By John F. Barnes, PT

Published in PT & OT Today, Vol. 5, NO. 40

We have all experienced or treated patients whose symptoms after a whiplash accident far exceed what could reasonably be explained by the velocity of the accident.  Full-blown symptoms have been frequently seen at automobile speeds below 10-15 mph.

Most victims of even relatively minor motor vehicle accidents usually describe a sense of detachment and shock.  The major symptoms of the whiplash may not appear for 48 hours and then may progressively worsen for many days, weeks or even months despite extensive care.1

In both the forward and backward motions involved, the front of the brain (which has the consistency of well-set Jell-O) slides forward and impacts against the rough and jagged edges of the eye orbits.  The orbito-frontal areas are particularly susceptible to hematomas, contusions, and intercerebral hemorrhages.  Particularly if the head is turned to either side at the impact, a phenomena called shearing may occur.

Psychoneuroimmunology research implies that “every cell in the body can communicate with every other cell.”  The reason that myofascial release and myofascial unwinding have been so effective with whiplash victims and other posttraumatic injuries may be explained by the fight/flight/freeze response developed by Dr. Peter Levine.2

He postulates that the fight/flight/freeze response is seen in animals in response to life-threatening experiences.  In other words, the preyed upon animal will flee or attempt to fight, but if run to the ground will enter a freeze response where it assumes a state of immobility while physiologically still manifesting high levels of activity of both the parasympathetic and sympathetic nervous systems.2

Myofascial release and myofascial unwinding release the contracted tissue, the tissue memory, and allows healing to commence.  Dr. Levine goes on to say that if the animal survives the attacks, it will go through a dramatic period of discharge of this high-level autonomic arousal through the motor system.  This discharge involves trembling, profuse sweating and deep breathing.  This type of discharge is frequently seen after a deep myofascial release, followed by substantial improvement.

In the case of a motor vehicle accident, a holding patter develops to protect the body against impact. As a result of the freeze response, this holding pattern is maintained indefinitely, manifesting sustained muscular contraction with resultant myofascial restrictions, leading to chronic myofascial pain and tightness.1

This explains why traditional therapy’s focus on symptoms is not enough for a complete resolution of the problem.  Myofascial release and myofascial unwinding release the muscular contractions, the myofascial restrictions and the holding patterns maintained by the “freeze response.”

The flight/flight/freeze response answers many questions we therapists encounter with our trauma victims. I will write future articles on this fascinating therapeutic model.

1 Robert Scaer, MD.  Bridges Magazine.  Observation on Traumatic StressThe Whiplash Model.

2 Levine, P., Walking the Tiger.  Healing Trauma Through the Body.

( Reprinted with permission. )

Myofascial Release and the Female Anatomy

( originally entitled “Fibromyalgia” )

By John Barnes, PT

Published in PT Today, March 4, 1996

What is fibromyalgia really?  What do fibromyalgia, chronic fatigue syndrome, chronic pain, headaches, pelvic/menstrual pain and dysfunction and PMS have in common?  These are simply different labels of a common denominator, unrecognized myofascial restrictions do not show up in all of the standard tests that are now performed, nor have most health professionals been taught how to recognize them.

Myofascial Release – “The Missing Link.”

Myofascial release is a new state of the art therapeutic approach for the relief of pain and headaches and the restoration of motion.

Fascia surrounds and infuses every organ, duct, nerve, blood vessel, muscle and bone of the pelvic cavity. Fascia has the propensity to tighten after trauma, inflammatory processes, poor posture or childbirth. The American way of childbirth is extremely unnatural and can be very traumatic to the woman, especially if she has a pelvic torsion and/or fascial restrictions prior to delivery, and most do!

Fascia has a tensile strength of over 2,000 pounds per square inch.  In other words, fascial restrictions have the potential of exerting enormous pressure on pain-sensitive structures producing pain or malfunction of the delicate pelvic structures.

Certainly, not all problems have a fascial origin, but restrictions of the fascia are the cause of many of these problems in a surprisingly high percentage of cases, especially when all the tests turn out negative and medication only helps temporarily or surgery did not change the situation.

I cannot tell you how many times I have heard stories of women being seen by doctor after doctor, taking more and more medication, as months, and then years, pass.  Desperation sets in…psychiatrists, psychologists, surgery, more surgery…nothing helps.  In fact, it continues to get worse over time and begins to spread to assorted symptoms throughout the body.  The woman begins to wonder if maybe it is “all in her head.”

