Myofascial release refers to the manual technique for stretching the fascia and releasing bonds between fascia and Lintegument, musles,and bones, with the goal of eliminating pain, increasing range of motion and balancing the body.

1. MMY
MYOFASCIAL RELEASE,
PRESENTED BY- DEBANJAN MONDAL(MPT)

2. INTRODUCTION:
Myofascial release refers to the manual
technique for stretching the fascia and
releasing bonds between fascia and
Lintegument, musles,and bones, with the goal of
eliminating pain, increasing range of motion
and balancing the body.

3. HISTORY:
The first description of the myofacial pain syndrome
was published in the German literature in 1843
As early as 1843,Froriep labeled the condition
involving tender bands or cords within muscles as
“Rheumatism” and he considered these tender
palpable bands to be deposits of connective tissues.

4. • Shortly thereafter,(1890) Grauhan histologically
described these bands as fibrous tissues that
surrounds muscles fibers and that is infiltrated with
lymphocytes.
• Steindler and luck term these “Trigger Zones” and
considered the sites to be within the ligaments or a
muscle.
• Since 1942,Travell conducted many studies on
trigger points.

5. DEFINITION:
Fascia is a tough connective tissue lining,
covering and investing muscles, and, indeed,
all cells, tissues and organs. Fascia is three –
dimensional and is continuous throughout the
body.

7. NA 1983 TA 1997 Description Example
Superficial fascia
Not considered fascia, but
subcutaneous tissue (
Panniculus adiposus and
Stratum membranosum)
This is found in the subcutis
in most regions of the
body, blending with the
reticular layer of the
dermis. [3]
Fascia of Scarpa
Deep fascia Fascia of muscles
This is the
dense fibrous connective tissue
that interpenetrates and
surrounds the muscles,
bones, nerves and blood
vessels of the body.
Transversalis fascia
Visceral fascia
Visceral fascia,
parietal fascia
This suspends the organs
within their cavities and
wraps them in layers of
connective tissue
membranes.
Pericardium
Layers of the fascia
There exists some controversy about what structures are considered "fascia", and how fascia should be
classified.[2]
The two most common systems are:
•the one specified in the 1983 edition of Nomina Anatomica (NA 1983)
•the one specified in the 1997 edition of Terminologia Anatomica (TA 1997)

9. TRIGGER POINTS:
• A hyperirritable spot, usually within a taut
band of skeletal muscle or in a muscle fascia.
• The spot is painful on compression and can
give rise to characteristic referred pain and
tenderness.

11. Note:
Each muscle has its own characteristic pattern
of referral. Often this can produce another
trigger point to become active in another
muscle within the zone of radiation of the
original trigger. These are called “SATELLITE”
trigger points.

12. PERPATUATING FACTORS:
• Mechanical: Structural inadequacies e.g The
short leg syndrome, the long second
metatarsal, short upper arms.
• Clothes: The constrictive clothing can produce
myofacial trigger points due to sustained
muscle compression (jeans related buttock
pain, wallet sciatica)

13. • Systemic: Metabolic endocrine, toxic,
inflammatory etc. commonly found systemic
factors include hypothyroidism, folic acid and
iron deficiency.
• Metabolic inflammatory: gout
• Relative Growth Hormone deficiency-As
growth hormone is necessary for muscle
repair and its secretion is related to deep
sleep which is frequently disturbed in patient
with pain.

14. Simons,Travell and Simon’s(1999)model of central trigger points
PATHOLOGY:
• Central trigger points forms almost directly in
the centre of the muscle’s fibers, close to the
motor endplate (neuromuscular junction)
• This formation is probably due to dysfunction
endplate activity.

15. • A metabolic crises occurs and acetylcholine
(Ach )is released at synapse, usually
associated with overuse or strain, leading to
release of calcium.
• The resulting ischemia in the area creates an
oxygen/nutrient deficit and a local energy
crisis.
• Without available adenosine triphosphate
(ATP), the calcium ions, which are keeping the
gates open for Ach to keep flowing, cannot be
removed.

