My approach to myofascial release (MFR) has evolved from a belief in the ability to singularly and selectively impact one single tissue deep within the body, to the exclusion of all else, to one of more metaphoric contact and impact. 

One such tissue is the diaphragm, the main muscle involved in respiration.

Short of surgical intervention, we cannot touch and isolate the diaphragm for intervention to the exclusion of all else, though many are taught it is possible.

While historical MFR narratives suggest we are releasing tightened fascia, modern views of this work suggest broader effects, with impacting cutaneous nerve tunnel syndromes and skin-based mechanoreceptors as probable effectors.

Effects to deeper tissues and structures may occur as indirect results of more central processing in the brain and central nervous system, and descending modulation.

Treatment to the lower thoracic and upper abdominal region is often seen as impacting the diaphragm and issues related to it. These issues might include lower rib region pain and cramping during exercise, reflux-like symptoms, autonomic-related issues and a wide range of other problems.

One way of treating this region, or effecting diaphragmatic release, is using a prolonged, gradual stretch with one or two hands; for example, a single-handed MFR-like stretch in a caudal direction, one that is being directed toward helping my client, Melissa, with the rib region pain she experiences while exercising. (You can see what I describe in this article in a video, “MFR for the Diaphragm,” at massagemag.com/current-issue.)

A Modified Approach

Modifications I’ve made to the more traditional view of MFR include the more unambiguous establishment of boundaries, obtaining permission before treatment using MFR, a slower style of therapy, and the allowance of treatment over clothing.

My approach to MFR relies strongly on my client affirming the relevance of my evaluation findings. As shown in the video at massagemag.com/current-issue, I was able to detect what I felt to be a tightened area in Melissa’s left lower intercostal region.

With a slow, steady pressure and stretch, I allowed her to process what she felt in response to my touch. Her affirmation of the replication of her rib region cramping became the determinant for me to linger and treat.

As she recognized her reaction to my pressure as both familiar and potentially helpful, my decision to treat the area was a simple one. Had she not been able to validate the sensation as a familiar one, I would have moved on, continuing evaluation.

In my model of manual care, I try to work less from my ego and more from the responses and validation of my client. While this sort of approach might be foreign to many who have been taught to be “the expert,” the one in charge of finding the source of the client’s problem, my years of experience and training do not provide me with the ability to know what my client is feeling and what they think might be helpful or harmful unless I ask them.

They and I negotiate the terms of treatment rather than me dictating it.

Treatment Progression and Follow-Up

As you will see in the video, the treatment progresses as I sustain my slow, gradual MFR-type stretch to Melissa’s lower rib and intercostal region until her symptoms dissipate or change.

That interaction alone may be sufficient, or we may seek out other areas or directions of a stretch that connect the client to familiar feelings. Treatment may need only be brief or may need to take place over many sessions.

With Melissa, I encourage post-treatment movement, which can take the form of exercise, but more frequently I recommend exploration of gradually increasing movement in a way that allows her to feel safe moving and exercising again without the previous pain or cramping that initially brought her to see me.

Experience has shown me that if my myofascial release treatment has not helped alleviate my client’s symptoms within two or three sessions, then I may suggest other interventions or approaches.

Explaining MFR to Clients

Here is the text of a handout I share with my clients to explain my approach. Feel free to use it or modify it for your own use.

I follow a somewhat novel way of performing an evaluation and applying the treatment, one that requires much more input from you, my client. I need your feedback in determining such things as whether or not my input (stretching, pressures) feel like they would be helpful, hurtful or neither. I cannot know what you are feeling unless I ask/you tell me and I rely very strongly on this feedback in making treatment decisions. The need for feedback will most probably exceed what other health professionals have asked you in the past, allowing you (or requiring you) to contribute much more to the process. If you are expecting to have me make all of the decisions, then our therapeutic relationship may not work out.

• Before I begin, I will thoroughly explain the purpose of the session or technique and of my hand placement, followed by obtaining your permission to treat.

• I start in the area of complaint. Many therapists may try to convince you of the belief that your problem stems from issues (or causes) elsewhere in the body. While this could theoretically be true, I will begin where you notice your symptoms.

• I will lightly place my hand/hands on the area, but I initially do nothing. This slow introduction allows you to determine if my touch feels safe to you.

• If my touch feels safe, I will begin by adding graded pressures and stretch, trying to seek out areas of tightness.

• If I find tightness (or similar), I will lightly add a bit more pressure or stretch (what I term, “snagging the area”) to the area, to bring about your awareness.

• If you’ve not already given feedback, I will ask, “Am I reproducing a sensation that is familiar to you?”

• If you note nothing, I may linger a bit unless sensation is too negative. This lingering allows you time to process, but if nothing about the pressure or stretch is familiar, then I will move on.

• If I did replicate a familiar feeling, I would use the 0-to-10 pressure/pain scale to determine the intensity of the sensation, followed by 0-to-10, “At what number would you stop me?” You determine the pressures that you feel would be helpful, without me influencing your decision.

• I will adjust pressure according to your feedback.

• I may then ask, “Does this stretch feel like it might be helpful or useful?”

• If you respond to the previous question with, “yes,” then I will remain in the area and treat.

• If you respond to the previous question with, “no,” I will ask, “Is there anything about this stretch that feels like it might be harmful?” If you believe it might, I will immediately stop.

• If all feels right to you and you think that my stretch, pressures, or intervention feels like it might be helpful, my therapy involves me holding a slow, static stretch for long periods of time with the goal of improving your functional abilities and reducing any negative sensations.

It is a very dynamic back-and-forth process between the two of us. I will require you to stay aware and present throughout the session, and I may repeat my questioning on numerous occasions throughout the session(s). Please remember, I cannot know what you feel unless I ask, and I will always ask. I will stop on occasion to allow you rest and to move a bit to see what you are feeling.

The goal of my treatment is to help you to move more freely or otherwise decrease your complaints. I will typically follow-up with functional activities and home stretching or activities, as appropriate.

About the Author:

Walt Fritz, PT, is a physical therapist who teaches his Foundations in Myofascial Release Seminars worldwide to massage therapists, as well as physical and occupational therapists and speech-language pathologists. You may learn more about his client-centered, neurologically-informed approach to myofascial release at foundationsinmfr.com.

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