KINETO 1 Myofascial Release and Met Presentation Slides

@Physiocouk #manchesterphysio
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Welcome
An introduction to Myofascial Release (MFR)
and Muscle Energy Techniques (MET)
With Katie Emmett & Daniel Smith
06/16/17 2
@Physiocouk #manchesterphysio facebook.com/physiocouk
Who are we?
Katies LinkedIn:
www.linkedin.com/katieemmett
Twitter: @KatiePhysiocouk
Dan's LinkedIn: www.linkedin.com/

danielsmith
Twitter: @DanPhysiocouk
3
Lets connect
Website: www.physio.co.uk
Twitter: @physiocouk
Facebook: www.facebook.com/physiocouk
4
Aims of today
Learn and understand fascia structures and it's anatomy
Learn the different Myofascial release techniques and how to

perform them
Learn the different types of Muscle Energy Techniques
Learn the handling of METs and when to use them

Itinerary
10.00 - 10.30 - Induction / Arrival
10.30 - 11.15 - Theory: MFR
11.15 -12.00 - Practical: MFR
12.00 - 12.30 - Lunch
12.30 - 13.00 - Theory: MET
13.30 - 14.00 - Practical MET
14.00 - 15.00 - Evidence and Case Studies

Theory:
Myofascial
Release

Definition
Myo = muscle
Fascia = a band or sheet of connective tissue
Release = the relaxation and/or stretching of tight structures

Definition
Safe and effective hands-on technique that works on the fascia to
release restrictions
Based on both massage work and gentle stretching

Works gently through the skin into the fascia surrounding the
muscles
Applied with a static, prolonged pressure to restricted tissue
Aims to release tension and stretch out restricted parts of the

fascia. Deeper layers can be reached as fascia releases

Definition
Myofascial Release is a specialised physical and manual therapy used for the effective treatment and
rehabilitation of soft tissue and fascial tension and restrictions
Myofasical Release UK
Myofascial release is a manipulative treatment that attempts to release tension in the fascia due to
trauma, posture, or inflammation. Connective tissues called fascia surround the muscles, bones, nerves,
and organs of the body. Points of restriction in the fascia can place a great deal of pressure on nerves
and muscles causing chronic pain.
Practitioners of myofascial release employ long stretching strokes meant to balance tissue and muscle
mechanics and improve joint range of motion in order to relieve pain
Spine-health

What is fascia?
Fascia is a layer of fibrous tissue that surrounds groups of
muscle, bone, blood vessels and nerves
It binds some structures together, while permitting other

structures to glide smoothly over each other
Fascia is classified depending on its distinct layers, functions

and anatomical position superficial, deep or visceral
Fascia are dense regular connective tissues, containing

closely packed bundles of collagen fibres orientated in a wavy
pattern parallel to the direction of pull

Anatomy - Fascia
Consists of cells and extra- cellular matrix (ECM) mainly fibroblasts and macrophages.
The ECM is made up of fibres, predominantly collagen and elastin and ground
substance

Anatomy - Fascia
Collagen is the fibre that makes fascia tough and durable. It is inelastic and provides
tensile strength and integrity. It is stronger than steel!
Elastin - allows the fascia to stretch and absorb shock
Ground substance is a viscous gel which provides the immediate environment of every
cell in the body
It is similar to egg whites in it's consistency.

it is able to distribute forces whilst maintaining its shape
contains sensory receptors, mechano, chemo, noci and thermo receptors and
therefore is a proprioceptive material
contains myofibroblasts which are able to contract in smooth muscle type manner and
these are responsive to stimulation and involved with wound healingautonomic
nervous system (ANS)