17. • A chemically sustained contracture occurs.
This is involuntary without motor potentials,
and should be distinguished from a
contraction, which is voluntary and involves
motor potentials, and spasm, which is
involuntary with motor potentials.
• As the endplate keeps producing this Ach
flow, the Actin/myosin filaments shorten and
bunch in the immediate area of the motor end
plate (centre of fiber)

20. • A contracture Knot forms the characteristic trigger
point nodule.
• When massage, stretch application, injection or
other modalities are applied, which disturbs the
sarcomeres, alters the chemistry or possibly
damages the endplate, the cycle is disrupted and
the tissue relaxes, often in seconds-often
permanently.

21. CLINICAL FEATURES:
• Spot Tenderness: A very tender small spot,
which is found in a taut band.
• A taut band: A ropelike swelling found within
the muscle probably due to sustained
shortening of muscle fibers.
• Jump sign: Pressure on the tender spot causes
the patient to physically react to the
precipitated pain by exclaiming or moving.

22. • Pain recognition: Digital pressure on the tender
spot induces/reproduces some of the patient’s pain
complaint and is recognized by the patient as being
some or all of his or her pain.
• Twitch Response: A transient contraction of the
muscle fibers of the taut band containing the
trigger point. The twitch response can be elicited by
“snapping” palpation of the trigger points.

23. • Elicited referred pain: An active MTrP refers pain in
a pattern characteristic of that muscle. Usually to a
site distant to the MTrp.
• Restricted Range of Movement: Full stretching of
the affected muscle is often involuntarily restricted
by pain.
• Muscle Weakness: The patient is unable to
demonstrate normal muscle strength on static
testing of the affected side as compared to the
contra-lateral non affected side.

24. ASSESSMENT & MEASUREMENT:
The effective treatment of Myfacial Pain
begins with defining the Tissues and or
Reflex that is maintaining the pain state.
1.Find the ‘Active Trigger Point’
2.Assess sympathetic involvement

25. Trigger points
Before being able to effectively treat (and
evaluate that treatment’s efficacy)
Trigger point must be first-
1.Identified
2.quantified

26. Pain assessment: Patient complaining of chronic
pain deserves to be examined.
Palpation and the utilization of pain assessment
tools including:
• Pain diagram
• The McGill Pain Questionnaire,
• Visual Analogue Pain Scale.

27. Visual Analogue Scale-
• The VAS is a simple robust pain measurement
tool.
• It can be used to measure severity and or
Improvement.
• The VAS is usually designed as a 10cm line
with description at each end.

28. The VAS for Pain severity measurement
No pain worst possible pain
The VAS for treatment Effect
No pain Complete pain relief

32. FINDING TRIGGER POINTS:
1. Pincer palpation-Only some muscles can be
lifted from surrounding tissue between the
thumb and forefinger and in this manner the
trigger point can be located,
e.g, the upper trapezius (neck) or
gastrocnemius muscle (calf).

34. 2.Flat palpation:Simply moving the fingertips
Transversely across the muscles fibres with
some pressure until a “taut band” is located.

36. INDICATIONS:
1.The patients has a complex, global, or
specific pain complaint that does not
follow dermatomes, myotomes, or visceral
referral patterns.
2.The patient’s has an chronic condition that
causes tightness and restriction in the soft
tissue (e.g fibromyalgia and post polio
syndrome).

37. 3. The patient has painful complex postural
asymmetry.
4. The patient has impaired respiration and an
inflexible rib cage due to chronic respiratory
disease,central nervous system injury,or faulty
mechanical relationships of the skeletal structure
and the soft tissue.

38. 5.The patient has asymmetrical muscle
weakness due to an acute or chronic
peripheral or central neuropathy.
6.The patient has frequent, intense headaches
that are triggered by a variety of stimuli
including myofascial trigger points, tension in
the posterior cervical musculature,
tempomandibular joints dysfunction, and
asymmetrical muscle tightness.

