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Myofascial Release Therapy, Indications, Warning

Myofascial Release Therapy/Myofascial Release is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the myofascial connective tissue restrictions to eliminate pain and restore motion. This essential “time element” has to do with the viscous flow and the piezoelectric phenomenon: a low load (gentle pressure) applied slowly will allow a viscoelastic medium (fascia) to elongate.

Myofascial release is a manual therapy technique often used in massage. The technique focuses on pain believed to arise from myofascial tissues the tough membranes that wrap, connect and support your muscles.

Fascia is a tough connective tissue that spreads throughout the body in a three-dimensional web from the head to the feet without interruption. Trauma, surgery, inflammation, etc. often restrict this web, resulting in highly intense pressure. This pressure, which is approximately 2,000 pounds per square inch, directly affects the nerves, muscles, blood vessels, bones, and organs.

Types of Myofascial Release Therapy

Superficial Fascia

Superficial fascia is the lowermost layer of the skin in nearly all of the regions of the body, that blends with the reticular dermis layer.^[rx] It is present on the face, over the upper portion of the sternocleidomastoid, at the nape of the neck, and overlying the breastbone.^[rx] It consists mainly of loose areolar, and fatty adipose connective tissue and is the layer that primarily determines the shape of a body. In addition to its subcutaneous presence, superficial fascia surrounds organs and glands, neurovascular bundles, and is found at many other locations where it fills otherwise unoccupied space. It serves as a storage medium of fat and water; as a passageway for lymph, nerve and blood vessels; and as protective padding to cushion and insulate.^[rx]Superficial fascia is present but does not contain fat, in the eyelid, ear, scrotum, penis, and clitoris.^[rx]

Due to its viscoelastic properties, superficial fascia can stretch to accommodate the deposition of adipose that accompanies both ordinary and prenatal weight gain. After pregnancy and weight loss, the superficial fascia slowly reverts to its original level of tension.

Visceral Band

Visceral fascia (also called subserous fascia) suspends the organs within their cavities and wraps them in layers of connective tissue membranes. Each of the organs is covered in a double layer of fascia; these layers are separated by a thin serous membrane.

The outermost wall of the organ is known as the parietal layer
The skin of the organ is known as the visceral layer. The organs have specialized names for their visceral fasciae. In the brain, they are known as meninges; in the heart, they are known as pericardia; in the lungs, they are known as pleurae; and in the abdomen, they are known as peritoneal.^[rx]

Visceral fascia is less extensible than superficial fascia. Due to its suspensory role of the organs, it needs to maintain its tone rather consistently. If it is too lax, it contributes to organ prolapse, yet if it is hypertonic, it restricts proper organ motility.^[rx]

Deep Fascia

Deep fascia is a layer of dense fibrous connective tissue which surrounds individual muscles, and also divide groups of muscles into fascial compartments. This fascia has a high density of elastin fiber that determines its extensibility or resilience.^[rx] Deep fascia was originally considered to be essentially avascular. However, more recent investigations confirmed a rich presence of thin blood vessels.^[rx] Deep fascia is also richly supplied with sensory receptors.^[rx] Examples of deep fascia are fascia lata, fascia leg brachial fascia, plantar fascia, thoracolumbar fascia, and Buck’s fascia.

Myofascial Release Purpose

When muscles and fasciae get injured, they become tight to protect the part from further damage and tearing, according to Myofascial Release.com. The shortness and tightness cause one side of your body, such as your buttocks, to become uneven, causing hip and low back pain. Myofascial release involves the therapist massaging the affected area by using compression forces to smooth the fibers and fasciae along the muscle’s gradient.

The Technique of Myofascial Release Therapy

Myofascial Release Practices to Try

With those rules in mind, here are some exercises you can do at home to relieve tightness and release any chronic tension that plagues your body. You’ll need a yoga mat and two tennis balls.

Relax Tight Calf Muscles

Roll up your mat to 2–3 inches in diameter. With your hands and knees on the floor, bring your forehead to the ground and tuck the rolled up mat into the crook of your knees. Gently sit up on your knees.

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If you have tight calves like mine, you’ll feel this immediately. (I think I actually said “whoa” out loud.) Spend some time here before releasing the mat and moving it to a point on your calves that’s about 1/3 of the distance between your knees and ankles. Sit up again, allowing your body weight to press the mat into your calves. Repeat with the mat positioned 2/3 of the way between your knees and ankles.

Once you’ve worked your way down your calves, unroll your mat and take Savasana. Cruikshank instructed us to do this after every exercise so that we would have the opportunity to notice any new sensations in the muscles.

Loosen Your Hamstrings

Sit on your mat with your legs straight out in front of you in a narrow V shape. Move the flesh from below your sitting bones so that they are resting directly on the floor.

