Gary D. Keown, PT and Tim Juett, PT of South Umpqua Physical Therapy Services in Winston, Oregon, have extensive experience in Physical Therapy and Myofascial Release. The integration of the Myofascial Release approach into their Physical Therapy practice has greatly enhanced their success. Their reputation for excellence and resolving difficult cases has led to the growth of four very successful Physical Therapy facilities in Oregon.
Myofascial Release is a relatively new addition to the armamentarium of the physical therapist. Because it is somewhat different from traditional physical therapy, many patients ask questions such as “What is it?” and “How does it work?” Myofascial Release is generally an extremely mild and gentle form of stretching that has a profound effect upon the body tissues. Because of its gentleness, many individuals wonder how it could possibly work. To help you understand, we are providing you with this article.
Fascia (also called connective tissue) is a tissue system of the body to which relatively little attention has been given in the past. Fascia is composed of two types of fibers: A) Collagenous fibers, which are very tough and have little stretchability; B) Elastic fibers, which are stretchable. From the functional point of view, the body fascia may be regarded as a continuous laminated sheet of connective tissue that extends without interruption from the top of the head to the tip of the toes. It surrounds and invades every other tissue and organ of the body, including nerves, vessels, muscle and bone. Fascia is denser in some areas than others. Dense fascia is easily recognizable (for example, the tough white mem-brane that we often find surrounding butchered meat).
When Fascia is Injured
Because fascia permeates all regions of the body and is all interconnected, when it scars and hardens in one area (following injury, inflammation, disease, surgery, etc.), it can put tension on adjacent pain-sensitive structures as well as on structures in far-away areas. Some patients have bizarre pain symptoms that appear to be unrelated to the original or primary complaint. These bizarre symptoms can now often be understood in relationship to our understanding of the fascial system.
Anatomy of Fascia
The majority of the fascia of the body is oriented vertically. There are, however, four major planes of fascia in the body that are oriented in more of a crosswise (or transverse) plane. These four transverse planes are extremely dense. They are called the pelvic diaphragm, respiratory diaphragm, thoracic inlet and cranial base. Frequently, all four of these transverse planes will become restricted when fascial adhesions occur in just about any part of the body. This is because this fascia of the body is all interconnected, and a restriction in one region can theoretically put a “drag” on the fascia in any other direction.
Treating Fascial Restrictions
The point of all the above information is to help you understand that during myofascial release treatments, you may be treated in areas that you may not think are related to your condition. The trained therapist has a thorough understanding of the fascial system and will “release” the fascia in areas that he knows have a strong “drag” on your area of injury. This is, therefore, a whole body approach to treatment. A good example is the chronic low back pain patient; although the low back is primarily involved, the patient may also have significant discomfort in the neck. This is due to the gradual tightening of the muscles and especially of the fascia, as this tightness has crept its way up the back, eventually creating neck and head pain. Experience shows that optimal resolution of the low back pain requires release of the fascia of both the head and neck; if the neck tightness is not also released it will continue to apply a “drag” in the downward direction until fascial restriction and pain has again returned to the low back.
Muscle provides the greatest bulk of our body’s soft tissue. Because all muscle is enveloped by and ingrained with fascia, myofascial release is the term that has been given to the techniques that are used to relieve soft tissue from the abnormal grip of tight fascia (“myo” means “Muscle”).
The type of myofascial release technique chosen by the therapist will depend upon where in your body the therapist finds the fascia restricted. if it is restricted through the neck to the arm, he/she may apply a very gentle traction to the arm, very slowly moving the. arm through range as restrictions are released. If it is ré-stricted in the back (more superficial than deep) he may apply a very gentle stretch on the skin across the back, with the use of two hands. If the thoracic inlet, deep transverse fascia is suspected of being restricted, the therapist may place one hand on the upper back and one over the collarbone area in front and apply extremely gentle pressure.
A key to the success of myofascial release treatments is to keep the pressure and stretch extremely mild. Muscle tissue responds to a relatively firm stretch, but this is not the case with fascia. Remember the collagenous fibers of fascia are extremely tough and resistant to stretch. In fact, it is estimated that fascia has a tensile strength of as much as 2000 pounds per square inch. (No wonder when it tightens, it can cause pain.)
However, it has been shown that under a small amount of pressure (applied by a therapist’s hands)fascia will soften and begin to release when the pressure is sustained over time. This can be likened to pulling on a piece of taffy with only a small, sustained pressure.
