This is most widely used manual technique which is widely used nowadays in as advanced rehabilitation processes. it is used in several conditions like stroke, cardiovascular disorders,to release diaphragm muscles,to release muscle tightness,to decrease spasticity,to increase range of motions of joints etc.

1. SUBMITTED BY-KHUSHBOO ANJUM
MPT 1ST SEMESTER,NEUROLOGY.
MYOFASCIAL
RELEASE
SCHOOL OF HEALTH SCIENCE
C.S.J.M.UNIVERSITY
KANPUR
A
NITION
B
CONTRAINDIC
ATIONS
PHYSIOLOG
Y
C
D

2. CONTENTS
.
• WHAT IS MFR?
•DEFINITIONS
•WHAT IS FASCIS?
•PHYSIOLOGY
•CAUSES OF SOFT TISSUE DYSFUNCTIONS
•EFFECTS-PAIN/SLEEP/QUALITY OF LIFE
•INDICATIONS
•CONTRAINDICATIONS
•PRECAUTIONS
•EXAMINATION
•TECHNIQUE
•TECHNIQUE BY ARTICLES
•REFRENCES

3. WHAT IS MYOFACIAL RELEASE?
•‘Myofascial release is a specialised physical and manual therapy used for the
effective treatment and rehabilitation of soft tissue and fascial tension and
restrictions.’
Myofascial release UK
•Myofascial Release (MFR) is a holistic, therapeutic
approach to manual therapy, popularized by John Barnes,
PT, LMT, NCTMB. MFR offers a comprehensive approach
for the evaluation and treatment of the myofascial system,
the system of tissues and muscles in the body.
This technique is designed to release restrictions such a
trigger points, muscle tightness, and dysfunctions in soft
tissue that may cause pain and limit motion in all parts of
the body. It has shown success in decreasing pain and
increasing mobility. (1)

4. DEFINITION
MYO= Muscle
Fascia= A band or sheet of
connective tissue
Release = The relaxation
and/or stretching of tight
structures

5. DEFINITION
•“Myofascial release is a manipulative treatment
that attempts to release tension in the fascia due
to trauma ,posture ,or inflammation. Connective
tissue called fascia surround the muscles
,bones,nerves , and organ of the body .Points of
restriction in the fascia can place a great deal of
pressure on nerves and muscles causing chronic
pain”.
Spine-health.com

6. WHAT IS FASCIA?
•Fascia is a layer of fibrous tissue that surrounds
groups of muscles , bone , blood vessels and
nerves.
•It binds some structures together ,while
permitting other structures to glide smoothly over
each other .
•Fascia are dense regular connective tissues,
containing closely packed bundles of collagen
fibres oriented in a wavy pattern parallel to the
direction of pull.

7. PHYSIOLOGY
Neuromotor controls and the central
nervous system- The thixotropy theory

8. CAUSES OF SOFT TISSUE DYSFUNCTION
Congenital factors (short/long leg, small hemipelvis, short upper extremity, fascial, cranial
and other distortions)
● Overuse, misuse and abuse (and disuse) factors (such as injury or inappropriate patterns
of use involved in work, sport or regular activities)
● Postural stresses
● Reflexive factors (trigger points, facilitated spinal regions)
● Chronic negative emotional states (anxiety, repressed anger, etc.)
● Nutritional deficits
● Toxic accumulations
● Infection
● Endocrine (hormonal) imbalances

9. EFFECTS
MFR techniques affect the continuous, contiguous, connective tissue
system, which envelops every cell and fiber in the body.
● The goal is to relieve fascial restrictions and to normalize the health
and tension of this body system.
● At the cellular level, MFR affects the elastacollagenous complex as
well as the consistency of the ground substance.
● MFR increases soft-tissue flexibility and relieves tissue tension while
decreasing the density and viscosity of the ground substance, thus
increasing the metabolic rate and improved metabolism and health

10. EFFECTS

11. EFFECTS
•Myofascial release have greater
effects in releasing upper trapezius
TrP with significant reduction in neck
pain and improved neck movements
as compared to spray and stretch
technique and there would be
minimal chances of early recurrence
of TrP after about 3 days of receiving
it.

