What is Myofascial release, and how is it integrated into the treatment?
The Fascial Planes make up the ‘bodily map’ of treatment at the King Manual Therapy Clinic, with all therapists and administrators trained in Fascial Work, so a unified language is agreed upon. Each bodyworker and allied health professional will see the body and it’s dysfunctions through different lenses, but we all work to heal and restore. This Fascial work was pioneered for people in Chronic Pain, and therefore the touch is very light. Some manual voice therapy can be very invasive, painful, and ultimately leave you feeling tender. Fascial based voice work will mean that you can sing that night, or immediately after whilst having a profound, and lasting effect on the voice.
To find out more about Fascia, continue reading…
Myofascial Release (MFR) was first brought to the world of manual therapy in the 1980’s by a renowned Osteopath, Robert Ward. Since it’s conception into the manual therapy narrative, the two respected voices in the fascial world are a massage therapist, John F Barnes and a Physical Therapist, Walt Fritz. Barnes shares a unique and spiritual perspective of working with fascia which he calls the ‘listening touch’, which is a supposed ability to tune into what the skin of the patient can tell you through your own hands (1990). This manual therapy narrative will show fascia as a moving, changing, conscious layer of skin which can even hold memory, that as therapists we can feel, palpate and change the flow of this subcutaneous layer to reduce pain and increase movement (Barnes 1990, Tozzi 2014, Myers 2014). Currently, this narrative is unfortunately not supported by pain science in its entirety, reducing the mystical to the concise, showing a moving structure relying heavily on adequate hydration which can be indirectly palpated (Langevin 2006, Fritz 2018). Building from this, Fritz’s method of treatment therefore encompasses a patient centred feedback approach, guiding and asking the patient whether they can feel anything changing, moving or releasing (Fritz 2018).
Fascia is neither a recent discovery; it has been documented since 1651, with the first explanation of Fascia being a ‘membranous tendon’ (Crooke 1951, Adstrum et al 2016). Although now we can categorise Fascia as; an anisotropic, complex and body wide signalling network with richly integrated mechanoreceptors interwoven into the layers of subcutaneous anatomy (Langevin 2006, Findley et al 2012, Dommerhault et al 2017).
Fascia can be divided into three layers although it is less discernible in it’s dissection than three layers (Langevin 2006, Adstrum et al 2016). The first layer is a superficial layer which holds a high volume of loose connective tissue and is high in levels of fat. This type of fascia is not found on surfaces such as the soles of the hands and feet as it is soft and malleable (Langevin 2006, Day et al 2012). The second layer of the fascia is labelled as Deep Fascia, and essentially coats muscle mass. This type of fascia can be found enveloping nerves and vessels in the body (Chaitow 2017). The final fascial frontier is the Epimysium which is directly involved in whether muscles feel tension or stretch and is deeply embedded and integrated within muscle fibres (Stecco, 2004). In this layer of fascia, there are mechanoreceptors such as the Golgi, Pacini and Ruffini Corpuscles. These mechanoreceptors play a significant part in the proprioceptive feedback loop with regards to pain and dysfunction (Bordoni and Zanier 2013). Within this body wide feedback loop, if muscle fibres are contracting in one part of the fascial anatomy, it is plausible that dysfunction can occur in another part of that same fascial plane (Langevin 2006).
Myers sought to better clarify the fascial anatomy by creating “Anatomy Trains’, a series of illustrations showing the bony connections of fascial tissue, and their connectivity to other anatomy (Mari and Fairweather 2012). This is well worth a read as an interested party.
Furthering this concept of interlinkage in the fascia, the main respiratory muscle for singers is the diaphragm (Sundberg 1986, 1987, 1992, Sivasankar and Erikson 2009, Sandage et al 2013, Kayes 2015). The diaphragm is implicitly linked to many surrounding structures, by muscle and ligament connections, however for the purposes of this article I will be looking at the fascial connections. The Fascia Transveralis and the Interfascial Plane are the two main groupings of fascial connections linking the diaphragm to the rest of the body (Lee et al 2010, Tirkes et al 2012). The Fascia Transveralis is an aponeurotic sheath connected to the Transverse Abdominus and the internal organ cover of the Parietal Peritoneum. The Interfascial Plane is deeply woven into the aortic system, inferior vena cava, liver, psoas muscles, quadratus lumborum, cardiac area, phrenic-esophageal ligaments and also the kidneys (Borndoni and Zanier 2013, Netter et al 2018). Any bodily fascial restrictions can cause dysfunction in muscles such as the diaphragm from as distant as the muscles of the pharynx by the connection of the fascia transversalis plane (Pieper et al 2004, Bordoni and Zanier 2013). Therefore the vocal treatment, connects the muscles of breathing to the para-laryngeal anatomy for a maximal treatment.
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