Myofascial release is utilized for the treatment of menstrual pain and/or dysfunction, back and pelvic pain, endometriosis and other inflammatory disorders.  It can treat the unpleasant and/or painful symptoms of pregnancy and childbirth, recurrent bladder pain and infection, painful intercourse, sexual dysfunction, elimination problems, coccygeal pain, painful episiotomy scars and the list goes on.  These problems can in many cases be substantially alleviated or eliminated by Myofascial release, nontraumatically and gently.

Inflammatory processes, such as endometriosis, can cause the fascial layers to adhere to adjoining tissues creating pain and symptoms.  Many times the fascial tissues will adhere around the bladder and the urethral areas creating the environment for infection, since fascial restrictions impede proper elimination of toxins and waste products from the tissues.  If the fascia tightens around the bladder it can limit the bladder’s potential to enlarge sufficiently, crating the need to urinate frequently or painfully.  When a woman coughs, sneezes or laughs, urine will tend to seep out since there is no give to the bladder.

Scars from abdominal/pelvic surgery, trauma or episiotomy scars can also create havoc in the pelvic area, causing menstrual dysfunction, pelvic pain, painful intercourse, constipation, diarrhea, and/or hemorrhoids.  Recent statistics have shown that hysterectomies are performed on the average every 45 seconds in the United States and it has been determined that over half a million of these procedures a year are deemed unnecessary.

Another common problem we encounter is coccygeal disorders from trauma, pelvic torsion, and childbirth. A malaligned coccyx can cause a multitude of problems in the pelvic area, including some of those just mentioned, as well as back and neck pain, and/or headaches due to the influence of the dural tube.  When the coccyx moves closer to the public symphysis, the musculoaponeurotic fibers from the pubis to the coccyx become so slack that they lose their tonus. If the origin and insertion of a muscle move closer together, a great portion of the muscle’s power is lost. Typical symptoms of a sacrococcygeal lesion in a female subject are the inability to sit for long periods of time, declining quality of sexual relationships and cystitis…the coccyx can lead to a general decrease in the motility of the entire body, and it should be checked in people who are devitalized or suffering from general depression.

Myofascial release has healed many women with menstrual and PMS symptoms.  Just picture the fascia tightening like a powerful three-dimensional net around the pelvic structures.  Then as the woman begins to bloat as her menstrual cycle begins, the combination of fascial tightness and increasing internal pressure begins to exert heavy pressure on nerves, blood vessels, etc., and the cramps begin, the back tightens and all the other unpleasant effects are a reaction to the abnormal internal pressure.

The non-traumatic, gentle nature of myofascial release is reassuring in that the patient need not worry, since these effective procedures will not worsen the patient’s symptoms or cause harm.

Myofascial release can free the structures producing pain and can also relieve the emotional pain associated with past unpleasant events or traumas.  The painful memories or emotions from beatings, rapes, molestation, or miscarriages seem to be stored in the body’s memory.

Many times the woman has dealt with these situations intellectually, but on the subconscious level, the body (the myofascial structures in particular) stores these past painful events.  As myofascial release frees the adhered tissue, the trapped emotions and painful memories fade away leaving the person with a sense of peace.  This return to balance is sort of like letting the steam out of a pressure cooker.  The comment I hear quite frequently from my patients is “I finally feel like myself again,” or “My sense of calm has returned.”

Myofascial release is not meant to replace the important techniques and approaches that you currently utilize, but acts as a very important added dimension for increasing your effectiveness and permanency of results in relieving pain and restoring function and the quantity and quality of motion.

( Reprinted with permission. )

Myofascial Treatment Proves Beneficial In Acute and Sports Medicine Settings

By John Murphy
Staff Writer

Published in “Advance for Physical Therapists”
September 2, 1996

Myofascial release techniques not only benefit patients with chronic pain, but can also aid patients with acute injuries from becoming chronic pain conditions.

“What people typically do when they first have pain is to ignore it.  That’s the reason why there are so many patients with chronic pain,” said Theresa Stayer, PT.  “It they would get treated at the time of injury, they would recover sooner and would not have to live with pain forever.”

Stayer has used the myofascial release approach on patients in an acute-care hospital beginning in 1986 and now continues to use it in an outpatient setting as vice president of SpecTraMed Inc., her private practice in West Bloomfield, MI.

In her experience, myofascial release can be used quite effectively on acute patients and has even treated patients who sustained severe injuries on the same day they were admitted to the hospital, i.e., motor vehicle accidents and orthopedic injuries. “That’s when you want to treat them. One of the positive effects of myofascial release is to increase localized circulation in the injured area which will enhance and quicken the healing response,” Stayer said.

