NEUROMUSCULOSKELETAL REEDUCATION: Yoga and Bodywork / Myofascial Release: why function therapists should focus on function versus alignment, why we feel pain, why bodywork (myofascial release) is so important, what happens to load during yoga poses, why urdhva dhanurasana is the best low back stretch ever, and how myoafascial release and yoga make up neuromusculoskeletal reeducation.
Fascia is a tough connective tissue made up of a protein element called collagen. It spreads throughout the body in a three dimensional web surrounding muscle fibers, muscle groups, tendons, ligaments, bones, organs, cells, and fills the spaces in between. It holds everything inside the body together in its proper place, and configures the unique tone of the legs, arms, torso and face. Fascia is the most elastic element in the body and has the ability to change extensively upon touch. During myofascial release, bodyworkers can feel the immediate tactile change of soft tissue underneath their fingertips.
FASCIA AND TENSEGRITY
Fascia is a system of tensegrity, or tensional integrity. When it is injured either from stress, trauma, overuse, inflammatory illness, or repetitive motion, it responds by increasing tensional forces. It coheres surrounding tissue, gaining thickness and density. This can lead to adhesion; the binding of nerves, muscles, blood vessels, and internal organs; and the pulling of bodily structures out of alignment. If the body goes untreated, without myofascial release, the body enters the cycle of compensation and structural imbalance. When adhesion is present in the body (which can feel small like peas, large like golf balls, or thick and tough like a taught non resilient bungee cord), the sliding and gliding effect on muscle over muscle and nerves in between muscle is reduced or diminished and movement no longer comes from individual muscle fibers or groups. Instead the affected area moves as a glued complex tugging at adjacent structures pulling the body out of alignment. The result is a cyclical pattern of constriction and compensation in the body and mind, causing asymmetry and manifesting signals of distress and sensations of pain.
POISSON’S RATIO AND FASCIA EFFICIENCY
When an object is stretched, like muscle, Poisson’s ratio measures the rate of contraction, perpendicular to the applied load, to the rate of extension, parallel to the direction of the applied load. Ultimate efficiency is a ratio of 1:1. Oddly enough, fascia has a Poisson ratio of 1:1.
Although fascia is stretched during spine flexion, a greater degree of stretch is experienced during spine extension, which is why a properly performed and aligned urdhva dhanurasana (backbend) is the most effective stretch for lumbardorsal fascia (low back) pain. To ensure correct function of fascia and to counter fascia’s reverse pull during back bending, it is imperative to fire the abdominal muscles (rectus abdominus, psoas major and iliacus). This, in conjunction with lordosis, controls force transmission efficiency and contributes to Poisson’s 1:1 ratio.
The musculoskeletal system is an unstable structure. It is affected by thought, gravity, and stimuli from the environment, and stabilized by the central nervous system. Although some doctors focus on stability, it is instability in the body that permits optimal function. For example, take a military jet. If a missile is fired at the jet, it is the unstable structure that can evade threat. If the structure where built more stable, it would not be as quick or efficient and would not be as able to avoid harm. Similarly, the instability in human structure allows us to dash from and escape a bull, because our structure is more unstable than his. Therefore, one should not look for structural stability at the expense of function. This is evident in spine fusions. Nevertheless, functional stability is most important. For example, a humming bird beats his wings 100 times per second while his beak is steady inside a flower. If he had to use muscle to compensate for the motion of his wings, he would catch fire. This is why he has a neck, which decouples his head from his body. In humans, the neck decouples the head from the motion of the shoulders during movement.
LOAD OSCILLATION AND NEUROMUSCULOSKELETAL REEDUCAITON
Fascia is made up of collagen, which is visco-elastic. When stressed over time, viscous materials, like honey, resist strain linearly. Elastic materials, like rubber bands, strain instantaneously and quickly return to their original state upon the removal of stress. Since viscoelastic materials, like collagen, hold both viscous and elastic characteristics, they experience time dependent strain. Because collagen is visco-elastic and has a stretch response of 1/3 of a second, it cannot be loaded continuously. Therefore, force oscillates between fascia and other structures like muscle and ligament, which means a true static yoga pose does not exist. Instead, posture is dynamic and continuously modified, even during stillness. It is the holding of yoga poses (still and dynamic) that changes neural pathways. In other words, function is driving alignment. This is called neuromusculoskeletal reeducation.
LOAD OSCILLATION IN LOW BACK
Load oscillation in the lower back is controlled by lordosis, which is controlled by the psoas. The psoas, however, is not designed to balance the load because it is attached to the fulcrum. The constant load transmission, instead, requires a very specific spine-pelvis coordination, triggered by trunk flexion and rotation of the pelvis. To increase load on fascia and decrease muscle activity, extend the spine; hence, urdhva dhanurasana for low back pain. To increase load on muscle and decrease load on fascia, flex the spine (forward folds). Anterior rotation of pelvis increases load on muscle, while posterior rotation decreases load on muscle. A 50/50 load on fascia and muscle is at 30 degrees of flexion. Regardless of flexion or extension, fascia is critical for minimizing and equalizing stress. Gait requires lordotic oscillations to alternate loading of tissues.
MANUAL THERAPISTS AND MOVEMENT THERAPY
Manual therapists, like bodyworkers and physical therapists work within the fascial network. By focusing on function and approaching the body in this manner, the therapist promotes soft tissue manipulation, encouraging the body to readjust tensional and asymmetrical forces. This causes muscles, tendons, ligaments, organs and bones to shift back into proper alignment. Movement therapy after myofascial release, like yoga and physical therapy, can teach the body to move in the new aligned space. Together the combination of myofascial release and movement therapy is called neuromusculoskeletal reeducation. When properly aligned, the body is free of pain and can perform optimally.
Just like the military jet, we are architecturally modeled unstable for faster response, mobility and freedom, making the health of the fascial system essential. Fascia is a tough connective tissue that surrounds and fills everything and every space of the human body. It is made up of a protein called collagen. Collagen is visco-elastic and cannot be loaded continuously; therefore, a static yoga pose does not exist. Instead, even in stillness, a yoga pose is dynamic and constantly being modified within. Due to fascia’s tensile force, fascia has a tendency of entering a cycle of contraction, which causes asymmetry. However, myofascial release can counteract the tensional imbalance. When myofascial release and movement therapy, like yoga, are coupled, new neural pathways are enforced. This is called neuromusculoskeletal reeducation.
1. Titus, Stuart W., PhD, “Heal Us Now,” retrieved August 5, 2012
2. Gracovetsky, Serge, Ph.d, “Is Fascia Necessary,” a lecture given at the first International Fascia Research Congress held October 4-5, 2007 at Harvard Medical School in Boston, Massachusetts
3. Wikipedia, Poisson ratio, retrieved August 6, 2012.
4. Wikipedia, visco-elastic, retrieved August 6, 2012. Meyers and Chawla (1999): “Mechanical Behavior of Materials,” 98-103.