Having completed this lesson, you will be able to:
- List three general guidelines for the application of myofascial approaches (e.g., limited use of lubricant or no lubricant, take out the slack in fascia, work fascia in all directions, work slowly and wait for the tissue to unwind, let the tissue guide you, etc.).
Different authorities on myofascial techniques offer varying perspectives on working with myofascia effectively, but certain common principles emerge for the application of myofascial techniques:
- Comfort and safety: Myofascial techniques should not feel painful, although the client may feel a burning sensation (described below). If pain is experienced, make sure you are applying the techniques correctly and that the client doesn’t have a strain, sprain, or other condition that contraindicates massage. If massage is contraindicated, myofascial techniques are contraindicated. Any skin condition that would be exacerbated by pulling on the skin contraindicates myofascial release in the local region.
- Use of lubricant: Use very little or no lubricant during the application of myofascial techniques. Using lubricant makes it difficult to “grab” the fascia and stretch it. Instead of engaging fascia, your hands slip over the surface of the skin. If the client’s skin is very dry or fragile, or if he or she complains that the burning of myofascial work feels too uncomfortable, use a small amount of lubricant to make the strokes more comfortable and to prevent tissue tearing.
- Depth: Lighter work engages the superficial layer of fascia while deeper pressure accesses deeper fascial layers. Work at a level that is comfortable for the client while maintaining clear intent and visualization of the structures you seek to affect.
- Take out the slack: When you apply a technique, you will drop into the tissue, depending on the level of fascia you seek to address, and then take the slack out of the tissue. Removing all of the slack in the tissue and then holding this stretch engages the tissue.
- Work in all directions: Once you have engaged the fascia, stretch it one direction, such as longitudinally, and then on the next pass stretch it horizontally. Now stretch it at oblique angles. Work in all directions to ensure that the tissue is free of restrictions.
- Feel the burn: The client may report feeling a burning sensation as you hold a fascial stretch. As long as this burning sensation is not too uncomfortable, this is a good sign that hydrogen bonds are breaking and the tissue is unwinding. Increased hyperemia is perceptible in the tissue after myofascial techniques are applied.
- Avoid tissue compression: When you engage the myofascia, you are taking the slack out the tissue in order to stretch it. Even when working with deep fascia, the motion of your hands is not to compress the tissue into the structures beneath it or to the bone. While you may drop your fingers, palms, or even forearm into the tissue to engage the myofascia at a particular depth, once you have reached the appropriate depth your intent is to move your hands apart or pull the tissue in a particular direction—not to drop deeper in order to compress muscle.
- Work slowly: The viscoelastic property of fascia suggests some specific methods for working with tissue during a massage session. If the tissue is dense or feels thick, cold, and viscous, slow down and warm the tissue fully before dropping into deeper structures. If you drop too deep too fast, the tissue will resist or sustain microtears and the client is likely to brace against your strokes. If you apply techniques that stretch the tissue, apply the stretches slowly because tissue generates greater tension when the rate of the stretch is faster and injury is therefore more likely. Release in myofascia doesn’t happen automatically and you may find that you need to hold a particular stretch 2 to 5 minutes. Maintain the stretching motion of a technique until you feel the tissue “melt” and give way. When you release the tissue and move out of a technique, go slowly so as not to cause shock to the tissue.
- Let the tissue guide you: The tissue may start to release in a given direction and you will feel a sensation that is often described as tissue unwinding. Allow the tissue to guide you. If it wants to move in a particular direction, allow it to release in that direction. Let go of your preconceived ideas about where the stretch needs to occur and follow the path of the unwinding tissues. It can feel pretty exciting when the tissue starts to lead you, but don’t feel disappointed if tissue unwinding doesn’t happen every session or with every body.
- Use passive and active movement to reset proprioception: When you have finished working on a particular body area, use passive range of motion to re-educate the myofascia about its potential for movement. At the end of the session when the client is fully dressed, have him or her take the different joints through full available range of motion actively. For example, have the client move his or her neck through forward flexion, extension, lateral flexion, and rotation. If you don’t reorient the client to full movement patterns, the proprioceptors may not reset and may limit the client’s amount of movement. The new freedom achieved during the session may be lost.