Fascia is a three dimensional web surrounding every tissue of the body which runs from head to toe without interruption, she explained.  Myofascial spans have the propensity through trauma, inflammatory process and poor posture to become solidified and shortened down, and can produce enormous tensile strength of up to 2,000 pounds per square inch.  This pressure from the myofascial restrictions can put abnormal pressure on the nerve that innervates the muscle, compromises the circulation and pulls the osseous structures too close together, which can jam the facet joints and bulge the disk.

Stayer prefers to treat patients before they become chronic.  A physician on the hospital softball team, for example, pulled his quadriceps while running to first base.  Stayer performed a deep cross hand myofascial release across the pulled muscle and the doctor went out and finished the rest of the game.  “He didn’t have to live with that pull for a week, a month or a year before it got treated (as other people might have done),” noted Stayer.  Getting to the injury right away is the best treatment short of avoiding the injury altogether.

In sports medicine, avoiding injury is the name of the game, and myofascial therapy can help in that arena, also.  While using myofascial therapy is just one method that therapists have to treat patients, it can be a very effective one in the right situation, noted John Woolf, PT, ATC.

Woolf is the director of the Arizona Athletic Treatment Center at the University of Arizona, in Tucson.  He presented a program on using myofascial techniques for athletes at the National Athletic Trainers Association annual conference in June.

Myofascial techniques are beneficial for stretching and preventing injuries, as well as treating injuries, Woolf indicated.  He explained that in traditional orthopedic rehabilitation, a stretch seems to exist only in one plane.  A standard hamstring stretch might require a patient to lie supine.  Lift the leg in the air, and hold and relax the muscle. The myofascial technique leg pull, on the other hand, involves traction to the entire leg combined with range of motion.

Both techniques are appropriate in their own situation.  Woolf described that the myofascial leg pull technique, for example may be used when the athlete resists the raised straight-leg stretch, rolls the hip up because it’s uncomfortable or doesn’t feel it’s working.

IN SUCH CASES, the leg pull provides more relaxation and control of increasing range of motion. Athletes have said that the stretch feels deeper and the muscles feel looser, noted Woolf.

He acknowledged that myofascial therapy is often delivered for outpatient orthopedic of chronic pain patients.  But when he began to apply it in the sports medicine setting, he was surprised to find how many athletes have chronic pain syndromes.

These include back pain, neck pain and recurring tendonitis, which could be incorrectly classified among general athletic diagnoses as strained or pulled muscles.  The athlete may realize that what feels like a pulled muscle could be the result of a long-time fascial restriction.

Woolf also incorporates the techniques into pregame and pre-workout warm-ups.  He gave the example of a football place kicker who has a soccer-style kick:  the kicker does not run at the ball head on but comes more from the side and across. The kicker moves from abduction to abduction and by using the leg pull technique, the therapist is able to stretch him throughout his functional motion.

Furthermore, this technique provides a relaxation throughout the lower limb and even into the low back, as opposed to just stretching the hamstring.  Woolf reminded that the myofascial extends throughout the entire body. That reflects how treatment should be provided.

In traditional orthopedic treatment, and the way anatomy is viewed, the body is segmentalized:  an arm or leg is treated.  For patients in general, and athletes in particular, Woolf said he disagrees with that notion.  “We don’t do anything with just a segment.  We use our entire bodies in sports, so that has to be kept in mind when determining the problem and providing treatment.”

Woolf keeps it in mind when treating acute injuries.  If he needs to include a myofascial technique within his treatment of an acute injury, he can treat the proximate area.  “You can get more intense with the technique as you get further away from the injury and still have a positive impact,” he said.

That’s exactly how myofascial release treatment works, said Stayer.  “You find the pain and look elsewhere for the cause.”

She described a woman with low back pain who had come to the hospital for physical therapy prior to a scheduled surgery.  The woman had torsion of the sacrum which was compressing the nerve roots and causing weakness in the lower extremities.  The woman was treated with myofascial release techniques to initially balance the pelvis by releasing the psoas, prirformis, iliotibial band, soleus and hamstrings.  As a result, the woman became pain-free and was able to avoid a lumbar laminectomy.

“The techniques, however, have to be done properly in order to work.” Emphasized Stayer.  Although holding the stretch for 90 to 120 seconds will get the myofascial release started, it’s usually not enough to make a permanent change.  She recommended holding the stretch, in each area, for three to five minutes to allow the release cycle to complete.

Stayer said that she believes all physical therapists could benefit from learning how to do myofascial release.  However, she cautioned that it is not appropriate for all patients.  Contraindications include malignancies, systemic or localized infections, and aneurysms, for example.

Similarly, not all techniques can be done on all patients.  While Stayer could use myofascial release on a pregnant woman for low back pain, she wouldn’t use a psoas release, in particular.

