Are you a little knotty? by C.A. Keith


Myofascial techniques have been developed and practiced for many years. Various massage techniques have evolved throughout history. The term ‘myofascial’ was first seen in medical books by Janet G. Travell during the 1940’s. She used the term to refer to musculoskeletal pain and treatment of trigger points. From that point on, various practitioners expanded on myofascial techniques using skin rolling, muscle stripping, soft tissue release, integrative fascial release and many other active and passive movements. Thus beginning the principle foundations of manipulating fascia and muscle tissue.

What is Myofascial techniques? 

Myo means muscle and fascia is a band. Fascia is a thin sheet of web-like, elastic, tough type of connective tissue.  Fascia surrounds and protects tendons, ligaments, tissues, muscles, bones and organs. Fascia is made up of collagen, elastin and a ground substance. Think of a piece of chicken breast.  There is a layer of tough tissue overtop of the breast. That is fascia.

Fascia that is relaxed works optimally and allows movement.  It also cushions and supports the body. When fascia is tight, it decreases the range of motion in muscles and joints and affects overall mobility.  Tightness leads to pain and restrictive movements.

Collagen, elastin and ground substance?

Collagen is found throughout the body in various forms. Collagen is a structural protein. It holds the body together and gives the body its’ structure and its strength. Collagen would be similar to scaffolding in a building.

Elastin is a highly elastic protein in connective tissues. Elastin gives the bounce and springiness to tissues. After lengthening or a stretch to a muscle, it bounces back to shape due to the presence of elastin.

Ground substance is a fluid gel like substance that assists with the glide and slip between structures. These fibres work together to give strength, protection and flexibility.

How did this happen?

Restrictioned tissues and tightness in muscles can occur from pain, over use, inactivity, trauma and scar tissue.  Fascial restrictions can lead to pain, discomfort and decreased mobility. Increased pain can lead to more pain, which in turn, further restricts tissue.  What follows, is a vicious circle of pain and limited range of motion in joints.

Tightness in fascia may affect the proper realignment of scar tissue, postural holding patterns and restrictions in musculoskeletal structures. Scars restrict movement. As a scar is formed, materials that rebuild the damaged tissue, become scattered and misaligned, which limits movement. After time, a scar becomes more tough and tightens surrounding tissues. Fascial techniques may loosen scar tissue and make tissue more pliable to reorganize scattered fibres. Stretching after treatment assists in the formation of new realigned scar tissue.

Poor posture leads to tension and adaptation in muscles. Sitting, standing or holding postures in one position for prolonged periods of time can lead to muscle imbalance, weakness and pain. Some holding positions may include balancing a telephone on the shoulder with head tilted, slumping and leaning in chairs, leaning on a desk, lifting the head up to look up at the rear view mirror, and so on.

These frequently held positions become stressed and adapt to the new shortened or lengthened positions. Fascial techniques may loosen fascia. Follow the treatment with a stretch to shortened muscle bellies as it may aid in restoring postural imbalances. Suggest various stretches for home care to continue restoring good healthy tissues.

I have tight fascia; now what?

Massage therapists, chiropractors, physiotherapists and other health practitioners can be trained in this modality to reduce fascial restrictions. Various fascial techniques may increase the range of motion, decrease tight restricted muscles, improve posture, increase blood and lymphatic flow and improve overall joint and muscle mobility.

Fascial restrictions cannot be noticed on a X-Ray, CAT scan or on a MRI.  There is very little scientific evidence to prove the effectiveness of fascial techniques. Structure of fascia cannot be anatomically or physically changed.  Perhaps fascial techniques may make the tissues more pliable, thus increasing range of motion.

Many scientists and others argue the believability of fascial techniques.  They insist that there is no way fascia can be manipulated as the tensile strength of fascia is similar to that of steel.

Patients have had a wide array of treatments to decrease muscle tightness that vary from  light stretching to aggressive nail-biting deep pressure. Pressure applied to tight muscles, tender points or trigger points in muscles can be uncomfortable to downright excruciating. This could be where some discrepancies may be. There are so many schools of thought and techniques that it makes evaluation and measurement difficult.

Does it hurt?  What does fascial techniques feel like? 

Typically fascial techniques are performed with little to no lotion or oil. The techniques might feel similar to friction or a light rug burn. There are a few different schools of fascial modality techniques.  Performed correctly, the client should feel little to no pain and maybe slight discomfort.

Through my experience practicing and teaching in Ontario, deep, heavy, nail-biting techniques do not win the race. Gentle manipulation can loosen tissue and joints so the body can move easier. More mobility leads to a decrease in pain. Any gentle techniques that cause a patient to relax, can assist in the own bodys’ recovery and holistic benefit. Whether relaxation is what is the determining factor in the improvement of condition, is left open for discussion.

Will it work for me?

Each patient has a form of treatment that works best for them. There is not one shoe fits all ideal. If the patient happily returns again and again and beams when they look forward to treatment, then that therapist is doing what their body needs, enjoys, and requires.

There could be a bit of a placebo effect going on as well. If the patient believes in the treatment, then it becomes believed.  Often a noticeable improvement in condition is recognized.

Until there is further knowledge insisting that fascial techniques don’t work, I will continue to use gentle fascial techniques. It works for me and my patients.  I can rest assured that they can go happily about their day with a feeling of contentment, relief and overall improvement of health and well-being.

It is better than barking up the wrong tree and left feeling knotty!

C.A. Keith


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