Is Myofascial Release Useful for Surgery or Recent Injury?

Written by Derrin Kluth, DPT

I’ve been asked by many people over the years if Myofascial Release Therapy can be useful not just for chronic pain and longer-standing problems, but also for more recent injuries or even surgeries? The short answer is yes, absolutely!

While it is definitely true that due to the way our health care system works and how it has developed over the last half decade or so that most people will seek Myofascial Release therapy for more chronic symptoms, it can also have wonderful and unique benefits in addition to standard therapy or rehabilitation for more acute healing too. It takes a bit of a change in approach and intent, but it can be very useful nonetheless.

To explain why, it helps to understand the concept of “The Three Stages of Healing” after an acute injury including after surgery.

Image credit: The Prehab Guys

I’ve discussed this shortly in prior blog posts, but here I will delve slightly deeper into it. For most people, the healing process from acute injury, including the three stages, tends to take roughly the same amount of time, although advanced age and general health issues such as diabetes can slow them somewhat.

The first stage is known as the “Inflammatory Phase” and most of us will be familiar with this one as the “swelling stage.” It is where the body is causing swelling and other processes in the area to both protect the injured area from further damage and prepare the injured tissue for the second stage of healing. This typically lasts somewhere between 1-2 weeks depending on the severity of injury.

Edema, aka Swelling, of the Forefoot.

The second stage is known as the “Proliferative Phase,” or less fancily as the “repair phase.” This is where the lion’s share of the actual tissue repair gets done by the body and as this process completes the swelling goes down and eventually disappears. Generally an obvious scar will form either inside and/or on the surface which will also slowly diminish until the tissue repair is complete. This typically takes somewhere between 1 week and 8 weeks depending on the severity of the injury.

And the third and final phase is known as the “Remodelling Phase.” During this phase the body “tears down” the changes it made to complete the first two phases and get the tissue back to normal, including shaping or remodelling the thick remnants of the healed scar to be more like the original tissue again.

Scar tissue remodelling occurs in Stage 3

Many people feel like they are completely healed for all intents and purposes going into this stage and by now have usually returned mostly or completely to their prior activity levels w/out significant problems. This stage is generally considered to last somewhere between 6 weeks and 3 months, although many in health care consider it to be more open-ended if there are any remaining symptoms, and this is where the pain or other symptoms would begin to be considered “chronic” if still present. Some experts consider the “chronic” phase to be its own fourth phase that the body has reached if it hasn’t completed the healing process correctly, and some consider it to be a lack of completion of the third stage. However, this distinction doesn’t really matter in real life recovery although it is conceptually useful.

Regardless, if you understand these concepts you now can understand that MFR is usually employed to help the system get back on track to normal in the chronic phase. But if employed correctly MFR can also be very useful in the three stages of acute healing as well.

The concepts are the same but how they are employed can vary by stage. They can be employed either by a therapist and/or simple versions can be taught to patients for use in the hospital/clinic bed and at home afterwards.

Bedside Physiotherapy in Hospital

In the first “Inflammatory” phase, MFR is usually used mostly for pain relief either at or around the site of injury. If there is an open wound or a closed wound with significant tissue damage beneath the skin (like a broken bone), then it would be avoided over the wound site itself, but it can be used gently nearby to generally decrease the total felt pain in the area which can have knock on effects as decreases in pain at the wound site.

If it is a closed wound without major underlying tissue damage then gentle MFR can be done on it to help decrease the pain felt here throughout this stage. It may also help with the swelling itself as keeping the tissue more loose can theoretically help fluid mobilization at or above the site between the site and the trunk. Tight tissue can restrict blood flow or fluids moving via other pathways and this can sometimes make swelling worse than it has to be for the actual healing process itself. MFR may help keep this “pooling” from occurring as much or at all.