The myofascial release approach has been around for years, but it is still a relatively new concept to insurance companies.  As of 1995, myofascial release received its own CPT code (97250), although practitioners can only use it for one 15 minute unit per patient per day.

Stayer explained that with only 15 minutes, myofascial release is viewed as the equivalent of a modality, like a hotpack, which she considers to be much less effective. Nevertheless, she often complements this 15-minute treatment with soft tissue mobilization, neuromuscular re-education or therapeutic exercise.

Currently, Stayer is in contact with the American Medical Association in an effort to obtain approval on extending the treatment time.  Insurance companies should know that sufficient myofascial release treatment, in the acute phase, in conjunction with other therapy, can head of potentially more serious (and more costly) chronic pain conditions.   “The ultimate goal of myofascial release whether done in the acute or chronic state is to return patients to an active pain-free lifestyle,” concluded Stayer.

( Reprinted with permission. )

Myofascial Release — An Introduction for the Patient

Published in Physical Therapy Forum Week of October 3, 1988
Gary D. Keown, PT and Tim Juett, PT of South Umpqua Physical Therapy Services in Winston, Oregon, have extensive experience in Physical Therapy and Myofascial Release.  The integration of the Myofascial Release approach into their Physical Therapy practice has greatly enhanced their success. Their reputation for excellence and resolving difficult cases has led to the growth of four very successful Physical Therapy facilities in Oregon.

Tim has just completed our advanced Myofascial Release III seminar and said he would like to share some case histories with you, which constitute a very valuable patient introduction to Myofascial Release.  I suggest you modify this to fit your facility’s particular requirements and print it as a handout for your patients and referring physicians and dentists.

Myofascial Release is a relatively new addition to the armamentarium of the physical therapist. Because it is somewhat different from traditional physical therapy, many patients ask questions such as “What is it?” and “How does it work?”  Myofascial Release is generally an extremely mild and gentle form of stretching that has a profound effect upon the body tissues.  Because of its gentleness, many individuals wonder how it could possibly work.  To help you understand, we are providing you with this article.

Fascia (also called connective tissue) is a tissue system of the body to which relatively little attention has been given in the past.  Fascia is composed of two types of fibers:  A) Collagenous fibers, which are very tough and have little stretchability; B) Elastic fibers, which are stretchable.  From the functional point of view, the body fascia may be regarded as a continuous laminated sheet of connective tissue that extends without interruption from the top of the head to the tip of the toes.  It surrounds and invades every other tissue and organ of the body, including nerves, vessels, muscle and bone.  Fascia is more dense in some areas than others.  Dense fascia is easily recognizable (for example, the tough white membrane that we often find surrounding butchered meat).

When Fascia is Injured
Because fascia permeates all regions of the body and is all interconnected, when it scars and hardens in one area (following injury, inflammation, disease, surgery, etc.), it can put tension on adjacent pain-sensitive structures as well as on structures in far-away areas.  Some patients have bizarre pain symptoms that appear to be unrelated to the original or primary complaint.  These bizarre symptoms can now often be understood in relationship to our understanding of the fascial system.

Anatomy of Fascia

The majority of the fascia of the body is oriented vertically.  There are, however, four major planes of fascia in the body that are oriented in more of a crosswise (or transverse) plane.  These four transverse planes are extremely dense. They are called the pelvic diaphragm, thoracic inlet and cranial base.  Frequently, all four of these transverse planes will become restricted when fascial adhesions occur in just about any part of the body.  This is because this fascia of the body is all interconnected, and a restriction in one region can theoretically put a “drag” on the fascia in any other direction.

Treating Fascial Restrictions
The point of all the above information is to help you understand that during myofascial release treatments, you may be treated in areas that you may not think are related to your condition.  The trained therapist has a thorough understanding of the fascial system and will “release” the fascia in areas that he knows have a strong  “drag” on your area of injury.  This is, therefore, a whole body approach to treatment.  A good example is the chronic low back pain patient; although the low back is primarily involved, the patient may also have significant discomfort in the neck.  This is due to the gradual tightening of the muscles and especially of the fascia, as this tightness has crept its way up the back, eventually creating neck and head pain.  Experience shows that optimal resolution of the low back pain requires release of the fascia of both the head and neck; if the neck tightness is not also released it will continue to apply a “drag” in the downward direction until fascial restriction and pain has again returned to the low back.

Muscle provides the greatest bulk of our body’s soft tissue.  Because all muscle is enveloped by and ingrained with fascia, myofascial release is the term that has been given to the techniques that are used to relieve soft tissue from the abnormal grip of tight fascia (“myo” means “Muscle”).