Slide a tennis ball under each thigh and position them directly under your sitting bones. Try leaning forward and back to increase or decrease the sensation as needed, but resist the urge to stretch forward, as stretching will pull on the muscle. This was another “whoa” moment for me. I didn’t need to do much more than simply sit there in order to feel a significant amount of pressure.

When you’re ready, move the tennis balls so that they’re about 1/3 of the way between your hips and knees and repeat the process. Then do the same with the tennis balls positioned about 2/3 of the way between your hips and knees.

Release Tension in Your Back

With your knees bent, lie on the mat with the tennis balls positioned on either side of your spine (about an inch apart) just below the trapezius muscles.

Allow your body weight to press the tennis balls into the muscles on either side of your spine. When you’re ready, use your legs to roll up two inches so that the tennis balls roll down your spine. Spend some time here and then continue to roll the balls down your back two inches at a time. Once you’ve traveled the length of your spine remove the tennis balls and take Savasana.

Perhaps it was the two and a half straight days of yoga I’d just done, but I actually fell asleep during this portion of the class. For me, it had the same effect as a deep tissue massage that’s both effective and relaxing.

Deepen Your Hip Flexibility

Lie down with your knees bent and the bottoms of your feet on your mat. Slide the tennis balls under your hips so that they’re positioned about 1 inch from either side of your sacrum. Rest here for as long as you like before straightening the right leg and moving the right tennis ball further away from the sacrum. Use your bent left leg to roll to the right slightly, increasing the pressure.

Continue to move the tennis ball away from the sacrum a little at a time, rolling your body to apply pressure. When you get to the outer edge of your leg just below the hip bone, roll your body so that you’re not quite all the way on your stomach and position the tennis ball so that it’s in the front “pocket zone” of your hip and apply pressure there. Judging from the symphony of collective gasps, groans and sighs in the room, were all carrying more than a little tension in our hips.

Adductor Self Myofascial Release

Extend the thigh and place foam roll in the groin region with body prone (face down) on the floor.
Be cautious when rolling near the adductor complex origins at the pelvis.
If a tender point is located, stop rolling, and rest on the tender point until pain decreases by 75%.

Hamstring Self Myofascial Release

Place hamstrings on the roll with hips unsupported.
Feet can be crossed so that only leg at a time is one the foam roll.
Roll from knee toward the posterior hip.
If a tender point is located, stop rolling, and rest on the tender point until pain decreases by 75%.

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Quadriceps Self Myofascial Release

Body is positioned prone (face down) with quadriceps on the foam roll
It is very important to maintain proper core control (abdominal drawn-in position & tight gluteus) to prevent low back compensations
Roll from pelvic bone to knee, emphasizing the lateral (outside) thigh
If a tender point is located, stop rolling, and rest on the tender point until pain decreases by 75%.

Iliotibial Band Self Myofascial Release

Position yourself on your side lying on the foam roll.
Bottom leg is raised slightly off the floor.
Maintain head in neutral position with ears aligned with shoulders.
This may be PAINFUL for many and should be done in moderation.
Roll just below hip joint down the outside thigh to the knee.
If a tender point is located, stop rolling, and rest on the tender point until pain decreases by 75%.

Upper Back Self Myofascial Release

Place hands behind head or wrap arms around the chest to clear the shoulder blades across the thoracic wall.
Raise hips until unsupported.
Stabilize the head in a neutral position.
Roll mid-back area on the foam roll.
If a tender point is located, stop rolling, and rest on the tender point until pain decreases by 75%.

Does self‐myofascial release with a foam roll or roller‐massager improve joint range of motion without affecting muscle performance?

The research suggests that both foams rolling and the roller massage may offer short‐term benefits for increasing sit and reach scores and joint ROM at the hip, knee, and ankle without affecting muscle performance.^{[rx,rx–rx,rx]} These findings suggest that SMR using a foam roll for thirty seconds to one minute (2 to 5 sessions) or roller massager for five seconds to two minutes (2 to 5 sessions) may be beneficial for enhancing joint flexibility as a pre‐exercise warmup and cool down due to its short‐term benefits. Also, SMR may have better effects when combined with static stretching after exercise.^[rx,rx] It has been postulated that ROM changes may be due to the altered viscoelastic and thixotropic property (gel‐like) of the fascia, increases in intramuscular temperate and blood flow due to friction of the foam roll, alterations in muscle‐spindle length or stretch perception, and the foam roller mechanically breaking down scar tissue and remobilizing fascia back to a gel‐like state.^[rx,rx,rx]

After an intense bout of exercise, does a self‐myofascial release with a foam roller or roller‐massager enhance post-exercise muscle recovery and reduce DOMS?

