Fascial theory

What is fascia?

Fascia is a network of collagen fibers that covers and connects every structure in our body, from the largest muscles and organs to the smallest arteries, and even the membranes of each cell. It is like a high-tensile plastic wrap that both separates everything in our body, and then holds it in place. Like fascia, tendons and ligaments are also made from collagen; all three are “connective tissue.” Ligaments join one bone to another, tendons join muscle to bone, and fascia connects muscles to other muscles and to the skin.

From the Greek for glue, collagen means “glue producer” and refers to the early process of making glue from animal products. The seamless, continuous web of collagen glues the body together and integrates all its structures. Collagen is also the main component of gelatin.

The Fascial Research Congress offers a more complete definition: “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” (fasciacongress.org).

What is myofascial release?

Myo- is Greek for muscle. Myofascial release (MFR) therapy manipulates both muscles and their connective structures to “release” restrictions and achieve long-term improvement to a body’s functioning. Unlike many forms of “complementary alternative medicine,” this type of bodywork has been shown by objective scientific studies to be effective; see about evidence-based medicine.

Interestingly, lengthening the fascia by external touch has many of the same effects as doing yoga. In yoga you stretch entire groups of muscles at a time, like when you lean forward to touch your toes. As you hold that pose for 30 seconds or longer, you gradually lean farther forward as the tissues elongate. Therapists “do yoga” on just one muscle at a time, using their own hands to slowly apply the stretching force. This lengthens your muscles and tendons and you feel looser, lighter, longer.

Rolf herself was a dedicated member of one of the first hatha yoga groups in New York city in the 1920s, and believed yoga to be one of the most effective forms of self-healing. When she began to learn manual therapy and osteopathy to heal others, her first intent was to help them get into yoga poses, using both her hands and movement re-education to gently (and not-so-gently!) guide their bodies into positions of free movement. To the receiver’s nerve receptors, there’s not much difference between putting her/his own body into a position of stretch, vs a therapist using their hands to stretch the tissues. Because both can have the same effect, I think of Rolfing as applied yoga.

There are two very different approaches to MFR, referred to as direct vs. indirect techniques. Though these two often look and feel nothing alike, they are both termed myofascial release because they share similar theories and a similar therapeutic intent. Rolf’s style is most closely aligned to what later became termed “direct” myofascial release, though with her osteopathic training she also had a focus on shifting bones and including active client movement. Later practitioners like John Barnes used a much slower, gentler approach with less movement, which they termed “indirect” release. See more here.

For an excellent overview of the history and theory, see a chapter from the book Modalities for Massage and Bodywork by Keith Grant and Art Riggs, “Myofascial release.”

What’s the difference between Swedish massage and Structural Integration?

People seek bodywork for two reasons: they want to feel good, or they want to stop feeling bad.

For someone who’s feeling stressed, who just wants to chill and be soothed, a good relaxation-style massage is wonderful. Relaxation-style treats the body by kneading tight muscles and gentle-touch techniques on the skin. This lowers the resting tone of the sore muscles. It includes sensory experiences with long flowing strokes, slow deep breathing, pleasurable rocking of the limbs to allow release of tension, and music designed to lower stress.

But if someone hurts, like from an old injury or a demanding job, they want the pain to go away. They get the best relief from therapeutic massage. I practice two forms: (1) deep-tissue myofascial, which is done through gentle-but-deep pressure combined with moving the muscle, aka “Soft Tissue Release,” and (2) a modified style of structural integration, a contemporary form of Rolfing called “Myofascial Integration — Posture Alignment.”

Myofascial therapy can different from Swedish in that it doesn’t necessarily follow a choreographed flow for the sake of bringing pleasure, but rather just fixes things. It focuses on imbalances of posture, shortened muscles, and restricted fascia like adhesions or scars. It addresses not just the muscles or the skin, but on the bigger-picture, the multi-joint structures. This can lengthen, separate, or reposition them relative to other structures. It uses no lotion, to get a better grip on the tissues and transmit lengthening forces through the skin.

This kind of therapeutic massage feels different from a relaxation one in a few ways. It has a goal, or focus: fixing whatever injury or pain you’re having, or addressing the balance of the entire body and the relationships between its structural and functional systems. It also involves more participation from the receiver (like my asking “stretch this way and inhale”), and doesn’t have as much sense of soothing flow. Because it’s more like physical-therapy than a spa experience, it is usually done with clothing, like a swimsuit or underwear/bra, and draping is only used for warmth and comfort. Many practitioners prefer not to even call it massage (see Rolfing is not massage).

Rolfing-style work is also done very slow and requires focussed concentration. Its very nature lends itself to a state of meditation, both in the giver and the receiver, and so it is often done in silence.

What’s the difference between deep-tissue massage and myofascial?

Most simply, myofascial is deep tissue applied with a line of tension. They might look the same to an outside observer, but to the therapist and the client they feel very different. Both have the intent of working with deeper layers, and both often have the client move a joint to induce movement of the muscle underneath the therapist’s applied pressure.