The type of myofascial release techniques chosen by the therapist will depend upon where in your body the therapist finds the fascia restricted.  If it is restricted through the neck to the arm, he/she may apply a very gentle traction to the arm, very slowly moving the arm through range as restrictions are released.  If it is restricted in the back (more superficial than deep) he may apply a very gentle stretch on the skin across the back, with the use of two hands.  If the thoracic inlet, deep transverse fascia is suspected of being restricted, the therapist may place one hand on the upper back and one on the collarbone are in front and apply extremely gentle pressure.

A key to the success of myofascial release treatment is to keep the pressure and stretch extremely mild. Muscle tissue responds to a relatively firm stretch, but this is not the case with fascia.  Remember the collagenous fibers of fascia are extremely tough and resistant to stretch.  In fact, it is estimated that fascia has a tensile strength of as much as 2000 pounds per square inch.  (No wonder when it tightens, it can cause pain.)

However, it has been shown that under a small amount of pressure (applied by a therapist’s hands) fascia will soften and begin to release when the pressure is sustained over time.  This can be likened to pulling on a piece of taffy with only a small, sustained pressure.

Another important aspect of myofascial release techniques is holding the technique long enough.  The therapeutic affect will begin to take place after holding a gentle stretch and following the tissue three-dimensionally with skilled, sensitive hands.

Myofascial Release is gentle, but is has profound effects upon the body tissues.  Do not let the gentleness deceive you.  You may leave after the first treatment feeling like nothing happened.  Later (even a day later) you may begin to feel the effects of the treatment.

In general, acute cases will resolve with a few treatments.  The longer the problem has been present, generally the longer it will take to resolve the problem, Many chronic conditions (that have developed over a period of years) may require three to four months of treatments three times per week to obtain optimal results.  Experience indicates that fewer than two treatments per week will often result in fascial tightness creeping back to the level prior to the last treatment.

Frequently there is increased pain for several hours to a day after treatment, followed by remarkable improvement.  Often remarkable improvement is noted immediately during or after a treatment. Sometimes new pains in new areas will be experienced.  There is sometimes a feeling of light-headedness or nausea.  Sometimes a patient experiences a temporary emotion change.  All of these are normal reaction of the body to the profound, but positive changes that have occurred by releasing fascial restrictions.

It is felt that release of tight tissue is accompanied by release of trapped metabolic waste products in the surrounding tissue and blood stream.  We highly recommend that you “flush your system” by drinking a lot of fluid during the course of your treatments, so that reactions like nausea and light-headedness will remain minimal or nil.

If patients have any questions or concerns that arise concerning myofascial release, they should be encouraged to discuss them with the therapist.

Case History—Chronic Low Back Pain (Post Surgery)
A 32-year old choker-setter had a lumbar laminectomy in 1983, followed by decompression surgery at the same level in October, 1985.  Five months after his second surgery he was referred to physical therapy by his surgeon for three weeks of treatment for chronic low back pain and bilateral anterior thigh pain.  His treatment included hot wet packs with concurrent interferential electrical stimulation, a home exercise program and myofascial release to the low back area as well as to the surgical scar itself.  After two treatments there was no further leg pain and only mild low back pain with movement.

After four treatments, the patient called and cancelled further appointments because he no longer was having any pain and had returned to his job as a choker-setter. Following up by telephone three months later, he reported having low back discomfort at times and never any leg pain.  He is very pleased with his ability to continue his strenuous job.  This is the most dramatic improvement I have experienced with any patient having similar symptoms after two or more low back surgeries.  The only difference in treatment with this patient was the addition of myofascial release.

Case History—Chronic Dislocating Patella
This 15-year-old female had a history of a chronic dislocating right patella for three years. AT age 11 she fell and hit a curb on the lateral aspect of the right knee.  Approximately one month later her patella began dislocating.  Dislocations gradually became more frequent.  She stated that with “just normal walking” the patella would dislocate and she would fall.  She had been having constant pain at the lateral aspect of the knee for the past two years.  Originally, her patella dislocated about twice per week, and this progressed to daily for a year prior to coming to us for therapy.  The only treatment given her was quadriceps and hamstring “sets” and a trial of two types of braces until she came to see us in June of 1987.

The physician’s referral to us requested SLR quadriceps strengthening and iliotibial band stretching. We treated her five times with ultrasound to the lateral retinacular area of the right patella, followed by myofascial release of the iliotibial band and lateral retinaculum. She was also given straight-leg raises against theraband with some external rotation of the hips, so as to emphasize strengthening of the VMO.

After the first treatment she had no further dislocations, even when running up and down stairs at home. Follow-up with this patient nine months later, she reported having no further problems at all with her right knee.

