Whew! It’s been a little too long since our last blog. This is the second of our (hopefully) 10 blogs uncovering myths and misunderstandings that perpetuate physical therapy and other rehab professions. Part 1 is here. Enjoy.
Have you ever felt that tightness and stiffness in your thighs after a hard workout? Yeah? Have you ever had that intractable soreness in your upper back after sitting at the desk all day? Sure, who hasn’t? How often do you get told your hip flexors are bound up tight and affecting everything from your running gait to your neck mobility?
Maybe you feel like something needs to be “released”. And if you’ve ever searched the internet for a solution or talked to nearly anyone in healthcare or fitness, you probably heard it was fascia that needed releasing.
Lucky for you, people that practice manual therapies—i.e. physical therapists, massage therapists, chiropractors—are ready to release all your fascial restrictions and make you loosey-goosey again. There’s just one problem. Can you guess based on the title of this post?
Correct. It’s a myth. We can’t stretch fascia. We can’t release it. The term “release” is a junk term.
Typical fascial or myofascial release treatments usually involve the practitioner feeling for “restrictions” then using their hands or some other instrument to apply a sustained stretch along the fascial line or twisting/squeezing/kneading the tissues in question (usually painfully). After some time, the practitioner will feel the “release” and treatment is done.
Here are some problems with this approach:
1. Fascia doesn’t stretch.
Studies of fascial strength have shown that relative to its weight it can withstand tensions similar to that of steel.
This isn’t new information. In a study conducted in 1931, scientists found the tensile strength of the iliotibial band (or ITB, that thick connective tissue on the outside of the thigh everyone is always foam rolling) was nearly 8000 pounds per square inch. A more recent study found the force needed to stretch the ITB just 1% of its length is around 1000 lbs.
I don’t know about other physical therapists but I can’t produce that much force! And if I could, believe me, you wouldn’t like it.
But even if you could withstand the pain, there’s another, bigger problem.
2. There’s almost no friction between the skin and the underlying muscles and fascia.
That means any force applied along the skin to stretch or release the fascia beneath is doing no such thing because it can’t—there’s no friction to transfer the force of the skin stretch to the fascia.
This should be inherently obvious just by moving the skin on the back of your hand. It moves readily. The only reason it stops is because the skin gets completely stretched.
The idea of stretching/releasing fascia by applying a force through the skin is as absurd as trying to stretch a bit of radial tire by using your hands, which are covered in Vaseline.
3. Clinicians cannot reliably detect restrictions in need of releasing.
Contrary to what experts may tell you, our hands are not super-sensitive instruments capable of detecting the nuance in ounces of resistance or millimeters of movement. With thresholds that small we often feel what we expect to feel, a.k.a. confirmation bias.
When clinicians are compared to each other there is very poor agreement on where a fascial restriction is. The fascial restrictions that they believe they’ve found rarely correspond to any real restriction using advanced imaging. Lastly, we can’t even prove if these so-called fascial restrictions are causes of inflexibility, feelings of tension, pain or decreased performance.
So, if a manual therapist isn’t stretching and tenderizing your fascia with his or her hands then what is the release they feel and why do you usually feel so good after?
The jury is still out but we think that the touching/stroking/squeezing/kneading is a soothing input to your nervous system that causes a change in the underlying muscle’s tone, ideally helping it to relax. The therapist may feel this change in tone as the muscle becomes more relaxed. You may feel you can move more freely as the muscle relaxes and stops opposing your movement. That could explain why you also feel less pain.
Another pain relief possibility is that aggressive and painful fascial release may result in your body releasing its own painkillers (endogenous opiates) to dull the pain of the technique. Afterwards you bask in the afterglow of painkillers coursing through your veins.
If it feels good and makes you feel better why does it matter if fascial release is actually releasing fascia or not?
Because believing that only a skilled clinician can stretch your fascia for you can make you believe that you need that person to “fix” you. That takes the locus of control away from you and makes you dependent on someone else for your health. That shouldn’t be the case.
If you’re feeling tight and sore it’s because of something you did or something you’re doing (or not doing) everyday. And if you can discover what that something is you can make the appropriate adjustments and be in charge of your own wellbeing. A skilled practitioner should be able to help with this.
If the occasional deep tissue massage or “fascial release” makes you feel good, that’s great but the therapist ought to be showing you ways to help yourself and prevent that pain and tightness in the future. Once you know what to do the rest is up to you.