Why neither foam rolling, nor instrument assisted soft tissue technique should be considered Myofascial Release
In this video Dr. Spina discusses the concept behind ‘myofascial release‘ therapies (MFR) and why the currently popular ‘foam rolling,’ as well as Instrument assisted soft tissue techniques cannot be considered under this banner. MFR therapies (which includes Functional Range Release ®) act to break down abberent fibrosis that has developed in fascia/connective tissue between planes/layers. In order to do so, relative motion must be created between the adhered layers as is described…foam rolling, instrument assisted techniques…or any other technique in which the load contact glides over the skins surface cannot achieve relative
motion and thus cannot physically release aberrant fibrosis.
The Superficial to deep fascial interface – Yellow superficial fascia reflected and showing its fuzzy relationship to profunda fascia. Picture courtesy of The “Integral Anatomy Series Vol 1: Skin & Superficial Fascia, Gil Hedley, 2005” (with permission)
In the brief experiment demonstrated, we only discuss their inability to create relative motion between the fascia superficialis and fascia profunda layer (Inter-layer motion), however also note that because these techniques do not utilize motion (active or passive) they cannot impart relative tissue motion between muscular components either….even when motion is utilized in conjunction with instrument assisted techniques, the fact that the instrument glides over the skins surface means that it does not contribute any load to the moving tissues. ***Further, even if they were able to impart such load….the time needed to alter fascial composition (approx 2 min by the literature) is far greater than is afforded by these methods.THIS IS NOT TO SAY THAT THEY ARE USELESS!!!!!! I desire only to describe why they are NOT myofascial release (and in so doing I hope to eliminate what I have commonly been hearing….that if someone has an injury it can be ‘foam rolled’ away). Foam rolling may induce some touch induced analgesia for example…and instrument techniques may be useful for imparting mild tissue injury in order to stimulate healing.
Trackbacks
- 3 top posts of the half year… « Functional Anatomy Seminars – Functional Anatomic Palpation Systems™ | Functional Range Release™
- In response to “Fascia Science: Stretching the power of manual therapy – by Dr. Greg Lehman” « Functional Anatomy Seminars – Functional Anatomic Palpation Systems™ | Functional Range Release™
- FunctionalAnatomyBLOG’s top 3 rated posts of 2012 « Functional Anatomy Seminars – Functional Anatomic Palpation Systems™ | Functional Range Release™
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Functional Anatomy Seminars - Functional Anatomic Palpation Systems™ | Functional Range Release™ 
I feel that this example is attempting to limit the definition of Myofascial release. A release of contractured soft tissue/MM/Tendon etc. is MFR. Trigger points & the Golgi tendon/MM spindle physiology is a pillar of MFR. Limiting the definition of MFR leads me to believe the founder of an active or functional stroking motion is selling their method, while creating a wedge in dialogue and definition that can affect insurance return.
Graston module 2 does include movement with treatment similar to active release technique.
I use Graston in my clinics and perform movement with every protocol. A totally different treatment is achieved with motion
T
Hello Dr. Fletcher
Thank you for you comment. While I do applaud the attempt to utilize motion with the techniques, I still cannot conceptualize how sliding the instrument over the skins surface would intact contribute to any lengthening effect. Even utilizing a foam roller in a stretched position would make more sense here because at least there is a significant compression (which does not occur with the instruments) occurring whilst the tissue is lengthened thus contributing further to the stretch of the soft tissues. This of course does not even take into account the depth of your target, when using an instrument, one can only hope to affect superficial tissues as it does not offer the ‘layering’ capabilities of hand contacts with appropriate articular positioning.
Again, I have to note as I did in the blog post, I am not claiming these techniques to be useless, I only want to encourage manual therapists to better define the lesions they mean to treat before they select a tool for the job.
Hello Dr Spina
I enjoyed your practical comparison of myofascial release with foam rolling (with a soft roll of under wrap) and the handle of a reflex hammer in a static single plane treatment.
Are you familiar with Técnica Gavilán ?