39. 7.The patient has impaired mouth closure,
swallowing and phonation resulting in
tightness and restriction of the hyoids and
muscles of the mastication.
8.The patient has dizziness secondary to active
myofascial trigger points.
9.The patient is a competitive athlete or
performer who needs subtle stretching to
increase speed or accuracy and to prevent
injury at the extreme range of motion.

40. CONTRAINDICATIONS:
Myofascial Release should not be used in
thefollowing ways-
 The patient does not tolerate close physical
contact or touch.
 The patient has an unstable medical
condition e.g unstable angina
 The patient has a dermatitis.

41.  The patient contagious or infectious disease that
is transmitted by the upper respiratory tract or by
direct contact with the skin.
 The patient does not trust the therapist.
 The patient is under the influence of drugs or
alcohol.
 The patient is unable to give informed consent to
treatment due to his mental status.

42. PRECAUTIONS:
Myofascial release consistently lowers blood
pressure. All patient must rest in horizontal
position for 15-20min following treatment.
The patient should get up slowly and not get
off the treatment table until any dizziness
has resolved.

43. • Myofascial release may lower blood sugar level,
particularly when deep trigger point releases are
performed. Individual who are diabetic should
check their blood glucose level prior to treatment.
Individual who are prone to hypoglycemia should
have a snack prior to treatment.
• Individual with healing fractures or wounds may
receive Myofascial Release to uninvolved areas.

44. • Individuals with compromised circulation may be
treated with Myofascial Release to uninvolved
areas.
• The patient is taking medication that increases
blood clotting times and causes the patient to
bruise easily.

45. TECHNIQUES:
CONTENTS-
1.Direct myofascial release
2.Indirect myofascial release
3.Self myofascial release

46. Direct Myofascial Release-

47. Direct myofascial release-
• The direct myofascial release method works
directly on the restricted fascia.
• The practitioners use Knuckles, elbows,or
other tools to slowly sink into the restricted
fascia applying a few kilograms-force or tens
of newtons and then stretch the fascia. This is
sometimes referred to as deep tissue work.

48. • Direct Myofascial Release seeks for changes in
the myofascial structures by stretching,
elongation of fascia, or mobilizing adhesive
tissues.

49. Michae!Stanborough has summarised his style of Direct
Myofascial Release technique as:
• Land on the surface of the body with the appropriate
‘tool’(Knuckles,or forearm etc).
• Sink into the soft tissue.
• Contact the first barrier/restricted layer.
• Put in a ‘line of tension’.
• Engage the fascia by taking up the slack in the tissue.
• Finally,move or drag the fascia across the surface while
staying in touch with the underlying layers.
• Exit gracefully.

50. Michael Stan borough applied direct myofascial
release on plantar fascia-

51. Direct myofascial release on the thigh by Michael
Stanborough-

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53. Direct Release Myofascial Technique -
The Trunk

54. Direct Release Myofascial Technique - The
Cervical Region
CERVICALREGION

55. Direct Release Myofascial Technique - Thigh

56. The Feet

57. Indirect Myofascial Release-
• The indirect gentle stretch, the pressure is in
few grams, the hands tend to go with the
restricted fascia, hold the stretch, and allow
the fascia to ‘unwind’ itself.
• The gentle traction applied to the restricted
fascia will result in heat, increase blood flow in
the area.
• The intention is to allow the body’s inherent
ability for self correction returns, thus
eliminating pain and restoring the optimum
performance of the body.

58. The indirect myofascial release,e.g. cross hand
technique according to John Barnes is as follows:
• With relaxed hand lightly contact the fascia.
• Slowly stretch the fascia until reaching a
barrier/restriction.
• Maintaining a light pressure to stretch the barrier and
wait for approximately 3-5 minutes.
• Prior to release,the therapist will feel a therapeutic
pulse(e.g. heat).
• As the barrier releases,the hand will feel the motion and
softening of the tissue.
• The Key is sustained pressure over time.

