Myofascial Therapy

Myofascial therapy, also known as trigger point or neuromuscular therapy (NMT), is actually one of several types of bodywork, the goal of which is to restore homeostasis ("balance") among the nervous, osseous, and soft tissue systems. In the hands of a good therapist, NMT can eliminate the cause of both acute and chronic fascial, muscle, or bone pain; this is achieved using soft tissue manipulation, intra-oral tissue release, positional release, cranial or trigger point therapy, and myofascial release. Since the cause, rather than just the symptoms, of the pain is being addressed, the effects are usually very long-lived.

    The mechanism of myofascial/trigger point therapy is quite well understood; the general features are illustrated in the diagram to the left (click for larger image). A solid explanation of this process would requires a background in biology, neurochemistry, and pharmacology. However, a multi-part, layman-level article on myofascial release by its founder, John F. Barnes, PT, was published in 1995 (part one, part two, part three).

    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 the cellular level. Fascia is composed of collagen, elastin and ground substance - together they give strength, support, elasticity, and shock absorption to our structure. Malfunction of the fascial system due to trauma, posture, and repetitive stress injuries, scarring, and/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.

    Over a period of time of assuming a poor posture, the body will begin to lay down extra tissue (collagen) to support that position. So the fascia will thicken in that area, holding the pattern of that posture. When fascia becomes stuck and dehydrated, it causes restrictions in the movement and fluidity of the muscles and soft tissue, creating pain and discomfort. Because it is an integral part of all anatomical structures, it plays a vital role in the functioning of the body. Restrictions within the fascial system can contribute to pain and dysfunction. These restrictions can be caused by postural imbalances, physical trauma, scarring, surgery and inflammation and abnormal tension or pressure. Because fascia is a continuous matrix throughout the body, a restriction in one part will affect every part. So pain is often experienced in a different part of the body, to the source of the problem.

    With all kinds of bodywork, a good practitioner must possess a thorough knowledge of human anatomy and physiology, but this prerequisite is more important in myofascial work. Incredibly, most people, male or female, have a much deeper understanding of how their car works than how their body works! However, people intensely involved in a sport tend to have quite a good knowledge of the anatomy of the body used in that particular sport. Runners know leg anatomy quite well, while tennis players know the arms and most of the trunk musculature. However, if you're to be a good athlete, you really have to know the whole mechanism, otherwise you'll be one of those runners who never does weight training or tennis people who never do interval workouts.

    Similarly, excellent bodyworkers must understand all of the body's systems and their interrelationships, or they are unable to perceive the body as the unified, complex equilibrium that it is, and can conclude that if they work on a muscle group, that's all that's required to relax it and have it remain that way. If you ever sense that a bodyworker is weak in anatomy, don't go back! At the end of this section is a selection of excellent internet sites for studying anatomy and occasionally physiology.

    Trigger point therapy is not unlike acupuncture, in that there is a huge number of trigger points throughout the body with which a practitioner must become familiar. A trigger point is a nodule in a muscle, palpation of which is very painful. They are formed in overworked or exhausted muscle fibers, which release excess Ca+2 ions from storage units in muscle cells called the sarcoplasmic reticulum; this results in a mass of these cells sticking together,  crushing the capillaries that should keep them oxygenated and thus resulting in a local lack of oxygen, or ischemia. It is thought that this crisis causes nearby muscle cells to form more trigger points as a compensatory, protective reaction. In fact, myofascial refers to trigger points' usually involving both muscle (myo-) and connective tissue (fascia).

    The treatments for trigger points are widely variable, and it's important to see a practitioner with long experience in this kind of bodywork. Trigger points can be deactivated via long pressure (a kind of deep muscle massage), vibration, pulsed ultrasound, electrostimulation, ischemic compression, injection (usually with a local anesthetic), and a very specific kind of stretching. An in-depth discussion of these techniques is beyond the scope of this brief introduction. If you believe you would benefit from myofascial release or a related modality, consult an established bodywork group who will either have a therapist on staff or can refer you to a reputable practitioner.