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Clinical Review
Myofascial Release
By: Ellenore Palmer, BScPT, MSc

Cinahl Information Systems, Glendale, CA

Edited by: Sharon Richman, DHSc, MSPT, PT

Cinahl Information Systems, Glendale, CA

Indexing Metadata/Description

Procedure: Myofascial Release

Synonyms: Soft tissue mobilization
Area(s) of specialty: Orthopedic Rehabilitation, Neurological
Rehabilitation, Women’s Health,
Geriatric Rehabilitation, Pediatric
Rehabilitation
Description/use: A manual therapeutic technique used to
“release” restrictions in myofascial
structures. The technique is based on
the premise that the body is encased in connective tissue or
fascia, which
is the ground substance that interconnects bones, muscles, nerves, other
internal organs,
and tissues. Low-load, long-duration stretch into the
myofascial complex is applied, with the goal to
restore optimum length of
the complex, decrease pain, and improve function.(1) A release may be
defined
as a “softening” or “letting go” of resistance in the tissue as perceived by
the therapist
Indications
Myofascial release (MFR) techniques are used to help alleviate
musculoskeletal pain, often as a
modality in conjunction with other
treatment techniques(1)
MFR may be implemented to alleviate muscle spasm and improve soft
tissue extensibility
In response to trauma, the fascia is presumed to tighten at a
histological, physiologic, and
biomechanical level. The fascia loses
its pliability, becomes restricted, and is a source of tension.
Over
time this may contribute to poor muscular biomechanics, altered
structural alignment, and
decreased strength, endurance, and
coordination(1)
MFR is advocated to facilitate stretch into restricted fascia. It is
proposed that restoration of the
length and health of the myofascial
tissue can take pressure off the pain-sensitive structures such
as
nerves and blood vessels and restore alignment and mobility to the
joints(1)
CPT codes: 97140
Reimbursement: Reimbursement depends on insurance coverage.
Some policies will pay for MFR
treatment, with a specified time limit. Many
MFR practitioners have chosen not to participate in financial
reimbursement
plans in order to provide more intensive one-on-one direct contact with the
patient than is
allowed under those plans

Guidelines for use of Myofascial Release

A sustained pressure is applied into the restricted tissue barrier; after

90–120 seconds the tissue is said
to undergo histological length changes and
release is felt. The therapist follows the release into a new
tissue barrier
and holds. After a few releases the tissue becomes more pliable(1)
MFR techniques can involve direct superficial or deep pressure at the
perceived point of restriction or
indirect low-load prolonged gentle
distraction of restricted tissues
MFR may be applied on areas that seem unrelated to the primary pain and
injury since injury in one area
may result in pain and dysfunction in a
distant area, hypothesized to be due to fascial interconnections
Self MFR or SMR (self-myofascial release) techniques may be incorporated into
a home treatment
program with tools such as a foam roller, tennis ball,
roller stick, etc.
Some practitioners include skin rolling, scar gliding, and cupping as
superficial MFR techniques.
Ischemic compression, use of handheld tools
(e.g., “knobber” and foam roll), and muscle repositioning
have been
identified as deep MFR techniques(1)
Ischemic compression, the application of sustained pressure to trigger
points, blocking blood flow to the
area, is considered by some to be a
technique separate from MFR. Literature differs as to whether
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myofascial
trigger point massage therapy is an MFR technique(1)

Contraindications/Precautions to Myofascial Release

Contraindications
Malignancy
Infection
Osteoporosis
Acute rheumatoid arthritis
Advanced degenerative joint disease
Blood clot/deep vein thrombosis (DVT)
Obstructive edema
Skin lesions
Open wounds
Acute injury or surgery in treatment area
Hyperesthesia
Severe diabetes
Goiter
Cortisone therapy or blood thinners
Precautions
Congestive heart failure (CHF)
Other organ failure
Bleeding disorders
Skin fragility
Edema
Certain types of cancers