Anatomy Muscle
tissue
Muscle is composed of fibres, nerves and connective tissues and
account for over 40% of the body weight.
The fibres contract to produce tension on the associated tissues

or tendons.
Muscle tissue is enclosed in fascia, which in turn is attached to

other structures including ligament.
There are three types of muscle tissues

Skeletal
Cardiac
Smooth muscles.
Macro structure
. Muscle fibres are made up of bundles of
fascicles
Several fascicles bound by epimysium to

form whole muscle
Connective tissue fascial sheaths

perimysium and endomysium join at end
to form tendons
Muscles are as much fascia as muscle

fibres hence term myofascial
Tendon inserts into periosteum

Anatomy Muscle
tissue
All muscle tissues have a superficial covering of vary thickness of
fascia, made of connective tissue and laced with adipose tissue.
Inside the fascia, the muscle tissue is surrounded

by epimysium and individual muscle bundles or fascicles are
surrounded by perimysium.
Endomysium is the connective tissue that separates muscle

fibers within a fascicles.
The unit of fascicles is a muscle fibre (or cell) called myofibril

Anatomy Muscle
tissue

Anatomy Muscle
tissue
Types of muscular tissue
Important when applying Myofascial release and METs as the orientation

and direction of the muscle fibre dictate the direction/angle force is applied

Anatomy Muscle
tissue
Muscle Spindle Fibres
Sensory receptors within the muscle belly that detect changes to the length of
a muscle. This information is relayed to the central nervous system and is
processed by the brain to determine the positions of body parts
Golgi Tendon Organs
Are located in the tendon of skeletal musculature. They detect changes to the
tension of the muscle providing proprioceptive feedback to the brain. They
prevent damage by inhibiting contracting muscles if the force is great enough
that there's a risk of tissue damage.

Function of fascia
Physical
To reduce friction
Provide a sliding environment for muscles
Suspend organs in their proper place
Transmit movement from muscles to bones
Provide a supportive and protective environment for nerves and
blood vessels as they pass through and between muscles.
Facilitates circulation lymph and blood
Provides support and connection
Physiological adaptable - plastic

Function of fascia
Communication
Mechanical pull and vibration through the concept of

tensegrity
Fascia has piezoelectric force. i.e changing mechanical force in

to electric energy
A sensory proprioceptive organ receiving and responding to

mechanical and chemical information via receptors. These
sensory nerves also communicate with the ANS influencing blood
flow and muscle tone.

Function of fascia
Movement facilitator
Reduced friction at macro and micro level

Distributor of forces/shock absorber
Enhances force generated by muscle contraction rebound
Provides a pre-tensioned background tone making muscle
contraction more effective and efficient ( feel like being shrink
wrapped)
Pre tensioned tone allows for maximum response during fight or
flight

Fascia why does it go
wrong
Age and injury can cause an increase of laying down of
collagen, increased cross linkages and restrictions
(adhesions)
Fascia increases its density and looses its ability to slide

freely when:
Trauma and injury
Infections or disease
Over and under use
Ischaemia
Local and systemic inflammation
Tissue dehydration
Emotional stress and centralised pain
Fascia when does it go
wrong
For example: injury micro tearing and fibrosis formation will
affect
Electrical conductivity in fascia
Cell to cell communication
Interfere with freedom of movement of fascial planes and
communication properties
Sensitisation of nerve endings
Influence plastic adaptation
SO the local pathology will affect local fascial communication

and cause a cascade of more remote symptoms.
Indications for Rx
Loss of mobility and range of motion
Increased amounts of scar tissue and adhesions
Increased tone of over active muscles
Poor quality of movement

Contraindications to
Rx
Local Systemic
Broken skin/Open cuts Cancer (Malignancy)
Skin conditions Acute Circulatory disorders

Haematoma Blood Thinning Medications (e.g.
Warfarin)
Healing Fracture Bleeding disorders (e.g.
Haemophilia)
Active infections Systemic Infection
Obstructive Oedema
Acute RA
Advanced Diabetes

Precautions to Rx
Pregnancy
Hypersensitivity
Hyper or Hypo- tension
Patient Anxiety
Acute/ Inflammatory stage of healing