Another important aspect of myofascial release techniques is holding the technique long enough. The therapeutic affect will begin to take place after holding a gentle stretch and following the tissue three-dimension-ally with skilled, sensitive hands.
Myofascial Release is gentle, but it has profound effects upon the body tissues. Do not let the gentleness deceive you. You may leave after the first treatment feeling like nothing happened. Later (even a day later) you may begin to feel the effects of the treatment.
In general, acute cases will resolve with a few treatments. The longer the problem has been present, generally the longer it will take to resolve the problem. Many chronic conditions (that have developed over a period of years) may require three to four months of treatments three times per week to obtain optimal results. Experience indicates that fewer than two treatments per week will often result in fascial tightness creeping back to the level prior to the last treatment. Range of motion and stretching exercise given to you will, however, keep this regression between treatments minimal.
Frequently there is increased pain for several hours to a day after treatment, followed by remarkable improvement. Often remarkable improvement is noted immediately during or after a treatment. Sometimes new pains in new areas will be experienced. There is some-times a feeling of light-headedness or nausea. Some-times a patient experiences a temporary emotion change. All of these are normal reactions of the body to the profound, but positive, changes that have occurred by releasing fascial restrictions.
It is felt that release of tight tissue is accompanied by release of trapped metabolic waste products in the surrounding tissue and blood stream. We highly recommend that you “flush your system” by drinking a lot of fluid during the course of your treatments, so that reactions like nausea and light-headedness will remain minimal or nil.
If patients have any questions or concerns that arise concerning myofascial release, they should be encouraged to discuss them with the therapist.
Case History — Chronic Low Back Pain (Post Surgery)
A 32-year old choker-setter had a lumbarlaminectomy in 1983, followed by decompression surgery at the same level in October, 1985. Five months after his second surgery he was referred to physical therapy by his surgeon for three weeks of treatment for chronic low back pain and bilateral anterior thigh pain. His treatment included hot wet packs with concurrent interferential electrical stimulation, a home exercise program and myofascial release to the low back area as well as to the surgical scar itself. After two treatments, there was no further leg pain and only mild low back pain with movement.
After four treatments, the patient called and canceled further appointments because he no longer was having any pain and had returned to his job as a choker-setter. Following up by telephone three months later, he reported having low back discomfort at times and never any leg pain. He is very pleased with his ability to continue his strenuous job. This is the most dramatic improvement I have experienced with any patient having similar symptoms after two or more low back surgeries. The only difference in treatment with this patient was the addition of myofascial release.
Case History — Chronic Dislocating Patella
This 15-year-old female had a history of a chronic dislocating right patella for three years. At age 11 she fell and hit a curb on the lateral aspect of the right knee. Approximately one month later her patella began dislocating. Dislocations gradually became more frequent. She stated that with “just normal walking” the patella would dislocate and she would fall. She had been having constant pain at the lateral aspect of the knee for the past two years. Originally, her patella dislocated about twice per week, and this progressed to daily for a year prior to coming to us for therapy. The only treatment given her was quadriceps and hamstring “sets,” and a trial of two types of braces until she came to see us in June of 1987.
The physician’s referral to us requested SLR quadriceps strengthening and iliotibial band stretching. We treated her five times with ultrasound to the lateral retinacular area of the right patella, followed by myofascial release of the iliotibial band and lateral retinacular She was also given straight-leg raises against theraband with some external rotation of the hips, so as to emphasize strengthening of the VMO.
After the first treatment she had no further dislocations, even when running up and down stairs at home. Follow-up with this patient nine months later, she re-ported having no further problems at all with her right knee.
This patient was a possible candidate for surgical release of the lateral retinaculum of the right knee. Because she had done exercises in the past without reduction of chronic dislocation of the patella, we feel that the rapid resolution of her problem was due primarily to the non-invasive release of the scarred and ad-he red lateral retinaculum with manual myofascial release techniques.
Case History — Myofascial Syndrome, Status Post Open Heart Surgery
This 73-year old patient had open-heart surgery on January 15, 1988. She came for physical therapy on. March 29, 1988, complaining of excruciating pain at the sternal surgical scar region and spreading up the left sternocleidomastoid and into the left upper extremity to the elbow. She also complained of paresthesis of the left side of the face, episodes of dizziness, difficulty breathing when tilting the head back, and lack of pulse in the left side of the neck.
