Myofascia – part 2

Last week I explained what myofascia is and how it can become restricted from, for example, poor posture.

How to identify Myofascial Restrictions?

It is important to acknowledge that it is difficult to diagnose myofascial restrictions as they do not show up on standard tests (x-rays, myelograms, CAT scans, electromyography etc).

Massage therapists utilise their palpation skills to find myofascial restrictions. For example fascial drag, this is a very light press & slow technique to allow the therapist to feel the restrictions in the fascia.

Who treats Myofascial Restrictions?

  1. Myofascial Release – Originated in the 1940’s. It is a specialised physical and manual therapy used for the effective treatment and rehabilitation of soft tissue and fascial tension and restrictions. John Barns a physical therapist based in the US is one of today’s leading lights in the world of myofascial release.
  2. Rolfing – Dr Ida Rolf, started working with client in the 1930’s and by the 1950’s was teaching her work under the name of Rolfing .   A physical therapy which aims to release stress patterns from the body.   It is normally to require a series of treatment often up to 10.
  3. Massage – massage therapists utilise direct and indirect technique to address Myofascial restrictions.

With indirect Myofascial techniques you apply pressure and wait of the fascial to release, when you meet restriction you stretch the fascia. With direct Myofascial techniques you drag the fascia to create a Chinese burn sensation.   Hence why in clinic I often rely on the gentler indirect Myofascial techniques even when I know my clients prefer deep pressure.

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    SittingMusclesChair sitting is unique in that Gluteus maximi are totally relaxed at the same time as having an upright torso, and they are therefore not able to contribute to lumbar extension and back stabilization as they usually do. Without the help of the Gluteal muscles, the Erector Spinae muscles above become tired and painful in a very short time, and give up fighting to maintain the correct "hollow" in the lumbar spine. The diagram on the left indicates what happens to three key muscles when you spend long periods of time sitting. The Hamstrings (H) are shortened by sitting.  Also, during sitting, the Gluteus Maximus (GM) is relaxed and unable to tension the lumbosacral fascia.  This means the Errector Spinae (ES) muscle group must therefore perform the entire lumber extension workload. This article discusses the link between lower back pain and the following muscle problems:-

    1. Shortening of the hamstring muscle.
    2. Overworking of the Erector Spinae muscle group and the development of trigger points.
    3. Overworking of the Iliopsoas muscle group and the development of trigger points.
    Hamstrings are shortened and inactive while sitting causing tension.  This is so common I will write a separate blog most on Hamstrings. Without the help of the Gluteal muscles the Erector Spinae muscles become tired and painful very quickly and struggle to maintain the correct "hollow" in your lower back.  Even thought you may consider sitting an apparently restful posture it is actually an intense workout for the Erector Spinae and the Iliopsoas muscle groups. If you are not using a full and appropriately shaped chair back, your Iliopsoas muscles must pull your torso forward to stop you falling backward, and they have to do that at the short end of their range of contractile length. That is a sure fire recipe for Iliopsoas muscle shortening and development of trigger points. Here are some indications that you have a shortened Iliopsoas
    • Diffuse achy - type pain radiating out from the groin area to the lower back, and possibly around to the side of the hip and the butt area. If the trigger points in the groin are not pressed, the pain is not sharp or stabbing.
    • Relief of pain is often experienced by sitting down.
    • Worse upon lengthening the iliopsoas, i.e. when one stands up, or straightens the hip joint.
    • Worse for doing situps.
    • Worsened by externally rotating the hip (i.e. making the knee cap look outward) when the hip joint is fully extended.
    • In patients with sciatic nerve pain, lying flat on one's back with the legs out straight causes the trigger point tightened iliopsoas to compress the lumbar vertebrae together, with the result that the nerve roots of the sciatic nerve are compressed too.
    • When lying flat on one's back, doing a straight leg raise reveals weakness on the affected side.
    • In patients with sciatic nerve pain due to nerve root compression, lying flat on one's back with legs out straight stretches that trigger point tightened iliopsoas. The result is that the iliopsoas compresses the lumbar vertebrae together, and the the nerve roots of the sciatic nerve are compressed at the same time.
    All the side effects of sitting for long periods of time can be addressed by deep tissue massage.