Orthopedic Considerations for Myofascial Release
The Myofascial Release Approach, as developed and taught by John Barnes, PT, is a multifaceted type of
manual therapy consisting of myofascial release techniques, soft tissue mobilization, craniosacral
therapy, structural balancing and movement facilitation. The objective of Myofascial Release (MFR) is to
restore order and balance of the entire body by providing comprehensive and individualized evaluation
and treatment. While Myofascial Release therapy is extremely popular along the east and west coast, it
remains relatively unheard of in the mid-south. Many people assume that Myofascial Release is
synonymous with massage since the meaning of the word, ‘myofascial’, can be broken down into two
words meaning, “muscle” and “fascia”, or connective tissue. However, fascia not only surrounds the
muscles, it also suspends and supports every organ, blood vessel, nerve, and bone in the body.
Restrictions that develop within the fascial system are often a contributing factor to a variety of
orthopedic issues ranging from low back, neck, hip, knee or shoulder pain, and even TMJ dysfunction.
Yet, many problems often go undiagnosed because fascial restrictions do not show up on standardized
tests such as x-rays, CT scans, or MRIs. Addressing these restrictions can help reduce unnecessary pain,
restore active range of motion, and allow a person to return to a healthy active lifestyle by restoring the
balance of the entire person.
Fascia is a continuous three-dimensional web of connective tissue that is interwoven throughout the
body from head to toe. It is primarily made up of two types of fibers: elastic fibers which are easily
stretched; and collagenous fibers, which are more dense and have less stretchability. In response to
direct trauma, poor posture, repetitive stress, or inflammation, the connective tissue tightness and
hardens over time, and begins to pull on the neuromuscular-skeletal systems, creating another source of
pain and symptoms in the body. The bones or osseous structures are passive elements, since they are
suspended in a three-dimensional web of connective tissue; their position is dependent on the balance
of the whole myofascial complex. Mobilizing a joint or passively moving a bone back into alignment
without releasing the soft tissue restrictions will only provide temporary results. Since the tensile
strength of fascial restrictions has been estimated to create a pulling force of approximately two
thousand pounds per square inch, this force can pull the osseous structures back into the previous state
of pain and dysfunction if the total system is not addressed. If the body is unbalanced, the skeletal
system will be strained again and again by taut fascia during movement, enabling symptoms such as
back pain, knee pain, shoulder pain etc. to recur.
Because the pelvis provides a foundation for the body, its position can have a direct effect on the
structural alignment on the rest of the body. A subtle imbalance in the pelvis over time can alter the
body’s vertical axis, thereby causing shortening or compression elsewhere in the body, leading to
abnormal postures and movement patterns, thereby and increasing the body’s energy expenditure;
leaving a person feeling weak, tired, and at risk for further injury. Many common orthopedic complaints
such as low back, hip, shoulder, or knee pain originate from imbalances in the pelvis. When evaluating
the pelvis, a discrepancy in the balance as little as an eighth of an inch can be considered significant. In
his book titled, Myofascial Release: The Search for Excellence, John explains,
“Treatment should be aimed at balancing the pelvis. This creates a stable foundation for the
spine, removing the wedging effect of the osseous structures by releasing the myofascial
Orthopedic Considerations for Myofascial Release
tightness of the psoas and associated structures. This could help long- standing back and pelvic
pain and dysfunction, and prevent unnecessary surgery by treating the cause of the problem. “
A comprehensive MFR evaluation includes visual analysis of static and dynamic movement working with
and against gravity, palpation of soft tissue mobility, as well as the customary joint mobility, strength
and range of motion assessments. Each individual is different and therefore must be evaluated and
treated accordingly. John Barnes’ Approach to Myofascial Release stresses the importance of treating
the whole person and not just the symptoms. He continually reiterates during his MFR seminars that
the symptoms are the tip of the iceberg and are very rarely related to the cause of the problem.
Myofascial Release is a whole-body approach designed to remove the pressure off of all pain sensitive
structures by providing a sustained but gentle stretch throughout the myofascial and neuromuscular-
skeletal systems by utilizing a combination of compression, decompression, rotation and de-rotation
techniques to release the soft tissue restrictions throughout the entire body.
A highly skilled MFR therapist can evaluate the texture and mobility of the fascia and determine the
depth of the restriction and where a person has been pulled off their vertical and transverse axes.