Aims and Benefits
Myofascial Release can decreases Pain: it is claimed that this technique can release
the bodys natural painkillers, endorphins, by allowing the blood, lymph and nerve
receptors to work efficiently so pain is relieved.
It helps to strengthen the immune system. When fascia is restricted, the lymphatic
flow is slowed down, which affects the immune system (the bodys first line of defence
against infection and primary aid to healing).
Myofascial Release increases the circulatory flow of lymph and therefore hastens
healing of injuries or infections.
Myofascial Release Technique can work to relieve pressure which may be caused by
fascial adhesions pressing on the nerves. Keeping a healthy circulatory system reduces
stress on the heart and can prevent painful cramps, brings nutrients to the cells and
takes away the waste; Myofascial Release Technique increases circulation and assists
this process.

Release guidelines
Gentle and sustained, pressure should be applied for a specific period of time
a minimum of 90 120 seconds
This amount of time permits fascia to naturally elongate and return to normal
resting length which will restore the healthy status quo, giving greater
flexibility, mobility and eliminating pain.
Techniques applied for less than 2 minutes will temporarily lengthen the
elastic fibres in the muscles and fascia and the tissues will feel looser for a
while but gradually tighten up again.
It is like stretching a rubber band if stretched for a short time it will quickly
spring back to its original shape but if left stretched around an object for some
time it will remain permanently lengthened.

Anatomy Trains Tom
Myers
Theory
Certain fascial lines become identified as we commonly see

restricted movement patterns
If structures can be grouped together in recognised fascial lines

then it is possible to release the tone in one structure and see it
presented further along the line
The point of restriction may be away from the point of pain

(victim and cause)

Anatomy Trains
Superficial Back Line
Function is to support the body in full upright extension
During child development it is this line we see mature to enable the child
to lift its head, crawl and then walk
With the knees extended the line is continuous
It has a higher degree of slow twitch endurance muscle fibres and extra
heavy sheets of fascia to overcome the postural demands (postural
adaptations!)
There is no deep back line although some aspects of the SBL are deeper
than others. There is no consistent and connected layer deeper than the
SBL
SBL myofascial tracts and bony
stations

Anatomy Trains
Superficial Front Line
Function is to balance the SBL and provide tensile support

from the top to lift those parts of the skeleton which extend
forward of the gravity line (pubis, ribcage and face)
Viewing the patient from the side reveals the state of

imbalance between the SFL & SBL

SFL myofascial tracts and bony
stations

Anatomy Trains
Deep Front Line
Infused with slow twitch endurance muscle fibres, the DFL provides
stability and subtle positioning changes to core structure.
Restriction within this line is seen in every patient who is dominated by
sitting
Restriction within this line affects the ability of gaining extension at the
hips and improving the postural alignment of the trunk and pelvis
Working alongside the SBL its co function is to control our ability to work
with gravity allowing our posture to selectively extend against or move
with gravity
Failure of the DFL does not cause an acute change but more functional
restriction over a period of time which may appear in another line.
Its role in surrounding the heart and lungs has a significant affect upon
respiration and also the potential for CV function
DFL myofascial tracts and bony
stations

Anatomy Trains
Demonstration of theory

Practical:
Myofascial
Release

Manual Handling and
Body Position
Posture
Bed height
Stance
Patient position
Use different parts of your hands/ arms to apply pressure

Keep arms straight to utilise body weight when applying
pressure/resistance.
Move from the hips and knees as much as possible
Oil (or cream)- only needs to be a little bit.
Look after yourself before you look after the patient!

