Advanced Massage article

Dedicated Followers of Fascia! Unravelling the mystery of myofascial approaches By Rachel Fairweather

Are you fascinated by fascia? Marvelling at the magic of myofascial release ? Crazy about craniosacral therapy?

Then you are not alone. Interest in myofascial and fascial related therapies has risen exponentially in the bodywork field over the last 10 years, paralleled by a similar rise in interest in the medical and scientific arena. Just as with it’s location in the body, the ubiquitous tissue of fascia literally seems to be found everywhere at the moment – more articles, more training courses, more clients asking about this work.

Without a doubt adding fascial techniques to your toolbox will enhance your ability to address puzzling pain issues, including those where emotional problems have literally lodged in the tissues. Understanding the nature of fascia can help to unlock the unique mind-body connections that can contribute to complex hurts that have been resistant to other therapeutic interventions. Yet if you are interested in further CPD training, finding your way around the maze of different types of fascia work can be really confusing. What is the difference between direct and indirect fascial work? Is myofascial release different than other types of fascial work? What on earth is Rolfing – was Rolf Harris a bodyworker before he moved onto Pet Rescue!? What has craniosacral therapy got to do with fascia? Read on and your burning questions will be answered!

Let’s start at the very beginning – What is fascia?

To understand fascial related therapies we first have to understand the nature of fascia itself. Most of us who studied Anatomy and Physiology on our qualifying level courses dutifully learned about all the different body systems such as the cardio vascular system, lymph system, digestive system and of course the musculo-skeletal system. Yet very few of us were given more than a passing reference to one of the most important and prevalent interconnected systems in the body– the fascial system. Indeed fascia has traditionally been so ignored in mainstream anatomical and medical thinking (which has then been reflected in bodywork) that prominent fascial researcher and bodyworker,
Robert Schleip, has coined it the “Cinderella tissue”. Yet as we all know, Cinderella finally got out of her dank basement and dazzled at the ball – and currently interest in fascia is rising to such an extent that hopefully over the years to come, a detailed knowledge of the fascial system will be a necessary part of both mainstream medical and complementary therapy anatomical knowledge.

Fascia – the boffin’s definition

For a nerdy definition of fascia lets turn to the International Fascial Research Congress – a wonderful initiative set up by pioneers in the field who have brought together manual therapists and scientists to give us a more full understanding of how fascial therapies work:

“Fascia is the soft tissue component of the connective tissue system that permeates the human body. It forms a whole-body continuous three-dimensional matrix of structural support. Fascia interpenetrates and surrounds all organs, muscles, bones and nerve fibers, creating a unique environment for body systems functioning. The scope of our definition of and interest in fascia extends to all fibrous connective tissues, including aponeuroses, ligaments, tendons, retinaculae, joint capsules, organ and vessel tunics, the epineurium, the meninges, the periostea, and all the endomysial and intermuscular fibers of the myofasciae.”

Fascia – the cheat sheet definition

If that definition made your eyes glaze over lets give you the translated “cheat sheet”. The key phrase in the above definition is “the soft tissue component of the connective tissue system”. Although it is true that all fascia is connective tissue, not all connective tissue is fascia – if you hit your anatomy books for a refresher you will find that for example blood is a form of connective tissue, yet is clearly not fascia. So, in other words fascia is the “soft tissue stuff” that is literally found everywhere in the body – around the brain (meninges); around every muscle fibre (endomysium), around the nerves (epineurium), in the ligaments, tendons and around muscles and bundles of muscles (myofasciae). The mind boggling truth is that all these structures can be considered fascia and furthermore are all interconnected in a gigantic silken spider’s web.

The easiest way of understanding fascia is with the idea that if we had a magical substance that could dissolve everything in the body EXCEPT fascia, we would still be left with a complete 3D representation of the body. Once you have this perspective of a tough silken fascia “body suit” that permeates every structure in the body you can start to appreciate the relevance of fascia to massage. Because fascia is an interconnected system, then strain or tension in one part of the system can cause pain, lack of mobility or other dysfunction elsewhere.

Fascial Work in Massage

The average massage therapist in the UK generally learns no or very little fascial work on their qualifying course; instead most of us are taught a Swedish massage routine which is designed primarily for relaxation and to enhance blood and lymph flow. Although these techniques are a great basis for starting out as a massage therapist, the addition of myofascial techniques will without a doubt enable you to get better results, more clients through the door and a greater satisfaction in your work. Doing effective fascial work requires sensitivity, willingness to follow your intuition, a sense of connection with the body and the development of what we call “listening touch”. I find these qualities usually come easily to massage therapists with good teaching and a little practice – indeed as we often work first with our hands and our heart and our head it can be easier for us to adopt this approach than physios or osteopaths whose training may have been more intellectually driven.

