By Lilly Longshore

For years after my spinal cord injury, I lived with a constant, painful pinch on the inside of my left upper thigh where my leg joins my pelvis. All the muscle relaxers and pain meds wouldn’t make it go away. I tried repeatedly stretching in hot tubs and utilizing personal trainers and yoga instructors, years of deep tissue massage — nothing I did worked.

Then one day I was referred to Ike Anunciado, the owner of 360 Physical Therapy in Vancouver, Washington, for a frozen shoulder. He introduced me to the world of fascia release and a technique called strain counterstrain. From that day on, I have used fascia release and strain counterstrain therapies to reduce my pain all over my body and to maximize what movement I have.

What is fascia? We are all familiar with that sinewy, clear membrane on raw chicken that seems to stretch forever. We have hundreds of yards of that stuff, known as fascia, wrapping each of our 650-plus muscles and every muscle fiber, blood vessel, lymph duct, organ, and nerve — from our heads to our toes. Once thought to be solely support tissue, research now shows that fascia is much more complex.

“Fascia surrounds everything,” says Anunciado, who holds a master’s in physical therapy. “It is a neural highway with many branches and connections — it flows.”  Research has revealed that fascia not only supports our many organs and body structures, but it also contains the same contractile fiber as smooth muscle, as well as pain receptors and neurotransmitters. In response to trauma, fascia can contract and clamp down on muscles, vessels, and organs, restricting blood flow, preventing proper function, and inhibiting drainage. This causes pain.

Debbie Boe, licensed massage therapist and owner of Head2Heal Massage Therapy in Vancouver, Washington, discovered the value of fascia release through personal experience. “I was in a horrible accident,” says Boe. “Fascia work had the most profound effect for my personal healing.” She has since taken numerous courses beyond standard massage therapy requirements to hone her skills in fascia release.

“I tell people to picture themselves in a long-sleeve, long-leg, one-piece leotard,” Boe says, describing the continuity of fascia and its constrictions. “I take the tummy of the leotard, grab it in my hands and I wad it up … a couple of times. You can visualize that leotard no longer fits right going up in the shoulders, around the waist, down into the legs. I’ve changed the fit of it and I’ve increased tension. That leotard is one-dimensional, it is just on the surface of your body. Fascia is a more intricate 3-D web than you can wrap your head around.”

For me as a client, I have noticed that as Boe works on my left ankle, for example, using a subtle, stretching motion, I might feel a distinct pinching way up in my ribs on the same side. Sometimes as she works on my right shoulder, I might feel pulling in my left hip. My fascia feels like a continuous sheath that crisscrosses my whole body.

No Magic Pill

There is no magic pill that releases fascia. It must be worked and released using physical means. An extreme example of fascia release is a “fasciectomy.” Fascia’s compressive strength is significant. With severe muscle swelling from significant trauma or something like a snake bite, fascia can constrict the swollen muscle to the point of causing necrosis or tissue death. A fasciectomy, or slicing through the fascial tissue, can be performed to relieve pressure and save the limb.

However, the medical professionals I see use very gentle, pain-free methods to release fascia and the associated tight muscles and kinked vessels.

Anunciado has mastered strain counterstrain for muscle and fascia release. He learned the counterstrain techniques by taking many courses provided by the Jones Institute of Carlsbad, California, and from years of hands-on practice in his clinic. “[Before owning my own practice,] I worked in a multi-disciplinary chronic pain center … where we addressed pain from all different sides … using direct technique,” explains Anunciado. “[Using traditional] physical therapies, I noticed there was a gap — people still hurt.” This observation caused Anunciado to further pursue strain counterstrain, which he was introduced to during his first year of physical therapy school in 1990.

