Muscle or Fascia: Which is tight, and how do I know?

A client recently asked me when she should see Pam, whose practice is primarily myotherapy, versus me to receive myofascial release. How would she know if she had tight muscles, tight fascia, or both?  What a great blog post discussion!

I share office space with my long-time friend Pam O’Connor, LMT (licensed massage therapist).  She owns Myotherapy and Massage, LLC, and has practiced for over twelve years.  We have several clients who see us both.  Some alternate their visits, seeing me one week and Pam the next.  They feel this rhythm keeps them feeling their best.  Others may start their bodywork journey with Pam, and she sends them to me if she suspects fascial involvement.  Others begin with me, and I send them to Pam for follow-up.  Some schedule us back to back, seeing me first to open the fascia and then Pam to dig into the muscles. 

We encourage our clients to experiment with bodywork and determine which intervention and what intervals keep them feeling great. Clients come in many different intervals, and some settle in regularly with either Pam or me.  We encourage them to choose which suits their body best and assure them we are okay with whatever they decide. Depending on lifestyle, history of injury, or diagnosis, the frequency of visits can vary widely.  Then there are the clients who just pop in when they have a flare-up and disappear until the next.  Everyone is different.  While we encourage regular wellness visits, we understand this doesn’t always fit into everyone’s busy lifestyle.

What is Myotherapy?

I asked Pam to explain myotherapy in her own words.  Here it is. Myotherapy is applying pressure to specific trigger points in the muscles to fatigue tight muscles.  The force also helps to elongate the muscles to release the spasms.  Treatment decisions are made based on the cause of the flare-up and the location of the pain.

Myotherapy was developed by Bonnie Prudden, a fitness expert and rock climber, in 1976.  Pam was fortunate to attend a workshop she led before Ms. Prudden passed away in 2011. I have received myotherapy from Pam many times, and it is NOT a fluff and buff massage, as Pam calls it.  It does get deep into the muscles.  She holds each pressure point for a few seconds, then lifts off and moves to the next.  If there is a particularly tender area, she may revisit it a few times throughout the session.  I find it very effective, as do many of her other fans, I mean, clients.

Myotherapy vs. Myofascial Release

Pam has sent clients to me for many years. She says she decides to recommend myofascial release to her clients if there is very little “give” in the muscles or if there is greater than normal discomfort with pressure. That is her indication there is likely significant fascial involvement. Another indicator is when the client reports feeling better for a while, but the pain recurs after a day or two.  If they continue to report this trend after several visits, she will recommend myofascial release or a combination of both.

I asked Pam how she explains myofascial release to her clients.  She has received myofascial release from me many times, so she has first-hand knowledge of the experience.  She describes it as a full-body stretch right where you need it and explains how fascia resembles the white stuff around a chicken breast.  Imagine if that was very tight around the muscle rather than just encasing it.  This explanation helps them get a general idea.  She will then give them my card and direct them to my website, my brochure, or me for more information.

Once clients decide to try myofascial release, they are often surprised at the differences in the process and the sensations.  After the evaluation process, they are often surprised when I ask them to lie face-up with their clothing on. They immediately notice that myofascial release is entirely different from myotherapy or massage. (I do ask them to bring a sleeveless top and loose shorts or sweats.)

What is Myofascial Release?

I like to introduce myofascial release through an arm pull.  I pick up their arm and hold at the wrist and elbow, explaining that I will gently pull until I feel all the slack is taken up, but I’m not dragging them across the table. As they relax into that sensation I’ll have them identify where they feel the tension. They are often surprised when they notice tension elsewhere than expected.  Occasionally, clients report feeling the tension in their chest, back, or even further from their arm.  As I continue to pull, I ask them to notice how the tension softens or changes.  As they tune in, they often report they feel the tension go away or shift to a new place in their arm or body.

This “tuning in” process helps the client feel tight places in their body that may be contributing to their pain. It helps them understand the interconnectedness of the fascial system and that their pain may be a whole-body issue, not just a localized problem.  I also use this information to inform where I work on the body and which technique to use.  I often move from one area of the body to another depending on what the client feels in their fascia.  In myotherapy, patterns are followed based on the location of the pain or the original cause.

Myofascial Release is Slow and Gentle

An additional difference between myotherapy and myofascial release is the time the technique is held. In myofascial release, once the “just right” tension is placed on the tissues, it is held for several minutes. As a release occurs, the therapist follows the tissue and maintains the tension, waiting for additional releases.  In some cases, a release can be very linear, but often the release can move in a non-linear pattern.  So, in both myotherapy and myofascial release, the therapist must be very present to feel into the tissues and provide the appropriate depth of pressure.

Tight Muscle or Tight Fascia?

To answer the original question, here is an excellent way to differentiate tight fascia versus tight muscles.  When the fascia is tight, pressure or tension in one area often results in sensations that don’t align with the muscles. Clients are often amazed when they feel this in their bodies.

Another clue that the problem may be in the fascia is when clients also report vague pain, and it is hard for them to say exactly where they feel it. They may also indicate that the pain or sensations seem to shift around or don’t seem consistent from day to day, yet they are always there. The web-like structure of the fascia will pull and compress differently depending on the tension and positioning in the rest of the body.

Another indicator that the problem is in the fascia is not getting results from traditional stretching or exercise. The fascia doesn’t respond to conventional stretching. You may get temporary muscle lengthening, but if the fascia is tight, it will pull right back where it was.  If you hold your stretches for a few seconds, you are not getting into the fascia.  The fascia responds best to a long, slow stretch.  The stretch must also be at just the right tension.  While working on my clients, I ask them to pay attention to how much pressure I’m putting into their bodies so they can learn to feel the just right amount of tension and transfer the sensation to their home stretching program.  I have clients who tell me they stretch all the time but still feel tight.  They get much better results once they learn how to stretch their fascia..

How Posture Affects Muscles and Fascia

I would be remiss if I left out a critical consideration in understanding the tightness in your body and how to improve how you feel.  How you hold your body and how you move your body throughout the day (and night) will make or break your success with any form of bodywork.  If you don’t understand how to improve your body alignment during rest, work, and play, you’ll be back.  If you chronically hold and move your body out of alignment, you may start with tight muscles, but your fascia will quickly follow.  To break the cycle of tightness and pain, you must learn to use your body how it was designed to move.

Relief for Tight Fascia

Since fascia is an all-encompassing system in your body, taking care of it means taking care of your overall health and wellness. If you stretch with the fascia in mind, you can’t stretch too much! You can learn more by taking my online course, A Beginner’s Guide to Myofascial Self-Treatment, or join us in Omaha, NE, for a workshop or personal consultation.

Updated June 10, 2024