The "Missing Link" in Your Treatment
John F. Barnes, PT
New England Journal of Medicine reported a study on the volume of people and
amount of money spent on traditional therapy and medicine vs. alternative
therapy, The stunning news was that as much money was spent (over thirteen
billion dollars last year) on alternative therapy as was with traditional
therapy and medicine. The study also demonstrated that people were willing to
pay cash for alternative therapy that produced the results that they needed and
that this trend continues to grow daily.
have had the opportunity of training over 50,000 therapists in my Myofascial
Release Approach and the demand for information on Myofascial Release is growing
Release techniques are utilized in a wide range of settings and diagnoses; pain,
movement restriction, spasm, spasticity, neurological dysfunction, ie, cerebral
palsy, head and birth injury, CVA's, scoliosis, menstrual and pelvic pain and
dysfunction, headaches, temporomandibular pain and dysfunction, geriatrics,
sports injuries, pediatrics, chronic fatigue syndrome, fibromyalgia, traumatic
and surgical scarring, acute and chronic pain.
Therapists tired of working in "assembly line" atmospheres, focused on quick symptomatic treatment, and who are overloaded with burdensome paper work are joining facilities and private practices that focus on Myofascial Release.
WHAT IS HAPPENING?
health professions had ignored the importance of an entire physiological system,
the fascial system that profoundly influences all other structures and systems
of the body. This glaring omission had severely affected our effectiveness and
the lasting quality of our efforts. Including Myofascial Release into our
current evaluatory and treatment regimes allows us to provide a more
comprehensive Approach to our patients that is safe, cost efficient and
restrictions can exert tremendous tensile forces on the neuromuscular-skeletal
and other pain sensitive structures. This enormous pressure (more than 2,000
pounds per square inch) can create the very symptoms that we have so long been
trying to eliminate. This knowledge frees us from only trying to relieve
symptoms and gives us the tools we need to find and eradicate the cause and
effect (symptoms) relationship for a permanent resolution of our patient's
Myofascial Restrictions can produce enormous pressures on pain sensitive structures.
THE ANATOMY AND PHYSIOLOGY OF FASCIA
is a tough connective tissue which spreads throughout the body in a three
dimensional web from head to foot without interruption. The fascia surrounds
every muscle, bone, nerve, blood vessel and organ of the body, all the way down
to the cellular level. Therefore, malfunction of the fascial system due to
trauma, posture, or inflammation can create a binding down of the fascia,
resulting in abnormal pressure on nerves, muscles, bones, or organs. This can
create pain or malfunction throughout the body, sometimes with bizarre side
effects and seemingly unrelated symptoms, not always following dermatomal zones.
It is thought that an extremely high percentage of people suffering with pain
and/or lack of motion may be having fascial problems; but most go undiagnosed,
as the importance of fascia is just now being recognized. All of the standard
tests, such as x-rays, myelograms, CAT scans, electromyography, etc., do not
show the fascial restrictions.
fascia can be broken down into three divisions: superficial fascial lies
directly below the dermis; deep fascia surrounding and infusing with muscle,
bone, nerves, blood vessels and organs of the body all the way down to the
cellular level, and deepest fascia within the dura of the cranial sacral system.
at the cellular level creates the interstitial spaces and has extremely
important functions of support, protection, separation, cellular respiration,
nutrition, elimination, metabolism, fluid and lymphatic flow. In other words, it
is the immediate environment of every cell of the body. This means that any
trauma or malfunction of the fascia can set up the environment for poor cellular
efficiency, necrosis, disease, pain and dysfunction throughout the body.
important factors concerning fascia are:
Pain and Dysfunction by Janet Travell, M.D, beautifully illustrates that
there is a myofascial element; for every muscle of the body is surrounded by a
smooth fascial sheath, every muscular fascicule is surrounded by fascia, every
fibril is surrounded by fascia, and every micro-fibril down to the cellular
level is surrounded by fascia that can exert pressures of over 2,000 pounds per
square inch. Therefore, it is the fascia that can ultimately determine the
length and function of its muscular component.
must be clear that medicine, modalities, muscle energy techniques, mobilization/
manipulation, massage and flexibility and exercise programs do not alter the
powerful fascial restrictions that occur in a high percentage of our patients.
These restrictions are only altered via Myofascial Release.