A total of four treatments were given in a ten-day period. They included moist heat, myofascial release and a home program of stretching the neck and shoulders.
Myofascial release was performed over the surgical scar, left chest, left neck, cranial base and left side of the face. A left “arm pull” was also performed. At the end of the fourth and final treatment, she reported feeling “100% improved.” She had no pain. She could feel a pulse again in the left side of her neck, breathing was unrestricted with cervical extensions, there was normal sensation in her face and no further episodes of dizziness. Her six standard cervical motions had improved a total of 40 degrees, including a gain of 15 degrees of extension.
Upon follow-up by telephone exactly four weeks following her final treatment, she reported feeling as well as after the last treatment. She only had “soreness” in the left neck and left axillary region when stretching while doing her home exercises, which I had recommended that she continue daily.
Case History — Status Post Right Mastectomy, and Radiation Burn
This 73-year old woman came for her initial physical therapy treatment on July 14, 1987. She had a right mastectomy in January, 1986. She received one year of chemotherapy following surgery, then six weeks (30 treatments) of radiation therapy. She had irregular shaped radiation burn with hypertrophic scarring over the distal third of the sternum (of approximately 6-7 mm. diameter). The right shoulder was drawn forward. The right shoulder and chest were extremely hypersensitive to mild touch and minor movement of the right shoulder. The radiation scar still had a small area of scab. She was referred to us as soon as the physician felt that the burn was sufficiently healed to begin physical therapy. Right shoulder external and internal rotation range of motions were within normal limits. Active flexion and abduction (standing) were respectively 0-130 degrees and 0-97 degrees.
She was given a home program of cane exercises and treated a total of 15 times (ending August 21, 1987) with moist heat and myofascial release to the chest, right upper extremity and neck. At the final treatment she had 160 degrees of motion of both right shoulder flexion and abduction (equivalent to the contralateral motions). She had no further discomfort, except for mild tenderness when pushing her range of motion exercises to the end of range.
On follow-up with this patient over seven months later, she had maintained her range of motion and reported no limitations of function and no pain. She felt fully recovered in every way other than “some tightness at the site of radiation.” She expressed how thoroughly grateful she was for the remarkable increase of motion and reduction of pain which occurred with such gentle and relatively painless techniques.
Tim Juett, PT
With 80% of Guatemala’s rural population living below the poverty line. Loving arms promotes income-generating opportunities by encouraging people to start small businesses with the expectation of achieving long-term economic stability and self-sufficiency. The income-generating initiatives of loving arms include co-operatives in individual villages and also initiatives that link multiple villages.
We coordinate volunteer work teams to travel from Canada to Guatemala at least twice yearly to support and work on various projects. We distribute food, donated clothing, hygiene projects, school supplies and other miscellaneous items in the communities in Parramos and Parrojas & Parajax. We coordinate free medical and dental clinics in the community of Parramos using the services of local volunteer doctors and dentists and we distribute donated medical and dental supplies. We support outreach programs in these communities. We provide programs and activities including youth sports, crafts workshops, and bible studies.
Magnolia Rehab specifically sponsors a child beginning school in Parramos. Our sponsorship covers the cost of the school and supplies for the entire year.
L.A.W. Publications (Child Identity Theft Program):
The primary purpose of L.A.W. Publications is to educate children and adults about the dangers of alcohol and drug abuse, as well as a variety of safety issues such as identity theft and gang-related violence prevention. We hope to accomplish our purpose by:
Working hand in hand with local law enforcement agencies.
Developing and publishing up-to-date educational material.
Providing exceptional service to law enforcement and the communities that they represent.
Every Year Magnolia Rehab sponsors the cost of Finger printing every child in Starkville, MS for Identity Theft purposes.
Sally Kate Winters:
Since the inception of the Sally Kate Winters Memorial Children’s Home in 1990, the mission of the program has been to offer the gift of humanity, love, and respect to children traumatized by child abuse and neglect. This mission has allowed the program to provide emergency shelter services to numerous children in need of a temporary, safe-haven while permanency was being sought for their lives. Through the years, additional programs were added to support children and families through an effort of preventing child abuse, neglect, and family violence. In 2006, the Sally Kate Winters Memorial Children’s Home began a proactive transformation to include new services, existing services, and a uniform agency approach that would most effectively serve local children and families.
Today, Sally Kate Winters Family Services remains committed to providing a continuum of care and comprehensive array of services for children and families that will empower them to seek an improved quality of life.
