Myofascial pain relates to pain and inflammation in the body’s soft tissues. This includes muscles, fascia, nerves, blood vessels, bone, joints and organs. Myofascial pain tends to be achy, vague, difficult to localise and may sometimes include feelings of pins and needles. For this reason it may often be confused with nerve pain.
What is Fascia?
Fascia is a web of connective tissue that is continuous throughout the body and all structures within it. It surrounds and envelops every single organ, tissue and cell. You can imagine fascia as the pith of an orange. The pith is continuous throughout the orange separating each segment and becomes the juice cells of the orange- fascia envelops every structure and cell in the body in the same way.
Fascia has no one point, starting or end point, it attaches to any and all fibrous tissues including organ, bone, muscle, nerve, tendon etc. In this way all parts of the body are linked and integrated with each other through our fascia, no matter how remote.
The fascial web suspends and supports the whole body. Fascia is made up of fibrous tissue (collagen, elastin and reticulin), whose fibers are arranged in an organized and parallel manner, this makes healthy fascia is very strong while also flexible. It is also made up of a watery, gel like substance (ground substance) which absorbs and transmits shock throughout the fascial system and acts as a transfer medium for nutrients and metabolites. Fascia is also full of sensory nerve endings relaying all manner of sensorimotor, movement, and sensation to the brain, which makes fascia one of our biggest sensory organs.
Up until about twenty years ago, fascia was largely ignored by medical science, however in recent years there has been a boom in the amount of research going into it. It is now recognised that fascia plays a role in many different things including pain, performance, brain function and proprioception (awareness of the position of our body in space).
Physical injury, poor posture and inflammation can change the physiological and physical makeup of fascia resulting in thickened, hardened bands while the watery gel like ground substance becomes more thickened and viscous. This changes it’s ordered parallel and elastic composition to that of disordered knotted inelastic bands that will tension surrounding structures all the way along the respective fascial pull.
These bands compress blood vessels, reducing circulation and compress nerves, resulting in pain. Change to the watery gel like substance- which will affect the ability of the area to metabolise correctly can result in trigger points or knots in the muscle which leads to further pain and restriction to movement.
Interruptions to the usual configuration of the fascia will inhibit its ability to relay information to the brain regarding position of our body in space and also its ability to relay information to local structures such as muscle so optimum patterns of movement are not being achieved which exacerbates the cycle of tension placed upon the fascial system.
What are the signs and symptoms?
Most people have muscle pain from time to time be it from exercise or a minor strain. Myofascial pain is longer lasting and can affect a group of muscles and the fascia that envelops them. Myofascial pain can arise from muscle, fascia or both. It can also arise from surrounding pain sensitive structures such as nerves blood vessels etc. that can be affected by hardened fascia.
Nerve endings in fascia responsible for relaying pain signals to the brain (nociceptors) can sometimes begin to act abnormally resulting in increased pain signals to the brain in response to various stimuli, this can be its own source of pain. Alterations in the physiological composition of fascia can result in restriction and hardening in of it, leading to compression of muscle nerve and blood vessel resulting in pain. Within the muscle there may be trigger points or “knots”, leading to reduced movement, weakness and pain.
Here are some quick signs and symptoms that you may notice yourself
- A muscle that is sensitive or tender when touched
- Muscle pain that happens with pressure on a trigger point
- Pain that feels like aching, burning, stinging, or stabbing, sometimes with pins and needles
- Reduced movement in the affected area
- Feeling that your muscle is weakened
The fascial system can be linked with other remote health problems such as:
- Tension headaches
The following have been documented to cause fascial tension which may lead to myofascial pain:
- Injury eg. broken ankle, torn ligaments etc.
- Surgical scarring
- Poor posture
- Muscle spasm
What is myofascial release
Myofascial release is the term used when referring to the various techniques for releasing restrictions in the fascial tissues. Each technique involves a gentle application of pressure that slowly allows the body's tissues to release down to the deepest levels, heal and reorganise, letting go of physical restrictions. It is a mild and gentle form of stretching that has a profound effect on the body, sometimes even incorporating an emotional release.
When may a manual myofascial release approach be helpful?
Myofascial release can be used to treat pain, loss in flexibility or loss of function to any part of the body where there is soft tissue.
Patients may have had an injury a long time ago that never rehabilitated to its pre injury status or they are left with a niggling pain and are not moving quite in the way they would have been before the injury. All treatment options may have been exhausted and you may have been to different chartered physiotherapists. The fascial element to their pain may not have been considered and the role it plays in their current dysfunction.
Conditions treated by myofascial release:
- Chronic pain
- Lower back pain
- Pain postpartum
- Pelvic floor dysfunction
- Carpal Tunnel syndrome
- Pain in any instance may have a fascial component
Are there any precautions or contraindications to treatment?
Myofascial release is a very gentle safe technique however there are some instances when it is not suitable:
- Open wound
- Healing fracture
- Active Rheumatoid Arthritis
Contraindications to Cranial release techniques:
- Acute intracranial heamorrhage
- Intracranial aneurysm
- Herniation of Medulla Oblongata
What does it feel like?
Myofascial release is a very gentle, sustained stretch of fascial tissue held for 90 seconds or longer until a release is perceived by the chartered physiotherapist.
You will feel a very light pressure of the physiotherapists hands, and you may feel a slight stretch which will be held depending on the type of release. During this time you may begin to feel warmer, begin to breathe a little faster, have an increase in heart rate or experience an emotional response which can come out of the blue. You may also feel some pins and needles, pulsing or vibrating around the area being released.
As the release continues these feelings will begin to settle down and you will begin to notice a general reduction in tension in the body and a feeling of relaxation. It is when the body is in this relaxed state that the release is complete.
What sort of results should you expect?
While myofascial release is a very gentle technique it can have profound effects on body tissues. You may leave that day feeling like nothing happened. Later that day or even the day after you may begin to feel the effects of treatment.
- Reduces fascial restriction
- Decreases pain
- Reduces oedema
- Restores range of motion
- Improves circulation
- Alters postural patterns
How many sessions will I need?
In general, acute cases should be resolved within 4-6 treatments. The longer the problem has been present, the longer it usually takes to achieve lasting results. Chronic conditions that have developed over a period of years may require more sessions per week initially. Once the chronic condition has significantly improved, less frequent treatments can help to maintain the patient's progress. To achieve long term effects it is important to resolve factors which may have lead to hardening of the fascia in the first place, so a tailored exercise programme provided as part of your one to one sessions or joining the pilates classes run in the practice. This will help you to maintain good body posture, preventing tensioning of the fascial system.
Myofascial release is a gentle technique using very light pressure to achieve a freeing effect on fascia that has become hardened and tight. This hardened fascia can have the effect of binding down, compressing and pulling on surrounding pain sensitive structures. Fascia itself which is full of sensory nerve endings can signal pain inputs to the brain when it is hardened and tight like this. Compression of underlying structures can have a knock on effects such as muscle trigger points and irritated nerves. It is important to fully restore fascial mobility in the prevention of pain, restoration of optimal patterns of movement and complete healing of injury.
For more information please go to http://fascialconnections.com/category/proprioception
The article was written by Carol O’Brien