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 and receive myofascial release (MFR).  A follow-up question was how she would know if she has tight muscles or 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 them Pam to dig into the muscles.  We encourage our clients to experiment with the bodywork they receive and determine which intervention and what intervals keep them feeling great. We have clients that come in many different intervals and some that settle in with either Pam or myself on a regular basis.  We encourage them to choose which suites 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 then disappear till the next.  Everyone is different.  While we, of course, encourage regular wellness visits, we understand this doesn’t always fit into everyone’s busy lifestyle.

I asked Pam to explain myotherapy in her own words.  Here it is. Applying pressure to specific trigger points in the muscles to fatigue tight muscles which are often the cause of pain.  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 had the good fortune of attending a workshop led by her 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 her many other fans, I mean, clients.

Pam has sent clients to me for many years. She  says she decides to recommend MFR 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 they felt better for a while, but the pain snuck right back up on them after a day or two.  If they continue to report this trend after several visits, she will recommend MFR or a combination of MFR and myotherapy.

I asked Pam how she explains MFR to her clients.  She has received MFR from me many times so has first-hand knowledge of the experience.  She likes to describe it as a full-body stretch right where you need it.  She will explain how fascia is much like 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 a client has decided to try MFR, they are often surprised at the differences in the process and the sensations.  After we go through the evaluation process and the client climbs on the treatment table they are often surprised when I ask them to lay face-up with their clothing on. Right away they are noticing this is entirely different from myotherapy or massage. (I do ask them to bring a sleeveless top and loose shorts or sweats.)

I like to introduce MFR through an arm pull.  I will pick up their arm and hold at the wrist and elbow. I explain that I will gently pull until I feel all the slack taken up, but I’m not dragging them across the table. I ask them to feel into that sensation and identify where they feel the tension. They are often surprised when they notice tension somewhere other than where they 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 the pain they are feeling. It helps them understand the interconnectedness of the fascial system and their pain may be a whole-body issue and not just a localized problem.  I also use this information to inform where I work on the body and which technique I will use. Barnes calls this the “fascial voice”.  I often move from one area of the body to another depending on what the client is feeling in their fascia.  Where in myotherapy there are patterns that are followed based on the location of the pain or the original cause.

An additional difference between myotherapy and MFR is the time the technique is held. In MFR, 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 in many cases the release can move in a very non-linear pattern.  So, in both myotherapy and MFR the therapist must be very present in order to feel into the tissues and provide the appropriate depth of pressure for the technique.

To answer the original question, this is an excellent way to differentiate tight fascia versus a tight muscle or muscles.  When the fascia is tight, pressure or tension in one area often results in sensations that do not fall in line 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 the pain they feel is vague 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 it is 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 be pulled 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 I’m 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 what the just right amount of tension is so they can transfer the sensation to their home stretching program.  I have clients who tell me they stretch all the time but still feel tight.  Once they learn how to stretch their fascia, they get much better results.

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 no matter what you do, you’ll be back.  If you are chronically holding and moving 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 the way it was designed to move.