59. Cross hand longitudinal stretching of the lumbar and
thoracic erector spinae musles-

60. Cross hand longitudinal stretching of the middle trapezii
musles:

61. Cross hand sretching of the quadricep
femoris muscle:

62. Self Myofascial Release-
• Self myofascial release(SMR) is when the individual
uses a soft object to provide myofascial release
under their own power.
• Usually an individual uses a soft roll, or ball on
which to rest one’s body weight,then,by using
gravity to induce pressure along the length of the
specific muscle or muscle groups, rolls their body
on the object, slowly allowing for the fascia to be
massaged.

63. Upper back
• Place hands behind head or wrap arms around
chest to clear the shoulder blades across the
thoracic wall.
• Raise hips until unsupported.
• Support your head in a “neutral” position.
• Roll mid-back area on the foam roll.
• If you find a tender spot, stop rolling and rest
on that tender spot until the pain reduces by
60-75%

65. Iliotibial Band
• Position yourself on your side lying on foam
roll.
• Bottom leg is raised slightly off floor.
• Maintain head in “neutral” position with ears
aligned with shoulders.
• This may be PAINFUL for many, and should be
done in moderation.
• Roll just below hip joint down the outside
thigh to the knee.
• If you find a tender spot, stop rolling and rest
on that tender spot until the pain reduces by
60-75%

67. Calf Complex:
• Rolling one calf at a time, start with
the roller at your ankle
• Roll upwards towards the back of the
knee
• If you find a tender spot, stop rolling
and rest on that tender spot until the
pain reduces by 60-75%.

69. Hamstring complex-
Ahead to completely work the entire
hamstring complex. Balance on your hands
with your hamstrings resting on the roller,
then roll from the base of the glutes to the
knee.
To increase loading, you can stack one leg on
top
of the other.

70. HAMSTRINGS

71. Hip flexors-
Hip Flexors: Balance on your forearms
with the top of one thigh on the roller.
Roll from the upper thigh into the hip.
Try this with the femur both internally
and externally rotated. To do so, just
shift the position of the contra lateral
pelvis. (In the photo, Mike would want to
lift his right hip to externally rotate the
left femur).

73. Tensor Fascia Latae and Iliotibial Band
In the starting position, you'll be lying on your
side with the roller positioned just below your
pelvis. From here, you'll want to roll all the
way down the lateral aspect of your thigh until
you reach the knee. Stack the opposite leg on
top to increase loading.

74. I.TBAND/TFL

76. Adductors:
Balance on your forearms with the top of one of your
inner thighs resting on the roller. From this position,
roll all the way down to the adductor tubercle (just
above the medial aspect of the knee) to get the distal
attachments. You'll even get a little vastus medialis
work in while you're there.

77. A
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78. Quadriceps:
This one is quite similar to the hip flexor
version; you're just rolling further down
on the thigh. You can perform this roll
with either one or two legs on the roller

80. Gluteus Medius and Piriformis:
Lie on your side with the "meaty" part of
your lateral glutes (just posterior to the
head of the femur) resting on the roller.
Balance on one elbow with the same side
leg on the ground and roll that lateral
aspect of your glutes from top to
bottom.

82. Gluteus Maximus:
Set up like you're going to roll your hamstrings, but
sit on the roller instead. Roll your buttock

83. Tibialis Anterior:
This is just like the quad roll, but you're
working on your shins instead.

84. Peroneals:
This one is similar to the TFL/ITB roll; we're just
working on the lower leg now. Roll along the
lateral aspect of the lower leg from the knee to
the ankle.

85. Triceps:
Start with your body in the same position as
you would for the latissimus dorsi. Now,
however, you'll want to place the roller at the
top of your triceps (near your armpit) and your
noggin on top of your arm to increase the
tension ..