Myofascial usually involves holding a sustained tension on tissues (indirect release) or making the tissues move in a certain direction (direct release). Both effect a sense of “travel,” of things moving. This is how it can alter posture, improve inefficient movement patterns, and release counterproductive holding patterns. It affects skin, muscle, fascia, and even the positioning of bones. It can feel intense, but not always deep. Little or no oil is used, so the skin is (gently) stretched along with underlying tissues. The modality trademarked as “Active Release Techniques,” usually performed by chiropractors, is a form of myofascial.

Deep tissue is focused work on specific groups of muscles for structural therapy and local soreness. It can feel deep, but not always intense. Lotion or oil are often applied, and there is sometimes a glide over the skin but not necessarily a stretching sensation. The modality termed “soft tissue release,” or more generically “pin and stretch,” is a common deep-tissue technique.

Both myofascial and deep tissue have their origins in osteopathy and Rolfing. Many therapists use the terms interchangeably, and practitioners will often have their own definitions and techniques, so the terms are not standardized.

See also a presentation I did for the runner’s clinic at the Running Room on this topic, wintersbodyworks.com/runningroom.

“Indirect” vs. “direct” myofascial release

The term “myofascial release” has no standardized meaning, and different techniques can look and feel completely different.

The indirect release style popularized in North America by John Barnes, similar to the later style of Walt Fritz, uses very slow pressure called “unwinding” which feels like it’s working in the tissue’s natural direction. The therapist’s hands might remain in one spot for 5 minutes or more, maintaining a sustained but often light pressure with minimal movement, and often applying pressure at a shallower angle. See for example a short video of Fritz demonstrating his “start by doing nothing” approach, in which his hands seem to barely move or apply any pressure, but which can still feel very effective or even deep. Indirect approaches are intuitive, allowing the body’s awareness to guide the touch.

By contrast, Rolf’s original style of direct fascial work involves more tissue movement, working into the direction of greater resistance, and sometimes uses a steeper angle of force — though with her intuitive eye, often she only had to press and hold one key spot, without moving tissue, to effect a release. While it doesn’t hurt if applied slowly and considerately (again: “it’s not how deep you go, it’s how you go deep”), it can still feel more intense. Rolf’s work was also informed by osteopathy and its focus on shifting bones to improve function, and her own work usually called for the client to do movements too. Unlike the more communicative/interactive client-guided indirect style, with direct release it’s the practitioner who decides where things should go, and then puts them there.

Some modalities can feel like myofascial release even if the therapist doesn’t use, or even disagrees with, the term. For example, Diane Jacobs’ Dermo-Neuro Modulation (DNM) looks similar to Barnes’ style, and Michael Leahy’s Active Release Technique (ART) can be quite similar to Rolf bodywork, but neither practitioner calls their work myofascial.

As our understanding of how it works evolves over the decades (from a more mechanical intent to a neuroplasticity model), myofascial therapists have tended to become less heavy-handed and more gentle, intuitive — more indirect. Most of my work uses the direct approach only because I personally find that it produces a more profound effect. But many people, e.g. those with fibromyalgia or sensitivity or delicate skin, prefer something even slower and more gentle feeling. And after learning Rolf’s original style from one of her earliest students, Ed Maupin, I’ve begun incorporating more movements and an awareness of refined joint motion. I tailor my style to each body’s preference.

See a further discussion of these two terms in the article Myofascial Release (p. 156), which has this helpful summary: “Often, direct-release techniques will offer immediate change at a faster pace, so clients experience more noticeable benefits in a shorter period of time. In contrast, some people release more quickly if encouraged to follow their own patterns. If too much pressure is applied and the work is overly intense or painful, the tissue will resist and less will be accomplished.”

How does it work?

Structural Integration can improve posture, correct inefficient movement patterns, and ease chronic pain. For some people, it can be more effective than relaxation massage.

Some practitioners believe that manual therapy can significantly lengthen and repattern fascia. But collagen is extremely resilient material — it has to be, given the huge stresses of pressure and tension placed on tendons. It is unlikely that any real change could be effected in the fascial structure of the body without aggressive work, like for example the stretching routines of a gymnast or the focused techniques of cross-fiber friction.

Rather, the benefits of myofascial are from neuro-muscular proprioception, which just means our body’s sense of itself. Pain and tension sometimes has a physical cause in the muscle, e.g. a trigger point, but most tension has a different cause. It is set by the nervous system. The brain itself decides how short and tight, or how long and loose, each muscle is. When we do a daily stretching routine we might be lengthening the collagen network a tiny amount, but mostly we’re retraining our brain to accept a longer length for that structure. Tiny sensors in our muscle called Golgi Tendon Organs will gradually allow us to stretch more without triggering pain and the sense of “that’s as far as it’ll go!” Once the muscles are in their new position or the fascia has “repatterned,” the brain will remember this new length and sense of ease. It is a neuro + muscular change.

One thing I include in my routines to achieve this reset is the Trager Method, which is described in more detail at my other site (and by coincidence or confluence Dr. Trager and Dr. Rolf both taught at Esalen around the same time).

