Myofascia, Tension and Stability

Armbruster_Tent_Maker_12-1024x768

During the Myofascial Release courses that I have taken, a common comparison was made between the fascia in the human body and a tent. I think it is a great example of how Fascia maintains structure, function and stability in the human body. It holds us together and allows us to move and be flexible, yet strong. The function of the skeletal system and the fascial system act like the poles of a tent and the ropes that hold up a tent. The poles are the skeletal system that create the shape of the tent but it is the importance of the tension of the ropes, which are the fascial system of the body, which maintains the integrity and holds the shape of the tent. Without the ropes, the tent, even with the poles, will fall over in the presence of an internal or external force. It is the fascia, which allows the tent to hold it’s shape and provide the function.

An example of dysfunctional fascia, which may be adhered and/or shortened would be like pulling one of the ropes too tightly. Think of the whole tent being pulled to that side. The same thing can happen with the body which adhered, shortened fascia can pull the body out of it’s center of gravity causing dysfunction, instability, weakness, reduced range of motion and pain. There are various causes of fascia that can become short, dehydrated and dysfunctional. When it comes to shortened fascia, everybody presents differently. It can begin at child birth or be present after even a minimally invasive surgery.

It’s finding the fascial restrictions that pull the body out of it’s center of gravity. The philosophy is to find the pain but look for the cause elsewhere as the cause and effect may not be in the same area. As a therapist, I’ve learned to treat without feeling that I know what it happening. There is a process, but I have to learn to be a good listener to find where the cause is.

Creating a long term effect of Fascial Release

Of the Fascial Release Course I attended, probably one of the most important things I brought home was reiterating the importance of stretching the fascial tissue to it’s stretch barrier and holding it until it lets go. That sometimes the stretch may have to be held for 3-5 minutes. When we complete the fascial release, we want it to stay there. Very often, the question I get from patients is, how do we get it to stay there so it doesn’t bounce back. I can give stretches to do at home to maintain our progress but it’s my job to release the specific fascial adhesions so that the home stretches are effective. To fully understand what fascia is, and what we are working with, we look at what makes up fascia.

Fascia in the body is described as: Fascia is a specialized system of the body that has an appearance similar to a spider’s web or a sweater. Fascia is very densely woven, covering and interpenetrating every muscle, bone, nerve, artery and vein, as well as, all of our internal organs including the heart, lungs, brain and spinal cord. The most interesting aspect of the fascial system is that it is not just a system of separate coverings. It is actually one continuous structure that exists from head to toe without interruption. In this way you can begin to see that each part of the entire body is connected to every other part by the fascia, like the yarn in a sweater.Fascia plays an important role in the support and function of our bodies, since it surrounds and attaches to all structures. In the normal healthy state, the fascia is relaxed and wavy in configuration. It has the ability to stretch and move without restriction. When one experiences physical trauma, emotional trauma, scarring, or inflammation, however, the fascia loses its pliability. It becomes tight, restricted, and a source of tension to the rest of the body. Trauma, such as a fall, car accident, whiplash, surgery or just habitual poor posture and repetitive stress injuries has cumulative effects on the body. The changes trauma causes in the fascial system influences comfort and function of our body. Fascial restrictions can exert excessive pressure causing all kinds of symptoms producing pain, headaches or restriction of motion. Fascial restrictions affect our flexibility and stability, and are a determining factor in our ability to withstand stress and perform daily activities. 

Fascia is comprised mainly of three things: Elastic fibers, Collagen fibers and Ground Substance that surrounds the Elastic and Collagen fibers. With fascial adhesions, it’s the collagen and elastic fibers that become bound to each other, greatly affecting the elasticity of the tissue, affection local movement, where ever that tissue is in the body, as well as movement and function of other areas of the body, as the fascial system is continuous throughout the entire body.

As an example, having a fascial restriction in the low back is like wearing a wet suit, leaning back, and having glue poured on the wet suit at your low back, and letting the glue dry. The glue will continue to pull you back and somewhere else in the body will have to compensate for that pull so your are balanced. It’s the systemic response to a local fascial adhesion.

Someone once said that releasing Fascia is like cooking stewing beef cubes. You can do it quickly and throw it into a pan on high (hard stretch for short periods) and it will cook but it will still be really tough or you can slow cook it at a lower temperature for a longer period of time and get a much better result (more pliable, elastic tissue as a result).

So as I locate a fascial adhesion, I apply a stretch only to the barrier. I could push harder, but I just go to the barrier and wait. During the stretch heat will be created that will warm the tissue, allowing the collagen fibers to stretch. You can feel the tissue slowly softening and elongating over the 3-5 minutes. But you just wait for the tissue to naturally lengthen. By doing this, the tissue will reform under the heat, same as plastic does under heat, and as you let go gently, the tissue will now remain in that lengthened position. Now the patient can go home with specific stretching to maintain that lengthened tissue with any other exercises given for that specific condition that they’ve come in for.