87. Pectoralis Major and Anterior Deltoid:
Lie prone with the roller positioned at an
angle slightly to one side of the sternum; the
arm on this side should be abducted to about
135° (halfway between completely overhead
and where it would be at the completion of a
lateral raise). Roll toward the humeral head
(toward the armpit).

90. Small muscles at the back

91. Skin rolling /cross hand/limb pull

92. Myofascial release of carpal tunnel syndromme.
Sucher BM.
• Current treatment for carpal tunnel syndrome may be ineffective or
associated with complications or recurrence. In the case reported
here, a myofascial release by the physician combined with the
patient's self-stretch reduced pain and numbness and improved
electromyographic results. The manipulative approach releases the
transverse carpal ligament,-and "opens" or dilates the canal. The
patient stretches the wrist, digits, and thumb, including myofascial
components. An aggressive, conservative approach lessens the need
for surgery in mild to moderate cases. Studies with magnetic
resonance imaging may be helpful to document canal size before and
after treatment.
• PMID: 8423131 [PubMed - indexed for MEDLINE]

93. Estimation of influence of myofascial release techniques on
esophageal pressure in patients after total laryngectomy.
Marszałek S, Zebryk-Stopa A, Kraśny J, Obrębowski A, Golusiński W.
Department of Athletics, University School of Physical Education,
Poznan, Poland, marszaleksl@wp.pl.
• In patients after total laryngectomy, increased tension in myofascial neck and arm
areas might be observed. Via fascial continuity it has an adverse impact on the
superior esophageal constrictor forming the "mouth of the oesophagus", which
hinders learning of esophageal speech. The aim is to assess the effect of manual
myofascial release techniques on esophageal pressure in patients after total
laryngectomy. Forty patients (12 F, 28 M), aged 43-75 (mean 56.8 years), 9 months
to 13 years (average 3 years) after total laryngectomy, 35 patients (87.5%) after
neck lymph node resection, 38 patients (95%) after radiotherapy. Esophageal
pressure was assessed using modified Seeman's method. Manual myofascial
release techniques were applied within head, neck, arms, upper trunk and upper
limb areas. Wilcoxon and Shapiro-Wilk's test was used for the purpose of statistical
analysis. Statistically significant decrease of the mean esophageal pressure was
observed after the physiotherapy treatment. The average pressure among the
examined patients decreased from 37.9 to 26.6 mmHg. The application of
myofascial manual techniques decreases esophageal pressure, thus allowing
patients to learn esophagus speech at a faster pace.

94. RECENT ADVANCES:
Effectiveness of osteopathy in the cranial
field and myofascial release versus
acupuncture as complementary treatment
for children with spastic cerebral palsy: a
pilot study.
• Duncan B, McDonough-Means S, Worden K,
Schnyer R, Andrews J, Meaney FJ.
• Department of Pediatrics at University of
Arizona Health Sciences Center in Tucson, AZ,
USA. brduncan@email.arizona.edu

95. OBJECTIVE: To assess the effectiveness of osteopathy in
the cranial field, myofascial release, or both versus
acupuncture in children with moderate to severe spastic
cerebral palsy, as measured by several outcomes
instruments in a randomized controlled trial. Children
between the ages of 20 months and 12 years with
moderate to severe spastic cerebral palsy were
enrolled.. CONCLUSIONS: A series of treatments using
osteopathy in the cranial field, myofascial release, or
both improved motor function in children with moderate
to severe spastic cerebral palsy. These results can be
used to guide future research into the effectiveness of
OMT or acupuncture in treating children with spastic
cerebral palsy.

96. The Complementary Journal Alternative and Medicine
The Effect of Deep-Tissue Massage Therapy on Blood Pressure and Heart Rate
• To cite this paper:
Alan David Kaye, Aaron J. Kaye, Jan Swinford,
Amir Baluch, Brad A. Bawcom, Thomas J.
Lambert, Jason M. Hoover. The Journal of
Alternative and Complementary Medicine.
March 1, 2008, 14(2): 125-128.
doi:10.1089/acm.2007.0665.