Examination

Contraindications/precautions to examination: See general precautions above

History
History of present illness/injury for which the
procedure is indicated
Mechanism of injury or etiology of
illness: Identify the reason for
referral
Course of treatment
Medical management: Medical
management will vary depending on the
specific
underlying condition; document any reported
diagnostic tests,
therapeutic interventions,
complications, and/or hospital stays
Medications for current illness/injury:
Determine what medications the
clinician
has prescribed; are they being taken as
prescribed? Are they
effectively controlling
symptoms?
Diagnostic tests completed: Depending
on presenting condition, patient
may have had
diagnostic imaging and/or EMG; review imaging and
reports as
able
Home remedies/alternative therapies:
Document any use of home
remedies (e.g., ice or
heating pack) or alternative therapies (e.g.,
acupuncture)
and whether they help
Previous therapy: Document whether
patient has had occupational or
physical therapy
for this or other conditions and what specific
treatments were
helpful or not helpful. Has
patient had myofascial release techniques used in
the
past? Were they effective?
Aggravating/easing factors (and length
of time each item is performed before the
symptoms
come on or are eased)
Body chart: Use body chart to document
location and nature of symptoms

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Nature of symptoms: Document nature of

symptoms (e.g., constant vs
intermittent, sharp,
dull, aching, burning, numbness, tingling)
Rating of symptoms: Use a visual analog
scale (VAS) or 0–10 scale to assess
symptoms at
their best, at their worst, and at the moment
(specifically address if pain
is present now and how
much)
Pattern of symptoms: Document changes
in symptoms throughout the day and
night, if any
(a.m., mid-day, p.m., night); also document changes
in symptoms due to
weather or other external
variables
Sleep disturbance: Document number of
wakings/night
Other symptoms: Document other symptoms
patient may be experiencing that
could exacerbate
the condition and/or symptoms that could be
indicative of a need to
refer to physician (e.g.,
dizziness, bowel/bladder/sexual dysfunction, saddle
anesthesia)
Respiratory status: Any history of
respiratory dysfunction, including use of
supplemental oxygen or mechanical ventilation?
Barriers to learning
Are there any barriers to learning? Yes__
No__
If Yes, describe ________________________
Medical history
Past medical history
Previous history of same/similar diagnosis:
Does the patient report prior
history of
presenting problem?
Comorbid diagnoses: Ask patient about
other problems, including diabetes,
cancer, heart
disease, complications of pregnancy, psychiatric
disorders, and
orthopedic disorders
Medications previously prescribed:
Obtain a comprehensive list of
medications
prescribed and/or being taken (including OTC
drugs)
Other symptoms: Ask patient about
other symptoms he or she may be
experiencing
Social/occupational history
Patient’s goals: Document what the
patient hopes to accomplish with therapy and
in
general
Vocation/avocation and associated repetitive
behaviors, if any: Is the
patient employed?
If so, what is the nature of the work tasks? Does
the patient
participate in recreational or
competitive sports?
Functional limitations/assistance with
ADLs/adaptive equipment: (include
limitations with self-care, home management, work,
community leisure)
Living environment: Inquire about
stairs, number of floors in home, with whom
patient
lives, caregivers, etc. Identify if there are
barriers to independence in the
home; any
modifications necessary?
Relevant tests and measures: (While tests and measures are
listed in alphabetical
order, sequencing should be appropriate
to patient medical condition, functional
status, and setting)
Anthropometric characteristics: Measure
swelling circumferentially where indicated
Assistive and adaptive devices: Make note of
use of assistive devices for mobility,
including
wheelchairs, walkers, and canes. Assess for appropriate and
safe use of device.
Does patient use glasses, hearing aids,
or other adaptive devices?
Balance: Assess static and dynamic balance in
sitting and standing as indicated
Cardiorespiratory function and endurance:
Assess vital signs as indicated and
appropriate. Borg
Rating of Perceived Exertion (RPE) Scale may be used to
assess exertion
level. The 6-minute walk test (6MWT) may be
used to assess endurance
Circulation: Assess peripheral pulses
Ergonomics/body mechanics: Assess body
mechanics during functional activities and
assess
workstation if indicated
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Functional mobility: Use FIM to assess