In the second “Repair” phase, MFR can continue to be useful for pain relief, but it can now also begin to be employed for scar mobility as the wound or deeper tissue begins to knit itself back together. This can help prevent later formation of tightness or restrictions that can otherwise limit normal movement if the scar is too stuck down and limits tissue mobility. Think trying to move a tarp if you’ve put a stake through it and into the ground. It wouldn’t get very far. MFR can help prevent the “stake” from being put down through the layers in the first place which can help speed overall recovery time.

MFR can help prevent the “stake” (aka fascial restrictions) from being put down through the layers in the first place

In the third Remodelling phase, MFR begins to take on its more traditional role as it is helpful in softening helping the end phase scar tissue and helps return it to its pre-injury or pre-surgery state to again allow more normal motion as during the second phase. It can also help here to continue the desensitization of the area to return to normal activity without causing hypersensitivity during muscle contraction in the area. In this way it may prevent a progression to the “chronic” phase and/or complete the third phase to avoid chronic pain (depending on your perspective as above).

Another concept I’d like to discuss here in relation to surgery is the concept of “Pre-hab,” short in this context for “Preventative Rehab.” Many times for various reasons people know that they will have to have a surgery at some later point. Perhaps a ligament didn’t heal up well after an initial injury, for example. Or another might be an older person having bone- on-bone arthritis and needing a repair after many years of wear and tear.

In any of these or similar cases, MFR can variously be applied to help symptoms until the surgery itself, theoretically preparing the tissues to be in their best state before surgery to allow for most efficient healing time, and specific strengthening or body mechanics interventions can be added to relevant tissues so the patient is ready for when rehabilitation begins after the surgery itself to make that process more efficient as well.

And just like the ideal preparation for a surgery using traditional physiotherapy/physical therapy, a therapist skilled in MFR can instruct the patient in home strategies and interventions to help support the above uses of MFR during the healing process after surgery.

For example, if a patient has been trained in how to do a MFR rubber ball or tool intervention similar to how they’re given an icing or heating schedule for swelling or pain, these interventions may help a patient avoid needing to take as many pain medications during healing and more easily take part in rehabilitation to speed recovery.

I worked for my first two years doing MFR therapy in a physical therapy clinic attached to an outpatient orthopaedic surgical clinic and utilized MFR to help many people before surgery, healing from surgery, or in rehabilitation after surgery in the ways described above.

Pre-Hab = Preventative Rehabilitation

Sometimes we were able to delay surgery for significant amounts of time. Many surgeons prefer waiting as long as possible to do a joint replacement as many replacements wear out over a decade or two. Due to this, the later in life a person has to have a joint replacement surgery the better to avoid having to do another one at some point. More rarely we were able to even avoid having more minor surgeries such as arthroscopic knee or shoulder repairs if the person responded very well to therapy. And regardless, most patients I worked with told me how MFR therapy helped them get more quickly back to normal afterwards if they did have surgery.

And finally, MFR can also play its more obvious role after an injury or surgery has become “chronic” in order to help return it back to normal, even if it hadn’t been applied at any stage before. The longer the post-surgery chronic symptoms have been present, the number or prior surgeries in the area, and the amount of restriction and/or pain has been present, usually the longer a return to more normal can take. But it is definitely possible that with time and regular clinical treatment, and to some extent buttressed by self treatment at home, that even old and apparently hopeless post-surgical symptom states can progress significantly and sometimes even greatly back towards normal enough and that patients can gain significant returns to prior ability and activity in these cases.

Even old and apparently hopeless post-surgical symptom states can progress significantly and sometimes even greatly back towards normal with MFR

I hope after reading this that you the potential client have a better idea of how MFR can be used and added to more traditional therapy at any stage of healing, including after surgery, to help achieve the best outcomes. It’s not just only useful for chronic pain!

If you find that you are curious about further information about Myofascial Release Therapy in these circumstances or have any questions, please feel free to contact us at our clinic. We’d be happy to connect you with an experienced MFR Therapist who may be able to help with or add to your acute injury or surgery recovery at any stage!