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Journey to Health
Kate Peck ATC, CMT
1113 Washington Street
Newton, MA 02146
(508) 245-2922
Myofascial Release and
Soft Tissue Approaches
in the Treatment of
Athletic Injuries
Kate Peck ATC, LAT, CMT
1. Everything is connected!
2. Look at the bigger picture!
3. What role does the fascia
play in injuries?
4. What injuries/conditions can be helped
by myofascial release?
5. What role do ‘myofascial chains’ have on
the treatment of injuries?
6. Feel for the “snag”!
7. Treating the “snag”.
1. Everything is connected!
Connective Tissue
Types of Connective Tissue
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•
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•
•
•
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Blood
Lymph
Bone
Cartilage
Tendons
Ligaments
Joint capsules
Fascia
Nerve sheaths
Blood vessels
Components of Connective Tissue
• Cells
• Fibers
• Ground Substance
Components of Connective Tissue
• Cells
– Fibroblasts
– Mast cells
– Macrophages
– Plasma cells
Components of Connective Tissue
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Fibers
- Collagen
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tough
very little ability to stretch
fibers unwind but do not stretch
provide the tensile strength & resiliency
- Elastin
Components of Connective Tissue
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Fibers
- Collagen fibers
- Elastin fibers
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give fascia its extensibility
may stretch to 150% of resting length without
tearing
Components of Connective Tissue
• Ground substance
– Intercellular fluid in all connective tissue
– Made up of:
• Water
• GAGs – Hydrophilic glycoaminoglycans – keep the ground
substance fluid, preventing adhesions
• Hyaluronic acid – keeps ground substance viscous (jelly-like)
– The proportion of these 3 components determines the
consistency of the ground substance, more gelatinous
or more liquid.
Components of Connective Tissue
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Ground substance
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In fascia it has the consistency of egg whites
It is how the fascia is nourished
provides lubrication so fibers slide over one another
keeps the spatial relationship between the fibers to
keep them from adhering to one another.
disperses shock
Why are we talking about all the
different kinds of connective tissue?
• To understand the
concept that the tissue is
continuous from the
periosteum of the bone
to the tendon, to the
muscle belly, back to
tendon and back to
periosteum.
Why are we talking about all the
different kinds of connective tissue?
• And that the tissue is
continuous from the
periosteum of the bone
to the ligament & joint
capsule, and back to
periosteum.
Why are we talking about all the
different kinds of connective tissue?
• Therefore, there is a
“fascial net” made up
of all the different
kinds of connective
tissue that connects
us from head to toe
and from superficial to
deep.
2. Look at the bigger picture!
• When we evaluate injuries with this
concept of a “fascial net”, we need to
evaluate the body as an interconnected
whole.
• An injury in one area of the body can be
the result of a “snag” in the fascial net
somewhere else in the body.
• The problem may not be where the pain is!
3. What role does the fascia
play in injuries?
What is Fascia?
• It surrounds every
tissue and organ in
the body including
muscle, bone,
nerves, arteries &
veins.
Three Layers of Fascia
• Superficial
• Deep
• Deepest
Three Layers of Fascia
• Superficial
– lies directly under the skin.
– is highly elastic & flexible.
– The majority of pain sensors are found here.
• Deep
• Deepest
Superficial Fascia
• Strolling Under The Skin
Three Layers of Fascia
• Superficial
• Deep - also called the Investing fascia.
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surrounds and supports all of the organs of the body
surrounds muscle group (ie. quadriceps)
surrounds each muscle (epimysium)
surrounds the fascicles within each muscle
(perimysium)
– surrounds each muscle fiber (endomysium)
• Deepest
Deep Fascia
• Muscle Attitudes video
Three Layers of Fascia
• Superficial
• Deep
– makes up fascial structures such as retinaculum,
aponeuroses, ITB, lumbodorsal fascia, palmar fascia,
planter fascia, etc.
– has more collagen fibers and less ground substance
so is dense.
– fiber orientation is multidirectional so can respond to
multidirectional stresses.
• Deepest
Three Layers of Fascia
• Superficial
• Deep
• Deepest
– forms the dural membrane that surrounds the
brain & spinal cord.
– It is continuous with the fascia of the body.
– we work with this in craniosacral therapy.
• Restrictions in the fascia can
effect every other tissue and
organ in the body.
• Including
nerves
arteries
and veins
• Releasing the restrictions in
the fascia can improve the
function of every other tissue
and organ in the body.
Fascial Dysfunction
Fascial Dysfunction
• Common causes:
– Trauma (sudden or cumulative)
– Postural misalignment
– Patterns of repetitive overuse, underuse, or
misuse
– Illness/disease
– Immobilization
– Aging
A word about immobilization . . .