functional mobility as indicated
Gait/locomotion: Complete a thorough gait
assessment as indicated by reason for
referral
Joint integrity and mobility: Assess joint
mobility in the affected limb(s), especially if
indicated by
impaired ROM or movement limitation in functional tasks.
Assess
temporomandibular joint as indicated
Motor function (motor control/tone/learning):
Assess coordination and muscle tone
as indicated
Muscle strength: Assess strength in the
affected limb(s) using manual muscle testing
(MMT), where
abnormal tone is not present. Measure circumference of
affected limb if
muscle atrophy appears present. Measure
grip strength if hand is involved
Observation/inspection/palpation (including
skin assessment): Assess skin for any
signs of irritation,
breakdown, or ill effects of treatment. Observe for
swelling, redness, and
bruising
Palpation: (1)
Palpate for areas of muscle spasm. To locate a
trigger point, palpate the muscle
perpendicular to
its fibers, feeling for a taut band of tissue. Once
a taut band is
identified, move along the band and
identify the most tender or rigid spot
The “release” technique requires the detection by the
therapist of changes in
restrictions in the soft
tissue. During a release, resistance is said to
“melt” and the
tissue is felt to elongate and relax;
however, objective measurable criteria for defining
a release are not available
There are no published reliability studies
documenting that the diagnostic method for
myofascial pain (palpation of trigger points) is
reproducible and valid
Posture: Assess for asymmetry in sitting and
standing posture (1)
Note uneven weight-bearing, trunk side flexion and
rotation, scapular rotation/tilt (e.g.,
measure
distance from inferior angle to spine), shoulder
levels, and clavicular angles
Assess the spine for increased kyphosis,
straightening or reversal of cervical and/or
lumbar
lordosis, and scoliosis
Assess for anterior pelvic tilt and increased lumbar
extension, and hip and knee
flexion in standing
Range of motion: Assess active and passive ROM
and flexibility of the involved joints
and, if applicable,
compare to contralateral limb. If active ROM is not normal,
is it impaired
by pain or muscle contracture? Perform muscle
length tests depending on area of trigger
points(1)
Reflex testing: Assess deep-tendon reflexes in
affected limbs
Self-care/activities of daily living (objective
testing): Complete an ADL assessment as
indicated. Referral
to occupational therapy for specific testing may be
indicated
Sensory testing: Assess sensitivity to
pinprick, light touch, vibration (tuning fork), and
temperature in the affected dermatomes. Assess
proprioception in affected joints

Assessment/Plan of Care

Contraindications/precautions: Patients with a diagnosis for which this procedure is used may be
at
risk for falls; if so, follow facility protocols for fall prevention and
post fall-prevention instructions at
bedside, if inpatient. Ensure that
patient and family/caregivers are aware of the potential for falls and
educated about fall-prevention strategies. Discharge criteria should include
independence with fall-
prevention strategies
Diagnosis/need for procedure: Soft tissue injuries due to
trauma, overuse, structural imbalance, or
inflammatory processes that have
resulted in abnormal muscle mechanics and decreased soft tissue
extensibility
Referral to other disciplines: To occupational therapist (OT)
or vocational therapist as indicated for
work conditioning; to psychologist
for stress-related concerns; to athletic therapist as indicated for sports

