Myofascial Release – a fascial understanding of chronic pain

Many ordinary people suffer from a wide range of chronic pain conditions. They are not necessarily athletes, they are not superfit, and they have not developed their pain as a result of deliberately pushing their body to its limit. For most of them, their pain is caused by restrictions in their fascia developed during their everyday lives.
Many of the clients who find their way to me and my team of myofascial release specialists have been told by medical practitioners that their pain is ‘untreatable’ and they’ve been left to ‘just live with it’. However, using specialist myofascial release techniques, we are able to successfully treat these clients and return them to pain-free movement – even after they’ve endured years of pain, ineffective medical treatment, and additional complications.
Treating clients using myofascial release challenges a therapist to unlearn traditional anatomy and take a truly holistic view of both the body itself and the mind–body connection.
Fascia is real. It is the main connective tissue in the body, connecting everything to everything else, in a three-dimensional bodywide web. The ligaments that hold our joints together and the tendons that connect muscles to bones are all made of fascia. Fascia wraps around and runs through every muscle, protecting it and giving it shape. Fascia encases and runs through organs such as our heart, blood vessels, nerves, and intestines. Going deeper, fascia holds together every cell and every fibre that makes up those organs, connecting each of them to its neighbours and through a vast network, everything to everything else.
If every structure in your body was removed, except for the fascia, you would be left with a perfect three-dimensional representation of yourself, right down to facial expression. Your knee bone is indeed connected to your thighbone, but not in the way you think.
How does knowing this help to treat pain?
In its healthy state, fascia moves fluidly and seamlessly to distribute tension and maintain balance in the body. However, like every other part of us, fascia can be damaged causing the fascial web to snag, become misshapen, and lose its flexibility and ability to move. This causes fascial restrictions and adhesions that lead to limited movement, pressure, and pain.
Some of the most common causes of fascial restrictions are:
• Accident
• Surgery and scar tissue
• Overuse and underuse
• Posture
• Stress
Accident
All of us will experience a variety of accidents and injuries during our lives, from childhood through to old age. A major trauma will usually be remembered long after the event and can have long-lasting effects. Even everyday minor incidents, such as bumping into a kitchen cupboard, missing your footing as you step off a kerb, or stubbing your toe, can create fascial injuries that are communicated deeper into the body through the fascial network.
These effects may be apparent immediately after an accident, but they can also emerge years later, having been carried in the fascia long after superficial healing has taken place.
In our clinics, we see clients who have experienced traumatic accidents at some time in their past. Some clients are only too aware that the accident is the cause of their current pain. At other times, the memory of a long-forgotten trauma stirs only after myofascial release treatment has begun to reduce their pain and they feel able to ask “do you think this could have had something to do with the pain?”
The key to treating traumatic injuries using myofascial release is to understand that fascia is susceptible to injury and can hold on to tissue memory long after the event.
Surgery and scar tissue
Scars may form as a result of accidents and injuries or, for many of us, they are the result of surgical procedures.
Surface scarring, particularly minor scarring, may heal and disappear as the surrounding area returns to normal. In other cases, the scars remain, looking and feeling different from the surrounding tissues.
Bigger scars are multi-layered – what you see and feel on the surface of your skin is the tip of the fascial iceberg. Unseen, under the surface, it is very common for these scars to expand; growing along lines of fascial tension and creating adhesions which can cause obstructions and problems of their own and lead to chronic pain.
In our clinics, we have successfully treated clients experiencing debilitating pain from years-old C-sections, burns, and surgery of various sorts. We work with the fascia in a way that encourages the tissues to soften, release, and be re-absorbed into the body. The results can be the complete elimination of pain and visible reduction of scarring. Working with clients as soon as it is safe to do so after surgery can also prevent fascial adhesions and secondary pain developing.
The key to working myofascially with chronic pain from scar tissue is appreciating the fluid nature of fascia.
