The Importance of Fascial Home Interventions, Part 2
Part 2: What Are The Different Types and How Do They Help?
Written by Derrin Kluth, PT, DPT, RMT
In our last instalment of this series, I discussed in detail how a Fascial Home Intervention Program differs from a more traditional Home Exercise Program. In this post I will continue in this vein and I will outline broadly the different types of home interventions that your therapist may prescribe for your specific problem and plan of care. I will also address how each type can be of use to a patient in their healing journey.
1) The first broad category is what we will call generally the “Releases,” although a longer name might be “Home Myofascial Release Interventions.” This category includes the use of any tool or technique whose aim is to soften, loosen, and desensitize trigger points and any stuck layers specifically in the collagenous fascial system. Generally the techniques will require a longer duration hold; up to 5-10 minutes per area or more depending on patient skill level.
Using a rubber ball to release restricted fascia.
While theoretically any tool will work, the most simple and common is the rubber ball. More advanced tools that target deeper parts of the system might include the use of specialized candidates such as the Thera-cane. Sometimes tools are developed for very specific areas like the Occipivot is designed for tight tissues up under the back of the skull, or the Cranio-Cradle is used to help target the fascia deep in the dural layers around the inside of the skull or spinal canal. When the patient masters the more simple Release techniques, they may learn more advanced fascial self-care techniques such as Rebounding, or using rhythmic movement to help relax the tissues, or Unwinding, which is a flowing multi-planar motion held in positions for longer periods of time.
2) A second category that a patient may be prescribed can be called “Fascial Stretching.” While this could technically be a sub-type of the first group, I think these types of interventions are distinct enough to warrant their own classification. Some of you who have taken various Yoga classes, especially Yin Yoga, will be fairly familiar with this type. Many others will be familiar with the simplest version of this category, the ubiquitous “muscle stretch” that can be held for 30-60 seconds and repeated several times, and often can give temporary relief. However, when longer time dimensions are applied along with specific controlled applications of the force of stretch, a person can begin to relax and release not just the muscle, but the fascial system in and around it, as well as its connections to fascia up or down the chain of total connection.
This type of technique can be used to stretch the whole chain, or just focus on parts of it. For instance, the yoga position of “Downward Dog” would be a fascial stretch of the whole continuity of fascia starting at the top of the head and running through the posterior muscles and other tissues of the neck, back, hips, thighs, and calves to the bottom of the feet. We could also target any of the muscles along this continuity (i.e. “links in the chain”) for specific attention, such as the calves, hamstrings, latissmus dorsi on the back, etc. While many people find the direct release interventions of the first category very effective in releasing their fascial system, some find mastery of this second category a useful adjunct, or even more effective depending on the individual.
Fascial Stretch for hamstrings using a yoga strap.
3) A third type of intervention that may be used is the Targeted Strengthening Exercise. Unlike its relatively common cousin found in the more scatter-shot Home Exercise Program, a Targeted Strengthening Exercise is meant to restore or improve any strength deficit that may be present in a muscle along a fascially connected line of tissue (otherwise known as a “myofascial chain” or “kinetic chain”) whose purpose is to provide the most ease in any performed motion the chain might contribute to. And often a muscle (or muscles) may have to be strengthened in a very specific way to maximize the ability to return to prior levels of function, or become an even better version of themselves than before!
For instance, consider a case using the chain of fascia and muscles described previously in the “Downard Dog” example. Say a person is having problems generating power to kick a soccer ball after a hamstring injury. Let’s suppose that the problem is that the fascia in and around the hamstring is tight because of some residual scar tissue after the muscle tissue otherwise healed up, creating a “straight jacket” effect which limits knee extension. We may initially focus on loosening the fascia in that hamstring so that it can allow the extending of the knee to its fullest range. But that might just be the first step! Once the fascia is loose, the muscles have to start taking over to contribute the stability the tight fascia used to provide. This might mean we have to restore muscle control by focusing on the force-absorbing capability of the hamstring to provide control of the knee throughout the kicking motion.