Every Year Magnolia Rehab sponsors the big Sally Kate Winters 5K Run/Walk which takes place in downtown West Point during the national child abuse prevention month (April).
Our service is directed to families who have suffered the loss of a loved one. It is designed to provide these families with the sincere and necessary feelings of comfort, consolation and hope during the most difficult time in their lives. Its uplifting message leaves a positive and indelible impression on the families.
Magnolia Rehab sponsors the publication of the book entitled “Lift Up Thine Eyes”. These books are distributed to local funeral homes in Columbus and West Point MS. They are handed out to the families who have lost loved ones.
The Arc of Clay County:
The Autism NOW Center provides high quality resources and information in core areas across the lifespan to individuals with Autism Spectrum Disorders (ASD) and other developmental disabilities, their families, caregivers, and professional in the field. Focus areas include: Early detection, Early intervention, and Early education; Transition from high school into early adulthood; Community based employment; Advocacy for families and self-advocates; Community Inclusion; Aging Issues; Policy; Implementation of Health Care Reform, including Long Term Care Services and Supports; Family and Sibling Support; and Networking in local, state, and national arenas.
Magnolia Rehab sponsors the Arc of Clay County through the donation of funds for tickets sponsoring a silent auction showcases 15 local artists which are paired with the arc class and the students from the T.K. Martin Center. These students will create masterpieces along with the local artists that will be auctioned off. All donations will benefit the Arc of Clay County.
The Public Relations Institute – Childrens Books
This organization works with daycares and daycare providers to give children and their families of 3 and 4 year olds an activity book entitled “A Special Gift”
The content of this book includes the importance of faith, family, freedom, nature, and friendship are all emphasized. This volume will be especially inspiring and helpful to parents and the childcare provider as they begin to instill positive values in their children.
Magnolia Rehab provides these books to the local daycares in Columbus, West Point, and Starkville, MS.
T.K. Martin Center:
The Mission of the T.K. Martin Center for Technology & Disability is to ensure that persons with disabilities are able to continually benefit from technological solutions and advances in the field of assistive technology.
In order to empower individuals with disabilities through leading edge technologies the T.K. Martin Center for Technology & Disability maintains a state of the art clinical, research and training program focusing modern technologies, in a comprehensive and integrated manner, to the needs of persons with disabilities.
The services of the T.K. Martin Center are made available to persons with disabilities regardless of age or diagnosis. Impairment has many limiting effects, which can be broadly categorized into the following, none of which is mutually exclusive:
- seeing and hearing (sensory function)
- learning and understanding (cognitive function)
The T.K. Martin Center provides comprehensive, multi-disciplinary evaluations to remove these limitations through the application of assistive technology, allowing individuals to participate in educational, vocational and leisure activities to the fullest degree they choose. The comprehensive nature of the services offered ensures that the correct solutions are achieved efficiently and effectively, with needs being met in a one-stop shop.
The staff of the T.K. Martin Center consists of a specialized team of Speech-language Pathologists, Occupational Therapists, Special Educators, and Rehabilitation and Biomedical Engineers. Facilities at the center include adaptive computer laboratories, design and fabrication workshops, a vehicle augmentation lab, a seating and mobility center and specialized evaluation rooms. The fusion of modern facilities and resources with a staff dedicated to the realization of untapped human potential ensures a comprehensive approach with integrated, composite outcomes for persons with disabilities.
The T.K. Martin Center is unique in the field of Assistive Technology because it is a direct clinical service center located on the campus of a major research university. This allows academic programs the opportunity to experience first hand the benefits of assistive technology as well as promote interdisciplinary research crucial to the application of assistive technology. The clinical service aspect of the Center also provides a site for practicum, internship, and cooperative study placements of students from Mississippi State University as well as other universities and training programs.
Magnolia Rehab sponsors the T.K. Martin Center through donations which also helped in the opening of the new T.K. Martin Center classroom in West Point, MS.
American Cancer Society (Relay for Life):
Every year Magnolia Rehab participates in Relay For Life which is an annual fundraiser for the American Cancer Society.
Magnolia Rehab donates money as well as employees of the company participating in the fundraising events.
Lymphedema is a progressive disorder, and comprehensive management requires an interdisciplinary effort.