97. ABSTRACT
Aim: In the present study, we describe the effects of deep tissue massage on systolic, diastolic,
and mean arterial blood pressure.
• Materials and methods: The study involved 263 volunteers (12% males and
88% females), with an average age of 48.5. Overall muscle spasm/muscle
strain was described as either moderate or severe for each patient. Baseline
blood pressure and heart rate were measured via an automatic blood
pressure cuff. Twenty-one (21) different soothing CDs played in the
background as the deep tissue massage was performed over the course of
the study. The massages were between 45 and 60 minutes in duration. The
data were analyzed using analysis of variance with post-hoc Scheffe's F-test.
Results: Results of the present study demonstrated an average systolic
pressure reduction of 10.4 mm Hg (p < 0.06), a diastolic pressure
reduction of 5.3 mm Hg (p < 0.04), a mean arterial pressure reduction of
7.0 mm Hg (p < 0.47), and an average heart rate reduction of 10.8 beats
per minute (p < 0.0003), respectively.

98. The effects of back massage before diagnostic cardiac catheterization.
McNamara ME, Burnham DC, Smith C, Carroll DL.
Massachusetts General Hospital, Boston, USA.
• OBJECTIVE: The purpose of this study was to measure the effects of a 20-
minute back massage on the physiological and psychological human
responses of patients admitted for a diagnostic cardiac catheterization.
PARTICIPANTS: Forty-six subjects admitted from home for a
diagnostic cardiac catheterization. MAIN OUTCOME
MEASURES: Heart rate, heart rate variability, blood
pressure, respiration, peripheral skin temperature, pain
perception, and psychological state. INTERVENTION: A 20-
minute back massage. CONCLUSIONS: A 20-minute back massage
appeared to reduce systolic blood pressure in patients awaiting a
diagnostic cardiac catheterization, while preparatory time in the cardiac
catheterization laboratory appeared to reduce diastolic blood pressure,
respiration, perceived psychological distress, and pain.

99. Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger
point release and paradoxical relaxation training.
Anderson RU, Wise D, Sawyer T, Chan CA.
Department of Urology, Stanford University School of Medicine, Stanford, California, USA.
PURPOSE: The impact of chronic pelvic pain syndrome on sexual function in
men is underestimated. We quantified sexual dysfunction (ejaculatory
pain, decreased libido, erectile dysfunction and ejaculatory difficulties) in
men with chronic pelvic pain syndrome and assessed the effects of pelvic
muscle trigger point release concomitant with paradoxical relaxation
training. CONCLUSIONS: Sexual dysfunction is common in men with
refractory chronic pelvic pain syndrome but it is unexpected in the mid
fifth decade of life. Application of the trigger point release/paradoxical
relaxation training protocol was associated with significant improvement
in pelvic pain, urinary symptoms, libido, ejaculatory pain, and erectile and
ejaculatory dysfunction.

100. Effects of myofascial release after high-intensity exercise: a randomized clinical trial.
Arroyo-Morales M, Olea N, Martinez M, Moreno-Lorenzo C, Díaz-Rodríguez L, Hidalgo-Lozano A.
Physiotherapy Department, High Altitude Training Centre of Sierra Nevada, Higher Sports Council,
Health Sciences School, University of Granada, Granada, Spain. marroyo@ugr.es
• OBJECTIVE: The usefulness of massage as a recovery method after
high-intensity exercise has yet to be established. We aimed to
investigate the effects of whole-body massage on heart rate variability
(HRV) and blood pressure (BP) after repeated high-intensity cycling
exercise under controlled and standardized pretest conditions.
METHODS: The study included 62 healthy active individuals. After
baseline measurements, the subjects performed standardized warm-
up exercises followed by three 30-second Wingate tests. After
completing the exercise protocol, the subjects were randomly assigned
to a massage (myofascial release) or placebo (sham treatment with
disconnected ultrasound and magnetotherapy equipment) group for a
40-minute recovery period. Holter recording and BP measurements
were taken after exercise protocol and after the intervention.