Using the bones as levers, therapists are taught to apply sustained pressure into the system, wait until
the easier elastic component releases, subsequently matching the resistance of that barrier, and then
waiting until the tougher and inelastic collagenous barrier releases. This sustained stretch can last
anywhere from two to ten minutes per area, as the collagenous component of the connective tissue
takes at least 90-120 seconds to release. If the pressure is not sustained for this amount of time, proper
elongation will not occur and the results will be temporary. However, if the stretch is sustained for a
time interval greater than 120 seconds, multiple releases can be attained. It is necessary to treat the
problematic or symptomatic areas as well as the whole body, so that the cause of the problem is
addressed; this will help minimize orthopedic pain and recurring dysfunction by achieving balance of the
myofascial and neuromuscular-skeletal systems.
One client’s perspective:
“ In my 62 years, pain has been an unwelcome companion through the removal of a blood
tumor by radiation as an infant; through polio at age six; through two spinal fusions for scoliosis
as a teenager; through the removal of a pituitary tumor; carpal tunnel surgery; and a total hip
replacement as an adult. Over the past fifteen years, I have tried exercise, traditional physical
therapy, chiropractic services, acupuncture, vitamin therapy and structural integration massage,
much of which wasn’t covered by health insurance.
Last fall, I experienced increasing pain in my left hip and leg. Assuming that this was connected
with my hip replacement ten years ago, I consulted my orthopedic surgeon. X-rays indicated no
problems there and my doctor said that my pain was coming from my back and, “...it was just
going to be like that”, and prescribed anti-inflammatory medicine. Having a history of gastro-
intestinal problems the year before, I did not want to take this strong medicine that would
aggravate my stomach and large hiatal hernia.
Orthopedic Considerations for Myofascial Release
Experiencing even more difficulty standing, walking, and sitting for extended periods of time, my
body felt like it was freezing up on me, and I began to think that I’d soon end up in a wheelchair.
I decided to revisit a suggestion, made by my pastor’s wife, to try Myofascial Release. I sought
my primary physician’s referral, and he agreed, yet he supplied another prescription for another
anti-inflammatory drug that thought I would need during the initial treatment.
After my first treatment, I discovered that my posture and breathing had significantly improved.
After years of trying to ignore and medicate pain without success, I am now trying to “listen” to
the pain and treat those areas with the help of the myofascial stretching home exercise program.
It is so liberating to know that there is actually something that I can actively do on my own about
my pain. I do not have to depend on just the office visits. I have not had to take anti-
inflammatory prescription drugs. In just a month’s time, my energy level and attitude have
improved tremendously. I look forward to my tomorrows of a more active lifestyle!”
Carol Cox, IPT Client
Another client’s perspective:
“I have had chronic pain throughout my entire body for the past ten years. I am glad to say that
after four months of going to Integrative Physical Therapy Inc. and receiving regular Myofascial
Release therapy, I am basically free of pain. I can do things again that I could not do 10 years
ago, like play golf. My shoulders, neck and knees feel so much better! Myofascial release has
not only helped with my chronic pain, but has improved my posture and overall well being. “
Preston Carpenter, IPT Client
Integrative Physical Therapy (IPT) is a private practice out-patient facility located in Southaven,
Mississippi, that specializes exclusively in John Barnes’ Approach to Myofascial Release. The clinic
provides individualized and comprehensive treatment for a wide variety of orthopedic issues such as
neck, back, hip, knee, shoulder, and temporomandibular joint (TMJ) pain, as well as sports injuries, post
surgical scarring, chronic pain, fibromyalgia, headaches, and women’s health issues. Treatment is
aimed at resolving the cause of the pain and not just treating the symptoms. To find out more about
how Myofascial Release can help you, call: (662)-349-6712, or e-mail: email@example.com.
Susan Jenkins, PT, is a physical therapist, advanced myofascial release therapist, and owner of
Integrative Physical Therapy Inc. Susan has been practicing as a physical therapist in Mississippi and the
Mid-South area for over 22 years. She has also had extensive training in Myofascial Release from John
Barnes and has specialized in his approach since 2001…
Julie Davidzuk, OTR/L, is an occupational therapist and advanced myofascial release therapist who has
been practicing in the Mid-South area for 8 years. Julie has also had extensive training in Myofascial
Release and has studied John’s Approach to Myofascial Release since 2004…