Myofascial Release: Definition, Functions, Layers, Research Studies & Treatment

What is Myofascia?

Myofascia (fascia) is connective tissue layers that support, wrap and surround all organs, bones, blood vessels, and nerves. Myofascia helps in functional movements by reducing friction between the structures. Myofascial has nerves that make it as sensitive as skin. It is the very thin layer under the skin that protects and separates the body [3].

Functions of the Myofascia

Functions of myofascia are as follows:

1. It separates the muscles from bones and other organs from each other.
2. Secondly, it supports the body to be in a certain position and attains the vital organs to be in shape.
3. Moreover, it protects the body by resisting mechanical stress internally and externally [3].

Myofascia layers

Layers of fascia are as follows:

1. Superficial fascia:

Superficial fascia is the lowermost layer of the skin in nearly all of the regions of the body, that blends with the reticular dermis layer. It consists mainly of loose areolar, and fatty adipose connective tissue and is the layer that primarily determines the shape of a body. It separates the skin from the musculoskeletal system allowing normal sliding and gliding in the muscles [3].

2. Deep fascia:

A deep fascia is a dense connective tissue that is commonly arranged in sheets that form a stocking around the muscles and tendons beneath the superficial fascia. The deep fascia consists of four layers.

1. The first one is the aponeurotic fascia that surrounds the group of muscles. It consists of two to three layers of collagen fibers and its function is that it connects the muscles with their movers. An example of this fascia is palm aponeurosis.
2. The second one is the epimysium fascia that surrounds the entire muscles. It covers one layer of the muscles.
3. The third one is perimysium fascia. It is the bundle of fibers inside the muscles which is surrounded by epimysium fascia.
4. The last one is the endomysium fascia layer that surrounds or wraps each fiber [3].

What is Myofascial Release?

Myofascial release are manual techniques used to release adhesion or restrictions in the myofascial layers. Myofascial release use  to treat myofascial pain syndrome, muscle and joint pain.

Myofascial Pain Syndrome Treatment Research Studies

Ineffective Myofascial Pain Syndrome Treatment: Research Studies

1. Foam Roller

A systematic review is a type of literature review that collect and critically analyze multiple research studies or papers. A systematic review by Cheatham et al. included 14 different articles that met the inclusion criteria, with a total of 260 healthy subjects, 179 were male, while 81 of them were female.44 The average age of the subjects was 19.6 years, with their ages ranging from 15-34 years old.

Cheatham et. al, reviewed studies that examined subjects using the foam roller which were hip range of motion, foam rolling sit and reach, knee range of motion, and ankle range of motion.44 5 studies used the roller massage which were ankle range of motion, knee range of motion, hip range of motion,  and roller massage sit and reach. The researchers discovered that self-myofascial release with a foam roller or roller massage can have short term effects on increasing the joint range of motion without negatively affecting muscle performance.44 Researchers also discovered that self-myofascial release can help after intense exercise.44

2. Myofascial Release Techniques

Castro-Sánchez et al., designed a placebo-controlled trial to determine the effects of myofascial release techniques. In this systematic review 86 patients with fibromyalgia syndrome were randomly assigned to an experimental group and a placebo group.45 The patients received treatment for 20 weeks, with the experimental group going under 10 myofascial release modalities and the placebo group received sham short-wave and ultrasound electrotherapy.45  After 20 weeks of myofascial therapy, the experimental group showed improvement in painful tender points, physical function, and clinical severity.45 At 6 months after intervention, the experimental group had a lower mean number of painful points and pain score.45 The results showed that myofascial release techniques can be complementary therapy for pain symptoms, physical function, and clinical severity, but they do not improve the postural stability of patients with fibromyalgia syndrome.45

A systematic review is a type of literature review that collect and critically analyze multiple research studies or papers. In the systematic review by Beardsley et. al, studies on acute and chronic clinical effects of self-myofascial release were assessed. Researchers concluded that self-myofascial release increases flexibility and reduces muscle soreness but does not get in the way of athletic performance.2 It can also improve arterial function, vascular endothelial function, and increase parasympathetic nervous system activity, which can be useful in recovery.2

A systematic review is a type of literature review that collect and critically analyze multiple research studies or papers. The systematic review by Ajimsha et al. included 19 randomized controlled trials assessing the effectiveness of myofascial release.39 Researchers concluded that myofascial release may be useful alone or in conjunction with other therapies and that treatment effects seemed to be retained.39 Upon further investigation of the specific article reviewed, it was discovered that 11 of the 19 systematic reviews suggested that lack of follow up or use of only immediate follow up measurements may have been limitations to the studies. This makes it difficult to assess the long term effects of myofascial release.

Effective Myofascial Pain Syndrome Treatment: Research Studies

There are over 45 studies support the efficacy of biopsychosocial model (ASTR) for treating chronic pain such as myofascial pain syndrome.

ASTR treats myofascial pain syndrome in a gentle, effective, and natural way by addressing muscle imbalances, scar tissue, trigger points, myofascial restrictions, inflammation, posture, body mechanics which are often the source of the pain. ASTR takes a holistic approach to address the root causes of pain, not just the symptoms. ASTR treatment can be done at home for myofascial  pain syndrome.

References:

1. Fricton J. Myofascial pain: mechanisms to management. Oral and Maxillofacial Surgery Clinics. 2016 Aug 1;28(3):289-311. https://pubmed.ncbi.nlm.nih.gov/27475508/
2. Aredo JV, Heyrana KJ, Karp BI, Shah JP, Stratton P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. InSeminars in reproductive medicine 2017 Jan (Vol. 35, No. 01, pp. 088-097). Thieme Medical Publishers. https://pubmed.ncbi.nlm.nih.gov/28049214/
3. Capo-Juan MA. Cervical myofascial pain syndrome. Narrative review of physiotherapeutic treatment. InAnales del sistema sanitario de Navarra 2015 Jan 1 (Vol. 38, No. 1, pp. 105-115). https://pubmed.ncbi.nlm.nih.gov/25963463/
4. Miernik M, Wieckiewicz M, Paradowska A, Wieckiewicz W. Massage therapy in myofascial TMD pain management. Advances in clinical and experimental medicine: official organ Wroclaw Medical University. 2012 Sep 1;21(5):681-5. https://pubmed.ncbi.nlm.nih.gov/23356206/
5. Laimi K, Mäkilä A, Bärlund E, Katajapuu N, Oksanen A, Seikkula V, Karppinen J, Saltychev M. Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clinical rehabilitation. 2018 Apr;32(4):440-50. https://pubmed.ncbi.nlm.nih.gov/28956477/
6. Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Myofascial pain syndromes and their evaluation. Best practice & research Clinical rheumatology. 2011 Apr 1;25(2):185-98. https://pubmed.ncbi.nlm.nih.gov/22094195/

44. Cheatham SW, Kolber MJ, Cain M, et al. The Effects of Self-Myofascial Release Using a Foam Roll or Roller Massager on Joint Range of motion, muscle recovery, and performance: A Systematic Review. International Journal of Sport Physical Therapy. 2015 Nov;10(6):827-38.

45. Castro-Sánchez AMCAD, Matarán-Peñarrocha GA, Arroyo-Morales M, Saavedra-Hernández M, Fernández-Sola C, Moreno-Lorenzo C. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial. Clinical Rehabilitation. 2011;25(9):800-813. doi:10.1177/0269215511399476.