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April 2017
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Imported from the USA, the myofascial massage takes its name from the suffix myo, which derives from the word muscle, and fascial, from the word fascia. It is a massage technique that does not work on muscles but between muscles (that is, on the fasciae that surround the muscles), and it originates from the osteopathy of Andrew Taylor Still, a therapy based on manual contact for diagnosis and treatment, which was the first to highlight the importance of fasciae as connective tissues that cover the body on a subcutaneous level. Although this therapy requires the therapist to have great precision and good anatomical knowledge, a myofascial massage is easy to carry out and can be adapted for the needs of the patient.

How it works
The muscles in the body are laid out in orderly fasciae covered by connective tissue that form a large ‘net’ called the myofascial system, and the method used for this neuromuscular massage works on this large covering of tissue and, at the same time, the muscular and nervous systems. The pressure exerted by the masseuse is strong and energetic and is focused on the muscle fasciae involved, making muscles more flexible and lively and reactivating their functions. This massage carries out an action on the interstitial fluid, or muscle lubricant, and this is why it improves the fluidity of movement; it works by freeing parts of the connective tissue (fascia), which covers the muscle, from tensions, stagnations and stasis, allowing the muscle to move freely in its range. The benefit of this action can be seen most when doing sporting activities: being well oiled, the ‘motor’ muscle allows the individual to give his/her best in terms of a sporting performance and will prevent muscular injuries. This is why myofascial massages are particularly recommended for athletes.

Not just for sportsmen and women…
With the necessary precautions, a myofascial massage is a good technique for everyone, and it is particularly effective for treating rigidness and muscle contraction, even if it is chronic. The benefits include improving posture and resolving muscle and joint pains.

A normal session

In a warm and enveloping atmosphere, made so with soft lighting and background music, the patient should be able to fully relax and try to distance thoughts about his/her everyday life. Before this though, the masseuse will have asked the patient to provide any useful information about any medical problems he/she may suffer from. The masseuse will then continue to maintain this verbal contact with the patient during the whole session, showing him/her the various manoeuvres that will be performed and asking him/her to change position when necessary.
The session begins with the patient lying face up with the masseuse exploring the body using the relevant massage techniques and trying to identify the points of tension in the patient’s body. Palpation of the connectivity allows him/her to clearly understand if there is muscle tension under the dermis, and, operating on the tensed connective layer in a reflexive way, the masseuse is able to relax the muscle(s) concerned. Once this is complete, the patient then turns over to lie face down.

From the second session on, which can happen after 3/4 days, the manoeuvres become more energetic and more pressure is applied as per the physical characteristics of the patient. Eventually, one session after the next, the body will be more relaxed and, consequently, easier to work. The first sessions do not last longer than 40 minutes so that the body does not undergo too much stress, but once the patient is used to the treatment, sessions can last up to 90 minutes.

The manoeuvres in detail
The myofascial massage begins in the cervical area of the neck and moves on to the shoulders, then the paravertebral zone and, finally, the lumbosacral area. The neuromuscular myofascial massage method uses normal massage techniques such as strong pressure and decontracting energetic movements that are performed using the thumb and fingers which work on the whole area being treated, and movements alter between slow yet intense sliding to specific techniques that work on the connective fasciae and muscles. For the sliding movements, for example, the masseuse places his/her hands either side of the spine, just below the neck, and slides the hands down along the spine until he/she reaches the patient’s bottom. At this point, the masseuse’s forearms will be touching the patient’s back, and once the hands reach the hips, the hands separate and move outwards. The sliding movements should be carried out with the hands closed, then, when going back up the body, the hands should open and, without interrupting the movement, the masseuse performs effleurage manoeuvres on the back and, whilst applying pressure, pushes the shoulders down. The movement then continues all along the arms and finishes here.
The more specific manoeuvres of a myofascial massage work through dealignment, which involves applying pressure vertically along the whole muscle perimeter, and detachment, during which the therapist performs a transversal action to move muscles to the side. Pressure applied to paravertebral muscles is also part of this technique. The masseuse starts from the sacral zone where he/she places his/her hands, with the thumbs approximately 2cm from the spine, and then applies perpendicular pressure between the vertebral spaces using the tips of the thumbs. This pressure should be applied for at least 4 seconds and, if possible, should be coordinated with the patient and masseuse’s breathing (expiration), and pressure is applied right to the bottom of the neck. Another technique is petrissage: the hands, in an ‘L’ position, should be placed in the area that will be treated then skin is ‘grabbed’ and squeezed between the thumbs and fingers. The masseuse gradually does this whilst moving along the body from the bottom upwards. This techniques relaxes and stretches the muscles.

The link between the masseuse and patient is so important, that, as mentioned, it requires the respiration of both to be synchronised. When breathing in, muscular tension increases slightly in the thorax, whilst, when breathing out, muscles and ligaments relax and become soft and pliable. For these reasons, the masseuse must ask the patient to breathe slowly and regularly, counting to 5 during inspiration and expiration. The masseuse will apply pressure when they both expire and will release the skin when inhaling.

After effects
Following the deep action performed on the body by the myofascial massage, some people experience an immediate feeling of well-being that consists of increased muscle movements and a feeling of lightness, whilst others feel very tired and experience the benefits later on. Over time this technique can improve a person’s posture, fluidity of movements and, consequently, his/her daily and sporting life style. A cycle of at least 10 sessions is recommended.

Seriously inflamed areas of the body must not be treated, or where there are vascular problems or bruising.

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