How does the Myofascial approach help to resolve pain and improve mobility?
Pain is one of the most common reasons for a patient’s visit to a doctor’s office. Research shows that 30% of patients with pain complaints seen in a doctor’s office had myofascial pain and 85% of patients presenting to a specialized pain clinic had myofascial pain. Postural stresses, inefficient biomechanics, and repetitive use are the most frequently described causes of myofascial pain syndrome.
What is Myofascia?
The word fascia is often misunderstood for the face as in “facial”. Fascia also refers to the roofing or siding material which is similar to the fascia of the human body. They both refer to the framework of either the house or in this instance the soft tissues of the human body.
So, what is fascia? – Fascia is a band or sheet of connective tissue, primarily collagen, beneath the skin that “attaches”, “stabilizes”, “encloses”, and “separates” muscles and other internal organs. It is further classified into superficial fascia, visceral fascia and deep fascia. Myofascia refers to the deep fascia covering the muscles, tendons and its associated structures that I would cover in this article.
Myofascia has a multitude of functions including,
- Force transmission
- Movement
- Stability
- Proprioception (joint position sense) throughout the body
- Promoting sliding and reducing the friction associated with motion.
A brief understanding of the structure of a muscle would help us to understand this better. A muscle belly is made up of several bundles of fascicles and each fascicle is made up of several myofibrils, as shown in the picture below. Each entity is covered by fascia which forms the myofascial layers which gives them the form and structure. The Myofascial layers have a lubricant named Hyaluronic acid (HA) which enables free sliding of the muscle fibers during movement.
When there is an increased stress on the myofascia resulting from injury or over-use this lubricant becomes thickened and stiff becoming a source of restriction. Myofascial stiffness has been shown to cause weakness and tightness which leads to improper movement patterns. This causes excessive tissue strain and overload of joint structures and nerves resulting in pain and dysfunction.
Mobilization of this dense myofascia to restore the gliding along the fascial layers followed by appropriate exercises and ergonomic corrections can therefore resolve pain and improve mobility.
What type of problems can be treated?
Myofascial dysfunction is associated as a primary contributing factor in several orthopedic conditions. Some of the common conditions include,
- Mechanical low back pain
- Sciatica
- Neck pain associated with postural stress as seen in desk job workers
- Plantar fasciitis
- Knee pain (early osteoarthritis)
- Frozen shoulder
- Carpal tunnel syndrome
- Rotator cuff dysfunction
- Trochanteric bursitis (hip pain)
- Groin pain
- Iliotibial band syndrome
- Patellofemoral dysfunction
- Thoracic outlet syndrome
- Tennis elbow
- Repetitive stress injuries
- Muscle tendonitis
- Tension Type Headaches
If you have pain and lack of mobility, consulting a health care professional such as a Physiotherapist with good understanding of the anatomy and biomechanics of the human body with knowledge and expertise in myofascia may benefit you.
References:
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3. Skootsky SA, Jaeger B & Oye RK. Prevalence of myofascial pain in general internal medicine practice. The Western Journal of Medicine 1989; 151: 157–160.
4. Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Current Pain and Headache Reports 2001; 5: 412–420.
5. Annaswamy TM et al; Emerging concepts in the treatment of myofascial pain: a review of medications, modalities, and needle-based interventions. ; PM R. 2011 Oct;3(10):940-61.
6. Kumka M, Bonar J. 2012. Fascia: A morphological description and classification system based on a literature review. J Can Chiropr Assoc 56:179–191.
7. Tuulia L, Mika P., A Practical Guide to Fascial Manipulation: An Evidence and Clinical-Based Approach. 38-40. Elsevier; 2017.
8. Stecco C., Fede C., Macchi V., Porzionato A., Petrelli L, Biz C, Stern R., and Caro R., The Fasciacytes: A New Cell Devoted to Fascial Gliding Regulation. Clinical Anatomy 31:667–676 (2018)
9. Stecco L, Stecco C., Fascial Manipulation: Practical part. Piccin; 2009.
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