“The basic concept of strain counterstrain,” he says, “is to find a dysfunctional tissue … shorten the fascia through that offending system, then that tissue will relax and pain will come down.” The concept of shortening muscle fiber to its shortest position, then allowing it to relax essentially allows the muscle fiber to “reset” itself. The concept works for fascia, too, but through different receptors. Fascia resets via nociceptors (pain receptors), whereas muscle resets through stretch receptors. Recognizing the value of strain counterstrain for clients, Anunciado now teaches this technique in his own clinic, as well as in seminars worldwide.

Sue Martin of Progressive Therapy, in Dadeville, Missouri, initially studied massage therapy to help her husband with his headaches. Seventeen years and thousands of course hours later, she makes her living helping many people with pain. “I learned about neuromuscular therapy, then [later] learned the fascial system and how it wraps around tender trigger points,” Martin explains. “When I put those two together, it seemed very effective and worked for the vast majority of people.”

It worked for me, for one. From my personal experience with Martin, I gained significant, long-lasting pain relief and better joint and muscle movement. Her technique of gently moving fascia and following it as it relaxes is very effective. And that pinch in my left leg? It has disappeared.

The mysteries of fascia are still being unraveled. Every two to three years, a worldwide group of medical professionals get together to discuss and present the latest research findings on fascia at the International Fascia Research Congress, the next of which is scheduled for November 2018 in Berlin. “As years go by, they are finding how fascia is integral in the health of our bodies,” says Anunciado. Some professionals are even calling fascia a new organ. Anunciado is excited about the ongoing research. “I’ve done a lot of different types of therapy … [Fascia] counterstrain is really an amazing tool for reducing pain.”

Knowledge of fascia and fascia work has been around for decades, yet it is not nearly as ubiquitous in practices as traditional, exercise-based physical therapy. As it is an essential tool that is often overlooked even though its efficacy is proven [see below], it is well worth requesting it from your doctor. Professionals in your area who have completed training on strain counterstrain at the Jones Institute can be found at www.jiscs.com.

Resources
• Jones Institute and certified practitioner list, www.jiscs.com
• Fascia Research, www.TuckeyPT.com
• Fascia World Congress,  www.fasciacongress.org
• Clinical Trials Evaluation, “Myofascial Release as a Treatment for Orthopaedic Conditions: A Systematic Review” (Journal of Athletic Training, July-August, 2013)

Fascia Release Clinical Trials Reviewed

By Tim Gilmer

The authors of a review of 88 clinical trials on fascia release [“Myofascial Release as a Treatment for Orthopaedic Conditions: A Systematic Review, Journal of Athletic Training, July-August, 2013] concluded the following: “Anecdotal evidence shows great promise for MFR as a treatment for orthopedic conditions. However, evidence-based research to support the anecdotal evidence is lacking.”

It is important to understand that fascia release (synonymous with MFR) is not inherently an evidence-based medical technique because it involves one practitioner using his or her unique skills and knowledge on one person with a specific complaint, and there are different techniques. In other words, by its nature, it lacks objectivity. Brent Bauer, M.D., observes in his analysis for the Mayo Clinic on fascia release and back pain [www.mayoclinic.org/diseases-conditions/back-pain/expert-answers/myofascial-release/faq-20058136]: “Many studies have found that massage, chiropractic manipulation, and similar manual therapies work as well as other treatments for back pain. Few studies, however, have tested myofascial release therapy specifically, partly because the exact elements of myofascial release therapy vary from therapist to therapist.”

The Journal of Athletic Training review of studies concludes that “results of the studies were … mixed, with some finding MFR to be effective for an orthopedic condition and others finding little to no effect. … This wide array of results reveals the need for future research.”

The authors go on to suggest an appropriate design for future research: “Participants should be randomized, the design should be double-blind, and the clinician performing the MFR should use it regularly in clinical practice. … Because of the nature of the technique, the effectiveness of MFR can vary with the comfort level of the patient, so the patient and clinician should both feel at ease around one another. Only one medical condition should be studied at a time, and MFR should be used alone. Also, if possible, MFR should be compared with a control (no-treatment) group and with other proven treatments.”