Post Treatment
Irritation
Very common for people to experience irritation for up to 72
hours after treatment.
Side effects can include:

Bruising
Redness
Tenderness/Increased Sensitivity
Increased symptoms
Aching similar to DOMS

Post Treatment
Irritation
Causes
The release of toxins/waste products from muscular tissue

Neurological sensitisation
Increased blood flow and micro trauma can lead to bruising and
redness
Advice
Reassure the patient it's a normal response to be sore

after soft tissue treatment
Advise them to use ice (safely)
Recommend they drink water to keep hydrated

Palpation
Finding fascia
1.Rest hand lightly on forearm do not press into the arm. This
is the superficial fascia
2. Allow your hand to sink into the forearm, this is the deep
fascia - the fascia of the forearm extensors
3.Withdraw out of the fascial layers..

Back
1. Gliding
2. Erector Spinae frictions
3. QL release

Shoulder
1. Upper fibre traps in side : Stripping Technique (1)
2. Upper fibre traps : Technique (2)
3. Pectorals

Glutes
1. Fix an stretch
2. Fix and stretch in side lying

Hamstrings
1. Gliding
2. Skin rolling/ Friction
3. Tack and stretch

Calf
1. Stripping
2. Gliding
3. Tack and Stretch
4. Gastroc on stretch - elbow stripping

Lunch

Theory:
Muscle
Energy
Techniques
(METs)

METs Definition
"A manual medicine treatment procedure that involves the voluntary
contraction of muscles in a controlled direction, at varying levels of
intensity, against a counterforce applied by the operator.
(Greenman 1996)
Muscle Energy Techniques are a manipulative treatment in which

patients muscles are actively used on request from a precisely
controlled position, in a specific direction and against a distinctly
executed counterforce. (Ward 2003)

METs Types
Isometric Contraction
Reciprocal Inhibition
Post Isometric Relaxation
Isotonic Eccentric Contraction
Isotonic Concentric Contraction
Isokinetic

METs: Protocol
With Isometric METs- the muscle/limb is moved until a barrier of
resistance is reached.
The isometric contraction is performed and held for 3-5 seconds.
The muscle is then allowed to fully relax (this can also take a few
seconds)
Passive mobilisation is then used to stretch the muscle/limb until a new

barrier of resistance is reached.
The contraction/relaxation cycle is then repeated until normal

movement is restored or no further benefit is gained (usually 3-5
repetitions at most).

METs: Isometric
Contraction
Method
Resistance is applied by the therapist
The patient produces an isometric

contraction of the muscle group that
opposes the affected muscle
The contraction is held
The patient then relaxes and a stretch

can be applied to the affected muscle.

METs: Isometric
Contraction
Theory
Agonist muscle contracts
Muscle spindles are activated to send

feedback on muscle length
This causes the release of an

inhibitory mediator at the spinal cord
The motor neurone of the Antagonist

muscle is inhibited by this, causing
relaxation

METs: Isometric
Contraction
Reciprocal Inhibition: Example
E.G. Hip Adductor Injury.
Hip abduction is resisted by the therapist

Agonist group (hip abductors) contract
Antagonists (hip adductors) are inhibited as a
result
Relaxation/Lengthening occurs in the adductors
(affected) muscle group

METs: Isometric
Contraction
Method
Resistance is applied by the

therapist
The patient produces an isometric

contraction of the affected muscle
They then relax and a stretch can

be applied

METs: Isometric
Contraction
Theory
Strong muscle contraction excites

Golgi tendon organs
This causes inhibition of the motor

neurone to the muscle
When the muscle contraction stops

the muscle relaxes and lengthens as
a result of this

METs: Isometric
Contraction
Post Isometric Relaxation: Example
E.G. Hip Adductor Injury
Resistance is applied against Adduction of the

hip
Isometric contraction occurs
When the muscle relaxes it will lengthen
And the hip can be passively stretched further
in to abduction

METs: Isotonic
Eccentric
Contraction
Method
The patient contracts the affected muscle while the therapist applies a
force stronger than the force of contraction.
This results in the muscle being lengthened whilst contracting.
Theory
Golgi tendon organs are excited by the contraction of the muscle. The
muscle is also being stretched/lengthened during the contraction
So when the muscles relaxes, these effects combine and this results in a
lengthening/relaxation of the muscle.

