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Molly McMillan, OTR/L, owner and director of Manhattan Myofascial Release, New York, reinforces this concept with her patients over and over: The right big toe is the bottom of the top of your head. “[The body] really is that connected,” she says.

McMillan is referring to the thought behind myofascial release, a therapy that is integral to some OT and PT practices. Myofascial release is focused on releasing the connective tissue, or fascia.

“The fascia is a part of our bodies that was relatively ignored when I was in college, but I think it is changing,” McMillan says. “Fascia is an interconnected web of tissue that … is essentially the fabric of the inside of our bodies … and what gives us support for all our movements. Because of its interconnected relationship with itself and everything around it, when it becomes restricted, it creates problems in other areas.”

Leta Jones, PT, CHT, senior physical therapist at Stanford Hand Rehabilitation Clinic in Palo Alto, Calif., who uses myofascial release trigger point therapy with at least 85% of her patients, says the need for the therapy starts with having a muscle that is just not working well.

“A major amount of the pain we have probably comes from muscle, and we have overlooked muscle for a long time,” Jones says. “It’s associated with things like sympathetic dystrophy, chronic regional pain, sprains, strains, fractures — almost any kind of a diagnosis that you can think of probably will have associated trigger points.”

Variations on a Theme

Jones says that while she relies on her hands to do the therapy, therapists also can use different means to apply the pressure of myofascial release, such as dry needling, which is into the muscle, instead of along the meridian of Eastern medicine. Jones says that other approaches involve putting the patient into a stretch position focused on the affected muscle and applying a cold spray along the muscle line, which is thought to release the trigger points. Still others use microcurrents or tools such as canes and balls to do the work.

But not everyone uses the trigger point approach. In fact, many therapists say that myofascial release has evolved into a more holistic, less aggressive therapy, like that described by John F. Barnes, a physical therapist.

Carol M Fisher, OTR/L, who practices in Lakewood and Lorain, Ohio, and teaches the pediatric myofascial release course for Barnes, says Barnes teaches therapists to view the whole body, at its highest functional position, looking for symmetry and alignment, and then remediating that to meet activity needs.

Although therapists who use the John Barnes approach use their hands to apply the technique; in reality, they use their whole body, McMillan says.

“The other thing to remember is that the pressure should not be that heavy. It’s mostly gentle, sustained pressure that you apply to affect the release,” she says. “You push until you just start to feel the barrier and wait for the body to release; then, as the body releases, you feel this softening and letting go. Then it will take you to the next restriction.”

In fact, McMillan says, too much pressure is counterproductive because the client’s body will react by holding if you’re pushing too hard, and will push back against you.

Robert White, PT, CHT, in Palo Alto, Calif., says myofascial release is an important part of what he does for his caseload of patients with orthopedic surgical and repetitive stress injury. Understanding the patient means understanding psychologically how much the patient trusts the therapist and physically how he or she responds to therapy.

“With myofascial release, your fingers are on them. You can feel the fascia; you can feel the muscle. And you should be manually listening to what is happening under your fingers. Are you getting the response you want, which would be a softening of tissue? Or is the patient responding poorly and you’re getting a tightening or a withdrawal?” he says.

OTs and PTs who do manual release therapy often complement the practice by teaching patients at-home stretches.

There is a difference, according to McMillan, between a typical stretch and one that complements myofascial release.

“Most people, when they stretch, they push the body into position and hold it as long as they can. It’s usually not very long because they’re forcing the stretch. What I do is teach my clients to collapse into it until they just start to feel something and then wait to allow their bodies to release. They should allow their bodies to continue dropping down into that position for at least a minute and a half, and preferably three to five minutes,” McMillan says.

Patient Profile

Fisher says that while she does not use myofascial release exclusively, she uses it often in conjunction with other therapy approaches to achieve the patient’s desired functional outcome. “What myofascial release allows you to do is get to the mobility required for that outcome a lot faster,” she says.

Like Fisher, McMillan first assesses patients to identify their restrictions, often having them simulate their activities.

“I then zero in on those restrictions and use this technique to release them. I then have the client do a home exercise stretching program. I also use other movement therapies to help them and, essentially, using this technique with a frequency of one to three times a week with a good home exercise program will help that person get back to doing their activities of daily living,” she says.

McMillan adds, however, that she would not use the therapy on very fragile patients, people in the end stages of cancer, or those who have active rheumatoid arthritis. She also would not use the therapy over an open wound and is careful using it on patients on certain medications, such as blood thinners.

Jones, who uses myofascial release on at least 85% of her patients, would not use it directly around a pregnant uterus because of the belief that some trigger and acupuncture points could cause spontaneous abortion. She says she uses it judiciously on people with severe pain.

A Credible Option?

Drucilla Likens Pape, OTR/L, who practices myofascial release therapy in private practice in Dayton, Ohio, and is a senior instructor with John Barnes’ myofascial release seminars, says the biggest misconception about myofascial release is that there is no research on its effectiveness. For starters, Pape sites research accumulated at the International Fascial Research Congress at Harvard University.

But Pape and others who practice the therapy lean heavily on their anecdotal success.

“For occupational therapists to truly understand myofascial release, one really must feel it and experience it. Myofascial release [dovetails] beautifully with occupational therapy’s goal to reduce pain and restore function, and is within its philosophy of treating the mind, body, and spirit,” Pape says. “It really goes hand in hand with occupational therapy.”

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Lisette Hilton is a medical writer for the Gannett Healthcare Group. To comment, e-mail oteditor@gannetthg.com.

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