S:\2011 official handouts\Sessions handouts\Myofascial Release Techniques.doc1/28/2015

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S:\2011 official handouts\Sessions handouts\Myofascial Release Techniques.doc1/28/2015

S:\2011 official handouts\Sessions handouts\Myofascial Release Techniques.doc1/28/2015

TABLE OF CONTENTS

Myofascial Technique Overview

Superficial Back Line

Plantar Fascia 1-2

Gastrocnemius/Soleus 3

Hamstrings 4-5

Erector Spinae Prone 16

Seated 11-12

Mountains & Valleys 13-15

Scalp 17

Cervical Posterior 18

Suboccipital Traction 19

Superficial Front Line

Dorsal Foot 6-7

Anterior Tibialis 8-9

Rectus Femoris 10

Trunk 20-21

Neck Anterior & lateral 22-24

Leg Traction 25

Anatomy

Superficial Back Line 26-27

Superficial Front Line 28-29

This handout is laid out as it will be presented in class-lower body: superficial back and front line, the

upper body: superficial back and front line. It was documented this way for the student’s benefit so we

do not leave class feeling unbalanced.

S:\2011 official handouts\Sessions handouts\Myofascial Release Techniques.doc1/28/2015

Myofascial Techniques

In the following techniques we will be looking at affecting the fascia and myofascia of the body. This

in turn will affect the muscles increasing movement and generally creating space for not only muscle

but bones, nerves, blood and lymphatic vessels and organs to function unencumbered.

Fascia is the most abundant of tissues in the human body. It invests, surrounds, separates, and supports

other structures of the body. Dr. John Upledger, DO refers to it as “the inner body stocking”. When

healthy and non-restricting it could be described as a similar to a mesh much like a piece of cheese

cloth soaked in a semi-dried glue with a great amount of tensile strength. It can be stretched and return

to its original state. It can be shortened and returned to its original state. However, with lack of

movement, sustained lengthening or shortening or sudden injury over-stressing it’s anatomy it can

retain its new found position and take on the consistency of cheese cloth whose glue has hardened.

There are many varied techniques to treat the fascia ranging from John Barnes’ slow sustained

stretching and tractioning, CranioSacral’s even more subtle manipulations to more aggressive

interventions such as Rolfing.

In these classes you will be learning very simple techniques that you can apply in the context of a full

myofascial session or integrate pieces of this work into your myomassology sessions. The individual

techniques are not as important as is your general understanding of working with the fascial system

to enhance your effectiveness in soft tissue release and normalization.

The main differences between myofascial and other massage strokes are as follows:

Use little or no lubricant (Still staying within the clients tolerance)

Stroke with specific intent to affect the fascia (lengthen, widen, make more pliable)

Keep the fascia engaged (stroke/stretch)

Be aware of the connectiveness of this tissue to other tissues.

Finally, “Put it where it belongs and call for movement”. This quote from Ida Rolf, simple as it is,

leads us to a complex concept when applied to a case by case application. We will use it in its

simplest interpretation and applied to the work presented here to mean-

Stroke down on the tissues of the Superficial Back Line

Stroke up on the tissues of the Superficial Front Line

We will be following the concept and theory of Thomas Myers’ Anatomy Trains. We will only be

scratching the surface and this is intended to be an introduction to this work. If interested it is

suggested that you delve further into his writings and theories.

1

Superficial Back Line

Plantar Fascia

Clients Position- Prone with foot hanging off the table

Area of Treatment- Plantar fascia lateral arch

Using the knuckles stroke from the anterior calcaneus to base of

the fifth phalange

Area of Treatment- Plantar fascia medial arch

Using the knuckles stroke from the anterior calcaneus to base of the first

phalange

Note: You may hyperextend the toes and then stroke

Clients Position- Prone with foot hanging off the table

2

Area of Treatment- Plantar fascia midline

Using the knuckles stroke from the anterior calcaneus to base of the third phalange

Area of Treatment- Plantar fascia distal transverse arch

Using the knuckles beginning just medial to the fifth metatarsal head stroke across the arch ending just

medial to the first metatarsal head.

3

Gastrocnemius/Soleus

Area of Treatment- Gastrocnemius and soleus stroke

Using the posterior proximal phalanges of the “soft, conforming, open handed fists” to stroke

beginning 1-1 ½ “distal to the knee ending at the ankle. This stroke is performed by leaning your

weight over your arms until your hands glide in the desired direction. As the leg narrows taper your

stroke and focus to the index fingers.

