Supporters claim help to thousands, detractors point to lack of evidence
The idea of myofascial release isn’t anything new. In fact, we trace its origins the the inventor of osteopathy, Andrew Taylor Still. But its long history has done little to alleviate the controversy and debate that surround the technique.
The actual term ‘myofascial release’ was coined back in the 1960s, and the art was popularized in the rehab world thanks to large part to John F. Barnes, PT. With almost 60 years’ experience in the profession, Barnes’ name is almost synonymous with myofascial release. His website claims that he has successfully trained over 100,000 physical therapists and physicians using his Myofascial Release Approach®.
But those supporters haven’t satisfied the detractors of the method, who claim evidence for the effectiveness of myofascial release is sorely lacking. In response, the research community has started evaluating the art more closely.
Fascia are sheets of bands of durable, elastic tissue that encase most structures within the body, muscle in particular. But various traumas, such as injury, overuse, or inactivity can affect and restrict this tissue, leading to pain, decreased blood flow and lessened range of motion.
The concept that came to be known as myofascial release was created in order to relieve these resulting symptoms. It utilizes sustained pressure to ‘release’ the constricted fascia to allow for elongation. According to John Barnes’ website, myofascial release views each patient individually and doesn’t allow for a “one size fits all” approach. One-on-one therapy sessions invoke hands-on treatments with therapists using a multitude of techniques and movement therapy. Patients are offered a thorough education in proper body mechanics and movement, self treatment instruction, enhancement of strength, improved flexibility, and postural and movement awareness.
Interestingly, practitioners do not use creams, oils, or any other substance so as not to interfere with the therapist’s ability to identify and assess the fascial restrictions.
The concept begins with ‘trigger points,’ or specific areas within muscle group that are particularly susceptible to irritation. Myofascial release focuses upon reducing tension or tightness in these areas. However, narrowing down the source of pain to a specific trigger point is often challenging, meaning myofascial release techniques are often applied over a broad area or muscle group.
The therapist will gently massage the myofascia and feel for stiff or tightened areas. Normal myofascia should feel pliable and elastic. The therapist will begin massaging and stretching the areas that feel rigid with light manual pressure. This serves to aid the tissue and supportive sheath in releasing pressure and tightness. The process is repeated multiple times on the same trigger point and on other trigger points until the therapist feels the tension is fully released.
Myofascial release practitioners claim the practice can help people with conditions ranging from back pain to headaches and migraines all the way up to cerebral palsy.
For years, detractors claimed there was a lack of or no solid evidence to back up the use of myofascial release. However, the tides seem to be turning. As recently as 2015, the Journal of Bodywork and Movement Therapies published a synopsis or review of randomized controlled trials utilizing myofascial release. The study was summarized in its own introduction:
“Anecdotal evidence shows great promise for MFR as a treatment for various conditions. However, research to support the anecdotal evidence is lacking.”
The investigators went on to report that literature regarding myofascial release was ‘mixed in both quality and results.’ They did allow, however, that the more recent studies were more impressive.
“Myofascial release (MFR) is emerging as a strategy with a solid evidence base and tremendous potential,” the study concluded. “The studies in this review may help as a respectable base for the future trials.”
One problem in accumulating evidence for myofascial release is that the techniques can vary from one practitioner to another.
At the beginning of this decade, the emphasis was on gathering a greater amount of evidence, but conclusive studies are still somewhat challenging to come by. A 2017 study published in Spine showed that MFR therapy produced considerable results in both pain and disability for people with low-back pain.
But the researchers offered a word of caution: “Because the minimal clinically important differences in pain and disability are, however, included in the 95% CI, we cannot know whether this improvement is clinically relevant.”
Last year, a study published in the American Journal of Physical Medicine and Rehabilitation allowed that MFR ‘could’ be better than a PT program for short-term relief of neck pain.
Ultimately, most studies seem to have one general conclusion—myofascial release has it uses, and seems to be effective for many conditions. It’s just difficult to quantify the methods or overall relevance of the findings. Until more research or evidence emerges, this is one area where the results may have to speak for themselves.