MFR has origins in soft tissue mobalisation, osteopathy, physical therapy, craniosacral therapy and energy work, among others, and all have become subtly blended to form what has been known as Myofascial Release for a number of decades. John F. Barnes has played a major role in myofascial therapy and has pioneered a sustained pressure MFR approach that is now being recognised by scientific research.
MFR is a treatment approach, a therapy and a rehabilitation tool. It is a hands-on therapy, meaning that the therapist applies pressure with the hands onto, and into, the client’s body. The therapist addresses the tissue barrier of resistance by feeling for tightness, restrictions and adhesions in any plane that may be causing pain or dysfunction. MFR is a client-led therapy involving communication between the therapist and client and actively promoting feedback on the responses to the treatment and body awareness.
The many aspects of the MFR approach depend on each other. The manual application of the techniques is one part; another is myofascial rebounding, and a third is myofascial unwinding. These three parts form an interlinked triangle. Two others parts that are also important are setting an intention as the therapist with every part of the triangle and communicating with and requesting feedback from the client (i.e., therapeutic dialoguing).
MFR is performed without oil or lotion to prevent slippage on the skin. Generally, clients are treated in their underwear or shorts and a bra top with sheets or towels for drapes. In most cases the MFR therapist performs a visual, movement and palpatory assessment and obtains a client consultation form.
Once the evaluation has been completed, the therapist commences treatment in areas that feel tight, hot or tender. These areas will not always be where the client is experiencing pain. This is because MFR is based on the entire fascial matrix, which, when restricted, creates a tensile force, affecting pain-sensitive structures throughout its network.
Imagine standing at one end of a long banquet table covered in a tablecloth and taking hold of the corners of the tablecloth. Pulling equally on both corners, you pull the tablecloth towards you evenly. Now imagine that the tablecloth has a nail driven into the middle and slightly to the right side of the table. If you take hold of the corners of the tablecloth again and pull, you won’t be able to pull evenly; in fact, the harder you pull, the tighter the cloth becomes. Now imagine that the corners of the tablecloth you are pulling are the areas of pain and where the nail is, is the restricted fascia. The more you work with the site of pain, stretching and releasing the tissue, the more give the restricted area has to bind the tissue towards it. However, if you follow those lines of restriction back to the origin (i.e., the nail) and remove it, you can restore the entire structure to an even and equal pull. This is how MFR works on a three-dimensional level. You take note of where the pain is, but you look, feel and trace the restricted tissue back to the origin of that restriction and release it; then work with creating balance and restoring function.
The actual application of the hands-on technique is a slow, sustained pressure held at the barrier of tissue resistance, usually for five minutes or more without slipping over the skin. The viscoelastic nature of fascia causes it to resist sudden forces. The Arndt-Schultz law, which states that weak stimuli increase physiological activity and very strong stimuli inhibit or abolish activity, shows that essentially less is more. Less pressure applied to tissue results in a greater response; firmer and quicker pressure results in tissue resistance. This emphasises the need for slow, sustained pressure, not forgetting the response of the various mechanoreceptors. If you push a boat away from a dock quickly, the boat digs into the water and doesn’t go very far. However, if you apply a gentle force, meeting the resistance of the water, the boat will drift farther away. MFR works the same way.
MFR therapists learn to become highly sensitive to the flow and ebb of the tissues under their hands by applying gently sustained pressure. Imagine that tissue is like a sponge. An MFR therapist slowly squeezes out the free water from the tissue encouraging fresh, clean water to return. At the same time, the hydrophilic nature of the collagen encourages the water molecules to organise themselves in the liquid crystalline matrix form, which Pollack (2013) calls bound water. The colloidal liquid crystalline matrix of bound water provides it with a high degree of viscoelasticity promoting bounce and give within the system.
The four mechanoreceptors of the fascial matrix mentioned earlier (Golgi, Pacini, Ruffini and interstitial) respond to stimuli. MFR, through its cultivation of touch and kinaesthetic awareness, stimulates these mechanoreceptors by applying pressure-sensitive techniques followed by sustained pressure to release the restricted fascia. As the tissue releases, it stretches, and as the client begins to spontaneously unwind, other mechanoreceptors are stimulated by this movement. The three applications in sustained MFR approach are techniques, unwinding and rebounding, which work with and promote the healthy activation of all of the fascial mechanoreceptors ultimately promoting and maintaining health and function.