METs: Isotonic
Concentric Contraction
Method
Therapist applies a resistance, the patient concentrically contracts the

affected muscle and moves through range of movement against the
resistance.
This movement is then performed repeatedly
Theory
This causes increased motor activity to a muscle which increases tone
Over time alongside strengthening exercise hypertrophy would occur.

METs: Isokinetic
Method
Varying amounts of force are applied by the therapist as the muscle is

contracted through its full range of movement
Force is altered to ensure the muscle moves at a constant speed through

its full range
(Its considered a combination of isotonic and isometric contractions)
Theory
Aims to increase strength and tone similar to isotonic concentric

contractions.

METs:
Contraindicatio
ns and
Precautions

METs: Practical

Remember:
Your body position and
handling skills
Post Rx advice where
appropriate

Neck and Shoulder
1. Supine Neck side flexion
2. Pec- abduction

Glutes
Internal/external rotation
Side lying

Hips
1. Abduction
2. Adduction

Hamstrings
1. Contract and Relax in Supine

Calf
1. Resisted Plantarflexion

Case studies

Case Study: Neck
Pain
PC/HPC: 25 year old female with an onset of neck pain and stiffness 1/12 following a
RTC. Feels worse in the mornings and aggravated by sitting for long periods. Scores
her pain 7/10 on the VAS scale.
SH: Work- Solicitor 85% desk based. Spends large amounts of time commuting in the
car and traveling on trains.
Hobbies- attends the gym 2-3 times a week. Not able to go since the accident
PMH: None
DH: Analgesics
Objective signs- increased uft tone R>L, Limited in all ROM of CX SP, TOP posterior
neck muscles, uft and rhomboids, active TP in R uft, no neurological symptoms to
note.

Case Study: Neck
Pain
Objective signs
Increased uft tone R > L
Limited in all ROM of CX SP
TOP posterior neck muscles, uft and rhomboids
Active TP in R uft,
No neurological symptoms to note

Case Study: Neck
Pain
Diagnosis?
What MFR techniques could you use?
Would you use METs? If so, why?

Case Study:
Hamstring
PC/HPC: 30 year old male, 4/10 pain into R hamstring when running. Felt pull 2/52
ago towards the end of a 5k run. Instant pain and unable to continue run.
No instant swelling of bruising. Pain eased 3/7 after tried running but still feels
pain. Also reports an increase of constant tightness.
SH: Work- Shop assistant. On feet all day. Training for Manchester 10k
PMH: L Shoulder surgery from cycling accident

DH: Nil to note

Case Study:
Hamstring
Objective signs-
Sway back posture
Reduced range in R hamstring in 90/90 test
-ve neuro symptoms on SLR
Palpation : area of adhesion located mid hamstring-

tender on deep palpation.

Case Study:
Hamstring
Diagnosis?

Case Study:
Shoulder Pain
PC/HPC: 45 year old Male with and 8/12 History of Right shoulder pain
that onset insidiously, coincided with being busier at work and doing
longer hours.
SH: Work- Desk based- pain gets worse through the day
Hobbies- Golf- unable to play due to pain
PMH: Hypertension
DH: Ramipril, Occasional Ibuprofen

Case Study:
Shoulder
Objective signs
Protracted shoulder posture with increased Tx Kyphosis

Limited ROM of the right shoulder and the neck
Positive outcome on impingement tests
Patient indicates pain refers to the elbow
Tenderness on palpation of the right shoulder joint, pectorals rotator cuff,
traps and thoracic spine musculature
Increased muscle tone and trigger points in the pecs and traps
Muscle weakness- on all shoulder movements
Joint stiffness in the right shoulder

Case
Study:Shoulder
Diagnosis?