This instrument assisted soft tissue technique does not only utilize movement, but involves 3 planes of motion, with functional patterns used in PNF. We apply loads concentrically, eccentrically and with dynamic stretching in functional multi-plane motions.
The use of the Gavilan instruments during these functional dynamic loads takes instrument assisted soft tissue mobilization to a new level.
The release of restrictions and fibrosis between different layers of fascia is apparent due to the phenomenal patient outcomes that are not temporary.
Gary Lang MS, ATC
Hi Gary
No I have not heard of this technique…but I will definitely take a look
cheers
Interesting post Dr Spina. Does ART create relative motion?
I did read some journals re Graston/IASTM and it sems that they do stimulate fibroblast proliferation…though I’m not sure if you can actually pinpoint where exactly in the tissue it is (unless you slice it, microscopy, etc)
As for fascia, it seems that there are so many definitions (see link below). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3091474/
Is there histological evidence/ microscopy to support the notion that technique A/B/C actually creates sliding of the superficial and deep layer of fascia.
great discussion people, lets keep it civil!!
Hi Ben…and thank you for contributing
Regarding ART, I do believe that it can act to create relative motion…I do have some issues with that particular technique (hence the reason I developed F.R.) and I have taken all of the courses…but I won’t get into that here. Techniques which attempt to pin down, and/or amplify a stretch using a combination of compression with tension during movement would be useful conceptually in improving plane sliding — some other issues arise however, for the example the amount of time spent applying the load.
Regarding the Graston utilization for fibroblast proliferation, I have no doubt in my mind that this occurs (which is in fact demonstrated as you point out), however this would occur with any form of ‘insult’ (injury) sustained by soft tissue. The real issue is when proliferation occurs, can the technique influence directionality of collagen deposition. Remember that scar tissue is normal collagenous tissue laid down haphazardly; thus any tissue insult can stimulate proliferation, however conceptually this type would not be optimal for tissue healing per se. Further, the depth of proliferation must be taken into account. As demonstrated by my simple ‘experiment,’ if it is questionable whether or not these types of treatment can affect even the most superficial layers, one could legitimately conclude that they cannot affect the underlying layers to any great extent.
Regarding Langevin’s work….yes, I am very familiar with all of her papers including this one. I take the anatomists view of what encompasses fascia (including the epi, peri, and endomysium) and I recommend this to all manual therapists as our treatment goals obviously must include these forms of connective tissue.
The evidence of tissue/layer sliding is in the works. Dr. Jay Triano at the Canadian Memorial Chiropractic College for example is currently examining several techniques using diagnostic ultrasound for the purpose of demonstrating their effectiveness in this regard (yet unpublished). Personally during my sports residency I had a lot of time to ‘experiment’ with dx ultrasound with Dr. Anthony Mascia (MSK Radiologist) – who frequently demonstrated lack of tissue plane sliding in cases of MSK injury…in addition to claiming that myofascial type tissue technique can alter this sliding beneficially (also unpublished)…I would be interested in conducting such research and hope to have the time and resources soon.
BTW – I commend you last comment. Obviously my post touched some nerves…this was not the intent. I only intended to apply histological knowledge to think through claims that are made regarding these techniques. I never said that the techniques were of no use, I simply wanted to demonstrate that the ‘claimed’ effect was seriously flawed. In addition, I want to encourage manual practitioners to better define the tissue lesions they are wanting to treat/alter so as to better select appropriate treatment tools.
Regards
ah… I think it’s much clearer now that you have added some explanation… How abt some of the newer stuff like Active Isolated Stretching, and old school PIR, PNF stretching , would they also create relative motion?
Thanks
As you may know, I have my own system of ‘stretching’/mobility training so I do not utilize AIS nor PIR/PNF personally. However in the case of stretching I do feel that there is some degree of relative created between muscle groups. However there would not be enough interns of intra-muscular sliding (ie. between bundles or fibbers without the application of a directed stretch provided for by a proper tissue contact. This is the reason that stretching alone would not be sufficient in resolving aberrant biomechanics due to fibrotic development (although useful in promotion of relative motion once tissues have been released.
