Background and terminologyFascia is the soft tissue component of the connective tissue that provides support and protection for most structures within the human body, including muscle. Osteopathic theory proposes that this soft tissue can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding ischemia|diminished blood flow. Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be addressed as well, including other connective tissue.*
The term myofascial was first used in medical literature by Janet G. Travell in the 1940s in reference to musculoskeletal pain syndromes and trigger points. In 1976, Travell began using the term "myofascial trigger point" and in 1983 published the reference Myofascial pain & dysfunction: the trigger point manual.* There is no evidence she actually used what is now termed "myofascial release". Some practitioners use the term "myofascial therapy" or "myofascial trigger point therapy" referring to the treatment of trigger points, usually in medical-clinical sense. The phrase has also been loosely used for different manual therapy techniques, including soft tissue manipulation work such as connective tissue massage, soft tissue mobilization, foam rolling, structural integration, and strain-counterstrain techniques.
Myofascial techniques generally fall under the two main categories of passive (patient stays completely relaxed) or active (patient provides resistance as necessary), with direct and indirect techniques used in each.
Direct myofascial releaseThe direct myofascial release (or deep tissue work) method engages the myofascial tissue "restrictive barrier" (tension). The tissue is loaded with a constant force until release occurs.* Practitioners use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a few kilograms-force or tens of Newton (unit)|newtons. Direct myofascial release is an attempt to bring about changes in the myofascial structures by stretching or elongation of fascia, or mobilizing adhesive tissues. The practitioner moves slowly through the layers of the fascia until the deep tissues are reached.
Robert Ward suggested that the intermolecular forces direct method came from the osteopathy school in the 1920s by William Neidner, at which point it was called "fascial twist". German physiotherapist Elizabeth Dicke developed connective tissue massage (German: bindegewebsmassage) in the 1920s, which involved superficial stretching of the myofascia. Ida Rolf developed structural integration, in the 1950s, a holistic system of soft tissue manipulation and movement education based on yoga, osteopathic manipulation, and the movement schools of the early part of the twentieth century, with the goal of balancing the body by stretching the skin in oscillatory patterns. She proposed that she could improve a patient's body posture and structure by bringing the myofascial system back toward its normal pattern. Since Rolf's death in 1979, various structural integration schools have adopted and developed her theory and methods.
Rolf reduced her practice to a maxim: "Put the tissue where it should be and then ask for movement."
Michael Stanborough summarized his style of direct myofascial release technique as follows:*
Different practitioners bring their own style, knowledge, and experience to their work which can have a significant effect on their client's experience.
Indirect myofascial releaseThe indirect method involves a gentle stretch, with only a few grams of pressure, which allows the fascia to 'unwind' itself. The dysfunctional tissues are guided along the path of least resistance until free movement is achieved.*
The indirect technique originated in osteopathy schools and is also popular in physiotherapy. According to Robert Robert Ward|Ward, myofascial release originated from the concept by Andrew Taylor Still, the founder of osteopathic medicine in the late 19th century.* The concepts and techniques were subsequently developed by his successor. Ward further suggested that the term "myofascial release" as a technique was coined in 1981 when it was used as a course title at Michigan State University College of Osteopathic Medicine|Michigan State University.*
Carol Manheim summarized the assumptions underlying the practice of myofascial release:*
The indirect myofascial release technique, according to Barnes,* is as follows: