Myofascial Trigger Points – A big problem
Back pain is one of the most commonly encountered problems that a patient reports to a therapist. Of the many reasons that cause a back pain, myofascial restrictions are a major cause. All of us know that there is an intimate connection between the muscle and fascia and the adherence of fascia to underlying muscle, local ischaemia, trigger points and taut bands can cause pain in any part of the body. So therefore, the release of fascia and taut bands becomes a very crucial element of manual therapy techniques for treatment. Irritation of fascia or muscle causes local inflammation. Chronic inflammation results in fibrosis, or thickening of the connective tissue, and this thickening causes pain and irritation, resulting in reflexive muscle tension that causes more inflammation. In this way, the cycle creates a positive feedback loop and can result in ischemia and somatic dysfunction even in the absence of the original offending agent.
Myofascial Release – Technique
Myofascial release techniques aim to break this cycle through a variety of methods acting on multiple stages of the cycle. Myofascial release techniques generally fall under the two main categories of passive (patient stays completely relaxed) or active (patient provides resistance as necessary), with direct and indirect techniques used in each.
The direct myofascial release (or deep tissue work) method works through engaging the myofascial tissue restrictive barrier, the tissue is loaded with a constant force until tissue release occurs. I commonly use knuckles, elbows, or fingers to slowly stretch the restricted fascia by applying a certain amount of force specific to the tissue in question. Direct myofascial release seeks for changes in the myofascial structures by stretching, elongation of fascia, or mobilizing adhesive tissues. The practitioner moves slowly through the layers of the fascia until the deep tissues are reached.
The indirect myofascial release
The indirect method involves a gentle stretch, with only a few grams of pressure, which allows the fascia to ‘unwind’ itself. The dysfunctional tissues are guided along the path of least resistance until free movement is achieved.The gentle traction applied to the restricted fascia will result in heat and increased blood flow in the area. This allows the body’s inherent ability for self correction to return, thus eliminating pain and restoring the optimum performance of the body.
Either of these methods can be used, depending on what is suitable to that particular patient. A very important component of this type of therapy is that no oil or lubricating medium is used. This is one of the differentiating features from conventional massage techniques. This helps the therapist in identifying small and subtle variations in tissue tension and fascial restrictions.
The common conditions in which MFR can help are back pain, bulging disc, bursitis, carpal tunnel syndrome, degenerative disc disease, fibromyalgia, frozen shoulder, headaches, neck pain, osteoarthritis, plantar fascitis, scars, sciatica and tennis elbow.