@Physiocouk #manchesterphysio facebook.

com/physiocouk
Welcome
Myofascial Release (MFR) workshop

With Louise Rigby & Kate McNally

@Physiocouk #manchesterphysio facebook.com/physiocouk

Who are we?
Kate’s LinkedIn: www.linkedin.com/katemcnally
Twitter: @KateMcPhysiocouk

Louise’s LinkedIn: www.linkedin.com/Louiserigby

Twitter: @LouPhysiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk

Let’s connect
Website: www.massage.physio.co.uk

Twitter: @physiocouk

Facebook: www.facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Aims of today
✓ Learn and understand fascia structures and it's anatomy

✓ Learn the indications and contraindication to myofascial

release techniques.

✓ Learn different myofascial release techniques and how to

perform them safely.

✓ Learn which outcome measures and other treatment

techniques to use with myofascial release.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Itinerary
10.00 - 10.30 - Induction / Arrival
10.30 - 11:15 - Theory: MFR
11.15 - 12:15 - Practical: MFR (Upper Limb)
12:15 - 12.45 - Lunch
12:45 -13:45 - Practical: MFR (Lower Limb)
13.45 - 14.30 - Treatments alongside MFR
14.30 - 15.00 - Evidence and Case Studies

@Physiocouk #manchesterphysio facebook.com/physiocouk

Theory:
Myofascial Release

@Physiocouk #manchesterphysio facebook.com/physiocouk

Definition
Myo= Muscle

Fascia = a band / sheet of connective tissue

Release = relaxation / stretching of tight structures

@Physiocouk #manchesterphysio facebook.com/physiocouk

 What is fascia?
Where is it found?
•Fascia is a layer of fibrous tissue that surrounds groups
of muscle, bone, blood vessels and nerves.
•It binds structures together, whilst permitting other
structures to glide smoothly over each other.
•Fascia is dense, regular connective tissue, which
contains closely packed bundles of collagen fibres aligned
in a wavy pattern parallel to the direction of pull.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Layers of Fascia
Fascia is classified depending on it’s distinct layers, functions and
anatomical position:
Superficial, deep and visceral

@Physiocouk #manchesterphysio facebook.com/physiocouk

Muscle anatomy
•All muscle tissues have a superficial covering of
vary thicknesses of fascia, made of connective
tissue and laced with adipose tissue.
A singular muscle fibre is referred to as a myofibril
and contains thick and thin myofilaments.

@Physiocouk #manchesterphysio facebook.com/physiocouk

Function of Fascia
● Reduce friction during a muscular
contraction
● Support the nerves and blood vessels as they
glide through the muscle.
● The fascia holds the muscle together and
keeps it in the correct place.
● The fascia separates the muscles so they can
work independently of each other.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Fascia- why does it go wrong?
Age and injury can cause an increase of laying down of collagen,
increased cross linkages and restrictions (adhesions)

Fascia increases its density and decreases its ability to slide freely
following:
• Trauma and injury
• Poor posture
• Infections or disease
• Over and under use
• Ischaemia
• Local and systemic inflammation
• Tissue dehydration
• Emotional stress and centralised pain
@Physiocouk #manchesterphysio facebook.com/physiocouk
 How can we treat fascia?

•Theory of fascial lines.

•Structures are grouped together in recognised fascial lines and when

one structure is released the benefits may be present further along
the line.

•The point of restriction may be away from the point of pain.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Anatomy Trains
Superficial Back Line (SBL)
• Function is to support the body in full upright extension

• With the knees extended the line is continuous

• It has a higher degree of slow twitch endurance muscle fibres

and extra heavy sheets of fascia to overcome the postural
demands.

• There is no deep back line although some aspects of the SBL

are deeper than others. There is no consistent and connected
layer deeper than the SBL

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk
 Anatomy Trains
Superficial Front Line

• Function is to balance the SBL and provide tensile

support from the top to lift those parts of the
skeleton which extend forward of the gravity line
(pubis, ribcage and face)

• Viewing the patient from the side reveals the state

of imbalance between the SFL & SBL

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk
 Anatomy Trains
Deep Front Line

• Infused with slow twitch endurance muscle fibres, the DFL

provides stability and subtle positioning changes to core
structure.

• Failure of the DFL does not cause an acute change but more
functional restriction over a period of time which may appear
in another line.

• Its role in surrounding the heart and lungs has a significant

effect upon respiration.