Case Study:
Sciatica
PC/HPC: 32 year old female with a 5-6 week history of back pain and pins
and needles radiating down the left leg. Initially noticed it after lifting a
heavy object at work
SH: Work- Cleaner- pain is aggravated by lifting and bent postures

Hobbies- Gym- Spinning class and Zumba- unable due to pain
PMH: Nil
DH: Naproxen

Case Study:
Sciatica
Objective signs:
Tenderness on palpation of the lumbar, gluteal and piriformis musculature

Muscular trigger points throughout the glutes and piriformis (which
trigger lower limb symptoms)
Piriformis tightness on testing
Hip flexor weakness
Positive findings for neural tension/irritation on Straight leg raise
Pain limited lumbar flexion and hip flexion and internal rotation
Indicates pins and needles down the leg laterally to the foot
Neurological symptoms aggravated by putting pressure on the buttock
(e.g. sitting)

Case Study:
Sciatica
Diagnosis?

Evidence: METs
The Immediate Effects of Muscle Energy Technique on Posterior
Shoulder Tightness: A Randomized Controlled Trial (Moore et al.
2011)
Investigated the immediate effects of METs on shoulder horizontal
adduction and internal rotation ROM
Used Asymptomatic baseball players as their study sample
Compared 3 groups: MET for horizontal abductors, MET for external
rotators and a control group
Found significant improvements in ROM using horizontal abductor METs

Suggests benefits for injury prevention and rehabilitation.

Evidence: METs
The effect of isolytic contraction and passive manual stretching on
pain and knee range of motion after hip surgery: A prospective,
double-blinded, randomized study (Parmar et al. 2011)
Compared Isolytic (Eccentric) MET to passive manual stretching for knee

ROM.
Used individuals post hip surgery following a fracture.
Assessed knee ROM and pain (VAS)
Found significant improvements in ROM using both treatment

techniques
MET group had significantly better reductions in pain
Suggests METs are a better technique as they impact on ROM and pain.

Evidence: METs
Muscle Energy Technique Versus Corticosteroid Injection for
Management of Chronic Lateral Epicondylitis: Randomized Controlled
Trial With 1-Year Follow-up (Kken et al. 2013)
Compared an isometric MET (resisted pronation) to Corticosteroid injections

Used patients with symptomatic Lateral Epicondylitis (Tennis Elbow)
Followed up at 6, 26 and 52 weeks to assess short and long term impact
Cortisone injections showed better improvements in pain, grip strength and

function initially but longer term follow-up found more benefit from METs
METs are a better long term treatment for Lateral epicondylitis than
Cortisone.

Evidence: MFR
Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety,
Quality of Sleep, Depression, and Quality of Life in Patients with
Fibromyalgia (Castro- Sanchez et al. 2010)
A randomised controlled trial, used an experimental and placebo

group
Recruited patients diagnosed with FMS aged 18 65 years
Experimental group underwent a protocol of massage-myofascial
release therapy during a weekly 90-minute session for 20 weeks
Pain was assessed with the Visual Analog Scale (VAS), which
assesses the pain intensity and degree of relief experienced by
the patient (score of 0=no pain; 10=unbearable pain)

Evidence: MFR
Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety,
Quality of Sleep, Depression, and Quality of Life in Patients with
Fibromyalgia (Castro- Sanchez et al. 2010)
Results:
The experimental group significantly improved pain, anxiety, quality of

sleep, and quality of life
The treatment reduced the sensitivity to pain at sensitive points, mainly at
the lower cervicals, gluteal muscles, and right greater trochanter.
Release of fascial restrictions in these patients also reduces anxiety levels
and improves sleep quality, physical function, and physical role
Massage-myofascial program can be considered as an alternative and
complementary therapy that can achieve transient improvements in the
symptoms of these patients.