4

Hamstrings

Area of Treatment-

Biceps femoris, semitendinosus, semimembranosus

Stroke from the ischial tuberosity to the lateral aspect of the knee

in the same manner used previously for the calf muscles.

Do not stroke into the popliteal space (behind the knee).

Area of Treatment-

Biceps femoris, semitendinosus, semimembranosus

With clients knee flexed palpate for the apex of the muscles outlining the popliteal (where the medial

and lateral hamstrings separate).

5

Utilizing three fingers of each hand place your fingertips into the “valley” between the medial and

lateral hamstrings. Perform a deep gliding friction movement in a superior then inferior direction.

Most inferior finger

As you perform this friction movement have

client medially then laterally rotate the lower leg.

6

Superficial Front Line

Dorsal Foot

Area of Treatment- Extensor tendons of the foot

Engage the fascia of the tendons and stroke from the toes to the ankle.

Area of Treatment- Intrinsic muscles of the foot

Stroke between the metatarsals from the toe web to the tarsals.

7

Extensor Retinaculum

Area of Treatment- Anterior ankle

Using a molding-conforming non-fist stroke from the

tarsals up over the retinaculum.

8

Anterior Tibialis

Area of Treatment- Anterior leg compartment between anterior tibialis and the tibia

Using knuckles engage and stroke the area just lateral

to the tibialis and medial to the anterior tibialis from the

ankle to the tibial condyle.

9

Area of Treatment- Anterior leg compartment between anterior tibialis and the tibia

Place knuckles (or fingertips as shown below) Into

the space between the tibia and the anterior tibialis.

Allow them to sink into the tissues. While applying

pressure without movement instruct client to plantar

then dorsiflex their foot.

Area of Treatment- Anterior tibial fascia

Place knuckles together forming a “roof”. Place this

roof over the tibia with the lateral edge of the tibia

riding in the peak of the roof. Engage and stroke from

the ankle to the tibial condyles then separate hands as

you spread laterally and medially.

10

Thigh

Area of Treatment- Rectus Femoris

Using either the fist surface of the hand or your forearm stroke

from 1-11/2” above the knee to the ASIS (anterior superior iliac

spine) of the ilium.

You may wish to repeat this stroke over the lateral

quadriceps muscles if either feels more toned than the

other.

Instruct client to raise their knee from the table and lower with the stroke.

11

Superficial Back Line

The following movement is performed with client in a seated position as shown:

Hips above knees Feet together

Slight extension at knees Weight forward on fe

Area of Treatment- Longissimus, iliocostals, spinalis, semispinalis rotatores & multifidus

Standing behind client place flat of fists along both sides of the spine on level of C7.

Instruct client to perform the following movements in progression slowly, one vertebra at a time:

1. tilt their head forward

2. using the weight of the head round their neck

3. using the weight of the neck and shoulders arch their back

4. using the weight of the torso round the lumbar and posteriorly rotate/tilt their pelvis

Keep the fascia of each region engaged as you stroke from C7 as far down the spine as possible.

(See following page)

12

This movement should be performed by keeping your body weight over the

client and not forcing but allowing your hands to move down along the spine.

13

Next we evaluate for “valleys and mountains”.

A valley is an area of the spine whereby the spine seems to sit in a “valley” of muscle (more anterior).

This is commonly found where there is a lordotic spine.

Valley

The opposite a mountain is where the spine is projected posterior to the paraspinal muscle

Mountains

Evaluate for mountains and valleys in a seated or standing position only (not while they are bent

over). Take note of your findings and treat accordingly.

14

A simple rule is used for treatment- Pile up on the mountains –Dig out the valleys

Following assessment instruct the client to perform the movement on the previous page.

.

As they do- Pile up on the mountains –Dig out the valleys in the following manner

Stroke diagonally into the lateral aspect of the

erector spinae “piling up on the mountains”.

15

Place knuckles medial to the muscles on both

Sides of the valley and stroke laterally

“digging out the valley”.

16

Erector Spinae

Area of Treatment- Longissimus, iliocostals, spinalis, semispinalis rotatores & multifidus

Using the flat of the forearm near the elbow stroke from the upper

trapezius to the iliac crest and over the sacral fascia

At level of scapular inferior angle

“turn the corner” and stroke with

position shown

Ask client to inhale and hold their

breath as you continue to stroke

over the lumbar onto the sacrum.

Have client exhale.

17

Scalp Fascia

Area of Treatment- Galea aponeurotica

Galea aponeurotica

Client positioned supine as you sit at the head of the

table place your fingers on the posterior skull feeling

for ridges in the scalp. To do this have fingers contact

the scalp through the hair. If found take these fascial

ridges and stretch them slowly and gently in an inferior

direction.