Lymphedema can affect any part of the body and can be of varying volumes. It occurs when there is an inability to remove lymphatic fluids, due to either genetic insufficiency or known cause of damage to the lymphatic system. In later stages there may be fibrotic tissue changes and increased fatty tissue. Lymphedema may be diagnosed by a primary care physician, general surgeon and/or vascular surgeon. Its prevalence worldwide is well over 100 million people, and in the U.S. exceeds 6 million. Individuals with lymphedema may be referred to a physical therapist who has received specialized training in Complete Decongestive Therapy for Lymphedema (DLT) treatment and management.
Anatomy and Function of the Lymphatic System
The lymphatic system collects excess interstitial fluid, protein, waste products and fat that have not been absorbed at the venous capillary level. From the body tissues, the lymphatic system transports and filters these constituents back to the venous system. There are lymph capillaries under the skin, and as the lymph transport vessels join and travel deeper in the skin, they are known as the lymph collectors. Collectors are characterized by having one-way valves and intrinsic contractibility to propel fluid towards the nearest lymph node bed. Lymph nodes filter noxious matter, such as dead cells and bacteria; produce white blood cells; and regulate the concentration of protein in the lymph.
The body is divided into the upper and lower body at the waist, and right and left at the midline; therefore, the flow of lymph to the regional lymph node beds is divided into four quadrants or watersheds. The regional lymph node beds are located in the inguinal groin for the lower quadrants, and in adjacent axillae for the upper quadrants. The head and neck drain separately into the supra clavicular area. From the regional lymph node beds, the lymph is transported deep into lymphatic trunks. From both legs and to left upper quadrant, drainage is into the thoracic duct, which lies in front of the spine. The R upper quadrant drains into the subclavian vein. The lymph is returned to the vascular system via the superior vena cava.
Types of Lymphedema
Primary Lymphedema is due to an insufficiency of the lymphatic system. The best estimates indicate that about 1 percent of the U.S. population presents with varying degrees of primary lymphedema. Primary lymphedema that is seen at birth or shortly afterwards is called congenital lymphedema, or Milroy’s syndrome, and is most common in one leg of boys. Primary lymphedema that presents during puberty is known as Miege’s syndrome and is most common in females, usually involving lower extremities.
Secondary Lymphedema is due to a known cause of damage to the lymphatic system. Damage can be either due to a medical condition or intervention. The most common form of secondary lymphedema worldwide is caused by an infection known as filariasis, which is caused by a mosquito-borne parasite that resides in some tropical regions of the world. Secondary lymphedema is the most common form of lymphedema in the U.S. and is normally seen secondary to cancer-related treatments or occlusion by cancer. Secondary lymphedema may also occur as a result of radiation treatment, scar tissue, history of multiple surgeries or obesity.
Combined Lymphedema is called phlebolymphostatic lymphedema and is due to chronic venous insufficiency. Damage to the lymphatic system is due to over-use over several years, often decades. Venous stasis ulcers are sometimes seen with combined lymphedema.
Stages of Lymphedema
Lymphedema is staged and starts with Latency, where the lymphatic system is compromised and subjective complaints occur. There may be no visible or palpable edema. Stage I, or Reversible Lymphedema, is an accumulation of fluid, and pitting edema may be present. Swelling at this stage reduces with elevation. Stage II,known as Spontaneously Irreversible Lymphedema is characterized by pitting becoming progressively more difficult because fibrosis of the tissues occurs. In Stage III, known as Lymphostatic Elephantiasis non- pitting fibrosis and sclerosis is present. There are skin changes, which include papillomas and hyperkeratosis. There is an increased risk for cellulitis, especially in Stages II and III due to high levels of interstitial protein, which are inviting to bacteria.
Management of Lymphedema
While there is no cure for lymphedema, the condition can be managed through a combination of early detection, clinical treatment, education and home management.
In the early stages of lymphedema, when very mild swelling is present, the condition is managed by compression garment wear, exercise and elevation.
If the condition progresses, management is by Complete Decongestive Therapy, which includes two phases. The first phase is Manual lymph drainage (MLD), which is a gentle manual treatment that reroutes the lymph flow around the blocked area to unaffected collateral segments. MLD is followed byLymphedema compression bandaging, which is a multi-layered system of short stretch, non-elastic bandages which are applied over foam padding to create a compression gradient. Benefits of lymphedema bandaging include a reduction in the return of lymph to the involved area once mobilized by MLD, decrease in fibrosis, reduction in the production of new lymph and an improvement in the efficiency of the muscle and joint pumps. Padding is used to decrease excess pressure in areas like the maleoli and medial epicondyles. Remedial exercises are given once the bandages are in placeand positively affect the lymphatic system through the influence of muscle contractions and deep breathing.Skin and nail care is important for good management of skin through effective moisturizing and first aid treatment of cuts and bites. Instruction in self-care is very important as DLT allows for management of lymphedema and is not a cure.