Evidence: MFR
Effectiveness of Myofascial release in the management of chronic
low back pain in nursing professionals (S.Ajimsha et al, 2013)
Results:
MFR group performed better than the control group in 8 weeks and 12
week
McGill Pain questionnaire and Ouebec Back Pain Disability Scale was used
to assess
MFR reported 53.3% reduction in pain compared to control groups 26.1%
at 8 weeks
MFR group reported 29.7% reduction in functional disability compared to
9.8% by control group at 8 weeks
This study provides good evidence that MFR when used along side specific
back exercises

References
The Immediate Effects of Muscle Energy Technique on Posterior Shoulder Tightness: A Randomized
Controlled Trial. Stephanie D. Moore, Kevin G. Laudner, Todd A. Mcloda, Michael A. Shaffer, Journal of
Orthopaedic & Sports Physical Therapy, 2011 Volume:41 Issue:6 Pages:400407.
The effect of isolytic contraction and passive manual stretching on pain and knee range of motion after
hip surgery: A prospective, double-blinded, randomized study. Shraddha Parmar, Ashok Shyam, Shaila
Sabnis, Parag Sancheti, Hong Kong Physiotherapy Journal, Volume 29, Issue 1, June 2011, Pages 2530
Muscle Energy Technique Versus Corticosteroid Injection for Management of Chronic Lateral
Epicondylitis: Randomized Controlled Trial With 1-Year Follow-up. Sami Kken, Halim Yilmaz, Ali Sall,
Hatice Uurlu, Archives of Physical Medicine and Rehabilitation, November 2013, Volume 94, Issue 11,
Pages 20682074
Ward R.C. et al. Foundations of Osteopathic Medicine. 2nd Edition. Baltimore, MD: Williams and Wilkins,
2003. (page 881)
Greenman P. Principles of Manual Therapy. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996.

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@Physiocouk #manchesterphysio

With Katie Emmett & Daniel Smith

Dan's LinkedIn: www.linkedin.com/

Learn the different Myofascial release techniques and how to

Learn the different types of Muscle Energy Techniques

Learn the handling of METs and when to use them

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk

Fascia = a band or sheet of connective tissue

Release = the relaxation and/or stretching of tight structures

@Physiocouk #manchesterphysio facebook.com/physiocouk

Based on both massage work and gentle stretching

Applied with a static, prolonged pressure to restricted tissue

Aims to release tension and stretch out restricted parts of the

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk

It binds some structures together, while permitting other

Fascia is classified depending on its distinct layers, functions

Fascia are dense regular connective tissues, containing

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk

Elastin - allows the fascia to stretch and absorb shock

It is similar to egg whites in it's consistency.

@Physiocouk #manchesterphysio facebook.com/physiocouk

The fibres contract to produce tension on the associated tissues

Muscle tissue is enclosed in fascia, which in turn is attached to

There are three types of muscle tissues

Several fascicles bound by epimysium to

Connective tissue fascial sheaths

Muscles are as much fascia as muscle

Tendon inserts into periosteum

@Physiocouk #manchesterphysio facebook.com/physiocouk

Inside the fascia, the muscle tissue is surrounded

Endomysium is the connective tissue that separates muscle

The unit of fascicles is a muscle fibre (or cell) called myofibril

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk

Important when applying Myofascial release and METs as the orientation

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Golgi Tendon Organs

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Mechanical pull and vibration through the concept of

Fascia has piezoelectric force. i.e changing mechanical force in

A sensory proprioceptive organ receiving and responding to

@Physiocouk #manchesterphysio facebook.com/physiocouk

Reduced friction at macro and micro level

@Physiocouk #manchesterphysio facebook.com/physiocouk

Fascia increases its density and looses its ability to slide

SO the local pathology will affect local fascial communication

Increased amounts of scar tissue and adhesions

Increased tone of over active muscles

Poor quality of movement

@Physiocouk #manchesterphysio facebook.com/physiocouk

Skin conditions Acute Circulatory disorders

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Hyper or Hypo- tension

Acute/ Inflammatory stage of healing

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk

@Physiocouk #manchesterphysio facebook.com/physiocouk

Certain fascial lines become identified as we commonly see