The data continues to get worse for the manual therapy denialists. Look its a small study from a Japanese team, and I am definitely extrapolating a lot here, but it appears that basic myofascial release (treatment to the muscular and connective tissue elements) appears to have an effect on the performance and function in this subject group.

Two primary outcomes were improved, forward flexion distance (how close they were to touching the floor) and walking speed. It may seem little but small changes in tissue tone can have a dramatic effect on the compliance, movement and ultimately even the output of the myofascial unit. The major reason this is possible is through neuromodulation. When tissue is restricted, there is commonly altered inputs from the sensory apparatus of the tendon and muscle. This means that the information being sent to the spinal cord and or central nervous system is likely to be altered and cause inhibitory signals in the descending or output pathways. So as simple as it sounds, basic interventions that improve tissue compliance, range of motion and joint movement are likely to improve the function of motor output.

Working in elite sport, there is a significant amount of anecdotal as well as empirical evidence that demonstrates that altering these tissue behavious leads to better performance. And there are likely to be two reason behind this.

1. The first is what we have just discussed, and that is the improvement in tissue dynamics both at the tissue level, improved sliding of tissue layers, as well as the effect this has on the afferent inputs and subsequent reduction in inhibitory drivers from the spinal and central nervous system.

2. The second is the psychological benefit that is attained by the reduction of inhibition, improved ease of movement and improved recruitment of the contractile units of the system. In many ways this may be placebo, but in some ways it is not. For instance if an athlete has felt restricted in a particular movement pattern for instance, lets say they can feel hamstring tightness when they kick a ball, ustilisation of myofascial release techniques may remove the tightness sensation. This increased ease of movement improves the confidence of the athlete to execute the skill and is likely to enhance consequent performance.

So what does myofasical release treatment entail?

Myo meaning muscle and fascial referring to the connective tissue (think the sinew that holds layers of tissue together and disperses forces across layers) is a treatment style that looks to create sliding, gliding and compliance between layers of tissue. This may between the skin and underlying fasical. Between the fascial layers and muscle or between the deeper fasical septa that divide compartments of muscle tissue. This type of treatment general requires pressure to be exerted that looks to slide these layers and either have the skin or underlying muscle tissue moving (usually through passive movement of the joint above or below). These friction or sliding motions may be longitudinal or oblique to the line of the tissue. In this study the intervention consisted of 3 bouts of 60 seconds conducted every day for 5 days. The key thing that I glean from this is the amount of time (3 minutes on the same spot) and the successive days of intervention.

To put this into a sporting context, working with athletes pitch or trackside, the implementation of interventions can be used for performance as well as injury reduction. Typically upon reporting restriction to an area, mysofascial release is performed to the affected area as well as above and below. If it is a restriction in this tissues compliance that is causing the increased sensitivity in this area there is often an immediate improvement in the sensation of restriction and the ability to resume activity at a high level immediately.

In a rehabilitation world that is shifting towards reduced manual therapy, I would encourage people who have become less hands on to explore different techniques to assist with tissue function and work closely with patients to understand whether the benefits exist, rather than using incomplete evidence to suggest that the evidence is not their. This is in no way to suggest that more active management strategies should not be implemented, but rather the combination may have more benefit than one intervention alone. I have an inkling that as the technology to measure tissue tone, afferent and efferent behaviour and tissue mechanical behaviour in-vivo improves, we may get the understanding of why manual therapy works so well, despite the current lack of evidence to support it from the current research.