Release is a whole body "hands-on" Approach to the evaluation and
treatment of the human structure. The therapist is taught to evaluate the
fascial system through visual analysis of the human frame three dimensionally in
space, by palpating the tissue texture and various fascial layers and observing
the symmetry, rate, quality, and intensity of strength of the craniosacral
rhythm. Proper Myofascial Release requires ongoing re-evaluation, including the
above procedures and observance of vaso-motor responses and their location as
they occur after a particular fascial restriction has been released. This
provides instantaneous and very accurate information enabling the therapist to
proceed intelligently and logically from one treatment session to the next, to
the ultimate resolution of the patient's dysfunction.
the therapist has determined where the fascial restrictions lie, he or she will
apply gentle pressure into the direction of the restriction.
first the elastic component of the fascia will release, and at some point in
time the collagenous barrier will be engaged. This barrier cannot be forced (it
is too strong). One waits with gentle pressure, and as the collagenous aspect
releases, the therapist follows the motion of the tissue, barrier upon barrier
until freedom is felt.
development of one's tactile and proprioceptive senses enhances the
"feel" necessary for the successful completion of these techniques. We
were all born with this ability to feel the releases and the direction in which
the tissue seems to move from barrier to barrier. When we first learn Myofascial
Release, we can perform these effective techniques mechanically and with a
little practice allows us to rediscover the "feel" and move to a
higher level of achievement.
is felt that each time we experience a trauma, undergo an inflammatory process,
or suffer from poor postures over time that the fascial system becomes
restricted. These restrictions act like the concentric layers of an onion. These
adaptive layers slowly tighten until we begin to lose our physiologic adaptive
capacity (our margin of error). Therefore, we slowly tighten, losing our
flexibility and spontaneity of motion, setting us up for trauma, pain or
restriction of motion. These powerful restrictions begin to pull us out of our
three-dimensional orientation with gravity. The goal of Myofascial Release is to
help return the individual's physiological adaptive capacity by increasing space
and mobility and restoring three-dimensional balance and returning the structure
to as close as potentially possible to its vertical orientation with gravity.
This equilibrium allows the individual's self-correcting mechanisms to come into
play and alleviate symptoms and restore proper function.
A comprehensive treatment program should also include appropriate modalities, exercise and flexibility programs, movement awareness facilitation techniques, instruction in body mechanics, mobilization and muscle energy techniques, nutritional advice, biofeedback and/ or psychological counselling. A therapist can easily learn the concept and techniques of Myofascial Release and no prior knowledge of mobilization or manipulation is necessary. However, Myofascial Release should be combined with muscle energy, mobilization and manipulation for those skilled at these important procedures, since it is usually fascial restrictions that created the osseous restrictions in the first place.
again, we are discussing an Approach that, when combined with the valuable
skills we now possess, acts as a facilitator and intensifier of treatment for
more consistent effectiveness and results for our patients.
This is a total Approach incorporating a physiological system, that when included with traditional therapy, acts as a catalyst yielding impressive, clinically reproducible results.
A NEW ERA
therapists of the near future will function quite differently from those of the
past. Building on and respecting the foundation developed by various health
professions, they will treat the whole person intellectually, emotionally, and
structurally. They will have a wide variety of techniques with which to help
others, thanks to continuing advances in scientific technology. With highly
developed sensitivity and creativity, they will be able to interact with the
patient intelligently and humanely, on an individual level and as part of an
therapist skilled in Myofascial Release is concerned with releasing and
reorganizing the body's fascial restrictions mechanically and reorganizing the
neuromuscular system. The reorganization occurs by supplying the central nervous
system with new information (awareness) that allows for change and improved
potential and consciousness.
is important for those providing treatment to realize that the body is a
repository of information. The body can be used as a biofeedback system for the
master therapists' finely trained, sensitive hands. It can then be used as a
handle or lever to provide access to emotions and belief systems and allow for
structural and biomechanical change.
Mastery means not only achieving a certain level of skill but is also an attitude. Masters are fully aware of what they are doing. They understand the importance of touch as an expression of acceptance, nourishment, and a form of biofeedback to glean information from patients' mind-body awareness. Their touch should be applied with focused awareness and conscious purpose. The focus should be fluid, moving from tight narrow (logical, analytical thought) to open, feeling everything at once without thought or effort (intuition, insight).
your patients not to view the cause of their dysfunction as a defeat but rather
to see it as a lesson. By looking for the positive, they can see its value,
learn from it, and allow themselves to heal. Help them to understand that one of
the best lessons is that they may not be able to change the circumstances of
their life, but they can change their reaction to their circumstance, they can
move from being passive, helpless recipients to active participants. This
important change in perspective creates a partnership between you and your
patients where you can help them help themselves.
Thus, mastery is teaching through example. The master therapist is real, calm, non-judgemental, intelligent, sensitive, strong yet flexible, supportive, compassionate, empathetic, and joyful.
Please refer to John F. Barnes book the Search for Excellence
Article reprinted with permission.
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