It’s taken some trust and open mindedness to adopt this treatment philosophy but I’m so grateful that I did as it has dramatically helped patients with mobility, strength, stability and reduced pain as a result.

What is Myofascia and Myofascial Release

I heard the perfect analogy for what fascia is in the body, from a structural standpoint. Take a jar and put all sorts of little things in it like golf tees, marbles, string, pencils and fill up the jar with it. Then pour in this liquid, to the brim of the jar, that will set, but remains 70 – 80% liquid (as that is what we are). When this liquid sets, it will also be very structurally strong as well as being fluid. Almost like a super-jello. So now in the jar, you have all those items listed above and poured between those spaces is this liquid that will set. When it sets, you can crack the jar and this structural jello will hold the shape of the jar with all the items listed above set within it. What the items listed above represent are our cells and to a larger scale, things like our bones, nerves, muscles, brain, arteries/veins and holds them all in the shape that is what we are.

It is an extremely strong, 3 dimensional, gelatinous web that surrounds everything in our body that allows us to move but also holds us in our shape. It is crucial that it maintains that fluid content in the same way that it is crucial that leather maintains that moistness to remain soft and flexible. If for some reason parts of our fascial system loose that fluid content, it becomes dry, it loses it’s flexibility and pliability and as the fascial system is continuous through the entire body, can affect the biomechanics through the entire body. There is never a predictable way that it can affect the body.

Fascia can lose it’s fluid content for many different reasons including trauma, surgeries (joint replacement/abdominal surgeries/child birth), inflammatory responses (IBS, Crohns,Pneumonia) and chronic longer term shortening of tissues (poor posture, sitting), microtrauma to muscle tissue from heavy activity like biking, running, weight lifting. Shortening of the fascia may have occurred recently or may have occurred as long ago as a traumatic childbirth. The body is able to compensate for where ever the fascial restriction are for a long time before the presentations may occur.

Two of the most common major presentations of fascial adhesions that I see are low back pain from adhesions occurring at the front of the pelvis/hip regions and back/shoulder/posterior neck pain occurring from adhesions forming at the front of the neck and chest area pulling the head and the shoulders forward. When you are pulled forward by fascial adhesions at the front of the body, the muscles that pull you back up (whether they be the low/mid/upper back or the back neck or shoulder muscles) become strained, fatigue and ultimately produce pain and spams.

The main mantra with this work is find the pain but look for the cause elsewhere.

In our original training, we were very symptoms oriented and it took a leap of faith to pull myself away from that to move towards this philosophy but it has been so affective. Deal with the fascial restrictions so the body can move in the manner to which it was designed to do. Just let the body move like it should. That’s what it really wants to do.

How does one release fascia back to it’s original property? That’s worth another blog entry. 🙂

The homecare exercise regime

When in process of rehabilitation, the work that you do at home is just as important as the work done during the treatment. Its a case of maintaining or continuing what progress was made during the treatment. I think it’s great as it helps to put some control into the hands of the patient so that the condition is manageable. I think we’ve all become accustomed to the philosophy that a person has a treatable condition, they come in to be treated and then they’re better and can continue on without any self-intervention.
As someone that experienced some severe low back issues in the past, I think it’s really important to have solid knowledge as to what is happening and exactly how my home exercises will be improving the condition.
It always seemed to be such an inconvenience though. Something where I had to take time away from my daily activities to do and without a solid understanding as to why I was doing it. People say to me that they just don’t have the time during the day. I think it’s very very important to have even just a little bit of time for yourself during each day. I think that taking that time away and spending it doing the self care is possible. For myself, my favorite thing is to watch a movie. I don’t think of it as watching a movie while I do my stretches. I think of it as stretching while I watch a movie. There is a difference. Watching a good movie is my prime motivation and stretching is just a position that I’m in while I watch the movie. This way, the whole process is more enjoyable and I’m more likely to do it. I have an attention span of about 1 minute. I call it EADD (exercise attention deficit disorder). But watching a movie and stretching is great because time flies so fast. I also play games on my iPad while I’m on the inversion table or I’ll go for a walk in the morning and have a coffee at my destination.
As a therapist, I’m a bit of a talker and usually spend my time talking about what I’m finding and how it is affecting the current condition. Then when it comes to the exercises at the end, I talk about how the exercise will improve the condition that I’ve been talking about during the treatment. Understanding and knowledge makes a person more in control of their condition I believe. It leads them to understand why they are in pain and what message the pain is telling them. It’s no different than having your finger above a candle. Your finger warms up and you pull it away as the low grade pain is telling you a message. An example is the shoulder. If the shoulder falls forward, it may cause a pinching pain when you raise it up. If you feel the pinching pain, then you need to recenter your shoulder so it tracks more efficiently. So it’s my job to tell you what the pain is telling you and what your body is doing and how you can improve your posture/biomechanics to where it is moving more efficiently and the pain is reduced. This makes you more knowledgeable and in control of the condition throughout the entire day.