How do I explain the fascial system and myofascial release to my clients? More or less something like this…
The fascial system is not extremely well understood but the research is starting to emerge. You will not see this system have its own chapter in a textbook as you do other systems such as the muscular, circulatory or nervous systems. However, with all the research being done in recent years I will predict that within the next decade it will be better understood and deemed worthy enough to be granted its own chapter.
Part of the reason for fascia being poorly understood is that our primary understanding of it has been developed through autopsy and dissection. It is the stuff that has to be cut through to get to the good stuff. Many of our tissues look and function very differently when they are in a living being versus a non-living being. Fascia is also difficult to see on our typical imaging systems. Therefore, medical professionals make judgments on what can be seen and pay less attention to what cannot.
With our current technology, we are better able to study fascia in a living being and are better able to understand its many roles. We know its primary role is to support. Imagine the fascial system as filling in space in the body between the muscles, bones, organs, etc. Imagine a nerve running from the neck down into the arm. When it is moving from one muscle to another is it not just hanging out unprotected in open space inside the body. The fascial system supports it. It is the same idea with the circulatory system. Arteries and veins are supported as they move from one are of the body to the next by the fascial system. Imagine the fascial system as being loose and having open space like wet gauze fabric but three dimensional. This three-dimensional system spans the entire body from head to toe supporting everything. It is very fluid when healthy so our structures can glide freely within it. We are also learning another role is to support the body during functional movement. There are layers of fascia connecting muscle groups that work together to help us move fluidly and hold us together are we do fast, heavy, large movements. This is an important protective feature.
This protective role is important in everyday activities but becomes crucial during an impact such as a motor vehicle accident or a fall. During an impact, the fascia’s role is to contract and hold tissues together and resist separation of the tissues. Normally the fascia is a hydrated fluid system that allows other tissues to glide within it. During impact, it tightens up to hold structures together. A helpful analogy is the game of Red Rover. In this game, kids form two lines by holding hands. A kid from the opposing team runs toward the line and tries to break through. The kids holding hands are like fascia. They tighten up, contracting their bodies to prepare for impact and prevent the line from breaking apart. If the force is too great, the line breaks. Our bodies, like the Red Rover line, can take a significant impact without breaking apart thanks to our fascial system.
So, if the fascia tightens to support us when there is an impact, why doesn’t it go back to normal after the injury? In a healthy system, it does. During an impact, this normally fluid system contracts and squeezes out the fluid then becomes very rigid. Over time in a healthy system, the fascia slowly regains its fluidity as the surrounding tissues heal allowing everything to glide normally again. The problem is that most of us are not living the ideal healthy lifestyle. We are far too sedentary. We don’t get great nutrition. We don’t drink enough water. We don’t get enough sleep. After injuries we are told to rest. We assume protective postures. We take medications that numb us. We are fearful of returning to our regular activities. In the worst case scenario we undergo surgical interventions which also cut through the fascial system triggering more tightening of the system.
When the system is unable to return to its more fluid state it continues to tighten. There is a slow pull through this three dimensional system. This can cause pain and discomfort in areas that are far from the original injury. Pull on the bottom of your t-shirt and notice the tension at each shoulder. The angles are different but there in tension in each. This is another useful analogy to understand the pull in this system. The tightening also reduces the space for tissues such as nerves and blood vessels to glide through causing pain and decreased blood flow which is crucial for the health of all our tissues and normal functioning of the body.
What can be done? The fascia must be coaxed back to its more normal state. Through the technique of myofascial release (MFR), a slow sustained stretch is applied to the restricted area of the body. This low load stretch encourages the fascia to open up, pull fluid back in and return to its normal state. Yet another analogy. Imagine a sponge. When you wring it out, all the water is forced out. If you hold it that way it will eventually dry out and hold the twisted shape. If you set it in shallow water, some of the sponge will soak up water but much will remain dry and twisted. If you gently untwist the sponge and slowly pull it as open as possible it will absorb more water. The job of the therapist is to gently untwist the fascia and encourage it to soak up as much fluid as possible.
The client has an important role both during the MFR treatment and after. During the treatment, their primary job is to breathe. I teach every client to breathe with their diaphragm. It continually surprises me how little movement of the diaphragm is present when I evaluate breathing in my clients. I explain to them how important it is for them to practice this method of breathing both during treatment and in their everyday life. Along with breathing, I ask them to focus. They need to focus in on what they are feeling and stay present with what is happening in their body. Some clients prefer to chat during a session. This is ok as long as they can also feel. If I sense they are not, I ask them to focus in during at least part of the session. I don’t want to change who they are but I do want them to learn to feel. Learning to feel a restriction and a release helps them learn to manage their bodies outside of a session.
Outside of the session, the client’s role is to maintain the progress made in therapy. They must maximize their wellness behaviors. This includes making sure they are drinking plenty of water, eating healthy food, working on their posture, and integrating more movement and stretching into their daily activities. These changes don’t need to be made all at once. Even small changes can make a huge difference during the healing process. For example, if the client usually does some simple stretching to help the aching in their neck, they can learn to hold stretches longer to mimic the MFR technique. They can adjust their stretches to choose stretches that maximize what their body needs. Ideally, the therapist helps the client identify opportunities for change that will maximize their healing process. I try to ask them to make a small change or add a new stretch after each session. Layering on a new strategy or stretch a little at a time helps clients see the benefits of each. When the benefits are seen the change is more likely to become permanent. I will often have clients come back and ask what else they can do at home. These changes help to hold the gains made in therapy and continue with more forward progress during additional MFR sessions.
I try to gauge their interest and provide more or less depending on how they are responding to the information. I always let them know they can ask questions anytime. I want them to fully understand what is we are doing and why.