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training
Other considerations: Controversy exists within the physical
therapy profession about the use of
MFR techniques
Treatment summary
Results of a 2018 systematic review of MFR as a treatment for
orthopedic conditions suggest that
MFR generally has positive
outcomes, but that few conclusions can be drawn due to a lack of
high-quality studies(2)
Eight RCTs were identified
The studies indicated that MFR may be effective for a variety
of orthopedic conditions. There
is a need for high-quality
RCTs
MFR may increase ROM in persons with limited ROM(6)
Headaches
MFR used in conjunction with microwave diathermy,
acupuncture, and therapeutic exercises
or trigger point
release may be more effective than acupuncture and
therapeutic exercises to
reduce pain and the frequency of
headaches in patients with tension headaches(7)
Based on the results of a systematic review of three
RCTs of patients with tension
headaches
Neck pain
MFR may be more effective than TENS, massage, and therapeutic
ultrasound to reduce
neck pain(8)
Based on an RCT of 41 patients with neck pain
Foot pain
Results of a systematic review of 6 RCTs indicate that MFR
reduces pain and functional
disability associated with
plantar heel pain(4)
Self-administered MFR
Self-MFR using a roller to apply pressure on the fascia may
be used as a supplemental
method of treating soft tissue
injuries, reducing muscle soreness after exercise, and
improving dynamic ROM and flexibility(9,10)
Self-MFR techniques involve small undulations back and forth
over a dense foam roller,
starting at the proximal end of a
muscle and working down toward the distal end, or vice
versa(9)
Results of a systematic review suggest that myofascial
release with foam rolling may
improve ROM if performed for 2
minutes in conjunction with warm-up exercises before
activity (3)
Because of anecdotal reports that self-MFR using foam
rollers allows athletes to
increase volume of
training, improve performance, and decrease
dysfunctions, foam
rollers are commonly used in
athletic facilities
The authors of a systematic review of the effects of
instrument-assisted myofascial release
on flexibility of the
lower extremity in physically active persons provide grade A
evidence that
foam rolling is beneficial in increasing ROM
and flexibility, and is most effective in
combination with
static stretching(5)
Breast cancer
MFR may be beneficial for some women with breast cancer
Based on an RCT, MFR may reduce upper extremity pain
in women with breast
cancer(11)
Fifty women received either 12 MFR treatments
and physical therapy treatment
or 12 placebo
treatments and physical therapy treatment
The women who received the MFR treatments had a
greater reduction in pain
than the placebo
group
See Description, Indications of
device/equipment, and Guidelines for
use of
device/equipment, above

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Problem Goal Intervention Expected Home Program

Progression
Myofascial Pain Therapeutic Progress duration Self-MFR using a foam
pain, relief, strategies
and intensity of roller may be used.
referred pain improved MFR applied
pressure Patient is instructed to
(e.g., low tissue techniques as indicated. The position body on the
back
pain, flexibility patient’s pain foam
roller and use
fibromyalgia, threshold is body weight to provide
plantar usually the limiting pressure
while rolling
fasciitis) factor for the back and forth over the
intensity of the fascia to be
treated
pressure
Tissue Improved Therapeutic Progress duration Equipment assisted
stiffness ROM strategies
and intensity of self-MFR techniques
with reduced MFR applied
pressure may be
taught
ROM techniques as indicated. The
patient’s pain
threshold is
usually the limiting
factor for the
intensity of the
pressure

Desired Outcomes/Outcome Measures

Reduced pain
VAS, pressure algometry
Increased ROM
Goniometric measurements
Sit-and-reach (SAR) test
Improved functional ability
6MWT
FIM
Improved ease of movement
Satisfaction surveys

Patient Education

There are numerous websites making various claims about MFR techniques. The
therapist should use
clinical judgment in referring patients to these
sites

References

1. Killens D. Mobilizing the Myofascial System: A Clinical Guide to Assessment and Treatment of
Myofascial Dysfunctions. Handspring Publishing Web site.
http://search.ebscohost.com.ibero.basesdedatosezproxy.com/login.aspx?
direct=true&AuthType=shib&db=nlebk&AN=2142525&site=ehost-live&scope=site. Published 2018. (GI)

2. Laimi K, Mäkilä A, Bärlund E, et al. Effectiveness of myofascial release in treatment of chronic

musculoskeletal pain: a systematic review. Clin Rehabil. 2018;32(4):440-450.
doi:10.1177/0269215517732820. (SR)