On another note, where I feel these systems fall short is in terms of the creation of passive motion vs active motion (mobility). It is the object of FR, using PAILs and RAILs training in conjunction, to improve mobility –i.e. to improve a persons ability to utilize their newly acquired ranges (mobility) by building strength simultaneously while stretching.
Great Post Dr. Spina, as always a very interesting topic.
Do you think that it is possible that the compressive involved with the IASTM and foam rolling interventions actually create a relative fascial tensioning via deformation of tissues similar to a transverse stretch technique? Thus by applying compression you would achieve tension forces just outside the locus of compression with a vectors perpendicular to the plane of the locus of compression.
(Hopefully my meaning is clear as I don’t have a nifty pencil model to help the explanation 🙂
I don’t think it would be as specific, nor do I imagine as effective as a hands on contact, nor does it offer the ability to layer through tissues or apply appropriate treatment duration as you mentioned above, however, I am thinking the concept could lend some weight to the aforementioned interventions and may explain some of their effectiveness. Thus, they might have some application in breaking down fascial adhesions but may not be the best tool for the job.
What are your thoughts?
As an aside, as a first time poster and long time reader of the FABlog I just want to thank you for taking the time to make and maintain such a fantastic resource.
Hello Dr. Comeau
Thank you for your question…also thank you for the kind words. I am glad to hear that you enjoy the posts.
Regarding your question, I find myself agreeing with your second paragraph which in essence summarized my thoughts. Any compressive load apply perpendicular to the surface will induce tension on either side of the contact via stretching the tissue. As you mentioned however, the amount of tension that can be created would be very minimal, especially if the tissue compression is being applied in neutral positions (ie. without a pre-loaded stretch). I also agree with the notion that the application of such a load would not be sustained for long enough to induce fascial adaptations and thus cannot conceptually be used to do so. This is not to mention the more obvious problem that without effective layering, only the most superficial tissues would be subject to the ‘stretch’ if any at all.
Regarding these treatment modalities, I believe their effectiveness to be the result of two process’:
1. By creating irritation in the tissues thus inducing a reactive inflammatory reaction/response – hence inducing healing.
2. Touch induced analgesia
I hope this answers your question although it seems that you have a similar view regarding this topic.
Thank you again
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Great topic and I love explanation as well as this website. I apologize if this was asked already but I have a few questions. You mentioned that movement was negligible with a more adhering surface, what is considered excessive movement and what is considered negligible movement when trying to make a difference? And in the case of a foam roller, what if the person remains fixed on the roller and then goes through and active and full ROM? Using your pencil diagram, could you fix the more external layer and then move a deeper layer, thereby creating realitive movement of the external layer? Finally, is there any research that says using IASTM absolutely can not create a change in fascial tension? Say I agree based on your model that IASTM can not sustain a large mob for 2 minutes, what if the mechanism for change is different? I appreciate any light you can shed and love the work you do.
hello John
Thanks for the question. ‘Excessive’ movement is not really a concern as much as it is to be able to move the superficial layer far enough relative to the underlying layer in order to create tension between them. Once this tension is created, then there will be a resultant force on the fibrotic tissue between the two layers which, if given enough time, “release” (ie. beneficial cellular alteration) will occur. Keep in mind that this does not even begin to examine the question as to weather or not such devices can ‘release’ the underlying myofascial tissue. The purpose of the demonstration rather was to show that adequate tension cannot even be developed in the superficial layers…thus one would come to the conclusion that tension most likely cannot be transferred any deeper.
As for the question regarding research, there is not real direct research either way. However using indirect evidence one should conclude that if tension cannot be adequately introduced in superficial layers, it would be even less likely to achieve said forces in deeper tissues.
Regarding remaining fixed on the roller with the addition of movement. I believe that this would provide far to broad a contact to induce any adequate external forces into the tissues. Again, as I have mentioned previously, I would not throw your foam rollers away! I feel that they are beneficial in terms of temporarily improving ROM prior to training, as well as for producing a strong touch induced analgesic effect…the point of the post is more that they are not creating a situation where a myofascial ‘release’ can occur.
Thanks for the kind words btw