12. INDICATIONS
.
● Primary intervention for neuromusculoskeletalfascial
impairments
● Secondary intervention for joint dysfunction, muscle
fiber dysfunction, fascial dysfunction, neuronal
dysfunction, periosteal and bone dysfunction, and
circulatory dysfunction
● Positive findings with myofascial mapping
● Decreased fascial glide or compromised mobility
● Joint hypomobility
● Soft tissue tension
● Postural deviations
● Dynamic limitations in range of motion

13. INDICATIONS
.
• Current trials have shown that MFR may promote wound
healing by affecting the extracellular matrix.(1)
• Myofascial Release Therapy on the Cardiorespiratory
Functions in Patients With COVID-19.(Myofascial release
techniques of the neck, thoracic, and diaphragm, along
with respiratory physiotherapy, could immediately affect
heart rate and ease of breathing and prevent increasing
diastolic blood pressure. If a patient with COVID-19 is
stable, pulmonary physiotherapists may consider using
these techniques while monitoring cardiopulmonary
function.)(3)
• Chronic low back pain(5)

14. contraindications
MFR, although passive, can be a direct or indirect intervention. MFR, therefore, is not
suitable for patients of all ages and conditions. The physician must reconsider
treatment if the patient has:(1)
•Healing fractures
•Advanced diabetes
•Severe osteoporosis
•Rheumatoid arthritis
•Malignancy
•Aneurysm
• NOT IDEAL FOR (4)
•with burns, injuries, or painful wounds
•with fractures or broken bones
•with fragile or weak bones
•with deep vein thrombosis or deep vein issues
•taking blood-thinning medications

15. PRECAUTIONS
.
● Systemic disorder
● Malignancy
● Nonunion fracture
● Cardiopulmonary impairment, such as
congestive heart failure

16. VIDEOS
.
• https://youtu.be/xw3j1OANkjQ

17. VIDEOS
.
• https://youtu.be/xw3j1OANkjQ

18. EXAMINATION
Myofascial examination:
● Three layers of fascial glide are assessed, including
(1) skin on superficial fascia,
(2) deeper layers of fascia, and
(3) mobility of soft tissue on bone.
● Tissues are palpated for mobility, flexibility, and freedom of tissue glide.
● Mobility is assessed in three planes:
(1) superiorly-inferiorly,
(2) medially-laterally,
(3) clockwise-counter clockwise.
● If fascial glide is tight, hypomobile, or inflexible, document findings on the body diagram;
MFR is
indicated.

19. TECHNIQUES
• A variety of tools including the fingers, elbows , knuckles, forearms and,
less frequently, the thumbs can be employed.

20. THE FINGERS
•Always keep the fingers slightly flexed with the
wrists in a neutral position.
•Keep a slight arch at the MP joints as well as at
the carpal tunnel.
•Correct: the wrists are in neutral and the
fingers are in a slightly flexed position.
•https://youtu.be/DWnlfN6YBsI

21. INCORRECT WAY
CORRECT -The wrists are flexed while the fingers are
hyperextended with excessive force at the MP joints

22. TOOLS

23. TECHNIQUE BY ARTICLE
Direct MFR for the TMJ
With the patient in a supine position:
1. Sit at the head of the table and gently hold the mandible with one hand and the opposite
mandible with your other hand;
2. Gently abduct the mandible, holding a firm and static force at the barrier until tissue release
finishes;
3. Slowly rotate the mandible and move it into additional abduction, keeping the steady force
at the barrier until tissue release finishes;
4. Gently adduct the mandible while keeping external rotation, applying steady force at the
barrier until tissue release finishes;
5. Slowly restore the mandible to a resting position and reassess the TMJ in motion for checking
engagement
Nahian A ; Unal M; Mathew J;Osteopathic Manipulative
Treatment: Facial Muscle Energy, Direct MFR, and BLT
Procedure – for TMJ Dysfunction ;SEPT17,2021.

24. TECHNIQUE BY
ARTICLE
1. 2.
3. 4.
Suboccipital release The
physiotherapist raised his
fingertips toward the ceiling and
placed his hand just below the
occiput, creating pressure to
release the tissues in this area.
The therapist then applied gentle
traction between the occiput and
the atlas
Anterior thoracic myofascial release
and sternal release The physiotherapist
placed one hand under the patient’s
head, just below the occiput, and held
it between his thumb and forefinger,
creating support in this area. The
therapist’s other hand rests on the
sternum, with the middle finger on the
midline of the sternum and the heel of
the hand just below the sternal joint.
Distraction moves the fascia and
sternochondral joints away from each
other, and the pressure was maintained
until the tissue was released
Anterior cervical myofascial
release The physiotherapist placed
one hand on the lower angle of the
jaw and the other hand just below
the lower edge of the clavicle. The
therapist exerted a downward force
on the lower edge of the clavicle
and an upward force on the jaw for
both sides. This pressure was
maintained until the tissue was
released .
Diaphragm release The patients were asked to lie on their
backs and relax their limbs. The physiotherapist stood beside
the patient’s bed, placing one hand on the diaphragm level
exerting gentle pressure, while the other hand was placed
under the patients’ trunks, parallel to the upper hand. The
pressure was maintained until the tissue was released

