Written by Pete Dorsa, MSPT
This article is taken from a conversation I have had with a lot of my patients were we look at their diagnosis and break it down. Fibromyalgia is a good example in that it tells us nothing about the cause. True it is based on having certain characteristics and trigger points, but that’s not the whole picture. When a therapist treats using a principled approach such as Myofascial Release, as taught by John F. Barnes, the patient is viewed from a whole person perspective not just their symptoms. And this will become clearer as I define some terms and ideas.
Let’s start be breaking down the word Fibromyalgia into 3 distinct parts: fibro for fibrotic or fibrous tissue = fascial restrictions, Myo = muscle, and Algia = pain. When we recombine these terms it really means the person has painful fibrous muscle. What it doesn’t tell us is anything about the cause or why this condition develops.
Let’s take a closer look at the fascial system. In all muscles there exists a tremendous fascial matrix. A muscle has an outer fascial covering which holds all of the muscle fibers together. A muscle fiber can be further divided into a fibril with its own fascial covering and we keep going down further layer by layer to the cell membrane which has fascial elements.
For example let’s say a muscle is composed of 100 fibers, each fiber has a fascial covering. Each fiber is composed 100 fibrils with their own fascial covering. This is just the beginning and it goes much deeper. The point is in each and every muscle their exists this vast connective tissue matrix that must be maintained in equilibrium or our body is not in balance or homeostasis, equilibrium.
When we are out of balance our body will compensate and alter our posture, some muscles shorten others lengthen neither are at their optimum and become fibrotic. Or maybe we have been in an accident or under severe emotional stress – anything that causes us to tighten up and/or alter our posture will result in compensatory patterns. This is the start of a fascial restriction. Gone unchecked we begin to experience more and more pain as sensitive structures – blood vessels, nerves get compressed or ischemic pain develops due to decreased blood flow.
Now so far I have described the fascia as it pertains to the musculature. The fascia within the abdominal and thoracic cavities cover all of our organs. The structural layout is quite different but the implications of fascial restrictions in these areas greatly affects how our respiratory, digestive and reproductive systems function, and this doesn’t even touch the surface of emotions associated with specific organs, maybe this can be another blog.
Getting back to Fibromyalgia, now that you know how fascial restrictions form it becomes evident that Myofascial release is going to be a significant modality of choice in ones treatment. The job of your therapist is to find the pain and look elsewhere for the cause. Often times patients will feel they are stuck in a straight jacket. This is due to the extensive nature of the fascial system. The take home point is fibromyalgia is reversible, these compensatory patterns can be changed. The longer a person has been dealing with fibromyalgia the more ingrained some of these patterns become. So it’s not a quick fix, it does take time and it requires participation. Self treatment, doing prescribed exercises and modifying posture when indicated will contribute to your success. I have always treated from the idea that I cannot fix anyone rather I partner with my patient in order to help them heal.
MFR is a manual therapy, hands on approach that treats the whole person by correcting imbalances caused by restrictions within fascial system. Restrictions are released by applying pressure over a period of time, no less than 2 minutes and longer if that’s what it takes to obtain a release. The amount of pressure needed is the point at which the barrier has been engaged but not pushed through. This is important in that more is not always better. There is a fine line between tissue tolerance, a person’s pain threshold and what is needed to release these restrictions. As an area starts to release your therapist will follow the tissue as it softens and re-engage the barrier at the next level until several releases have occurred. Often times patients will comment they feel lighter, have more mobility or feel the weight more evenly on both feet. All of these responses indicate restrictions have been released. Since treatment is best done directly on the skin wearing a loose tank top (women) and baggy shorts will help your therapist treat you more effectively.
Thanks for reading,
Peter Dorsa, MSPT has been practicing MFR therapist since 1994.