An orthopedic surgeon wrote that normally when...one
opens a thigh to remove fascia for surgical procedure,
one will be struck by the smooth surfaces of contact
between the fascia and the underlying muscle and that
these surfaces fairly glisten and are not adherent....On
the other hand, when one opens a thigh that has been at
rest, either in a cast or in a splint, or as a result of rest in
bed, one finds that the fascial surfaces, as well as the
surface of the underlying muscle, is dull and does not
glide; often times many small adhesions have formed
between the muscle and fascia.
- Ralph K. Gormley, 'The Abuse of Rest in Bed in
Orthopedic Surgery', J.A.M.A., August 19, 1944
Fascial Dysfunction
• Results in:
– Formation of adhesions
– Dehydration / thickening of the ground
substance – resulting in fibers being closer
together, so more likely to form adhesions.
Myofascial Release (MFR)
Myofascial release:
– Breaks up adhesions
– Changes the viscosity of (liquifies) the ground
substance.
Myofascial Release (MFR)
• Indications:
– Area of muscle feels tight & restricted.
– Muscle group or compartment feels tight &
restricted.
– Skin is “stuck down”.
– History of an old injury and still has decreased
ROM and/or pain.
– Restricted ROM without specific injury.
– Decreased power or strength
Myofascial Release (MFR)
• Indications:
– Painful movement.
– Cast is removed.
– After surgery.
– Visible scars in the area of complaint or the
myofascial chain.
– Palpable thick, adhered, and/or fibrous tissue.
– Series of overuse injuries in one fascial chain.
Myofascial Release (MFR)
• General Contraindications:
– Malignancy
– Aneurysm
– Acute rheumatoid arthritis
– Systemic infection – fever, cellulitis
Myofascial Release (MFR)
• Cautions:
– Lymphedema – need specific training
– Advanced osteoporosis
– Advanced diabetes
– Hemophilia or anticoagulant therapy
Myofascial Release (MFR)
• Local Contraindications:
– Open wounds or burns
– Sutures
– Hematoma
– Localized infection
– Suspected or healing fracture
– Tumor
4. What injuries/conditions can
be helped by myofascial release?
• After the acute phase of any injury
– Splinting/holding
– Compensatory patterns
• Itis’s
– Tendinitis/Tendinosis
– Bursitis
– Fasciitis
• Pain
– Neck pain
– Back pain
– Joint pain
5. What role do ‘myofascial
chains’ have on the
treatment of injuries?
Myofascial Chains
• The anatomic connective tissue links
among muscles, bones, and fascial
membranes that go from head to toe.
Superficial Back Line
• Plays a major role in
maintaining posture &
creating extension in the
body.
• Conditions involving the
SBL:
– Plantar fasciitis, achilles’
tendonitis, chronic
hamstring tightness &
hamstring tendonitis,
chronic low back strain,
chronic neck strain &
headaches.
Superficial Front Line
• Functions to balance the
SBL & maintain the
general flexion tension of
the body.
• Conditions involving the
SFL:
– Tibial stress syndrome,
patellar tendonitis, pubic
symphysitis, head forward
posture & headaches.
Lateral Line
• Functions to create a lateral
bend in the body – lateral
flexion of the spine, abduction
of the hip, eversion of the foot.
• Important in treating left sideright side imbalances.
• Conditions involving the LL:
– IT band syndrome & headaches.
6. Feel for the “snag”!
(the root of the problem)
Feeling Your Own Fascia
• Pull on the fascia of your shoulder.
• How far down the arm does it effect? (It
should go all the way down to your hand.
If not, you have restrictions)
• Notice that the more times you do it, the
farther down the arm it effects. That is
because you are already effecting the
fascia
Feeling Your Own Fascia
• Feel your own fascia on your extensor
forearm.
• Flex & extend your wrist.
• Make contact (engage the tissue) with
your other hand & with gentle pressure
toward your elbow, feel the effect on your
ability to flex your wrist. (This is how a
fascial restriction can effect ROM.)
Feeling Your Own Fascia
• Pinch the skin over your elbow.
• Flex & extend your elbow.
• Feel the effect on your ability to flex your
elbow. (Again, this is how a fascial
restriction can effect ROM.)
Evaluation of the Superficial Fascia
• Superficial Translation
• Skin Rolling
7. Treating the “snag”.
Myofascial Release (MFR)
• The ability of the fascia to “release”
depends on:
– The amount of force
– The speed at which the force is applied
– The amount of time the force is applied
Myofascial Release (MFR)
• In MFR we slowly apply a low load force,
over a long period of time to effect change.
Treating the Superficial Fascia
• Superficial Translation
• Cross-hand Technique
• Skin Rolling
Evaluating & Treating
the Deep Fascia
• Deep Translation
• Deep Cross-hand Technique
• Traction Releases
Treating the Deep Fascia
Walt Fritz Techniques*
• Lumbar MFR Lift
• Thigh MFR Rotation
• Cervical Lift
* for more Walt Fritz techniqes, google Walt Fritz videos
Journey to Health
Kate Peck ATC, CMT
1113 Washington Street
Newton, MA 02146
(508) 245-2922