Fascial techniques can be used a treatment in themselves or integrated with other modalities such as trigger point, Swedish massage and stretching. At Jing we definitely favour the integration of techniques in a whole body treatment as we believe in the principle of the “gestalt” – the whole being greater than the sum of the parts. So integrating myofascial work with trigger point and other techniques will often get more effective results than just fascial work alone. In my own clinic I have successfully used fascial techniques to treat pain issues such as low back pain, sciatica, carpal tunnel syndrome, RSI, sporting injuries, rotator cuff problems,
fibromyalgia, pelvic and menstrual problems, IBS, and headaches. I have also used my knowledge of fascial skills in conjunction with therapeutic talk skills to facilitate my client’s ability to identify and work with emotional holding patterns in their bodies which were contributing to their pain patterns. Fascial work is an integral part of every single treatment I do – without a doubt learning fascial release techniques has been the biggest single investment of my career.

Why do fascial release techniques work?

All the approaches to working with fascia believe that the manual forces applied during hands on therapy change the “density, tonus, viscosity or arrangement of fascia” in a permanent or semi- permanent way. There are several theories about why this happens:

Thixotrophy – or the gel to sol theory

Ida Rolf first proposed the theory that connective tissue is a colloid substance in which the ground substance can be influenced by the application of energy (heat/mechanical pressure) to change from a more dense gel state to a more fluid sol state. This characteristic is called thixotrophy. The type of movement required to produce this change is crucial, as it needs to be SLOW. If quick movement is applied to a thixotrophic substance it will remain solid; if slow movement is applied the substance will literally melt under your fingers. The thixotrophic nature of fascia is important when doing myofascial bodywork as with the correct application of technique we can enable this change from a solid to gel state thus releasing long held myofascial restrictions that are causing pain and dysfunction. Although the thixotrophic nature of fascia has long been believed to be the reason for the efficacy of fascial techniques and the “melting” sensation we feel beneath our hands as practitioners, recent research by Robert Schleip and others has questioned this assumption. Schleip points out that the thixotrophic effect is reversible (think of melted butter going back to hard) and therefore doesn’t account for permanent tissue changes. Also research suggests that the amount of force and time required to produce permanent changes in fascia are much greater than that applied during manual therapy.

Piezoelectric Force

James Oschman and others have suggested that the way in which fascia can change its shape is due to a phenomenon known as piezoelectricity. Basically the idea is that pressure creates an electrical current through the tissue – the fascia behaves like a “liquid crystal”. The suggestion is that the electric current stimulates the fibroblasts to alter their activity in the area. John F. Barnes describes it in the following way (Myofascial Release, the Search for Excellence): “Piezoelectric behaviour is an inherent property of bone and other mineralized and nonmineralized connective tissues. Compressional stress has been suggested to create minute quantities of electrical current flow. Like untwisting a copper wire, the techniques can restore the fascia’s ability to conduct bioelectricity, thus creating the environment for enhanced healing. They can also structurally eliminate the enormous pressures that fascial restrictions exert on nerves, blood vessels and muscles. Myofascial release can restore the fascia’s integrity and proper alignment and, similar to the copper wire effect, can enhance the transmission of our important healing bioelectrical currents.”
Schleip points out that the time cycle involved is again too slow to account for the immediate tissue changes felt by the practitioner.

The Role of the nervous system

A newer explanation proposed by Robert Schleip focuses on the mechano receptors found in the fascia – manual stimulation of these leads to changes in tonus of the motor units under the practitioner’s hand. The fascial system and autonomic nervous system are closely linked leading to changes in fascial tonus and ground substance viscosity. This would explain the short-term changes that are felt beneath the practitioner’s hands.

Overview of different Fascial approaches

A “full fascial toolbox” would really encompass techniques not just for the myo-fascia (fascia around and within the muscles) but also the cranial fascia and the visceral fascia. Newer techniques also work on the fascia around the nerves and blood vessels.

Approaches that work on the myofascia – Structural

Integration and Myofascial release (MFR) Techniques are often referred to as “direct” or “indirect”. In the direct method we have a clear concept of where we want the tissue to go to produce a certain effect. This is used in Rolfing and Structural Integration techniques where we wish to produce optimal alignment in the body.

