In the following lessons, we’ll explore massage techniques, often called myofascial release, which work directly with fascia to promote pain-free movement and postural balance. The effects of myofascial techniques on the body are described along with general assessment techniques for identification of myofascial restrictions, guidelines for the application of myofascial techniques, specific techniques for reducing myofascial restrictions, and integrating myofascial work with Swedish massage.

Causes of Myofascial Dysfunction

While we have briefly discussed myofascial dysfunction and why it occurs at various places, it is helpful to review some common causes. Note that any and all of the issues described here, as well as other issues not described here, might contribute to myofascial dysfunction. Usually, more than one issue is present at any given time, complicating the issue. For example, a client might have both a repetitive stress injury and a poor diet that will influence myofascial balance and the healing process.

• Postural habits: Postural habits like a head-forward position, slumped shoulders, or hyperextended knees creates tension that can lead fascia in certain areas to thicken while some muscles assume static positions to brace the body. When the myofascia around joints becomes unbalanced, the joint structure may function from a position of misalignment, leading to pain or injury.
• Diet: Poor nutrition and dehydration can affect the quality of the ground substance of connective tissue, causing it to thicken, cool, and settle into a gel state. Hydrogen bonds attach tissues together, leading to a decreased range of motion and an increased susceptibility to injury. Poor quality ground substance can lower a body’s resistance to pathogens and leave it open to disease.
• Repetitive mechanical stress: Repetitive stress such as might occur on a job can create stress and trauma in tissue that leads to adhesions and thickening of fascia. Nerves, blood vessels, and lymph vessels might be compressed by the tightened tissue, impacting circulation and further complicating the condition.
• Injury: When skin, muscle, tendon, ligament, or fascia is injured, the healing process involves tissue remodeling with collagen fibers. These fibers are distributed in the crisscross arrangement of adhesions and scar tissue. While gaps in tissue are filled and areas of mechanical stress are reinforced, this process shortens and binds the tissue, creating imbalances and tension. Additionally, nerves, blood and lymph vessels, and organs in the region can be impaired, leading to chronic pain conditions, loss of function, restricted movement, and the possibility of re-injury (tissue injury and repair is discussed in depth in Chapter 22).
• Chronic stress: Chemicals released as part of the flight-or-fight response, especially cortisol, cause changes to connective tissue and weaken connective tissue structures. Cortisol inhibits the activity of fibroblasts and reduces their number in connective tissue. Wounds, fractures, muscle strains, tendon sprains, and joint injuries are less likely to heal correctly in a body exposed to chronic stress.
• Lifestyle: A sedentary lifestyle and habits like smoking can change the body’s internal chemistry and influence the quality of ground substance. This might cause tension patterns to develop, the thickening of ground substance leading to a gel state in connective tissue as well as susceptibility to illness and disease.

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<TITLE>Concept Brief: Fascia

Greater amount of ground substance = ↑ thixotropy

Functions: Structural integrity, protection, shock absorption, immune defense, cellular exchange

Location:

Superficial = just below the skin

Deep = at all layers of the body providing framework for organs and tissues

Horizontal planes of fascia = places where fascial sheets converge at joints

Fascial bands = superficial fascia in horizontal strips that restrict fat deposits

Myofascial chains = connect foot to top of head—anterior and posterior—superficial and deep.

Dysfunction caused by postural habits, diet, repetitive mechanical stress, injury, chronic stress, sedentary lifestyle

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