Once the edema volume has been minimized in phase 1, patients are measured for compression garments, which they are encouraged to wear daily to maintain gains. Patients and/or caregiver education is an important component of lymphedema management to insure individuals are able to manage their condition at home. Follow up with a therapist every 6 months is indicated so the lymphedematous limb can be evaluated and measurements taken for new garments.
Goals of Complete Decongestive Therapy include
- volume reduction of fluid and fibrosis
- restoration of tissue mobility
- restoration of joint range of motion
- prevention of infection
- improved cosmesis
- improved quality of life
Lymphedema is a progressive disorder, and comprehensive management requires an interdisciplinary effort. Effective long-term management will enhance quality of life.
Additional resources include:
- National Lymphedema Network, http://www.lymphnotes.com/
- Lymph Notes, http://www.lymphnotes.com/
- Step up-Speak Out, http://www.stepup-speakout.org/
- National Institute of Health (NIH), http://www.nlm.nih.gov/medlineplus/lymphedema.html
Sally Micucci is a physical therapist working for Genesis Rehab Services, Gorham, NH, and is a master clinician in lymphedema management. Sally has had training for Manual Lymph Drainage from the Upledger Institute and did her Complete Decongestive Therapy training with the Norton School in November 2007. Sally graduated from Pinderfields College of Physiotherapy in Wakefield, UK, 16 years ago and has been working in the U.S. for 13 years.
Foldi’s Textbook of Lyphology, 2nd Ed.
Position Statement of the National Lymphedema Network. Topic: Exercise. http://www.lymphnotes.com/article.php/id/401/
MYOFASCIAL RELEASE THERAPY is a treatment that involves a mild and gentle form of stretching the fascial connective tissue. When an injury scars or hardens the facia in one area, it can put tension on other areas of the body even some distance from the injured area.
MYOFASCIAL RELEASE THERAPIST specialize in helping to alleviate the pain and restore functional ability for patients. Generally, cases will resolve with four to twelve weeks of treatment, two-to-three times a week. However, when working with chronic pain patients it could take more therapy than the “average” patient. Experience indicates that fewer than two treatments a week will often result in fascial tightness creeping back to the level prior to the last treatment. The key to success is the teamwork between the practitioner and the patient with both being actively committed to the short-term treatment program. Magnolia Outpatient Rehabilitation offers their services for people who have been injured in an auto accident, at work, or who have been involved in a personal injury. Our team of certified and licensed professionals administer a program that is designed to keep the patients directly under the medical guidance of their referring physician, who in turn will provide all of the care and services that they feel are necessary in conjunction with the MYOFASCIAL RELEASE treatment. Typical programs run from four to twelve weeks depending on the health care provider’s direction.
FASCIA – A specialized system of the body that has a similar appearance to a spider web. It is a single connective tissue that lines and covers nearly every muscle, nerve, bone, artery, and vein as well as all our internal organs from the top of our head down to our toes. As you can see, it plays an important role in the support of our bodies.
|The John F. Barnes’ Myofascial Release Approach is considered to be the ultimate mind/body therapy that is safe, gentle and consistently effective in producing results that last.Fascia is a tough connective tissue which spreads throughout the body in a three-dimensional web from head to foot without interruption. Trauma, posture or inflammation can create a binding down of fascia resulting in excessive pressure on nerves, muscles, blood vessels, osseous structures and/or organs. Since many of the standard tests such as x-rays, myelograms, CAT scans electromyography, etc., do not show the fascial restrictions, it is thought that an extremely high percentage of people suffering with pain and/or lack of motion may be having fascial problems, but most go undiagnosed.The viscoelastic quality of the fascial system causes it to resist a suddenly applied force. This explains why the “old form” of myofascial release which was an attempt to force a system that cannot be forced produced pain and limited results.The John F. Barnes’ Myofascial Release Approach consists of the gentle application of sustained pressure into the fascial restrictions. This essential “time element” has to do with the viscous flow and the piezoelectric phenomenon: a low load (gentle pressure) applied slowly will allow a viscoelastic medium (fascia) to elongate.