Indirect release is the term applied to releases in which the practitioner follows the direction of ease in the client’s tissues rather than working directly on the restriction first. This is similar to releasing a stuck drawer by pushing it in first. Myofascial release (MFR) uses this approach. In the indirect approach the fascia is
put on a stretch or given slight pressure to initiate a response in the tissues. The therapist then literally “follows” where the tissue wants to go with their hands whilst keeping the stretch. After holding the stretch for between 3-5 minutes the tissue will eventually release in the place where it needs to. This sensation can feel literally magical and can require a level of practice to master.

Some of the most well known fascial approaches are:

• Rolfing or Structural Integration (SI) as developed by Ida Rolf in the 1960s. Rolfing seeks to re-establish proper vertical alignment in the body by manipulating the myofascial tissue so that the fascia elongates and glides rather than shortens and adheres. SI work aims to literally change the shape of the body into more optimal alignment thereby easing pain and dysfunction caused by fascial restrictions. SI work typically takes the body through a series of sessions – 10 in the original “Rolfing recipe”; starting at the feet and working the way up the body to achieve balance and ease. SI approaches incorporate:
– Systematic “body reading” to identify imbalances
– A series of deep direct fascial techniques that incorporate work with fists, fingers, forearms together with active movement by the client. This follows one of Ida Rolf’s great dictums “Put it where it belongs and call for movement.”

• Other Structural Integration approaches: Other SI approaches include KMI (Kinesis Movement Integration) as developed by Tom Myers; Hellerwork (includes dialoguing and
emotional work) and many others. All of these approaches are based heavily on Rolf’s original work and retain most of her original concepts and techniques. For example, KMI uses 12 sessions rather than 10 to incorporate Tom Myers new ideas around the way fascia links together (“Anatomy Trains”). However the techniques are broadly identical to those used by Rolfers and SI practitioners from different schools share more similarities than differences in the way they work.

• Myofascial Release (MFR): originally coined by the osteopath Robert Ward, in the 1980s the term MFR was adopted by a physical therapist John Barnes to describe his method of freeing restrictions in the myofascial system. The overall intention of MFR is to relieve pain, resolve structural dysfunction, restore function and mobility and release
emotional trauma. MFR techniques rely heavily on the ability of the practitioner to use the “listening touch”; tune into the tissues and follow the fascia to where restrictions are held. Techniques taught in this approach usually include cross hand stretches, arm and leg pulls and many others. Some of the techniques taught have a cross over with those from craniosacral therapy (ie: transverse fascial plane releases) or in some cases more direct approaches.

Craniosacral therapy and Visceral Manipulation

Both MFR and structural integration approaches focus mainly on the myofascia – the fascia running through and around the muscles (“myo”). An all round fascial practitioner would also be proficient at techniques that seek to identify and release deeper fascial restrictions ie: that found in the cranium and around the organs.

• Visceral Manipulation: developed by the visionary French osteopath Jean- Pierre Barrall, sees restrictions in the viscera (organs) as primary to other types of pain including musculo skeletal restrictions. Through tuning into the fascial restrictions around the organs with a sophisticated sense of “listening touch”, excellent results can be gained.

• Craniosacral Therapy: Works on the deepest layers of the fascia: the dura mater surrounding the brain and spinal cord. William Sutherland was the osteopath who pioneered this approach to healing by recognising the potential of the cranial bones to move; John Upledger has popularised craniosacral therapy in the last few decades.

There’s all so much exciting stuff! – Where should I start? With all the exciting fascial CPD training around the UK at the moment it’s easy to feel like a kid in a sweetshop – just where should I start with this fascial feast? As a general rule, from my own perspective, I would recommend learning direct or indirect myofascial techniques first then progressing to cranial then visceral work. This is because in my view, the latter techniques require increasing levels of sophistication and refinement of touch and ability to connect with the body tissues. Splash out for a longer training rather than a 1 day workshop as this will not really give you enough experience with the techniques to get results (although can be good as a taster).

I hope this has given you some ideas and confidence to play with training in different fascial approaches. Fascia work is fun, fun, fun and gets astounding results. Keep your work fresh and exciting and you will always have clients coming back for more.

Rachel Fairweather is co-founder and director of the Jing Institute of Advanced Massage Training and a specialist in integrated myofascial approaches. Based In Brighton, London and Edinburgh the Jing Institute runs a variety of courses in advanced techniques to help you build the career you desire. Our Certificate in Advanced Myofascial Releaseis unique in offering hands on skills in all the major approaches described above.

Please call or check our website for further information and course dates: Web: Email: Tel: 01273 628 942

Article published in Massage World Magazine

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