25. TECHNIQUE BY
ARTICLE
1. 2.
3. 4.

26. THE LOWER EXTREMITY
.

27. TENSOR FASCIA LATA
.
PATIENT’S POSITION-Sidelying with lower leg flexed to 30° at the hip
and knee. The upper leg is supported on the lower leg but with less
flexion at the hip and knee. The lumbar spine is in neutral
THERAPIST POSITION-Standing behind the client at the level of their
waistline and facing forward.
TECHNIQUE-Locate the muscle, anterior to the gluteus medius. Use
an elbow to sink into it until an obvious barrier to any more depth is
encountered. Wait without increasing the pressure. If another layer
becomes available, follow it down and wait once again. When there is
an obvious and sustained tone change, add a line of tension and
move slowly in an inferior direction. The movement across the
surface might only be 2–3 cm.
MOVEMENTS- Anterior–posterior tilt of the pelvis with direction.
‘Take your tailbone away toward the wall in front of you’ as an
example of posterior tilt.

28. GASTROCNEMIUS
PATIENT POSITION-Prone, with feet off the end of
the table to allow for easy dorsiflexion.
THERAPIST POSITION-Work from a stool for
technique number 1. Face toward the feet while
standing or sitting at the client’s side, at around
mid-thigh level, for technique number 2.
TECHNIQUE-1. Use an elbow flexed to 90° and take
up a contact in the tendo Achilles.Establish a line of
tension in a superior direction. Tether the tissue
while the client dorsiflexes. Focus the release at the
junction of the tendon and the muscles .

29. SOLEUS
PATIENT’S POSITION-Prone with feet off the end of the
table to allow for easy dorsiflexion. Use a bolster to
induce 10–15° of knee flexion and put the
gastrocnemius off stretch.
THERAPIST POSITION-Sit on a stool at the end of the
table, facing towards the head. Standing is also
acceptable.
TECHNIQUE-Use an elbow or fingers to sink into the
tendo Achilles. Sink slowly through the tendon into the
investing layer of fascia that lies between the soleus
and the gastrocnemius. Take up a line of tension in a
superior direction and tether the tissue while the client
dorsiflexes.

30. ANTERIOR COMPARTMENTINTEROSSEUS
MEMBRANE
PATIENT POSITION-Sidelying with upper hip and knee
flexed, and supported by a pillow.
THERAPIST POSITION-Standing at the foot of the table.
TECHNIQUE -Use an elbow with 90° of flexion and begin
above the malleolus of the fibula.Glide proximally 2–3
inches at a time between the tibia and fibula. Superficial
fascia can be treated more quickly – the interosseus
membrane will respond to slow, steady contact. Encourage
the client verbally to fully allow the weight of the treated leg
into the table.

31. PLANTAR MYOFASCIAE
PATIENT’S POSITION-Prone with feet off the end of the table
to allow for easy dorsiflexion.
THERAPIST POSITION-Sitting on a stool at the end of the
table.
TECHNIQUE-Use the knuckles, soft fist or elbow to engage the
soft tissue just anterior of the calcaneus. Take up a line of
tension in an anterior direction.Work progressively through to
the ball of the foot as well as into deeper layers in subsequent
passes.
MOVEMENT-Have the clientlift their toes, with direction –
‘Lengthen the bottom of your foot by taking your toes up
under the table towards your knee cap’.Dorsiflexion can also
be used in this.

32. REFRENCES
•1 Nahian A ; Unal M; Mathew J;Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR,
and BLT Procedure – for TMJ Dysfunction ;SEPT17,2021.
•Fareeda Shaheen Shah. (2020). EFFECTS OF MYOFASCIAL RELEASE AND VAPOCOOLANT SPRAY WITH
STRETCH TECHNIQUE ON UPPER TRAPEZIUS TRIGGER POINTS. Pakistan Journal of Rehabilitation, 5(2), 43–
48. Retrieved from http://ojs.zu.edu.pk/ojs/index.php/pjr/article/view/803
3) Fereydounnia S, Shadmehr A, Tahmasbi A. Efficacy of Myofascial Release Therapy on the
Cardiorespiratory Functions in Patients With COVID-19. jmr. 2022;16(1):77-84.
4) https://www.healthline.com/health/chronic-pain/myofascial-release#risks
5) Wu Z; Wang Y; Myofascial release for chronic low back pain: A Systematic review and meta-analysis;
2021 JULY.
6) . Dutton, Mark. Orthopaedic examination, evaluation, & intervention. New York : McGraw-Hill, c2004
pages 331-332, 1218
•Stanborough M;Direct Release Myofascial technique;1ed;2004