This patient was a possible candidate for surgical release of the lateral retinaculum of the right knee. Because she had done exercises in the past without reduction of chronic dislocation of the patella, we feel that the rapid resolution of her problem was due primarily to the non-invasive release of the scarred and adhered lateral retinaculum with manual myofascial release techniques.

Case History– Myofascial Syndrome, Status Post Open Heart Surgery
This 73-year old patient had open heart surgery on January 15, 1988.  She came for physical therapy on March 19, 1988, complaining of excruciating pain at the sternal surgical scar region and spreading up the left sternocleidomastoid and into the left upper extremity to the elbow.  She also complained of paresthesis of the left side of the face, episodes of dizziness, difficulty breathing when tilting the head back, and lack of pulse in the left side of the neck.

A total of four treatments were given in a ten-day period.  They included moist heat, myofascial release and a home program of stretching the neck and shoulders.

Myofascial release was performed over the surgical scar, left chest, left neck, cranial base and left side of the face.  A left “arm pull” was also performed.  At the end of the fourth and final treatment, she reported feeling “100% improved.”  She had no pain.  She could feel a pulse again in the left side of her neck, breathing was unrestricted with cervical extensions, there was normal sensation in her face and no further episodes of dizziness. Her six standard cervical motions had improved a total of 40 degrees, including a gain of 15 degrees of extension.

Upon follow-up by telephone exactly four weeks following her final treatment, she reported feeling as well as after the last treatment.  She only had “soreness” in the left neck and left axillary region when stretching while doing her home exercises, which I had recommended that she continue daily.

Case History—Status Post Right Mastectomy and Radiation Burn
This 73-year old woman came for her initial physical therapy treatment on July 14, 1987.  She had a right mastectomy in January, 1986.  She received one year of chemotherapy following surgery, then six weeks (30 treatments) of radiation therapy.  She had irregular shaped radiation burn with hypertrophic scarring over the distal third of the sternum (of approximately 6-7 mm. Diameter).  The right shoulder was drawn forward.  The right shoulder and chest were extremely hypersensitive to mild touch and minor movement of the right shoulder.  The radiation scar still had a small area of scab.  She was referred to us as soon as the physician felt that the burn was sufficiently healed to begin physical therapy.  Right shoulder external and internal rotation range of motions were within normal limits.  Active flexion and abduction (standing) were respectively 0-130 degrees and 0-97 degrees.

She was given a home program of cane exercises and treated a total of 15 times (ending August 21, 1987) with moist heat and myofascial release to the chest, right upper extremity and neck.  At the final treatment she had 160 degrees of motion of both right shoulder flexion and abduction (equivalent to the contralateral motions).  She had no further discomfort, except for mild tenderness when pushing her range of motion exercises to the end of range.

On follow-up with this patient over seven months later, she had maintained her range of motion and reported no limitations of function and no pain.  She felt fully recovered in every way other than “some tightness at the site of radiation.”  She expressed how thoroughly grateful she was for the remarkable increase of motion and reduction of pain which occurred with such gentle and relatively painless techniques.

Tim Juett, PT
Roseburg, Oregon

Tim is a very caring and highly intelligent health professional who believes in multi-faceted approach treating the whole person.

I would like to thank Tim and request anyone else interested in sharing anything of this nature, case histories or their experiences to feel welcome to write me.  I look forward to hearing from you.

John F. Barnes, PT

Myofascial Release and the Equine Athlete

by Mark F. Barnes, MPT

Myofascial release has been used for many years to successfully treat musculoskeletal dysfunction in humans.  It has proven to be extremely effective in elongating foreshortened connective tissue and restoring functional movement.  In my human practice that involves treating professional and elite athletes myofascial release has been an important tool in my armament for facilitating strength, power and coordination for these high level athletes.

Over the last eight years I have been utilizing this technique for the treatment of racehorses and getting amazing results.  Just like the professional athlete, the performance horse sustains injuries that have resultant soft tissue tightening and compensatory neuromuscular activity.

The Anatomy and Physiology of Fascia
The fascia is a tough connective tissue which spreads throughout the body in a three-dimensional web from head to hoof without interruption (Fig. 1).  The fascia surrounds every muscle, bone, nerve, blood vessel, and organ, all the way down to the cellular level.

Fascia at the cellular level (ground substance) creates the interstitial spaces and functions to support and protect the cell, separate cell from cell, and allow cellular metabolism, respiration, and elimination.  In other words, it is the immediate environment of every cell of the body.  The fascial system has three basic components:  ground substance mentioned above, collagen, and elastin.  Generally, the fascial system is one of support, stability, and cushion, forming ligaments, tendons, and fascial sheaths.  It is also a system of locomotion and dynamic flexibility forming muscle.

