of connective tissue which wraps around all of the soft tissues within the body. Starting with the superficial fascia which lies just blow to the deeper layers which encases and runs through our organs such as our heart, blood vessels, nerves and muscles which make our limbs work. The ligaments that hold our joints together and the tendons which connect the muscles to the bones are all made of fascia.
To describe fascia in it’s physical form would then it would be described as a flimsy, white membrane; this membrane is innervated by nerves which send signals back and forth to the brain and react to what is happening in the body.
If you have ever prepared a chicken breast for dinner and noticed the membrane which lies beneath the skin then this fascia (apologies to any vegetarians who may be reading!)
Above: The web like nature of fascia (the white tissue), wrapping around the layers of the bodies tissues.
What is Fascia Made Up of?
We’ll briefly discuss the main components which make up fascia and give it it’s physical form.
The main components of fascia are:
Collagen, Elastin and Water.
Collagen and elastin are the two proteins which give fascia it’s physical form and that physical form exists throughout the body including nerves, cells, organs, bones muscle and skin connecting everything with everything else.
Collagen provides strength whilst Elastin provides flexibility. Lastly, we’ll talk a little bit more about the third component…water.
Fascia is the main connective tissue in the human body and the human body is 70% water on average, so it’s not surprising that the main component of fascia is water. Water gives the fascia the fluidity it needs for movement.
Any reduction in the bodies water content will adversely affect the fascia. Rather than the loose, hydrated slippery wet material it should be the fascia becomes dehydrated and gel like. It becomes sticky and begins to stick to it’s self and the other structures it surrounds. This process effectively squeezes the water out of the fascia and the structures it supports.
How Does Fascia Become Injured and Cause Pain?
We get a little technical here, try to stick with it!
Fascia contains special cells, known as fibroblasts which are responsible for maintaining it’s structure. When any damage occurs to fascia, the fibroblasts are stimulated in producing collagen., the strong structural protein, to repair the damage. In most cases, the fibroblasts complete the repair and the fascial web returns to its normal balanced function. However, there also many occasions when the increased tension in the fascia around the injury. This tension triggers the fibroblasts to keep producing more collagen as they attempt to repair the damage.
Over time the extra collagen creates adhesions (where the fascia sticks to itself and other tissues) reducing the fascias ability to slide freely.
As the extra collagen forms it begins to squeeze the fluid out of the fascia.
As we looked at earlier, fascia is made up of 70% water so this is similar to squeezing the water out of a sponge. This changes the sponge, or tissue, from being soft and pliable to hard and brittle. Everything contained within the fascia, including muscles, nerves and blood vessels is squeezed to he point it cannot relax and let go. Initially, this will take place at the initial site of injury but over time this spreads to adjacent areas of the body, eventually creating change in the lines of tension throughout the body. At this stage, fascial tension can create changes to muscle tone, loss of coordination, and imbalanced posture were one side is favoured over the other.
Fascial tension also stimulates nerve endings which measure damage and signal pain which can create a tendency for the body to stop using the area it thinks is damaged.
How do Myofascial Release Techniques Differ From the More Traditional Bodywork Techniques?
During traditional therapies the therapist moves their hands over the tissues of the body; moving, stretching and manipulating the muscles and connective tissue. The therapist will use a variety of massage strokes to lengthen, re-align and flush through the tissues in order to to loosen and encourage blood supply to the area. The difference with myofascial release is the therapist will simply place both their hands over the area of restriction and wait until the warmth of their hands allows them to gently sink into the tissue. This process will normally take at least a couple of minutes as the therapist uses their experience to identify when their hands have met the required depth. Once this depth has been achieved the therapist will then apply a gentle stretch to the tissues and wait for the tissues to “release”. Often this release is experienced as a melting in the tissues or a sensation the tissues have “let go”. The therapist is able to palpate when a restriction is fully released, becoming aware of the changes in the tissues as well as the increased fluid flow.
Above: An example of cross handed release technique often used during a myofascial release treatment. The therapist will hold this position for several minutes whilst they sink into the tissues. Once the correct depth has been established the therapist will then begin to move their hands apart until a barrier or resistance is felt; the therapist will then wait once again until the resistance (and tissue) begins to release. The aim of myofascial release is to wait for the body to release the tissues voluntarily rather than applying pressure and forcing the release which can often lead to the body forming a ‘guard’ response. This guarding response will usually cause a tightening of the tissues around the site of pain…potentially increasing pain and creating the feeling of ‘tightness’ and restriction to the client.
How do Myofascial Release Techniques Help to Restore Fascia?
We go a bit technical again here…keep with it guys!
As we discussed earlier fascia is made up of proteins and water. This combination gives the fascia a gel like consistency enabling it the ability to slide in and around the layers of tissue it surrounds but also gives it the ability to bounce and give – almost a trampoline like quality – adapting to the movement of the tissues it surrounds.
Fascia also has the ability to change from it’s natural gel like consistency to that of either a more fluid state or to a more solid matter. The ability for a property to change consistency is known as thixotropthy. Thixotrophy is triggered by temperature (heat) and mechanical force (pressure). If a thixotropic substance is subjected to a short sharp shock it will it will immediately resist but if gentle sustained pressure is applied then the fascia will melt and return to it’s more fluid – gel like state.
An example of this is fascia is subjected to forceful injury, such as from an accident or surgery, it will normally respond by hardening, usually causing restriction and pain.
Often, when fascia is in this hardened state it will not respond to being forced to loosen such as from heavy or deep pressure form a hands on treatment or from a forceful stretching routine. Generally the client will feel as though the tissues are actually tightening and the treatment or stretching routine is not helping their condition or injury.
The warmth given off by the therapists hands and the gentle sustained stretch which is applied during a myofascial release session is what the fascia responds to.
Who Can Benefit from Myofascial Release?
In my experience, clients most able to benefit form a myofascial release fall into the following categories:
Those suffering from a chronic pain condition such fibromyalgia or chronic pain syndrome. Often these clients cannot tolerate deep or heavy pressure during a treatment. The deep yet gentle approach of myofascial release can often be an effective treatment for these clients, helping to ease the symptoms of tightness, pain and restriction without the harsh or heavy pressure often associated with other treatment modalities.
Clients who have suffered an injury and attempted therapies to try and resolve their pain but found the stretching and strengthening routines, which have worked in the past, are not having any lasting any effect. The client may experience a weakness or a feeling of disconnect in the injured limb or around the site of the injury; despite sticking to their stretching and strengthening routines they simply cannot make progress in the same way as they have done in the past. I have often found in these clients there are fascial restrictions present. When fascia becomes dehydrated and restricted it can begin to compress the nerves bound within the tissues creating the feeling of weakness and disconnect often reported by clients. Myofascial release can help to release and free up any restrictions, assisting the client in regaining flexibility and releasing any nerve structures which may have been bound down by fascial restrictions. Following treatment, clients usually feel able to return to their rehab plans with much more successful outcomes.
So there you go – an explanation of what fascia is and how it can contribute to pain. Straight forward enough (!) It’s a difficult subject to explain in a short blog but I hope this gives you some understanding of the fascial system and the potential benefits myofascial release can offer. If you found this of interest then keep a look out as I will be posting some follow up blogs in the coming weeks where I will discuss in more detail how myofascial release can help with conditions such as IBS, acid reflux, breathing restrictions, swallowing difficulties and TMJ…and a few more!
Until then, I hope this has given some of you a little more insight into the fascial system and how it could potentially be at the source of your ongoing pain or injury.