The research suggests that foam rolling and roller massage after high-intensity exercise does attenuate decrements in lower extremity muscle performance and reduces perceived pain in subjects with a post-exercise intervention period ranging from 10 to 20 minutes.^[rx,rx,rx] Continued foam rolling (20 minutes per day) over 3 days may further decrease a patient’s pain level and using a roller massager for 10 minutes may reduce pain up to 30 minutes. Clinicians may want to consider prescribing a post‐exercise SMR program for athletes who participate in the high-intensity exercise. It has been postulated that DOMS is primarily caused by changes in connective tissue properties and foam rolling or roller massage may have an influence on the damaged connective tissue rather than muscle tissue. This may explain the reduction in perceived pain with no apparent loss of muscle performance.^[rx] Another postulated cause of enhanced recovery is that SMR increases blood flow thus enhances blood lactate removal, edema reduction, and oxygen delivery to the muscle.^[rx]

Does self‐myofascial release with a foam roll or roller‐massager prior to activity affect muscle performance?

The research suggests that short bouts of foam rolling (1 session for 30 seconds) or roller massage (1 session for 2 minutes) to the lower extremity prior to activity does not enhance or negatively affect muscle performance but may change the perception of fatigue.^[rx,rx,rx]It’s important to note that all SMR interventions were preceded with a dynamic‐warm‐up focusing on the lower body.^[rx,rx,rx] Perhaps the foam roller or roller massagers’ influence on connective tissue rather than muscle tissue may explain the altered perception of pain without a change in performance.^[rx] The effects of foam rolling or roller massage for longer time periods has not been studied which needs to be considered for clinical practice.

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Clinical Application

When considering the results of these studies for clinical practice four key points must be noted. First, the research measuring the effects of SMR on joint ROM, post‐exercise muscle recovery and reduction of DOMS, and muscle performance are still emerging. There is diversity among study protocols with different outcome measures and intervention parameters (e.g. treatment time, cadence, and pressure). Second, the types of foam and massage rollers used in the studies varied from commercial to custom made to mechanical devices attached to the rollers. It appears that higher density tools may have a stronger effect than softer density.

Indications of Myofascial Release Therapy

Sciatica – (shooting pain in the buttocks and legs) is often caused by pain in the piriformis or other gluteal muscles, and not by irritation of the sciatic nerve. Many other trigger points are mistaken for some kind of nerve problem. (And, to be fair, some kinds of nerve problems can be mistaken for trigger points! More on this to come.)
Chronic jaw pain – toothaches, earaches, sinusitis, ringing in the ears (tinnitus)- and dizziness may be symptoms of trigger points in the muscles around the jaw, face, head, and neck.
A sore throat or a lump in the throat – is often caused or aggravated by trigger points anywhere around the throat.
Appendicitis pain – often turns out, sometimes after surgery, to be caused by a trigger point in the abdominal muscles. Wow.
Severe MPS – is often mistaken for fibromyalgia (and other causes of pain hypersensitivity).
Migraine and tension-type headaches
Periarthropathy (shoulder, hips)
Tendinosis
Insertion tendinopathy.
Arthritis
Degenerative cervical, thoracic or lumbar spine syndrome.
Spinal syndrome with segmental functional disorder.
Visceral pain syndrome.
Repetitive motion disorders (like carpal tunnel syndrome)
Spinal problems
Pelvic pain
Night cramps
Phantom pain
Post-herpetic neuralgia (pain left behind by shingles)
Neck/Back Pain
Shoulder Pain
Tennis/Golfers Elbow
Headaches
Hip and Gluteal Pain
Knee Pain
Achilles Tendonitis/Tendonosis
Plantar Fasciitis
Sciatica
Muscular Strains/Ligament Sprains
Chronic Pain
Athletic Performance

ContraIndications of Myofascial Release Therapy

Pregnant women
People who are not able to understand the treatment
Patient unwilling – fear, patient belief.
Unable to give consent – communication, cognitive, age-related factors.
Medical emergency or acute medical condition.
Over an area or limb with lymphedema as this may increase the risk of infection/cellulitis and the difficulty of fighting the infection if one should occur.
Inappropriate for any other reason.
Abnormal bleeding tendency
Compromised immune system
Vascular disease
Children
Patients with epilepsy
Psychological status
Patient allergies
Unsuitable patient for any reason

General Guidelines

Spend 1-2 minutes per self-myofascial release technique and on each side (when applicable).
When a trigger point is found (painful area) hold for 30-45 seconds.
Keep the abdominal muscles tight which provides stability to the lumbopelvic-hip complex during rolling.
Remember to breathe slowly as this will help to reduce any tense reflexes caused by discomfort.
Complete the self-myofascial release exercises 1-2 x daily.