Myofascia, Tension and Stability

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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.

Post Operative Myofascial Release

When a person has had surgery, whether it be abdominal, cranial, shoulder, back, hip, knee or any joint surgery, often a neglected portion of the recovery is Myofascial Release of joints and tissues affected by the surgery. Adhesions can occur in the joints or tissues as a result of the surgery itself or the period where the person has to keep themselves, or a portion of their body, immobile during the healing phase immediately after the surgery.

I became acutely aware of this necessity after my heart surgery, where I had a heart valve replaced. To do the surgery, they had to cut through my breast bone to access the heart and do the surgery.  So for the next month, I had to keep my arms and shoulders pulled forward. I wasn’t able to open up my chest and bring my arms up and stretch them back while the sternum repairs itself. As a result, all the tissues around the front of my chest, my upper abdomen and the front of my neck were put in a shortened position for an extended period of time. All the tissues in the front will become adhered to each other and keep the tissues shortened which dramatically alters the center of gravity with the body and the shoulders and neck/head are pulled in a forward position. This is just a quick example of the effects of immobilization after surgery but doesn’t include the effect of the scar tissue created by the surgery itself.

I have seen the same effects with shoulder surgery, back surgery, hip/knee/ankle surgery. A bit portion of the rehab process is the return the joint or body part back to it’s normal mobility with myofascial release and strengthening. A body just wants to move in the manner in which it’s designed to do. That’s the best way to return a body to normal. The techniques are different for scar tissue release, for soft tissue release and for release of tissue surrounding the joints like ligaments, tendons or the capsule that surrounds joint. All can shorten, but all can be returned back to a good functional range of motion.

The principals of Myofascial Release are adhered to (pardon the pun) to create an increase of mobility that is gentle, effective and creates a long term effect. Every release will last a while but it’s so important that the patient has a full understanding of how they are presenting and how they can maintain the work that we do at home. It should never be about depepnding on the therapist to “fix” you. We assess the condition, educate, we begin the process to facilitate and allow the patient to help maintain the progress with home exercises.

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.