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk
Anatomy Trains
Demonstration of Theory

@Physiocouk #manchesterphysio facebook.com/physiocouk

What is Myofascial
Release?
Myo = muscle

Fascia = a band or sheet of connective tissue

Release = the relaxation and/or stretching of tight

structures

@Physiocouk #manchesterphysio facebook.com/physiocouk

What is Myofascial
Release?
“Myofascial Release is a specialised physical
and manual therapy used for the effective
treatment and rehabilitation of soft tissue and
fascial tension and restrictions”

Myofascial Release UK

@Physiocouk #manchesterphysio facebook.com/physiocouk

 What is Myofascial
Release?
•Safe and effective hands-on technique that works on the fascia to
release restrictions.

• Applied with prolonged pressure to restricted tissue.

• Aims to release tension and stretch out restricted parts of the

fascia.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Aims and benefits
Myofascial Release can decreases Pain:
Endorphin release/ increased temperature/ pain gate theory.

Myofascial release can help the immune system.

Increased lymphatic flow.

Myofascial Release promotes healing

Increased blood flow and cell nutrition

Myofascial release can reduce tension

Stretching/ elongation of fascia/ Increased heat in tissues
@Physiocouk #manchesterphysio facebook.com/physiocouk
 How is myofascial release
applied?
• Gentle and sustained, pressure should be applied for a prolonged period of
time 60 – 120 seconds

• This amount of time permits fascia to naturally elongate and return to

normal resting length which will restore the healthy status quo, giving
greater flexibility, mobility and eliminating pain.

• Techniques applied for shorter periods will temporarily

lengthen the elastic fibres in the muscles and fascia and
the tissues will feel looser for a while but gradually
tighten up again.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Manual handling and body
position
Posture
• Bed height
• Stance
• Patient position

• Use different parts of your hands/ arms to apply pressure

• Keep arms straight to utilise body weight when applying
pressure/resistance.
• Move from the hips and knees as much as possible
• Oil (or cream)- only needs to be a little bit - some advise not to be able to
tack and pin effectively.

Look after yourself before you look after the patient!

@Physiocouk #manchesterphysio facebook.com/physiocouk
 Post Rx soreness?

Very common for people to experience post Rx soreness for up to 72

hours after treatment.

Side effects can include:

• Bruising
• Redness
• Tenderness/Increased Sensitivity
• Increased symptoms
• Aching similar to DOMS

@Physiocouk #manchesterphysio facebook.com/physiocouk

Post Rx soreness?
Causes

• The release of toxins/waste products from muscular tissue

• Neurological sensitisation
• Increased blood flow and micro trauma can lead to bruising and
redness

Advice

• Reassure the patient it's a normal response to be sore after soft

tissue treatment
• Advise them to use ice (safely)
• Recommend they drink water to keep hydrated

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Indication for Rx
• Loss of mobility and range of motion

• Increased amounts of scar tissue and adhesions

• Increased tone of overactive muscles

• Poor quality of movement

@Physiocouk #manchesterphysio facebook.com/physiocouk

Specific Pathologies
treated with myofascial
release
● Whiplash associated conditions
● Fibromyalgia / Non- specific chronic pain
● Lower back pain
● Individuals with reduced ROM
● Postural Tension
● Reduced blood flow from trauma or post surgery
● Reduced immune system

@Physiocouk #manchesterphysio facebook.com/physiocouk

Contraindications for Rx
Local Systemic
Broken skin/Open cuts Cancer (Malignancy)

Skin conditions Acute Circulatory disorders

Haematoma Blood Thinning Medications (e.g.
Warfarin)
Healing Fracture Bleeding disorders (e.g.
Haemophilia)
Active infections Systemic Infection
Obstructive Oedema
Acute RA
Advanced Diabetes

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Precautions to Rx
• Pregnancy

• Hypersensitivity

• Hyper or Hypo- tension

• Patient Anxiety or lack of communication during

Rx

• Acute/ Inflammatory stage of healing

@Physiocouk #manchesterphysio facebook.com/physiocouk

Research
Benefits of Massage-Myofascial Release
Therapy on Pain, Anxiety, Quality of Sleep,
Depression, and Quality of Life in Patients with
Fibromyalgia
Castro-S anchez A, Guillermo A, Narrocha, Granero-Molina, Aguilera-
Manrique,Quesada-Rubio J and Moreno-Lorenzo,(2011). Evidence based
complementary and alternative Medicine.

