PT Tip of the Month

Myofascial Release Treatment

Myofascial release (MFR) therapy is a hands-on or self-applied treatment used to treat muscle tightness and spasm. It is a treatment frequently used when patients lose function and/or flexibility due to musculoskeletal injury.

What is fascia?

Fascia fibersFascia is a layer of fibrous connective tissue that wraps like a spider web around muscles, blood vessels, and nerves. This connective tissue helps to hold tissues together and let them glide smoothly by each other during movement.

How is myofascial pain caused?

When fascia is healthy it wraps around tissues like a loose web or sleeve. When it becomes impaired, fascia becomes stiff causing tension and pressure to the surrounding structures. This tension can be caused from surgical procedures, inflammation, or trauma. Poor posture or stress has also been linked to chronic myofascial dysfunction. Pressure can be as high as 2,000 pounds per square inch and does not usually show up on imaging such as X-rays, CT scans, or MRI.

Symptoms

Myofascial pain occurs in a localized portion of tissue which presents as deep achy pain, point tenderness with palpation, limited range of motion and weakness. Patients may report a “knot” in the muscle and pain in other areas, known as referred pain. Headaches can also occur when this tightness occurs in the neck or base of the skull.

Treatment

Foam roller used for treatmentMyofascial release is a technique frequently used by physical therapist, chiropractors, and massage therapists to provide relief for patients from myofascial pain. This technique is used to engage the restrictive tissue by apply a direct force until a release occurs. This pressure can be applied with finger tips, the clinician’s elbow, or even tools designed for this treatment. While applied, a slow stretch occurs in the fascia and adhesive tissue is mobilized. After, static stretches can be used to promote muscle flexibility. Self myofascial release can be performed with foam rollers or massage balls. Cushions are also made for those who are affected by fascial tightness in the neck, causing headaches. Physical therapists frequently combine passive stretching and foam roller to form a comprehensive home exercises program for these patients. Once improvements are made with range of motion, flexibility, and pain level a physical therapist will progress a patient to strengthening and postural exercises. Providing support and improving posture of the low back, shoulders, and neck can reduce the stress which causes myofascial pain.

In addition to a referral to physical therapy, many doctors with prescribe medication for the management of symptoms. Anti-inflammatories such as ibuprofen (Advil) or naproxen (Aleve) can be prescribed or purchased over the counter. These medications are used for a short period, commonly in the acute phase, to reduce inflammation in the affected tissues and therefore reduce pain.

Trigger point injections can be used in the chronic phase to reduce symptoms. This treatment is an injection that is inserted into the trigger point to deliver a dose of an analgesic medication, like lidocaine. These are frequently used when patients report pain radiating to other areas of the body.

Other medications that have been used for this condition are pain medications, muscle relaxers, and anti-depressants which have been shown to be affective for many diagnoses including fibromyalgia, however these are prescribed at the discretion of your medical practitioner.

AcupunctureA new technique that is becoming popular for myofascial pain syndrome is known as dry needling. Dry needling is a specialized treatment performed by some doctors and physical therapists (depending on state regulations). To perform this treatment, the practitioner pushes a small thin needle through the skin, similar to acupuncture, to stimulate the trigger point, muscle, and other tissues. This stimulation is thought to result in a small twitch in the muscle upon insertion of the needle helping to release the tight band or spasm present. Overall, this treatment helps to decrease pain and improve function.

If you feel that you have signs or symptoms of adhesive capsulitis, and you would like to schedule an evaluation, call 617-232-PAIN for our Brookline office, and 617-325-PAIN for our West Roxbury office.

References:

  1. Borg-Stein J. Treatment of fibromyalgia, myofascial pain, and related disorders. Phys Med Rehabil Clin N Am. 2006 May;17(2):491-510, viii.
  2. Bennett, Robert (2007). "Myofascial pain syndromes and their evaluation". Best Practice & Research Clinical Rheumatology 21 (3): 427–45 Mayo Clinic Staff (3 Dec 2009). ”
  3. Harris, R. E.; Clauw, Daniel J. (2002). "The Use of complementary medical therapies in the management of myofascial pain disorders". Current Pain and Headache Reports 6 (5): 370–4.
  4. Borg-Stein J. Treatment of fibromyalgia, myofascial pain, and related disorders. Phys Med Rehabil Clin N Am. 2006 May;17(2):491-510, viii.
  5. Annaswamy TM, DeLuigi AJ, O’Neill BJ, et al. Emerging Concepts in the Treatment of Myofascial Pain: A Review of Medications, Modalities, and Needle-based Interventions. PM R volume 3, issue 10 (October, 2011), p. 940-961.
  6. Yap E-C. Myofascial Pain: An Overview. Ann Acad Med Singapore 2007;36:43-8.

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33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
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