Overuse and underuse
As fluid beings, we are designed to move and to use our bodies. However, as our world has become more advanced, systems, machines, and gadgets have been invented that have changed our lifestyles and reduced our opportunities to move.
Overuse and underuse are related, with growing problems arising from our modern lifestyles, including work and leisure. Both can cause fascial injuries.
The underuse of being stuck in one position working at a computer or on a production line, hour after hour, day after day, for months and years creates more and more layers of fascia, which stick together forming fascial restrictions that cause pain. To counteract this, many of us instinctively feel the need to move, but the vigorous exercise we do to counteract our jobs can create micro-tears in muscles and fascia; like tiny scars that build up and harden and develop into adhesions that lead to pain.
Repetitive strain injuries (RSI) from work and sport form a significant part of our work at Pain Care Clinic. The key to working myofascially with such injuries is to understand the need to work with sustained pressure to encourage the body to unwind and let go of accumulated stuckness.
Posture
When functioning properly, the body is held upright by ligaments and fascia rather than by muscles. In this state the body can maintain an upright position without conscious postural control or muscle fatigue.
Poor posture can develop as a result of holding unnatural postures for prolonged periods, for example, sitting at a desk. As our fascia tightens to maintain this unnatural position, exerting new forces within our body, the fascia becomes less fluid and more rigid. Where this results in pressure on nerves, this can lead to a vicious circle in which a person avoids movement in the hope of avoiding pain, which in turn creates more restrictions and more pain. In addition, arthritic conditions such as ankylosing spondylitis and degenerative diseases like Parkinson’s disease can cause postural changes that make physical demands on the fascial network.
Treating chronic pain, arising from poor posture and postural conditions requires an appreciation of how fascia shifts and rebalances along functional lines of movement, and how tight fascia can restrict movement and impact on nerves, bones and other structures. In our myofascial release clinics, we use hands-on techniques during sessions and also instruct our clients in gentle fascial stretching techniques. so they can rebalance postural tension and reduce and eliminate pain.
Stress
Stress is a natural phenomenon and a physiological response to both real and perceived danger. Some stress can be good. Running to avoid a speeding car as you cross the road can save your life. The stress of a virus entering your system will trigger your immune system to kick in and resolve the temporary illness, which is a good thing.
However, after just seven days of sustained increased stress, such as that from prolonged pain, the mind–body goes into a state of exhaustion, in which normal protective immune responses are no longer triggered and the body is vulnerable to disease and injury. Over time, this changes the mind–body from a balanced self-regulating system into an unstable environment, where eventually even the slightest additional stress can spread the pain to other areas or magnify it.
When clients come to understand this process, often much of the distress attached to their health issues falls away, and this in itself can start them towards conscious self-care and recovery. For others, hands-on myofascial release encourages their bodies to relax and rebalance.
While it’s not yet proven, some researchers believe the fascial network works as a communication system distributing secondary referred pain. For many clients with chronic pain conditions such as fibromyalgia and who have benefitted from myofascial release, this is a plausible explanation that chimes with their experience.
Summary
Myofascial release is a gentle hands-on bodywork technique, that works on the fascia to release physical restrictions and pain patterns, and restore movement to the body. This relieves pressure on muscles, bones, nerves and organs, resolving chronic pain.
Coming from a holistic tradition, myofascial release takes a mind–body approach, recognising that emotional experiences and trauma can play an important part in the experience of pain.
Myofascial release looks beyond where the pain is felt to the source, which may be elsewhere. Appreciating the scale and intricacy of the fascial network, it is possible to understand that correcting an imbalance in a client’s pelvis can resolve their persistent headaches.
Particularly satisfying for a myofascial release therapist, is that with a shared understanding of fascia, it is possible work on and work with clients to help them help themselves out of chronic pain.
Amanda Oswald is lead therapist at paincareclinic.co.uk and author of Living Pain Free: Healing Chronic Pain with Myofascial Release. She practises in London and Leeds, and runs myofascial release training courses and workshops for therapists and interested groups throughout the UK.