@Physiocouk #manchesterphysio facebook.com/physiocouk

Research
Systematic review including x10 studies

Myofascial release - more of an ‘umbrella term’

8/10 studies also used trigger point and PNF as part of their
Rx techniques

Findings: effective for reducing pain in some pathologies

such as plantar fasciitis.
Most effective when combined with exercise, strengthening
and electrotherapy.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Research
Myofascial release therapy in the treatment of
occupational mechanical neck pain: a
randomised parallel group study.

Rodríguez-Fuentes, I., De Toro, F. J., Rodríguez-Fuentes,

G., de Oliveira, I. M., Meijide-Faílde, R., & Fuentes-
Boquete, I. M. (2016). American Journal of physical
medicine & rehabilitation, 95(7), 507-515.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Research
Effectiveness of myofascial release in the
management of chronic low back pain in
nursing professionals
Ajimsha, M. S., Daniel, B., & Chithra, S. (2014). Journal of bodywork and
movement therapies, 18(2), 273-281.

@Physiocouk #manchesterphysio facebook.com/physiocouk

Practical

@Physiocouk #manchesterphysio facebook.com/physiocouk

Back
• Gliding
• Longitudinal stretch
• Longitudinal stretching + “wind ups” and
positioning
• Skin Rolling

@Physiocouk #manchesterphysio facebook.com/physiocouk

Shoulder/ Upper Traps
• Stripping
• Isolated MFR over trigger points
• Supine UFT
• Circular motions
• Press and glide using thumb - longitudinal

@Physiocouk #manchesterphysio facebook.com/physiocouk

Lunch

@Physiocouk #manchesterphysio facebook.com/physiocouk

Quadriceps
• Gliding
• Longitudinal stretch
• Skin rolling
• Forearm stretch and roll

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Hamstrings
• Gliding
• Longitudinal stretch
• Skin rolling
• Stripping
• Tack and stretch

@Physiocouk #manchesterphysio facebook.com/physiocouk

Calfs
• Gliding
• Gliding on stretch
• Tack and stretch
• Forearm stretch and roll

@Physiocouk #manchesterphysio facebook.com/physiocouk

Glutes
• Side lying position with muscles on a stretch
• Towel for pt comfort and dignity
• Communication!
• Pin under great trochanter

@Physiocouk #manchesterphysio facebook.com/physiocouk

Treatments that work
well alongside MFR

@Physiocouk #manchesterphysio facebook.com/physiocouk

Taping

@Physiocouk #manchesterphysio facebook.com/physiocouk

Trigger pointing/ Soft
tissue release

@Physiocouk #manchesterphysio facebook.com/physiocouk

Exercise

@Physiocouk #manchesterphysio facebook.com/physiocouk

Foam Rolling

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Outcome measures
● Pain scores (VAS)
● (Pre/ Post) Muscle length / stretching / special testing
● Anxiety Levels
● Quality of Sleep (Quality of Sleep Index Questionnaire)
● Ability to complete ADL’s
● Quality of Life Questionnaire

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Case study 1
Subjective:
40 year old male reports 4/10 dull ache pain into lower back. No neurological
symptoms or red flags. Aggs- desk based job. Eases- hot baths, lying down.
24hr- stiffness in AM.

Objective:
Anterior tilted pelvis
Excessive lumbar lordosis
Reduced range into lumbar flexion/ side flexion bilaterally
Positive modified thomas test
Tender to palpate on Lx paraspinals and quads.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Case study 1
Which myofascial release techniques could you use?

What outcome measures could be used to check it is

effective?

Any other treatments alongside MFR?

 Case study 2
Subjective:
25 year old female reports 5/10 dull ache pain into calves and
hamstrings following an increase in the frequency of running while
she is training for a marathon. No neurological symptoms or red
flags. Aggs- running Eases- rest, heat and stretching.

Objective:
Posterior tilted pelvis.
Reduced range into lumbar flexion
Limited range into ankle dorsiflexion bilaterally
Restrictive 90/90 hamstring length test 120 bilaterally.

@Physiocouk #manchesterphysio facebook.com/physiocouk

 Case study 2
Which myofascial release techniques could you
use?

What outcome measures could be used to check it

is effective?

Any other treatments alongside MFR?

@Physiocouk #manchesterphysio facebook.com/physiocouk

Thanks for coming!
Don’t forget to follow us on Twitter: @physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk