Myofascial Therapy, or MFT as we’ll refer to it, is an anatomically specific form of bodywork that is intended to free fascial adhesions, to reduce pain and restore a joint to a fuller range of motion. It is performed on a table from a medium-low height on an unclothed client, but no oils or lubrication are used.
Before performing any MFT work, it’s important to assess the current ROM of the client to strategize the work for the current session and for longer range planning. The therapist checks for postural imbalances and limitations in a joint’s ROM. These imbalances and limitations inform the therapist on where to work. Postural signs indicate work is necessary in the agonist muscles, and ROM signs indicate work in the antagonist muscles for a particular action. For instance, if a client’s vertebrae are laterally flexed to the left, this could indicate work to be on the left vertebral flexors - the erector spinae, internal and external obliques on the left side. But if when assessing lateral flexion to the left, there was stiffness or choppiness in movement, that would indicate that work was necessary on the lateral flexors on the right side, as those muscles were resisting smooth movement.
When beginning an MFT session, the first thing we do is warm the tissues to be worked. This can be accomplished by using compressive strokes, “S” strokes, skin rolling, friction, or other strokes that will bring fresh blood to the area to be worked. Additionally, mechanical means, such as moist heat pads, can be used to warm the muscles and get them ready for the primary work. Warming the tissue thoroughly will ensure that the client is more comfortable when the actual MFT strokes begin. The skin should be very red; this will indicate to the therapist that the underlying tissue is ready to proceed.
There are two main categories of strokes used in these sessions: Longitudinal Release (LR) and Cross-fiber Friction (CF). In LR, the primary stroke is slack-sink-stroke. With vaulted hands, start at the the ending point of the stroke, stretch the skin from the end of the stroke to the starting point of the stroke (about 1 inch), then sink in to the client’s pressure scale of six, the move over the muscle fiber in the direction of their contraction. That is, along the length of the muscle fibers. You can repeat this stroke on the area if required, or move to the next inch along the muscles path and do another slack-sink-stroke. Moving an inch or less at a time, and you also move very slowly. Travel that single inch in a slow exhalation.
Cross-fiber Friction, conversely, works in two strokes. First is the slack-sink-stroke performed perpendicular to the direction of the muscle fiber, and the second is sawing. In this stroke, you place your vaulted fingers on the spot to be worked, sink in to the client’s six, and then with exceeding slowness, saw the muscle fiber, moving about a half-inch in each direction of the stroke.
There is a third category of stroke that is primarily done on the abdomen - pin and strip. This is a type of MFT known as Neuromuscular Therapy, and uses very light pressure, but can achieve dramatic results in reducing back pain. At a later time I will describe this form of work in more detail.
At the conclusion of the session, the therapist should re-assess the client’s posture and movement, allowing the client to see how much improvement has been noted, and to allow the therapist to take note as well. At this time, the therapist should also be re-booking the client for another session to continue making improvements to the client’s body, as well as doing some client education to enable the client to be more pro-active in their own body’s care.
LR and CF bring about dramatic change in the muscle fiber. Muscle and fascia tissues are thixotropic, and when you apply the shearing forces of these two types of stroke to the tissue, the tissue changes its viscocity and basically re-boots, or resets itself to a homeostatic state. This re-booting allows normal posture and movement to resume, resulting in less pain and more balance to the client’s body.