3. Hendricks S, Hill H, Hollander S, Lombard W, Parker R. Effect of foam rolling on performance and
recovery: A systematic review of the literature to guide practitioners on the use of foam rolling. J
Bodywork Movement Ther. 2020;24(2):151-174. doi:https://doi-
org.ibero.basesdedatosezproxy.com/10.1016/j.jbmt.2019.10.019. (SR)

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18/9/22, 20:57 Rehabilitation Reference Center

4. Pollack Y, Shasua A, Kalichman L. Manual therapy for plantar heel pain. Foot. 2018;34:11-16.
doi:https://doi-org.ibero.basesdedatosezproxy.com/10.1016/j.foot.2017.08.001. (SR)

5. Syeda M, Bartholomew J, Santiago S, Peterson J, Baker RT, Cheatham SW. The immediate effects of
instrumented-assisted soft tissue mobilization on range of motion, strength, and power in the lower
extremity: A critically appraised topic. Int J Athletic Ther Train. 2021;26(1):1-7. doi:https://doi-
org.ibero.basesdedatosezproxy.com/10.1123/ijatt.2019-0068. (SR)

6. Stanek J, Sullivan T, Davis S. Comparison of compressive myofascial release and the Graston
Technique for improving ankle-dorsiflexion range of motion. J Athl Train. 2018;53(2):160-167.
doi:10.4085/1062-6050-386-16. (RCT)

7. Georgoudis G, Felah B, Nikolaidis P, Damigos D. The effect of myofascial release and microwave
diathermy combined with acupuncture versus acupuncture therapy in tension-type headache patients: A
pragmatic randomized controlled trial. Physiother Res Int. 2018;23:e1700. doi:10.1002/pri.1700. (RCT)

8. Rodriguez-Huguet M, Gil-Salú JL, Rodriguez-Huguet P, Cabrera-Afonso JR, Lomas-Vega R. Effects of

myofascial release on pressure pain thresholds in patients with neck pain: a single-blind randomized
controlled trial. Am J Phys Med Rehabil. 2018;97(1):16-22. doi:10.1097/PHM.0000000000000790. (RCT)

9. Ceca D, Elvira L, Guman JF, Pablos A. Benefits of a self-myofascial release program on health-related
quality of life in people with fibromyalgia: A randomized controlled trial. J Sports Med Phys Fitness.
2017;57(42924):993-1001. doi:10.23736/S0022-4707.17.07025-6. (RCT)

10. Kalichman L, Ben David C. Effect of self-myofascial release on myofascial pain, muscle flexibility, and
strength: a narrative review. J Bodyw Mov Ther. 2017;21(2):446-451. doi:10.1016/j.jbmt.2016.11.006.
(SR)

11. De Groef A, Van Kampen M, Verlvoesem N, et al. Effect of myofascial techniques in addition to
standard physical therapy for treatment of pain and upper limb problems in breast cancer survivors:
randomized controlled trial. Manual Ther. 2016;25:e160. doi:10.1016/j.math.2016.05.318. (RCT)

Reviewer(s)

Diane Matlick, PT, Cinahl Information Systems, Glendale, CA

Lynn Watkins, BS, PT, OCS, Cinahl Information Systems, Glendale, CA

Rehabilitation Operations Council, Glendale Adventist Medical Center, Glendale, CA

Original document: 2012 Oct 19

Latest revision: 2021 Oct 03

Coding Matrix
References are rated using the following codes,

listed in order of strength:

Code Description
M Published meta-analysis

SR Published systematic or
integrative literature review

RCT Published research

(randomized controlled trial)

R Published research (not

randomized controlled trial)

C Case histories, case studies

G Published guidelines

RV Published review of the

literature

RU Published research
utilization report

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QI Published quality
improvement report
L Legislation

PGR Published government

report

PFR Published funded report

PP Policies, procedures,
protocols

X Practice exemplars, stories,

opinions

GI General or background
information/texts/reports
U Unpublished research,
reviews, poster
presentations or other such
materials

CP Conference proceedings,
abstracts, presentation

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