Myofascia, or aponeurosis, is described as the tissue of movement. It is a loose but strong and dense system of continuous connective tissue running through the body from head to toe. In its healthy state the myofascia rests in a lose wave type fashion, absorbing force and protecting, supporting and connecting all muscles, ligaments, bones and organs. Interestingly, each individual’s fascia is formed on the basis of that person’s movement patterns. The patterning commences from birth, when one’s body comes into contact with gravity. So unlike a muscle or ligament that has a specific origin and insertion, each human’s fascia is different. This connective tissue runs between muscles, ligaments and tendons, suspends organs and ‘fills’ spaces. Its connectivity, somewhat like the old Negro spiritual ‘the thigh bone is connected to the knee bone’, has a tensile strength of around 900 kilos and is designed to absorb forces and thus protect the body.
Healthy myofascia can become stressed, sticky and hard if it is placed under abnormal load or traumatised. Inflammation sets in, causing stiffening of the tissue, reducing distribution of fluid and disturbing blood flow. The smooth glide of muscle on muscle is lost, restricting the ebb and flow of organs within the abdominal, cranial and thoracic cavities. Smooth biomechanics become stiffened and one cannot ‘relax’. Prolonged exposure to these stresses causes damage and scarring of the myofascia and may lead to permanent disability to soft tissue. The abnormal pressure developed by the injured myofascia acts to literally squeeze the body from inside out, thus pressuring the bones, organs, muscles, ligaments. The damage is obvious but some sufferers respond well to the bodywork of the Pilates Method. Pilates exercises recreate accurate glide of the myofascia in an active sense. In the more chronic case, this thickened myofasica may require some help from manual passive release in conjunction with the exercise.
Myofascial release was first described by osteopaths in the early 1980s. Since then the approach has been understood and quickly taken up by physiotherapists, chiropractors and remedial massage therapists. It comes in the form of direct and indirect myofascial release techniques
Direct myofascial release uses the hand, elbow or knuckles to palpate the surface, sink into the soft tissue with a reasonable pressure until the first barrier of tension is felt. A counterforce against this restriction is provided and maintained until the tension begins to release, then the hand is dragged across the fascial surface to increase the stretch. The practitioner will move down through the layers and along the fascial train until the fascia is stretched, elongated and the adhered tissues are mobilised.
The indirect method is a gentle stretch allowing the fascia to unwind itself. Dysfunctional tissues tend to move along the path of least resistance. The practitioner will make light contact to the fascia with relaxed hands, slowly stretching it until the barrier is reached. The pressure is maintained for 3-5 minutes. The practitioner will feel the heat produced and the tissue softens. The key is to maintain a sustained pressure.
In both cases treatment of one area will create an effect in other areas. My treatment of choice is the direct and harder method. It does create treatment soreness but the results are amazing. I find specifically the myofascia around the abdominal layers is an area missed by many manual therapists. Its connectivity through the lumbar and thoracic fascia is vital to the work that we do. Release and amazing results will unfold.
How does our myofascia become damaged? Unfortunately it is quite common. Poor work biomechanics, repetitive movement patterns, direct trauma and even psychological stress releases cortisol and creates inflammation in the fascia. All of these triggers are damaging our myofascia and as a result leading to perpetuating poor health. Your client may describe headaches, muscle pain, non-specific aches, re-occurring injury, loss of posture and flexibility. So we as Pilates practitioners can now understand the close connection between movement and treatment of the myofascia. Address this topic as part of your initial assessment, be mindful when noticing that movements are getting stuck. Refer your client to a manual therapist for a short succession of releasing treatments. Your client and your movement education will both benefit.
Jen Guest – PAA President