Trager’s techniques of gentle traction and movement combined with awareness-focusing can help “reset” a part of the body, or alter its proprioception — its sense of self in relationship to gravity. This eases old holding patterns and brings awareness of held tension through biofeedback.

I make the movements somewhat random: by varying the speed, rhythm, or amplitude of the rocking-like movements, the receiving body can’t predict the movements, so it can’t as easily hold muscles that are unnecessarily tight or unconsciously guarded. During the gentle traction, the client visualizes “what could make this movement feel more free? What could make it feel more light?” and can thus tune in to muscles that are holding. This produces a deep type of relaxation and looseness, one that can sometimes be felt days later.

A Rolfer would say: the therapist isn’t imposing a change upon a client’s body, but rather helping the body remember its original childhood state of being light in gravity, unhindered by injury and use. It’s a form of bodywork that sticks with you, that stays: because your body likes the feeling of the new freedom, the new patterns will imprint.

Applying pressure and stretch to fascial structures can free “stuck” layers by manually separating and lengthening the fibers, softening the ground substance, improving hydration and vascular flow, and activating a release in the Central Nervous System. I think of the process as “meet, melt, move.” First I make initial contact, I meet the body. I then slowly sink in, allowing the receiver’s awareness to welcome the touch, which feels like melting into the tissues. Finally, and this is the most important, I slowly begin to move, to induce a sense of “travel.” This is accomplished first by taking up slack in the fascial fibers — it stretches the zig-zag crimp. Imagine slowly pulling on the edges of a piece of corrugated cardboard: the crimping flattens and lengthens. But that’s only the start! By maintaining a gentle traction for many seconds or even a few minutes, the “ground substance” of the fascia — the jello-like matrix which holds and houses and nourishes the collagenous network — can begin to stretch. Unlike pulling on corrugated cardboard, this is more like stretching taffy. If you pull taffy fast when it’s cold, it’ll snap. But warm it and take things slow, and the taffy will effortlessly achieve a new shape. This process also re-hydrates the tissues, almost like squeezing a sponge repeatedly under running water. You can see the process of vascular rehydration in real life in this fascinating video Strolling under the Skin. Finally, regarding the involvement of the CNS, this topic is too vast and subtle to engage in here, so instead I direct the reader to explore Diane Jacobs’ dermo-neuro-modulation (DNM).

A last factor, thinking of the taffy example above, is warming up the tissue. Collagen has a property called thixotropy, which means that it resists fast movement or changes while it’s cold, but gets pliable when it’s warm or moved slowly. It’s like Jello, which is also made from collagen. Warming up the soft tissues (superficial fascia and skin, muscle, fascia around muscle, and tendon) through Swedish massage, hot packs, or slow lengthening allows the collagen to release. One of the best ways to warm up the fascia to painlessly stretch it is hot stone massage. The heat and density of the stones swiftly softens muscles and other tissue. While the thixotropic effect goes away as soon as the heat/pressure are released, the sense of looseness remains.

Some possible mechanisms for how it works
(adapted from Stanborough’s Direct Release Myofascial Technique, 2004)
  • stimulating Golgi tendon organs inhibits tone
  • stretching Ruffini receptors inhibits sympathetic nervous system
  • increased parasympathetic response relaxes the whole being
  • … which in turn relaxes smooth-muscle fibers in fascia
  • stimulating interstitial receptors and fibers increases ground substance renewal
  • stretching muscle spindles lowers tone
  • inhibiting afferent signals to the brain (“gamma gain”) resets unconscious resting tone (“gamma bias”)
  • releasing mechanical restrictions to breathing improves blood chemistry and increases a sense of well-being
  • assisting lymphatic and blood flow quickens healing and awakens sensation
  • ineffectual holding patterns (“co-contraction”) are reduced, resulting in freer movement
  • the thixotropic release, while temporary, remains as a sense of looseness — similar to how a chiropractor’s quick cracking of a joint provides lingering sensation even though the adjustment itself is split-second
  • emotional contraction patterns (e.g. slouching as a way of guarding against a sense of vulnerability) are corrected, allowing for a sense of lightness-in-gravity and lightness-in-spirit
  • decompressing the whole organism improves the relationship with gravity and one’s environment, both external and internal, increasing the sense of confidence
  • communication in the therapeutic relationship — communication via touch, talk, and interpersonal connection — can alter one’s old model of self and improve self-esteem
  • general neural plasticity, along with ground-substance expansion, leads to better movement
  • the overall sense of self in gravity and space (“proprioception”) is integrated and enhanced, leading to immediate improvements in the sense of health

The exact mechanisms by which fascial therapy works are not yet fully understood, but that it does work is evident to most who’ve tried it. It could be merely a matter of cutaneous sensory/nerve input, as hypothesized by Jacobs’ DNM. Some other examples of what might be happening are given in these articles, If We Cannot Stretch Fascia, What Are We Doing? and We Have Much to Learn from Fascia Research.

I conclude with the immortal words of Rolf herself: “I don’t know why it works, I only know that it works. I invent all these explanatory rationalizations later on.”

Further reading

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