18

Cervical Region

Area of Treatment- Erector spinae (Longissimus cervicis, spinalis, semispinalis, etc.)

Contact the erector spinae muscles (anterior to the

upper trapezius and behind the sternocleidomastoid)

on level of C6 and stroke up to the occiput.

Swing your elbow using the entire arm for this move.

You may also reverse the direction by un-curling

your fingers and stroking down the erector spinae.

19

Suboccipital Region

Area of Treatment- Erector spinae (Longissimus cervicis, spinalis, semispinalis, etc.)

Cup clients head in your pals and curl your

fingers back to almost 180° and contact the

occipital “ledge” gently with your fingertips.

Next bring your hands down and into the

table. As you do so traction the head toward

you.

20

Superficial Front Line

Trunk

Area of Treatment- Rectus Abdominis

Begin this technique with your fingers curled

placed on level of the umbilicus just off the

midsaggital line.

Uncurl your fingers, engaging the fascia, and stroke up over the costal cartilage to approx. the fifth rib.

Do not stroke or put pressure on the xiphoid process.

21

Area of Treatment- Obliques and sternal fascia

Stroke just inferior to the lower margin of the costal

cartilage following the contour moving onto the cartilage

just lateral to the sternum to the clavicle.

Continue just inferior to the clavicle laterally ending

at the pectoralis major insertion on the arm.

Neck

22

Area of Treatment- Sternocleidomastoid and posterior neck

Do not contact the neck anterior to the sternocleidomastoid!

Use your conforming non-fist to contact the lateral neck

with your knuckles resting at the anterior border of the

sternocleidomastoid (see below). Pressure should be

sufficient to engage the fascia using little compressive force.

Instruct client to rotate head/neck away from you (rotate on the midsaggital plane – not rolling the

back of their head on the table) as their movement stretches the fascia.

As they rotate head/neck lower elbow and stroke across back of neck

Alternate technique

Area of Treatment- Sternocleidomastoid and posterior neck

23

With clients head rotated to the opposite side place your non-fist on the sternocleidomastoid, engage

and stroke accross the posterior neck.

NOTE: When rotating clients head or asking them to do so their head/neck should be kept in line with

the long axis of the spine. To do so lift head from table and turnhead. Remember the head rotates

from the C1-C2 joint (Figure 1). Do not allow client to “roll head” on table moving off the midsaggital

line.

Figure 1

Figure 2

Area of Treatment- Sternocleidomastoid

24

With the head turned engage then stroke from the sterrnomastoid origin to the insertion. Using very

little compressive force and by lowering your elbow use a “scooping” motion to lift as you stroke and

stretch the fascia. Take your stroke over the mastoid and onto the occiput.

25

To integrate the superficial back line cup clients calcaneus’ and traction with focus of stretching the

achilles tendon. Then allow the stretch to travel up the back line.

26

BONY STATIONS

13. Frontal brow ridge

11. Occipital ridge

9. Sacrum

7. Ischial tuberosity

5. Condyles of femur

3. Calcaneus

1. Plantar surface of toe phalanges

MYOFASCIAL TRACKS

12. Galea aponeurotica/scalp fascia

10. Sacrolumbar fascia/erector spinae

8. Sacrotuberous ligament

6. Hamstrings

4. Gastrocnemius/Achilles tendon

2. Plantar fascia and short toe flexors

27

13

11

9

7

5

3

1

2. Plantar fascia and short toe flexors

4. Gastrocnemius/

Achilles tendon

6. Hamstrings

8. Sacrotuberous ligament

10. Erector spinae/

Sacrolumbar fascia

12. Galea aponeurotica/scalp fascia

28

BONY STATIONS

12. Mastoid process

10. Sternal manubrium

8. 5th

rib

6. Pubic tubercle

5. Anterior inferior iliac spine

Patella

3. Tibial tuberosity

1. Dorsal surface of toe phalanges

MYOFASCIAL TRACKS

Scalp fascia

11. Sternocleidomastoid

9. Sternalis/stenochondral fascia

7. Rectus abdominis

4. Rectus femoris/quadriceps

Subpatellar tendon

2. Short and long toe extensors, tibialis

anterior, anterior crural compartment

29

1

3

5

6

8

10

12

2. Short and long toe extensors, tibialis

anterior, anterior crural compartment

4. Rectus femoris/quadriceps

7. Rectus abdominis

9. Sternalis/stenochondral fascia

11. Sternocleidomastoid

Patella

Subpatellar tendon