When we think Myofascial Release (MR) we think of foam rolling, “mashing”, laying on a lacrosse ball, getting a massage or deep tissue massage, receiving gratin technique, or maybe even manual therapy from physical therapist. You go in to the clinic or you grab whichever torture device you so choose and for the next (5 minutes for most) 10 minutes to an hour or so we allow ourselves to be put in pain. You jump, cry, wince, moan and groan but afterwards we may be bit soar but we feel better, looser, more mobile. But why?

The original thought process for manual therapy (synonymous with MR in this piece) and why it worked was defined as the biomechanical model. Wellens summarizes this model as the following:

“To summarize this model, it is proposed that biomechanical dysfunctions characterized by a combinations of segmental joint hypo or hyper-mobility  suboptimal postures, muscle weakness and/or poor muscle control play a significant role in the emergence of painful MSK conditions by putting too much strain on different tissues which would ultimately lead local and/or distant tissues to sustain damage or to function sub optimally. The end result of this dysfunctional state would then often be pain. The role of manual therapy in such a model is to find these aforementioned dysfunctions and treat them via manual mobilizations or manipulations, stabilization exercises and postural corrections among others. It is proposed that the manual mobilizations or manipulations will restore the joint play by restoring tissues optimal lengths or by reducing a fixation or sub-luxation and thus, restoring optimal joint function which, in turn, will lead to the resolution of the dysfunction and thus, the pain.

Whoa! What does that mean? In Laymen’s terms: Limited mobility or excessive mobility puts improper strain on muscle tissue which can lead to poor function and usually pain. MT finds these dysfunctions and treats them with manual mobilizations or manipulations and exercise and postural correction. Through the MT we can restore tissue’s proper length by making it more mobile or “less mobile” (through stability work) restoring it to proper function and reduce pain.

Again, WHAT? Basically through the pressure in our hands or a simple tool or lacrosse ball we can’t create enough force to tear our fascia. Lets put that in perspective; if I were to dig my thumb into you and could create enough force for your fascia to release, or even cause micro tears, however you want to describe it, humans would be very frail and fragile and we not be able to function in everyday life. Every fall, stubbed toe, shin on desk would cause torn muscles with no question. So then why after massage or self MR do we instantly feel so much better and have more ROM? Foam rolling works, but not how most people thinks it does. There are a few theories out there but the one we are talking about today is the theory of Neurophysiological Effect (NE)

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Numerous Studies have demonstrate immediate positive effects on pain after non specific MR or MT. The NE effects could be a combination of the CNS and PNS. The exact mechanism of this model is far from being explained but the basics are that pain is the brains output in response to various stimuli including but not limited to nociceptive input.

Wellness simplifies the thought: “a simple explanation for a good part of the effectiveness of manual therapy could be that the novel stimulation introduced in the CNS by manual therapy may help the brain down regulate the perceived threat of current stimuli and thus decrease the pain by means of descending inhibition and other peripheral and central mechanisms (which include a placebo response).”

Lastly, I am not saying Manual therapy does not work. I am a recent graduate from PT school and Manual therapy is used in every one of my patients in some form or fashion. Everyone should use self MR by rolling on a roller or lacrosse ball. But what I do believe is that the mechanically lengthening tissue to reduce pain and symptoms is not a sound argument anymore with current research and that another avenue of thought should utilized. The nuerological avenue is my “main street” right now. But MR or MT we can nuerologically calm down the brain which then will calm down the area of pain and thus we may be able to move with improved ability and pain free.

Wellens, F; The Traditional Mechanistic Paradigm in the teaching and practice of manual therapy: Time for a reality check. Clinique Physio Axis.

Written by: Dr. CJ DePalma, DPT, CSCS

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