The Response of the Fascial System to Trauma

As in humans, the tightening of the fascial system is a protective mechanism that is a response to trauma.  This trauma may arise from an acute injury like a tendon strain, chronic compensatory muscular work, or repetitive injury from poor training techniques.  The fascia loses its pliability, becomes restricted and is a source of tension for the rest of the body.  This loss of pliability is further exacerbated by an inflammatory process.  The ground substance solidifies, the collagen becomes dense and fibrous, and the elastin loses its resiliency.  These fascial restrictions slowly affect the quality and quantity of motion available to the horse.

Over time this can lead to poor muscular biomechanics, altered structural alignment and decreased strength and endurance.  This tightening will also produce overuse muscular compensations.  Resultant is decreased performance and functional capacity of the horse.

Myofascial Release Treatment
Myofascial release is a hands-on technique that facilitates a stretch into restricted soft tissues.  A sustained pressure is applied into the tissue barrier after 90-120 seconds the first release will be felt. The practitioner follows the release into a new tissue barrier and holds.  After a few releases are felt the tissue will become soft and pliable. This restoration of length and health to the myofascial tissues will take the pressure off the pain sensitive tissue like nerves and blood vessels, as well as restore alignment and mobility to the joints.  By elongating the fascial system we can restore the efficiency within the neuromuscular elements and proper mechanical length of the connective tissues. Therefore restoring the natural abilities of coordination, strength and power to the horse.  We have had a great success with this treatment approach especially when utilized with other treatment techniques such as joint mobilization, therapeutic exercise programs and modalities.  The combination of these techniques are beneficial in creating pain free performance, There are many types of equine sporting events with their unique types of injuries to the horse, both acute and chronic.  The biomechanics of proper movement for these various events can be observed, analyzed and addressed therapeutically. It is an exciting new field that can be approached from a problem solving, comprehensive, professional program of treatment.

( Reprinted with permission from the John Barnes Institute, Paoli, PA )

What is Myofascial Release?

Myofascial Release is a very effective hands-on technique that provides sustained pressure into myofascial restrictions to eliminate pain and restore motion.  The theory of Myofascial Release requires an understanding of the fascial system (or connective tissue).

The fascia is a specialized system of the body that has an appearance similar to a spider’s web or a sweater.  Fascia is very densely woven, covering and interpenetrating every muscle, bone, nerve, artery and vein as well as all of our internal organs including the heart, lungs, brain and spinal cord.  The most interesting aspect of the fascial system is that it is not just a system of separate coverings.  It is actually one structure that exists from head to foot without interruption.  In this way you can begin to see that each part of the entire body is connected to every other part of the body by the fascia, like the yarn in a sweater.

Fascia also plays an important role in the support of our bodies, since it surrounds and attaches to all structures.  These structures would not be able to provide the stability without the constant pull of the fascial system.  In fact, our bones can be thought of as tent poles, which cannot support the structure without the constant support of the guide wires (or fascia) to keep an adequate amount of tension to allow the tent (or body) to remain upright with proper equilibrium.

In the normal healthy state, the fascia is relaxed and wavy in configuration.  It has the ability to stretch and move without restriction.  When we experience physical trauma or inflammation, however, the fascia loses its pliability.  It becomes tight, restricted and a source of tension to the rest of the body.  Trauma, such as a fall, whiplash, surgery or just habitual poor posture over time has a cumulative effect.  The changes they cause in the fascial system influence the skeletal framework for our posture.  The fascia can exert excessive pressure producing pain or restriction of motion.  They affect our flexibility and are a determining factor in our ability to withstand stress and strain.

The use of Myofascial Release allows us to look at each patient as a unique individual.  Our one-on-one therapy sessions are hands-on treatments during which our therapists use a multitude of Myofascial Release techniques and movement therapy.  We promote independence through education in proper body movement, through the enhancement of strength, flexibility and postural and movement awareness.

( Reprinted with permission from the Myofascial Release Treatment Center, Paoli, PA)<

