Fig. 11.1
Fascia man (Courtesy of John Barnes)
The trained JFBMFR therapist finds the cause of symptoms by evaluating the fascial system. The technique requires continuous reevaluation during treatment, including observation of vasomotor responses and their location as they occur after a particular restriction has been released.
When the location of the fascial restriction is determined, gentle pressure is applied in its direction. It is hypothesized that this has the effect of pulling the elastocollagenous fibers straight. When hand or palm pressure is first applied to the elastocollagenous complex, the elastic component is engaged, resulting in a “springy” feel. The elastic component is slowly stretched until hands stop at what feels like a firm barrier. This is the collagenous component. This barrier cannot be forced; it is too strong. Instead, the therapist continues to apply gentle sustained pressure, and soon, the firm barrier will yield to the previous melting or springy feel as it stretches further. This yielding phenomenon is related to viscous flow; that is, a low load (gentle pressure) applied slowly will allow a viscous medium to flow to a greater extent than a high load (quickly applied) pressure [4, 5]. The viscosity of the ground substance has an effect on the ground collagen since it is believed that the viscous medium that makes up the ground substance controls the ease with which collagen fibers rearrange themselves (Jenkins DHR). As this rearranging occurs, the collagenous barrier releases, producing a change in tissue length [4].
JFBMFR techniques and myofascial unwinding seem to allow for the complete communication of mind with body and body with mind, which is necessary for healing. The body remembers everything that ever happened to it, and Hameroff’s research [6] indicates that the theory of “quantum coherence” points toward the storing of meaningful memory in the microtubules, cylindrical protein polymers that we find in the fascia of cells. Mind-body awareness and healing are often linked to the concept of “state-dependent” memory, learning, and behavior [7, 8]. For example, a certain smell or the sound of a particular piece of music may create a flashback phenomenon, a visual, sensorimotor replay of a past event or an important episode in our lives with such vividness that it is as if it were happening at that moment. Work based on the writings of and expanded upon by Barnes, Hameroff, and colleagues [6] includes position-dependent memory, learning, and behavior, with the structural position being the missing component in Selye’s state-dependent theory as it is currently described [7, 8].
During periods of trauma, people form subconscious indelible imprints of the experience that have high levels of emotional content and which could not be processed at the time of occurrence. The body can hold information below the conscious level, as a protective mechanism, so that memories tend to become dissociated, or amnesiac, called memory dissociation, or reversible amnesia. Subconscious holding patterns eventually form for specific muscular tone or tension patterns, and the fascial component then tightens into these habitual positions of strain as a compensation to support misalignment that results (tensegrity effect). Therefore, the repeated postural insults of a lifetime, combined with the tensions of emotional and psychological origin, seem to result in tense, contracted, bunched, and fatigued fibrous tissue. A combination of mental and physical stresses may alter the neuromyofascial and skeletal structure, creating a visible, identifiable physical change which, itself, generates further stress, such as pain, joint restrictions, general discomfort, and fatigue. A chronic stress pattern produces long-term muscular contraction which, if prolonged, can cause energy loss, mechanical inefficiency, pain, cardiovascular pathology, and hypertension [9]. Memories are state (or position) dependent and can therefore be retrieved when the person later repeats that particular state (or position). This information is not available in the normal conscious state, and the body’s protective mechanisms keep us away from the positions that our mind-body awareness construes as painful or traumatic.
It has been demonstrated consistently that when a myofascial release technique takes the tissue to a significant position, or when myofascial unwinding allows a body part to assume a significant position three-dimensionally in space, the tissue not only changes and improves, but memories, associated emotional states, and belief systems rise to the conscious level. This awareness, through the positional reproduction of a past event or trauma, allows the individual to grasp the previously hidden information that may be creating or maintaining symptoms or behavior that deter improvement. With the repressed and stored information now at the conscious level, the individual is in a position to learn which holding or bracing patterns have been impeding progress and why. The release of the tissue with its stored emotions and hidden information creates an environment for change. As such, no longer do patients habitually find themselves holding or stiffening to protect themselves from future pain or trauma. Release of fear and emotion takes place simultaneously with physical fascial release and physiologic release of the associated stress hormones.
Fascia and New Explanatory Paradigms
Clinical evidence has demonstrated that restrictions in the fascial system are of considerable importance in relieving pain and restoring function [10]. Myofascial release becomes vitally important when we realize that these restrictions can exert tremendous tensile forces on the neuromuscular-skeletal systems and other pain-sensitive structures, creating the very symptoms that we have been trying to eliminate [11].
An important component of the theory behind the mind-body connection is the ability for people to transmit natural bioelectrical currents along the endogenous electromagnetic fields of the three-dimensional network of the fascial system of another person [4]. Medical applications of exogenous bioelectromagnetics (like x-ray) are very common. Endogenous bioelectromagnetic field, natural within all living beings, has only more recently been studied [4, 12].
Increasingly, medical researchers and experienced health professionals are beginning to view the body as a self-correcting mechanism with bioelectric healing systems. According to Cowley [13], some scientists are starting to explore the body’s sensitivity to electromagnetic energy. Electromagnetic fields “trigger the release of stress hormones… [and] can affect such processes as bone growth, communication among brain cells, and even the activity of white cells” [13].