MFR also allows the collagen and elastin fibres to rearrange themselves into a more conducive resting length by the application of biomechanical energy or pressure from the therapist’s hands (piezoelectricity). This makes use of the semiconductive nature of proteins.
It is thought that the time needed for tissues to begin to rearrange themselves is approximately 90 to 120 seconds; the viscous ground substance determines the ease at which this occurs. Because collagen begins to change only after 90 to 120 seconds, MFR techniques must be performed for more than five minutes to influence the entire fascial network (Barnes 1990; Covell 2009).
As the collagen and elastin fibres reorganise themselves, cross-linkages in these fibres are broken down, fascial planes are realigned, local circulation (waste and nutrient exchange) improves and the soft tissue proprioceptive sensory mechanisms are reset. As the sensory mechanisms are reset, there is a reprogramming of the central nervous system, enabling a normal functional range of motion without eliciting the old pain pattern.
Taking into consideration the viscoelastic nature of fascia, its mechanoreceptive properties and the Arndt-Schultz law, it becomes clear that the application of quick, firm force will result in the entire matrix effectively pushing the therapist’s hands back out. Instead, the therapist must place the hands on the body and, with a gentle pressure, lean into the tissue to reach the barrier of restriction. The feeling of the various fascial layers is quite distinguishable to trained hands, which is discussed later.
The therapist waits, feeling for the moment the hands sink into the tissue, and takes up the slack as it is offered. The time element is important. The slower the pressure is applied, the greater the release of the collagen within the viscoelastic ground substance and the increase of bound water. The slow, sustained pressure also allows the therapist to connect with the entire fascial matrix increasing the kinaesthetic awareness of restrictions that may be distant to where the hands are; these restrictions draw the hands towards them.
Apart from the physiological response to pressure applied for about 90 to 120 seconds is the fact that the system recognises the pressure as a positive influence. Fascia responds to touch by softening and yielding, allowing the therapist to follow that softening through barrier after barrier of restriction in any direction in a three-dimensional manner. This sensitivity of the fascial restrictions in all planes and the yielding of the tissue to the sustained pressure applied without force and without slipping on the skin creates an environment in which the time element and kinaesthetic awareness of each technique is paramount. Because the tissue begins to release only after about 90 to 120 seconds of pressure, each technique must be performed longer than this to facilitate lasting change. Experience and results have proven that MFR techniques should be performed for five minutes or more, a fact that recent research is now confirming.
MFR therapists feel for tissue resistance in all techniques; this is called the end-feel, or tissue barrier. The term end-feel is used to refer to where the tissue moves and where it is stuck. Where it feels stuck (i.e., has an abnormal end-feel) is where a technique is applied; the client is then reassessed and treated accordingly. In MFR, the end-feel is where the tissue (fascia) feels stuck and is resistive to subtle pressure or traction. If the therapist continues to pull or push (i.e., force) past this tissue resistance, or end-feel, the tissue simply shuts down and the efforts to release it become useless.
The MFR therapist may complete two or three fascial techniques and then have the client stand up again so the therapist can see and feel what has changed and where to treat next. Another important form of feedback during the treatment session, to help the therapist determine technique progression, is vasodilation, or red flare. This occurs where there is an increase in circulation as the tissue releases along the lines of pull. The client may also report a sense of tissue movement or softening in sites distant to where the therapist’s hands are. This is due to the release of restrictions along a line of pull. The MFR therapist should also note any spontaneous movement or twitching anywhere in the client’s body; this is called myofascial unwinding and is addressed in detail in chapter 10.
One important aspect to mention is that ‘less is more’ with MFR. It is not about how much pressure you use; it’s about how much resistance you feel. Because everyone’s fascial makeup is unique, the work has to be applied as a unique, individualised treatment. People are injured three-dimensionally in space and have three-dimensional bodies. Therefore, you must treat them with the pressure their own unique fascial matrix requires, in a three-dimensional manner.
One last key aspect of the MFR approach is the mental connection clients are encouraged to make with their own bodies. When a mental connection is made with the physical, there is a subsequent dramatic improvement in tonicity which promotes a release of the tissue. MFR therapists encourage their clients to focus on their own bodies during treatment to enhance the effect of, and response to, the therapy. This sense of self is called interoception (Schleip et al. 2012). Research presented at the 2012 International Fascia Research Congress showed that sensory stimulation is enhanced by active cortical stimulation (Moseley, Zalucki and Wiech 2008). In other words, actively engaging the client in the treatment process increases and enhances therapy results.