John F. Barnes, PT always says in Myofascial Release (MFR) Seminars, “You can’t force a system that won’t be forced.” As I ponder this statement for my first blog, I reflect back on my 22 years as a physical therapist. I remember as a young therapist being frustrated with hamstrings that wouldn’t give, tight hip flexors in kids with Cerebral Palsy, and tight heel cords for those who ‘toe walk’. Being well versed in many techniques on “how to stretch a muscle,” I began leaning more towards the PNF (Proprioceptive Neuromuscular Facilitation) and NDT (Neuro Developmental Treatment) as taught by my expert instructors at LSU Medical Center.
NDT uses the notion that “every movement is preceded by a weight shift” and that “elongation occurs on the weight-bearing side.” So as we shift our weight, that side must elongate or lengthen, to un-weight the opposite side before any movement of the human body can occur. But what if that weight-bearing side won’t ELONGATE? Problem # 1. In NDT principle, “mobility proceeds stability,” so it needs to lengthen. As a traditional therapist working in a rehab setting my first year, I was constantly faced with this issue. My second year as a PT, I decided to take an MFR/NDT course with Regi Boehme, OT (a certified NDT instructor, and John F. Barnes student and instructor of Myofascial Release). It was in this course, that I learned how to perform a cross-hand release, inhibition with elongation (similar to Rebounding, one of the three pillars of JFB MFR Approach®), how to BE with my patients, and participate in what Regi called ‘the dance‘ between therapist and patient. She had great compassion for patients as she herself had polio, resulting in a short leg, and her receiving therapy for many years of her life. Regi was kind, compassionate and had great therapeutic hands! Her expert NDT and MFR techniques melted my tight hip flexores in a way that I had never felt or experienced before. I was astonished that the results lasted for weeks, not days as had been my previous experience with regular, ‘non-neurological stretches’ as I liked to call them. I felt so tall! Being a mere 5’3” that was very significant to me.
I immediately was able to implement the MFR principles Regi taught me, cross hand releases and the oscillatory inhibition with elongation, to my therapeutic ‘treatment bag’. I saw physical and physiological changes with my patients. The results lasted much longer than my previous techniques. MFR produced an emotional change with the patients too. They reported things like, “no one has ever done this for me before” (gratitude) or “I feel great after just one session” (amazement). They were actually excited about what therapy could do. I quickly realized that I was working smarter not harder, than my fellow therapists, so I taught a few of my co-workers the cross hand release. They got the same results. I was no longer trying to force a system that would not be forced. The low load long duration stretch that was being provided during the cross-handed release was causing the golgi tendon organs (muscle cell receptor) to “reset” and the muscle length tension to change, causing elongation! Yay! Success! I did not realize the depth of John F. Barnes Myofascial Release Approach ® or that it had other components besides this structural one, until much later. John also says, “after implementing MFR 1 (learning the cross-handed release technique) into your practice, you will significantly out perform the majority of therapists and get better, lasting results.” I experienced this first hand as a PT.
I now, after taking MFR courses from John Barnes himself, watching him treat in person, receiving treatment from him, and utilizing the principles he developed, can say that I understand with more clarity why this fascial system can not be forced. The fascia is a network of supportive and connective tissue that is fluid filled and runs continually from head to toe without interruption. It is made of collagen, elastin, and a gelatinous ground substance. It is highly elastic and dynamically acts like a fluid. I like to compare its elastic component to a super bouncy ball, or a rubber band. It has loads of potential energy in all directions 360 degrees at every point. Any load placed on this system in any direction, affects everywhere else in this system. Being highly charged, literally, and elastic, it will resist and respond to forces applied to and through it. If you push it or pull it in a forceful manner, it will push back, like a loaded sling shot, or a bouncy ball. The force you exert on it, will load the system and it will just spring back at you. As a therapist, using a cross handed position, we engage the barrier, sink to the place where the ‘dead halt’ occurs, and the give has stopped, and HOLD. The time matters! Initially the MFR structural technique was 90-120 seconds, Regi taught me 3 minutes, John now teaches 5 minutes or until the fascia releases. You effect change in the system with these longer hold times. The structural component has time to give, softening dehydrated ground substance, releasing restrictions, and facilitating physiological changes that assist with authentic healing. When release occurs, a new layer, a new depth barrier, can be engaged. Since the fascial system is such an elastic and electrically charged system, the removal of the therapists hands (dismount) is very important. Some say it may be the MOST important. Removing the hold of this cross handed release is just as important as the hold itself. If a therapist yanks her hands out, the tissue will spring back in response. A very slow, depth by depth, exit must occur. This ensures that the tissue will remain in its adapted and reorganized state.
There is an art to JFB Myofascial Release Approach® that requires technical skill, presence, and a bit of therapeutic finesse. There is a respect for each person, mind, body, and spirit. When we engage the fascial system, we are connecting deeply to the very core of the person beneath our hands. It is a two-way street. We must obtain permission, settle ourselves, be grounded and wait without intrusion. Forcing causes resistance. Resistance is the opposite of release. John also says, “We never force, we never injure.” I like that as a therapist, and as a patient. Other Myofascial Release techniques that I have run across on the internet, and witnessed in practice, are very forceful and painful, or fail to allow the patient to lead the dance, and thus produces dependency and a “fix me” mentality. The patients take no ownership of their own wellness, and it is also hard work on the therapist. Any type of forcefulness or fixing in therapy sessions can evoke the emotion of anger in our patients stemming from the sense of intrusion. This, in my professional opinion as a PT for well over 20 yrs, is NOT true myofascial release, but a dishonorable attempt to force a system that will not respond in a healthy or lasting manner. I feel like ‘the dance’ that Regi and John have taught me, is so much more beautiful and therapeutically beneficial when there is no forcing and no frustration, but only the release that frees us in motion.