Copper wire is a well-known conductor of electricity. If copper wire becomes twisted or crushed, it loses its ability to conduct energy properly. It is thought that fascia may act like copper wire when it becomes restricted through trauma, inflammatory processes, or poor posture over time. Then, its ability to conduct the body’s bioelectricity seems to be diminished, setting up structural compensations and, ultimately, symptoms or restrictions of motion [4]. Just like untwisting a copper wire, myofascial release techniques seem to restore the fascia’s ability to conduct bioelectricity, thus creating the environment for enhanced healing. Release techniques can also structurally eliminate the enormous pressures that fascial restrictions exert on nerves, blood vessels, and muscles [4].
Fascial “Memory”
It appears that not only the myofascial element but also every cell of the body has a consciousness that stores memories and emotions [4, 14]. Research findings suggest that the mind and body act on each other in often remarkable ways. With the help of sophisticated new laboratory tools, investigators are demonstrating that emotional states can translate into altered responses in the immune system, the complex array of organs, glands, and cells that comprises the body’s principal mechanism for repelling invaders. The implications of this loop are unsettling. To experts in the field of psychoneuroimmunology, the immune system seems to behave almost as if it had a brain of its own. This is creating a revolution in medicine in the way we view physiology. More than that, it is raising profound and tantalizing questions about the nature of behavior, about the essence of what we are [15].
Fascia is not accessed by traditional mechanical methods such as point mobilization modalities or traditional stretching methods. Fascia, instead, responds to the combination of the intentional application of endogenous bioelectromagnetic energy fields and the sustained mechanical pressure at the myofascial barrier from within the therapist. Through the palms and fingers of the therapist’s hands, this gentle, sustained mechanical pressure seems to open memories and experiences in restricted fascia, for upon the release of restrictions, patients commonly become transported back to an injurious experience and with similar emotion, relating the experience in three-dimensional detail [4]. Once the trauma is completely experienced and fascial restrictions have given way, healing can commence. We have yet to learn the cellular mechanism of the healing process, it is believed that as restrictions are removed from fascia, body energy, blood, lymph, neurotransmitters, neuropeptides, and steroids are free to flow, restoring balance, homeostasis, and overall health to the system [4].
Myofascial release is not offered to replace traditional physical therapy techniques, but rather to supplement and enhance them as a complementary approach in evaluating and treating patients with pain, restriction of motion, and structural symptoms.
Yoga
Yoga historically evolved from a Hindu spiritual and ascetic discipline which utilizes specific body postures (asana) along with breath control (prana) and simple meditation to achieve unity of body and mind. Asana is the Sanskrit term for the physical postures of yoga. (Interestingly, many “traditional” Western physical therapy stretches and exercises are based in yoga tradition, but they do not incorporate the mindful focus in addition.) However, asana is only one of eight “limbs” of yoga, the majority of which are more concerned with mental and spiritual well-being rather than the physical. This technique is about creating balance in the body through development of strength and flexibility, including stretching. One style, vinyasa, utilizes the poses quickly in succession to create body heat through movement, while other styles go more slowly to focus on increasing stamina and perfect alignment of the pose.
Yoga has been found to be effective in the treatment of low back pain. In looking at randomized trials of yoga in low back pain with pain level as a mandated outcome measure, five RCTs suggested yoga significantly reduced low back pain compared to usual care, education, or conventional therapeutic exercises [16]. An 8-week yoga program demonstrated reduced pain, reduced catastrophizing, increased acceptance and mindfulness, and increased cortisol levels in women with fibromyalgia [17]. Positive results are shown in primary dysmenorrhea in reducing the pain intensity and duration [18]. In children with functional abdominal pain and irritable bowel syndrome, yoga has reduced pain and frequency, especially in children between 8 and11 years old [19]. In a yogic prana (breathing) energization technique (YPET) study of fresh simple fractures of extra-articular long and short bones, patients within the yoga treatment showed significant improvement over controls in pain reduction, tenderness reduction, swelling, and increased fracture time density and number of cortices united [20].
Feldenkrais Method or Awareness Through Movement®
Feldenkrais Method is a form of somatic education developed by Dr. Moshe Feldenkrais, a physicist, judo expert, mechanical engineer, and educator who utilized this knowledge base to design a method of gentle movement and directed attention to improve movement and enhance human functioning. Another name for this treatment method is Awareness Through Movement®. It is based on the principles of physics, biomechanics, and an empirical understanding of learning. It has been successfully utilized in all age groups in both physically challenged and physically fit groups, including professional athletes. It is claimed to be useful for helping those with chronic pain, those wishing to improve their self-awareness and self-image, and in central nervous conditions such as multiple sclerosis, cerebral palsy, and stroke.
Literature is scarce for treatment of chronic pain with Feldenkrais Method, but one study of 14 women with nonspecific neck and shoulder pain in a self-report study model demonstrated significant improvement and found the technique “wholesome, but difficult.” Additionally, they reported positive changes in posture, balance, a feeling of release, and increased self-confidence, and these positive effects remained after 4–6-month follow-up [21]. In a study comparing Body Awareness Therapy (BAT), Feldenkrais Method (FM), and conventional physiotherapy in patients with nonspecific musculoskeletal disorders, both the BAT and FM groups improved over conventional therapy in pain and quality of life, and they remained stable over time, while the conventional therapy group deteriorated at 1-year follow-up [22].
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