101. • RESULTS: After the exercise protocol, both groups showed a significant
decrease in normal-to-normal interval, HRV index, diastolic BP (P > .
001), and low-frequency domain values (P = .006). After the recovery
period, HRV index (P = .42) and high-frequency (HF) (P = .94) values
were similar to baseline levels in the massage group, whereas the HRV
index tended (P = .05) to be lower and the HF was significantly (P < .
01) lower vs baseline values in the placebo group, which also showed a
tendency (P = .06) for HF to be lower than after the exercise. Likewise,
diastolic BP returned to baseline levels in the massage group (P = .45)
but remained lower in the placebo group (P = .02). CONCLUSION:
Myofascial release massage favors the recovery of HRV and diastolic
BP after high-intensity exercise (3 Winga Effectiveness of a home of
ischemic pressure followed by sustained stretch for treatment of
myofascial trigger points.

102. • Myofascial Effects: Massage works directly with the muscles (myo) and
connective tissues (fascia), helping to facilitate greater mobility in the
body. This is especially important for the diabetic because elevated
blood sugars cause a thickening of connective tissue, which in turn
affects mobility and elasticity of the myofascial system. This can be
noted in general levels of stiffness in muscles, tendons and ligaments,
as well as decreased range of motion in the joints. Stress hormones
also contribute to chemical changes in the connective tissue, causing a
stickiness between the layers of fascia. Massage therapy can
significantly counter this effect. Range of motion, stretching and
regular exercise are also important to help encourage flexibility and
health of the myofascial system.
• Author Mary Kathleen Rose massages one of her many diabetic
clients.

104. • Myofascial Effects -- For the client with
diabetes, you may likely find a thickening of
their connective tissue caused by increased
blood sugars. Massage will help to increase
mobility and tissue elasticity that has been
hindered by that thickening effect. Of course,
a good exercise program -- with an efficient
stretching regimen -- will also benefit your
client.

105. Integration of myofascial trigger point release and paradoxical relaxation
training treatment of chronic pelvic pain in men.
Anderson RU, Wise D, Sawyer T, Chan C.
Department of Urology, Stanford University School of Medicine, Stanford,
California, USA. rua@stanford.edu
• PURPOSE: A perspective on the neurobehavioral component of the etiology of chronic prostatitis
(CP) and chronic pelvic pain syndrome (CPPS) is emerging. We evaluated a new approach to the
treatment of CP/CPPS with the Stanford developed protocol using myofascial trigger point
assessment and release therapy (MFRT) in conjunction with paradoxical relaxation therapy (PRT).
MATERIALS AND METHODS: A total of 138 men with CP/CPPS refractory to traditional therapy
were treated for at least 1 month with the MFRT/PRT protocol by a team comprising a urologist,
physiotherapist and psychologist. Symptoms were assessed with a pelvic pain symptom survey
(PPSS) and National Institutes of Health-CP Symptom Index. Patient reported perceptions of overall
effects of therapy were documented on a global response assessment questionnaire. RESULTS:
Global response assessments of moderately improved or markedly improved, considered clinical
successes, were reported by 72% of patients. More than half of patients treated with the
MFRT/PRT protocol had a 25% or greater decrease in pain and urinary symptom scores, as
assessed by the PPSS. In those at the 50% or greater improvement level median scores decreased
69% and 80% for pain and urinary symptoms, respectively. The 2 scores decreased significantly by
a median of 8 points when the 25% or greater improvement was first observed, that is after a
median of 5 therapy sessions. PPSS and National Institutes of Health-CP Symptom Index showed
similar levels of improvement after MFRT/PRT protocol therapy. CONCLUSIONS: This case study
analysis indicates that MFRT combined with PRT represents an effective therapeutic approach for
the management of CP/CPPS, providing pain and urinary symptom relief superior to that of
traditional therapy.