But perhaps we have to address other parts of the body as well. We also may have to increase the capability of the force-generating muscles on the front of the thigh bone, the quadriceps, to create power during the kick after a period of weakness due to not being able to extend the knee the whole way because of the hamstrings area’s tightness. Maybe the patient spends a lot of time at the computer studying or working at the computer off the field. This may cause tightness in the calf down the chain because of a constant bent knee position in sitting that needs to be taken into account and loosened up as well. Or a forward head posture relative to the trunk that causes the shoulder blade muscles to be stretched out and weakened so they can’t provide stability down the chain to make the thigh muscles’ job easier. The more we strengthen the whole chain, the better performance the patient may reach and the less likely they may be to re-injure themselves later! These types of interventions can be done until a person’s body is ready to take over while doing the activities the person wants to perform. Correctly applied Targeted Strengthening Exercises can be a very important part of any healing journey.
Targeted strengthening exercise for the core muscles.
4) Another type of intervention that a patient may encounter is less physical but no less important. A person may need to be educated in ways to use their body that will prevent the provocation and/or worsening of their symptoms, either in the moment or over time. A fancy name for these might be “Biomechanical Retraining Interventions.” This broad category can include everything from breaking bad postural habits during computer use that are contributing to neck, arm, or hand pain to specifically training our soccer player patient from before in how to kick the ball in a way that doesn’t require overloading or overstretching the hamstring in order to prevent injury. Bad sleeping positions causing back pain. Walking or running with a foot’s arch falling in causing knee pain. Poor lifting technique during lifting, reaching overhead, or pushing a vacuum cleaner staining our shoulder blade muscles. Gym exercises that make us look good but hurt our shoulder. Using a cane or walker improperly leading to a hurting hip.
The variety of potential interventions in this category are as different as the ways a patient could possibly use their body! Knowing how to perform activities in a way that maximizes the ability of a myofascial chain to accomplish a task while minimizing the effort and risk of injury is just as important over the long term as making someone’s pain feel better in the short term. Maybe even more to prevent problems from getting worse over time. This category of interventions addresses this important aspect of recovery.
5) The final type of intervention I will discuss is not completely a separate category per se, but in some ways can apply in important ways to any and all of the other types, and are often integral parts of them. Let’s call them broadly “Mental Interventions.” Their purpose is to focus on and improve the mental and central neurological aspects of a patient’s recovery.
For instance, a patient may be having trouble releasing a painful trigger point in their back with a ball because the “Fight or Flight” part of their nervous system is very strong and guarded in that area, and preventing the person from relaxing the tissue enough to let the ball sink in to desensitize the trigger point. They may need to be taught to correctly utilize visualization, breathing, and other relaxation techniques to calm and counteract the guarding patterns for the patient to adequately do their home interventions. Practitioners of meditation might be familiar with this type of intervention.
Meditation practice.
Another example might be developing strategies or tricks to cue their attention when they are falling into bad posture while working at the computer. A therapist can train them in techniques that initially bring the performing of bad habits in real time to their attention so that they can be changed and better habits can be developed over time. Using these, the patient can go from a state of needing to concentrate to perform the better habit to making it so automatic that they perform the correct posture almost without thinking about it, and getting rid of a major cause of pain in the process!
Computer use creating habitual postures.
A final case of this type might be familiar to practitioners of Tai Chi or similar disciplines where a patient may require developing a sense of mindfulness of motion. Perhaps a big part of our favourite soccer player patient’s problem is that they have a malfunction in the body’s conscious and unconscious position sense system that tells them where their leg is in space. They may require a form of mental training that better lets their brain keep track of where their joints and fascial system are in relation to the rest of their body in order to produce the most forceful kick or prevent going too far and re-injuring themselves. These types of interventions are subtle but powerful and often overlooked in therapies that don’t appreciate how the fascia is the brain’s connection to knowing where all it’s body’s parts are and what they are doing.
In conclusion, I hope the reader finds themselves more aware of and familiar with the different types of home interventions that a fascial therapist may prescribe for them. And I hope that this familiarity will empower a patient to feel comfortable asking their therapist if he or she thinks that one or more of these types of interventions might be appropriate in their healing journey! Future instalments of this series will focus on ways fascial therapies can be applied to different types of specific patient problems.
Disclaimer: As an Amazon Associate, we earn from qualifying purchases.