Contributed By Derek R. Austin, PT, DPT, MS, BCTMB, CSCS; Beth Barberree, BA, RMT; S. Pualani Gillespie LMT, MS, RN, BCTMB

Myofascial release (MFR) is a manual technique involving small amounts of force directed in specific directions for long durations. Many practitioners and recipients of MFR swear by its efficacy at reducing pain, improving movement, and resolving fascial restrictions. However, it is not known whether MFR is truly more effective than other massage techniques or even no treatment at all. Recent research may help illuminate when MFR can be helpful and for which conditions.

This month's Massage Therapy Foundation research column highlights a systematic review of research published in 2015 in the Journal of Bodywork and Movement Therapies. The review found promising results for many conditions, including subacute low back pain, fibromyalgia, lateral epicondylitis, plantar fasciitis, headache, and fatigue in breast cancer patients.

Methods

The authors searched multiple online databases for research articles and had strict inclusion criteria to find randomized controlled trials (RCTs) using MFR as an experimental treatment. The authors selected 19 articles based on their inclusion criteria from 133 articles initially identified. The selected articles were rated based on physiotherapy evidence database (PEDro) scale scores, a 0-10 scale that estimates the chance of bias due to study design. Most studies were of medium to high-quality, with PEDro scores ranging from 5/10 to 8/10. The majority of studies were limited based on small sample size and lack of long-term follow-up. Nevertheless, the authors found a surprisingly large number of RCTs on the topic of MFR.

Results

Due to the large number of studies with varied populations and results, the studies are summarized in individual bullet points.

• A moderate-quality study comparing techniques to improve hamstring flexibility found proprioceptive neuromuscular facilitation (PNF) stretching to be superior to MFR and MFR to be superior to no treatment.
• A high-quality study showed MFR to immediately improve pelvic symmetry, though these conclusions were limited by a small sample size of only 10 participants.
• A high-quality study on subacute low back pain compared three manual treatments including MFR and found back pain reduced in all groups with no difference between groups.
• A high-quality study of MFR for plantar fasciitis showed immediate reduction in pain and improvement in foot function but lacked long-term follow-up. A second high-quality study for MFR for plantar heel pain showed a large and significant improvement in function and reduction in pain following MFR compared to a sham ultrasound group.
• A moderate-quality study of MFR immediately following high-intensity exercise favored 40 minutes of MFR in reducing heart rate variability and blood pressure when compared with no treatment.
• A high-quality study of MFR for neck and back pain used a new technique of dynamic ultrasound to assess fascial movement and restrictions and found improved fascial mobility following MFR.
• A high-quality study of intra-oral MFR therapy for chronic temporomandibular disorder found MFR with or without self-care instruction to be more effective over the short-medium term in reducing pain and improving range of motion than no treatment.
• A moderate-quality study of individuals with healthy shoulders compared indirect tri-planar MFR for 3 minutes to moist heat for 20 minutes and found them equally effective at improving shoulder range of motion.
• Two high-quality studies of fibromyalgia patients found evidence of MFR helping alleviate symptoms. The first study showed that ongoing MFR treatment reduced anxiety, sleep disturbance, and pain. The second study showed that MFR improved pain, sensory, and affective dimensions.  Together these studies seem to show the benefit of MFR as a complementary therapy for fibromyalgia.
• A moderate-quality study of patients with tension headaches showed significant reductions in headache frequency after receiving direct or indirect MFR but not when receiving no treatment.
• Two moderate- to high-quality studies of breast cancer survivors (BCS) found MFR to have a possible benefit in this population. The first study showed MFR improved the salivary flow rate of BCS, likely indicating a relaxation response. The second study showed MFR added to a program of core stabilization exercises reduced fatigue, tension, and depression in BCS as well as improved vigor and muscle strength compared to a usual health care advice group.
• A high-quality study of MFR combined with kinesiotaping for venous insufficiency in postmenopausal women showed improved venous return, reduced pain, and improved quality of life.
• A moderately high quality study of MFR for computer professionals with tennis elbow (lateral epicondylitis) showed large, significant, and long-lasting reductions in pain and disability following MFR when compared with a sham ultrasound group.  A second, high-quality study showed that adding MFR to conventional physiotherapy for patients with chronic tennis elbow was more effective at reducing pain, disability, and grip weakness.
• A high-quality study of MFR in managing the chronic low back pain of nursing professionals showed that using MFR as an adjunct to specific back exercises was much more effective in reducing pain and disability than sham MFR with the same exercises.
• A moderate-quality study of hamstring and quadriceps flexibility in health individuals showed MFR was as effective as stretching for improving range of motion.

Discussion

Due to the varied conditions treated, study designs, and durations of MFR, the authors were unable to draw any strong conclusions regarding MFR for any specific conditions. The researchers reported that the evidence tends to favor MFR as an adjunct therapy more effective than no treatment for many conditions. Due to the generally high-quality of the studies and the fact that they are RCTs with control groups, the current research evidence seems to support the use of MFR in clinical practice.

Unfortunately, as with many studies of manual therapy, most RCTs in this review were unable to blind the researchers themselves from knowing who was receiving MFR or another treatment. The lack of researcher blinding can cause bias in favor of positive results for MFR. The authors suggest future research should build on the preliminary research evidence for MFR identified by current RCTs.

Reference:

• Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA. Effectiveness of MFR: systematic review of randomized controlled trials. J Bodyw Mov Ther. 2015 Jan;19(1):102-12. doi: 10.1016/j.jbmt.2014.06.001. Epub 2014 Jun 13. Review. PubMed PMID: 25603749.

Are you interested in becoming more research literate? Do you know what research bias is and how researchers control for it? Are you familiar with different levels of research evidence, ranging from expert opinion to randomized controlled trial up to systematic review? There is a huge need for massage therapists to be research literate, especially with more massage research being published today than ever before. The Massage Therapy Foundation (MTF) offers a Basics of Research Literacy course online. You will receive 8 hours of NCBTMB-approved continuing education credit when you complete the course. More details are available at: www.massagetherapyfoundation.org/research-literacy-courses/.

To read other studies regarding massage, please view the Massage Therapy Foundation review article archives, browse accepted MTF Research Grant abstracts, or search PubMed for massage therapy research.