This is an excerpt from Myofascial Release by Ruth Duncan.
Always prepare yourself, both mentally and physically, to treat a client. You do this by setting, and acting on, a therapeutic goal and using constructive communication and good dialoguing skills. Focus on your sense of touch whilst maintaining a non-judgemental and open-minded approach so that the treatment is client focused. See chapter 3 for a more in-depth discussion of mental preparation and therapist and client communication.
Before you place your hands on a client, be aware of your own body. Make sure you feel comfortable and relaxed in the space you are in, and that you have left all of your mental clutter at the treatment room door. You need to bring all of your focus into the treatment room and to be fully present with your intention. Some therapists call this grounding or focusing.
Mental Preparation and Communication
Before the treatment session, you need to set a clear intention of what you are about to do. That is, you need to approach and work with your client in an open-minded way so you can respond to the needs of the client rather than myopically follow a symptomatic recipe-orientated approach.
Always approach your client's body with interest, empathy, caring and curiosity about what you are going to find. Cultivate an attitude of ‘How can I help?' and ‘Tell me what you want me to do' in your hands. Every technique is applied slowly and gently from beginning to end, never rushed, never forced. Always feel and search for the tissue barrier and wait for it to release rather than overwhelm it.
Making a connection with your client is crucial. Having performed the initial intake and gathered personal details followed by the postural and palpatory assessment, explain to the client the technique you are going to apply and where you are going to apply it. Ask the client to assist in the process by bringing awareness to where your hands are and communicating with his body, in whatever way works for him, to allow his body to soften to your touch. This can be as simple as asking him to allow his body to become soft underneath and around your hands.
The preceding is how you create and establish your and your client's mental space before physically performing the hands-on work. Your task is then to maintain this mental space and open communication throughout the treatment session. If you find your mind wandering to outside noises or thinking about things other than what's going on under your hands or in your own body, you must re-establish your intention, connection and communication so that the focus is always on you and your client.
The more you and your client can both expand your connection and explore your inner awareness, the greater the influence of the unconscious (right brain) mind and the hypnagogic state will be. General chitchat is something to avoid here because it activates the left analytical and logical side of the brain, breaking the connection between your hands and your client's body.
You also have to consider that, with MFR, A plus B does not equal C alone. It equals the sum of the person's fascial makeup and subsequent restrictions, her personality and attitude and life experiences. No two people are the same, which is why MFR is not a protocol, or a recipe-orientated approach. All MFR techniques, although applied in the same way, involve following and feeling for the unique three-dimensional restrictions in each client's body making every session completely different to the next.
Tissue Barrier of Resistance
MFR techniques are applied slowly and diligently as you soften into and through the superficial fascia to meet the more resilient, deeper fascia where the restrictions lie. Each technique is applied with intention and without forcing the barrier.
I mentioned in previous chapters the terms end-feel and tissue barrier of resistance. These terms describe the subtle tissue resistance of the muscular and elastocollagenous component of the fascial web unique to every person. In earlier chapters I mentioned that applying MFR is not about how much pressure you use; it's about how much resistance you feel. Every technique is applied with ‘listening hands'. You apply appropriate pressure for the correct amount of time and follow the movement and release offered by the person. The time element is vital to allow the much slower release of the collagen and the movement of the bound water. From a fascial point of view, the point at which the tissue changes from a relaxed, or soft, state of give to a subtle but definitive state of resistance is called the tissue barrier of resistance. This barrier is where your hands meet the muscular and elastocollagenous barrier of resistance, which must not be forced.
Depending on the technique, the tissue barrier of resistance can be felt in every plane as well as in the direction of unique pull of restriction through a client's body. We also use the phrase depth barrier to describe the tissue barrier of resistance you feel when leaning into the client's body. This is mostly used when performing cross-hand release techniques.
As the musculoelastic tissue depth barrier softens, you need to maintain your pressure and take up the slack to meet the next subtle barrier of tissue resistance. This process is continued for approximately five minutes, sometimes longer, to allow both the musculoelastic and collagenous aspects of the tissue to yield and release.
When you place your hands on the client's skin, lean into the client's body slowly and feel your hands sinking into the tissue as though you were making handprints in clay. Where this yielding sensation stops and you feel you need to use muscular strength to apply more pressure is the depth barrier of tissue resistance. As your hands sit on this barrier, without force, your sustained pressure with sensitive hands allows the tissue to respond by relaxing and yielding (like handprints in clay). Now you lean into the next depth barrier of tissue resistance and wait for it to yield, and follow the process again and again. Because fascia is a three-dimensional matrix, the barrier of resistance can also be felt on multiple planes, all of which you will follow. Because you want to get as deep as possible into the tissue or the joint, you should always maintain your focus on the depth barrier of tissue resistance, but be aware of fascial resistance and yielding in other directions.
The following is a breakdown of MFR technique application into simple stages:
■ Always performs MFR skin on skin without any oil, wax or lotion.
■ Set an intention to make a therapeutic connection with, or to ground, yourself and your client.
■ Place your hands gently on the client's body, leaning into the depth barrier of tissue resistance or tractions to meet the tissue barrier of resistance, and wait for a sensation of yielding whilst dialoguing as appropriate with the client.
■ Never force the tissue or slip or glide your hands over the skin at any time.
■ Gently take up the slack as the tissue releases to the next barrier of tissue resistance.
■ Wait at the barrier for further yielding and softening before taking up the slack to the next barrier.
■ Apply second- and third-dimensional pressure to the tissue (a different plane of movement or direction to the one in place), which is technique dependent, whilst maintaining the first-dimensional pressure. Wait at the tissue barrier or end-feel of all the dimensions for a release and softening to happen in any one direction.
■ Dialogue with the client during the technique looking for feedback or any responses to and effects of the technique.
■ Take up the slack at the point at which every barrier of tissue resistance releases and softens, and follow to the next barrier.
■ Wait to feel a release of tissue and restrictions three-dimensionally, and facilitate that release by taking up the slack of tissue as it releases.
■ Disengage slowly from the tissue after approximately five minutes or more, depending on the client.
■ Dialogue further with the client for feedback or any other responses to and effects of the technique, which can indicate subsequent areas for treatment.
■ Look over the client's body for red flare of the skin (erythema), which occurs with tissue change. This can also indicate subsequent areas of treatment.
Effectively, MFR is a three-dimensional technique that is applied to treat the three-dimensional restrictions within the three-dimensional fascial continuum. As you become more proficient with the techniques, you will find that your hands will begin to follow and become much more fluid with the tissue as it releases and softens as opposed to mechanically applying pressure in various directions.
Learn more about Myofascial Release.