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Introduction

Massage, in its various forms, has been practiced the world over for centuries. In fact, there are historical records for the use of massage as far back as 2000BC (Moyer et al., 2004). Paolini (2009) suggested massage has been used successfully to:

• Relieve stress
• Alleviate pain
• Increase fluid mobilisation
• Improve soft tissue mobility
• Decrease heart rate and blood pressure
• Decrease anxiety

However, scientific research into the mechanisms of massage techniques and how such perceived benefits occur has only been available recently. In fact, there are unfortunately many things which are still unknown about the science of myofascial release. In this article we will discuss the best available research and theoretical support for some commonly asked questions including:

• What is fascia?
• What is a myofascial trigger point?
• What is myofascial release?
• The relevance of foam roller self myofascial release

So if you’re ready, lets get to it!

What Is Fascia?

Fascia is a part of the soft tissues of the body. It is made up of collagen, elastin and ground substance, and acts as a covering sheet of connective tissue for our muscles, bones, nerves, blood vessels and organs (Barnes, 1997). Whilst it primarily provides support, stability and cushioning, the fascia is also involved in locomotion and dynamic flexibility. The 3 components of the fascia have varying roles, which include:

1. Collagen – provides fibrous properties required stability, support, and structure
2. Elastic – provides elastic properties required for dynamic flexibility
3. Ground substance – a gel-like component required for cushioning

Whilst the fascia is an essential component of the human body, pathological tightening of the fascial system can lead to the development of many musculoskeletal injuries/problems treated by health professionals and therapists (Barnes, 1997).

What Goes Wrong With The Fascia?

In response to trauma, both macro- and repeated episodes of micro-trauma, the fascial system undergoes a protective tightening. At a cellular level, each of the components of fascia undergo the following specific changes:

• Collagen – becomes fibrous and dense through the development of “cross-links”
• Elastin – loses its resilience
• Ground-substance – hardens and solidifies (Forrest, 1983; Stuaber, 1990; Barnes, 1997)

This results in the fascia losing pliability and flexibility is reduced. Hunt (1985) identified that this loss of resilience and development of such adhesions is detrimental to the function of the myofascial tissues.

As you may expect, such restrictions will lead to alterations in movement patterns and can adversely impact on the structures of the body including neural structures (nerves) and articular structures (i.e. joints, ligaments etc).

Furthermore, from an athletic viewpoint shortened functional length of a muscle may lead to:

• Reduced strength
• Reduced contractile potential
• Reduced athletic performance
• Increased injury risk (Murphy et al., 2003)

Interestingly, up until this point we have only discussed the fascial components of the myofascial until (we may have forgotten something?). The muscle component of the myofascial system can definitely contribute to tightness, dysfunction, pain and reduced function. This problem is frequently caused by myofascial trigger points (MTrPs). 

What Is A Myofascial Trigger Point?

Whilst MTrPs have been previously described for several centuries (Simons, 1975), they were brought into clinical consideration of health professionals and therapists by Dr Janet Travell. Dommerholt et al. (2006) defined a myofascial trigger point is defined as:

A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band

MTrP affect many of the body’s systems and have the following characteristics:

• Motor: including muscle stiffness/reduced range of motion, altered motor functions and muscle inhibition and weakness (Lucas et al., 2004)
• Sensory: including pain on palpation or distal referral, peripheral and central sensitisation (Vecchiet et al., 1990; Vecchiet et al., 1998)
• Autonomic: including vasoconstriction, vasodilatation, lacrimation, and piloerection (Gi et al., 2006; Lidbeck et al., 2002)

MTrPs can further be divided into active or latent MTrPs. An active MTrP produces symptoms which may include local or referred pain or paraesthesiae. In contrast, a latent MTrP will not produce a pain or symptoms unless it is stimulated (Dommerholt et al., 2006).

The work of Dr Travell has lead to the detailed description of muscular referred pain patterns and a greater understanding of the myofascial genesis of pain (Travell & Rinzler, 1952). This has lead to the development of what is known as Myofascial Pain Syndrome, a recognised medical diagnosis defined by Harden et al. (2000) as:

The sensory, motor, and autonomic symptoms caused by MTrPs

Recognition of the myofascial system as a source of pain and dysfunction has lead to the development of multiple therapies aimed at correcting or reducing these issues. One of the most popular, and one which is widely discussed on this blog, is myofascial release. As discussed below, this can be performed by a therapist or with use of a foam roller.

What Is Myofascial Release?

Myofascial release is a manual soft tissue technique which is used to address areas of tightness or spasm in the soft tissues. As previously suggested, these areas of tightness can be a result of:

• Muscle Spasms
• Myofascial Trigger Points (MTrP)
• Adhesions
• Excessive release of acetylcholine (Moyer et al., 2004; Paolini, 2009).

The literature discusses 2 types of myofascial release techniques:

1. Direct/Focussed Pressure (also known as Trigger Point Release)
2. Slow and Sweeping Pressure (also known as Stripping)

The principles of the 2 techniques are similar where pressure is applied for 60 – 90 seconds (sometimes longer) and then slowly released. The videos below show the 2 techniques being used clinically.

Stripping Example Video

Trigger Point Release Example Video

Can I Use The Foam Roller for Self Myofascial Release?

Of course, that’s the whole point! Paolini et al. (2009) discusses the benefit of self myofascial release techniques with the foam roller. This will allow you to reap the benefits previously discussed without the need for you to attend a therapist!  The foam roller exercises discussed previously on this blog can be used to successfully rehabilitate many common musculoskeletal problems.

Overview Video of Self Myofascial Release with a Foam Roller

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References

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Dommerholt JD, Bron C, Franssen J. Myofascial trigger points: An evidence-informed review. The Journal of Manual & Manipulative Therapy. 2006;14(4):203-221.

Forrest L. Current concepts in soft tissue would healing. Br J Surg 1983;70:133-146

Ge HY, Fernández-de-las-Peñas C, Arendt-Nielsen L. Sympathetic facilitation of hyperalgesia evoked from myofascial tender and trigger points in patients with unilateral shoulder pain. Clin  Neurophysiol 2006;117:1545-1550.

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Hernandez-Reif. Field T, Krasnegor J, Theakston H. Lower back pain is reduced and range of motion increased after massage therapy. Int J Neurosci. 2001;106(3-4):131-145.

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Murphy DF, Connolly DA, Beynnon BD. Risk factors for lower extremity injury: a  review of the literature. Br J Sports Med 2003;37:13–29.

Paolini, J. Review of myofascial release as an effective message therapy technique. Athletic Therapy Today 2009;14(5):30-34.

Simons DG. Muscle pain syndromes. Part 1. Am J Phys Med 1975;54:289-311

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Stuaber WT, Clarkson PM, Fritz VM, Evans WJ. Extracellular matrix disruption and pain after eccentric muscle action. J Appl Physiol 1990;69:868-874

Travell JG, Rinzler SH. The myofascial genesis of pain. Postgrad  Med 1952;11:452-434.

Vecchiet L, Giamberardino MA, Dragani L. Latent myofascial trigger points: Changes in muscular and subcutaneous pain thresholds at trigger point and target level. J Manual Medicine 1990;5:151-154.

Vecchiet L, Pizzigallo E, Iezzi S, Affaitati G, VecchietJ, Giamberardino MA.Differentiation of sensitivity in different tissues and its clinical significance. J Musculoskeletal Pain 1998;6:33-45.