I recently attended a pediatric myofascial release workshop in San Jose, taught by an Occupational Therapist who specializes in working with children. She has extensive training and experience in the use of myofascial release as part of her treatment program. I took the course to learn ways in which my skills could help a broader group of kids.
I love children. In addition to the children I've treated professionally, I have enjoyed volunteer work in a variety of organizations, caring for, teaching, and mentoring kids anywhere from 6 months to 18 years of age.
The majority of children I have worked with professionally saw me for an injury or for chronic pain. I've used myofascial release to treat children with scoliosis, movement dysfunction, trauma, pain, and headaches. It's a great complement to traditional pediatric therapy, as this technique can allow for increased mobility and significant improvement in structural alignment.
In addition to these areas familiar to me, the course also covered specific application to children with head injuries, birth trauma, neurological dysfunction, and cerebral palsy.
In the neurologically impaired child, there is secondary tightness due to the effects of spasticity and limited movement ability. When added to more traditional therapy, myofascial release can be of great help for these secondary problems. I would love to be part of the team that helps kids with cerebral palsy, neurological dysfunction, or even those with autism or other developmental behavioral disorders who struggle with movement dysfunction.
To parents of children dealing with chronic pain, I would like to pass on a local resource that may be of help. While at the course, I met a physical therapist who works at Lucile Packard Children's Hospital at Stanford; she's part of a multidisciplinary team at the Pediatric Pain and Symptom Management Clinic. This team works together to develop an individualized treatment plan for children and adolescents who struggle with chronic pain. We are fortunate to have this resource nearby. For more information, see their website: Pediatric Pain Management
Overall, it was a good course. I look forward to using the information taught, in combination with my previous training and experience, to treat the children and adolescents that I see.
What is Myofascial Release? How would I know that I need it? How can this form of manual therapy help me?
Fascia is the connective tissue that spreads throughout the body in a three-dimensional web, from head to toe, without interruption. Fascia surrounds all of the soft tissue and all of the bones of the body.
Fascia, unlike muscles, tendons, and ligaments, does not simply connect one bone to another or cross over joints to allow them to move and maintain static positions; rather, it's one continuous structure that connects each part of the body to every other part of the body, like the yarn in a sweater. It provides a sliding and gliding environment for muscles, transmits movement from muscles to bones, and provides a supportive and movable wrapping for nerves and blood vessels as they pass through and between muscles. Fascia also suspends organs in their proper place.
In its normal, healthy state, fascia is relaxed and wavy; it has the ability to stretch and move without restriction. When we experience injury, inflammation, or scarring, whether from a trauma, a strain, a fall, a bump to the head, whiplash, surgery, repetitive stress injuries, or even the cumulative effects of habitual poor posture, fascia becomes tight, restricted, and a source of tension to the rest of the body. Because fascia surrounds everything in the body, tightness anywhere in this structure can cause muscle pain, nerve pain, joint pain, decreased circulation, loss of mobility, and loss of function.
When fascia becomes tight, normal soft tissue treatment, such as massage, will not help it to stretch out and become mobile again. Massage, or other kinds of soft tissue mobilization, helps localized tender or tight areas in muscles relax, decreases tension and spasm, improves blood flow, and decreases pain. The kneading and deep pressure of massage can help work out knots or reduce trigger points in the muscles, and if those are the only problems with the soft tissue, resolve the pain. However, often the effects of massage are only temporary, because it does not effectively address restrictions in the fascial tissues.
Myofascial Release ("myo" is Greek for "muscle") is a type of hands-on therapy that provides gentle, sustained pressure into myofascial restrictions to relieve pain and restore mobility. In myofascial release, affected fascia is slowly stretched by the therapist's hands until a barrier or restriction is reached, and then a light pressure is maintained for typically three to five minutes, until the barrier releases. As the restriction releases, the therapist feels motion and softening of the tissue.
Common problems treated effectively with myofascial release include chronic pain, back pain, neck pain, headaches, TMJ problems, fibromyalgia, scoliosis, head trauma, movement dysfunction and neurologic dysfunction. It is gentle enough for pediatrics and fragile geriatrics, but can also be deep and effective for sports injuries.
In my experience, when dealing with more chronic, complicated, or widespread problems, the addition of myofascial release to other forms of soft tissue mobilization, joint mobilization, exercise, and education has been the difference between learning to live with a problem and recovering from the problem.
If my Physical Therapist does manual therapy, what does that mean, and how will it help me?
I am a Physical Therapist who uses manual therapy to help address the underlying causes of a person's pain or dysfunction. Not all physical therapists are manual therapists, and not all manual therapy is the same. Sound confusing? I'll try to explain.
Tight or weak muscles can make it difficult to move the way you are supposed to without having pain as a result; most physical therapists teach people how to do exercises that address areas of tightness or weakness. When a person performs exercises to become more flexible or stronger, it commonly becomes easier to function, and pain is decreased.
However, what if you are in too much pain to do the exercises, or the exercises are not enough to help get rid of the pain? What if there were a kind of hands-on therapy that could help your body heal better than just exercise alone? That's what manual therapy is; it's a generic term for hands-on therapy that helps address the underlying cause of a problem, and more quickly and completely heal that problem.
There are many different types of manual therapy. For example, some manual therapy focuses on joints, which can become stiff and tight. When tightness of the capsule around the joint is the cause of the decrease in motion, a physical therapist may use joint mobilization manual therapy techniques to help the stiff joint become more mobile; better mobility allows better function and lessens pain.
Not all joint tightness comes from tightness of the capsule around the joint; often, tightness comes from problems in the soft tissues surrounding the joint.
There are many different kinds of soft tissue in the body, including muscles, tendons, ligaments, nerves, and blood vessels, these and the organs all having one thing in common: they are surrounded by fascia, a connective tissue that spreads throughout the body in a three dimensional web, from head to toe, without interruption. Fascia has an appearance similar to a spider's web or a sweater; for those who cook chicken, the thin, glistening, membranous tissue found all over the chicken is fascia.
Tight or immobile fascia typically results in chronic pain, referred to as myofascial pain, often diagnosed by pressure on sensitive points in the muscles ("trigger points") causing referred pain in seemingly unrelated areas of the body. The pain persists or worsens, and normal soft tissue treatment, such as massage, tends to be ineffective in causing the fascia to stretch out and become mobile again.
There is a manual therapy treatment able to restore mobility to the fascia and effectively treat myofascial pain, called myofascial release. My next blog entry will describe what myofascial release is, how it is different from other forms of soft tissue treatment, and how it is effective in decreasing pain and increasing mobility and function when other forms of exercise, joint mobilization, or soft tissue work have not worked well enough.