Equine Myofascial Release

I first met Ruth Mitchell and her friend Maxeen several weeks ago when they came by to visit the shop. Ruth is a Certified Equine and People Myofascial Therapist. As providence would have it, I had a mare that had sustained a pasture injury to her right fore shoulder, so I asked if they would look at her. Upon briefly viewing Fizz and her movements, they came to the conclusion that there were several other problems, which started with the shoulder injury. Ruth has been treating the mare by herself since Max had to go back to Minnesota. She will be moving to this area shortly. Fizz was stiff in her right fore which caused her to overcompensate with her rear legs. Each step taken was a step and a hop with both rear legs together. We made an appointment for the following week, as these ladies were house hunting (for Max) when they stopped by. Fizz responded tremendously to just her first treatment. Ruth applied pressure and massages to the muscles in the upper body, hip and legs on Fizz. It was utterly amazing to see my grand mistress of the barn move more freely and with less discomfort after just this first treatment. The second treatment brought out a little jog in her. The step-hop as well disappeared. Fizz is now able to move each leg independently again. Each time Ruth works on her, she gets a little better in movement. We will continue Fizz’s treatments to hopefully get a full recovery for the next show season. If you are interested in finding out more on Myofascial Release Therapy or in need of a good Therapist I recommend you give Ruth a call. She does offer a free consultation. Contact Ruth at (540) 721-4545.

(Reprinted with permission from Fox Creek Saddlery, Bedford, VA)


Melody wasn’t feeling well.  She ached, her bones felt wrong, her muscles didn’t feel right.  When she walked, it didn’t feel right and when she ran, that felt even worse. There was a lot that didn’t feel right and a lot of Melody to feel bad.

Melody is a 12 year old horse.  A bright chestnut Tennessee Walker with a sweetness about her that includes everyone around her.  Even her stable mate, the not-so-sweet tempered and jealous bay, Cupcake.

So, discovering that Melody didn’t like to be mounted and occasionally bucked, and not being able to figure out what was wrong, Melody’s owner Becky called in Ruth Mitchell.  Ruth is not a vet, she is a Physical Therapist and Massage Therapist for two-legged types and Equine Sports Massage Therapist for the horsey crowd who, some years ago, decided that she could do for horses what she did for people.  Even with twenty nine years of experience behind her, it took time, some serious study of horse anatomy, her love of animals and particularly horses, to get her to the place she is now – which is top of the horsey list of horse fixers.

With her training, Ruth has managed to transport her art across the species to work out the kinks, ease old bones, hydrate torn muscles and other connective tissues and loosen a tight one to give the animal she’s working with better mobility.

It was a hot July day when Ruth arrived at the Farm in Novelty, Virginia.  After a short getting-to-know-you chat with Melody, she asked the owner to take the reins and lead the horse through a series of maneuvers to demonstrate posture, symmetry and asymmetry. “Square her up.”  Was the first request.  This involved getting the horse standing evenly and squarely on all four hooves.  Melody had difficulty with that and the physical therapist, cued by the stance, began to look at the right hind leg.  The chatter between owner and therapist was full of words and phrases that meant little to a layperson but included such things as “Walk her for me…” and then “She’s turning in on herself…” and “…some skittering in the hind legs”.

An extensive and thorough examination that took nearly two hours followed and included eye, nostril and ear checks, palpating of muscles and abdomen as well as putting the horse through a lunging exercise (having her canter in a circle to observe the gait.)

At the end of it, Mitchell was able to give her assessment of the problem.  “Sometimes,” she said “the fascial tissue will lock down with scar tissue and the trick is to rehydrate the affected area and manipulate it to get it working again.” This means that muscles can tighten up due to an old injury which makes the muscle painful to work, and when it scars over, that tissue has to be treated to encourage it to begin functioning properly again.  Like people, a horse will compensate for an injury by using other parts of its body, eventually changing the muscular alignment and causing chronic pain.

The treatment Ruth Mitchell used is called Myofascial Release. It involves gentle stretching, compression and direct pressure on the affected muscle that transmits a request to the brain to “send fluids”.  It involves the circulation, lymph glands and nerves.

Melody loved it.  Her head drooped and she closed her eyes in total relaxation under Ruth’s ministering touch.  Cupcake leaned across her stall and pawed the ground, demanding the same attention.

After a while, Mitchell said that she could feel the muscle and connective tissue hydrating under her hands.

At the end of the session, the therapist said that four or five treatments should bring Melody back on form.  The degree of improvement will depend on the severity of the injury and the age of the animal.  But, following several therapeutic sessions with Ruth, Melody is greatly improved and almost ready to play.  Her favorite game?  Chasing deer through the woods.

On top of individual appointments like Melody’s, Ruth treats horses at a saddlebred barn where a lot of neck and back injuries occur.  She also treats the horses at Chatham Hall Girls School.  “Very often,” she says, “the therapy will include the rider.  If we see that the horse is not responding well to the therapy, we will take a look at the way the horse is riden and if necessary, correct any physical imbalance in the rider that may be causing the horse’s alignment to be off center. Treating both of them proves to be very effective and makes them both more comfortable.”

For appointments, Mitchell can be reached at 540-721-4545.

(Reprinted courtesy of Bedford Bulletin.)