What Are Massage Therapists Doing With Myofascial Release?

The thing is, myofascial release is not well defined; it is a broad term covering a wide variety of techniques.

This includes osteopathic techniques, rolfing, structural integration, massage therapy, cupping and IASTM. My interpretation of myofascial release may differ from others, but in this post I am referring to myofascial release as a manual technique that applies tension to soft tissue structures and is accompanied by active or passive movement, to promote relative tissue motion.

Neurological Responses to Myofascial Release

Fascia is highly innervated by mechanoreceptors. This was documented by Robert Schleip in 2003. His article Fascial plasticity – a new neurobiological explanation Part 1–Part 2 is an interesting and very readable two-part article laying out a possible neurological explanation for the beneficial effects of myofascial release.

Mechanical Responses to Myofascial Release

The literature of Robert Schleip, Carla Stecco, Antonio Stecco and Thomas Findley support the idea that along with the neurological response and contextual response massage therapy has a mechanical effect on the fascial system. A summary of the proposed mechanisms includes but is not limited to

Nitric oxide release

Altered hyaluronic acid production

Changes in the extracellular matrix

Fibroblast response to shear force

Any type of massage therapy is actively engaging the nervous system by stimulating mechanoreceptors at the level of the skin, as well as at deeper level fascial layers. Deep, slow myofascial release techniques stimulate sensory endings known as the ruffini endings. Stimulating these slow adapting sensory receptors has the ability to alter the motor output and the experience of pain.

“Fascia and the autonomic nervous system appear to be intimately connected. A change in attitude in myofascial practitioners from a mechanical perspective toward an inclusion of the self-regulatory dynamics of the nervous system is suggested.”

-Fascial plasticity – a new neurobiological explanation: Robert Schleip

Are Massage Therapists Breaking Adhesions?

With such a lengthy post on myofascial release I would be remiss if I did not address the notion of breaking down adhesion. “An adhesion is an attachment of tissue at unusual non-anatomic sites which can be, vascular or avascular, innervated or not innervated.” 

There is little to no research that I am aware of that would indicate that massage therapy can manually break down mature adhesions. There is however literature to support the idea that massage therapy may be able to break down NEW AND IMMATURE abnormal adhesions.

Research by Geoffrey Bove and Susan Chapelle has demonstrated that manual therapy has the ability to break down immature adhesions. A recent case study demonstrated the effect of manual therapy on immature postoperative adhesions. Susan Chapelle has posted a well put together summary of the latest evidence of massage therapy and the effect on scars and adhesions Susan Chapelle- Understanding and Approach to Treatment of Scars and Adhesions.

What is the Clinical Relevance Of The Fascial System In Massage Therapy?

The “fascial system” serves to provide a conceptual model by which to explain the function of the global fascial net during movement, including the interconnections of fascial tissues with joint capsules, nerves and intramuscular connective tissues.

One of the proposed dysfunctions is an alteration of  loose connective tissue that may adversely affect the sliding motion of fascial layers. This may be due to age, trauma or inflammation. This alteration of loose connective tissue is described as a densification In The Functional Atlas of the Human Fascial System.

Is a fascial densification the same thing as fibrosis?

Stecco makes a distinction between a pathological fibrosis and densification:

• Densification refers to an alteration of the loose connective tissue (adipose cells, glycosaminoglycans and hyaluronic acid) Densification can involve an alteration in the quantity or quality of the components of loose connective tissue and an alteration in fascial viscosity.
  “Densification may affect the sliding and gliding of tissue. The different layers of the body contain viscous loose connective tissues that allow a gliding, sliding function, protecting sensitive neural structures, as well as facilitating pain-free, efficient movement and force transmission. Gliding function may be lost because of trauma, inflammation or aging, resulting in fibrosis, thickening, densification.” -Pavan et al 2014
• Fibrosis is defined as an alteration of dense connective tissue, specifically a rearrangement of the composition and structure of the dense connective tissue.

Nerve Entrapment

Many cases of peripheral nerve entrapment occurs following a traumatic injury, this is often the case with the sciatic nerve in proximal hamstring syndrome. It could be argued that this thickening and entrapment of peripheral nerves is a development process, could manual therapy play a role in slowing or reversing this progression?

Conclusion
Over the last 6 years I have read quite a bit on fascial research.  Myofascial release is an effective treatment technique; the catch is that it may not work in the way some were taught. Over time the supportive theories behind techniques evolve or change completely and myofascial release is an example of this.