"There's no end to the things you might know, depending how far beyond Zebra you go!"
- Dr. Seuss
Effects of Myofascial Release and Positional Release Techniques
- Releases facial adhesions and restriction that create pain in muscles, joints, and connective tissue
- Reduces restrictions in overworked fascia, which can take the strain off joints without destabilizing them
- Helps reduce inappropriate muscle tension and improves muscular resilience
- Helps awareness of movement and position in space
- Helps reduce stress (physical and psychological), which helps to rebalance the body as a whole
Theory and Practice
Ehlers-Danlos Syndrome (EDS) can bring a variety of challenges to those who experience it, including joint hypermobility, skin fragility, and chronic pain. In the past two decades researchers have begun exploring the link between fascial health and symptom relief (particularly pain).
It has long been known that fascia plays a crucial role in your musculoskeletal health. In the context of the human body, muscles, bones, and connective tissues form a system where muscles provide tension, while bones and other tissues provide compression. This interconnectedness allows for efficient and balanced movement and stability. Proper muscle contraction is crucial not only for movement but also for maintaining the integrity of musculoskeletal structure. When muscles contract, they generate (positive) tension that is transmitted through fascia and other connective tissues to the bones. This tension allows for proper alignment and support, ensuring that forces are distributed evenly across the structure.
Hypermobility, such as that found in EDS, disrupts this balance within the musculoskeletal system. When muscles contract in hypermobile individuals, the excessive joint mobility can prevent the muscles from generating the tension needed by the body, which results in injury to the fascia and further weakens the entire system. Injury to the fascia creates fascial restrictions that put extreme pressure on the tissue that it surrounds, including muscles, nerves, lymphatic tissue, and connective tissues like ligaments and tendons. Researchers found that EDS subjects have a higher mean thickness in the deep fascia of the body than in non-EDS subjects. This thickness can significantly increases pain. Fascia also contains small-diameter fibers that transmit nociceptive signals (i.e. pain) to the brain , which has led researchers to suggest that myofascial pain is a key aspect of EDS-related discomfort.
Recent studies on the relationship between fascial mobility and pain sheds light on the potential for managing EDS symptoms more effectively through manual manipulation modalities such as Myofascial Release and Positional Release Techniques (aka Strain-Counterstrain techniques). By addressing fascial imbalances and restrictions, you may experience relief from pain created by myofascial restrictions. Releasing facial tension and adhesions can also result in improved posture and reduce the effects of musculoskeletal problems associated with misalignment, dislocations, subluxations, and scoliosis. This generates a positive feedback loop within the muscle-fascia-ligament/tendon-skeletal system that can reduce pain and increase stability.
Research also indicates the significance of the fascia in proprioception – your body's awareness of movement and position in space. Poor proprioception is a common complication of EDS and POTS. Optimizing fascia mobility can enhance body awareness and movement control.
Additionally, connective tissues, including fascia, play a crucial role in maintaining hydration within the body. Fascia has an intricate network of fluid-filled spaces that help nourish cells and maintain tissue health. In hypermobile individuals, compromised fascial health can impact fluid distribution. Injured fascia may not effectively hold and distribute fluids, leading to the potential for dehydration and inefficient fluid balance within the tissues, which can further contribute to discomfort and pain. Therefore, proper hydration is an important component for connective tissue health (including the fascia).
Background and Training
When I began working with Ehlers-Danlos (EDS) clients in 2023, I had no idea where this adventure would take me. My first regular EDS client was recommended to me by her "EDS Doc" for Myofascial Release. Since then, I have had additional clients referred to me by PTs and OTs. As I began working with these clients on a regular basis, I realized just how much I enjoyed each person's unique and individualized health puzzle. It is exciting for me that my clients can present with wildly different issues at each session. I quickly learned to rapidly adjust to their needs in the moment and focus on fascial, muscular, neurological, and/or lymphatic issues during any given session. At the same time, I have had several clients come to me with dysautonomia, especially POTS (Post-Orthostatic Tachycardia Syndrome), which has its own set of unique complications and is often, but not always, associated with EDS. I have had success working with my clients that suffer from EDS and dysautonomia and continue to do research and take classes (theoretical and hands-on) for both issues. I believe the more tools I have at my disposal the better suited I am for dealing with the various issues that can arise with these syndromes.
My Personal Journey
Over the past decade, I have been trying to unravel my own complex variety of signs and symptoms for which, after numerous blood tests, MRI's, and other diagnostic assessments, which have ruled out everything from Chronic Lyme's to Gulf War Illness and MS. One day my primary care physician at the VA said, "We may never find out what's going on." At some point, I think many individuals with EDS and dysautonomia have heard this or something similar. Finally, after breaking down and deciding to pay out of pocket for help, I went to a functional medicine specialists who suggested that I might have EDS and POTS. Since this has also become a personal journey, I feel it allows me to empathize with my clients in ways that many others cannot.
References
Alsiri, N., Al-Obaidi, S., Asbeutah, A., Almandeel, M., & Palmer, S. (2019). The impact of hypermobility spectrum disorders on musculoskeletal tissue stiffness: An exploration using strain elastography. Clinical Rheumatology, 38(1), 85-95.
Bénistan, K., & Martinez, V. (2019). Pain in hypermobile Ehlers-Danlos syndrome: New insights using new criteria. American Journal of Medical Genetics. Part A, 179(7), 1226-1234.
De Paepe A, Malfait F. The Ehlers-Danlos syndrome, a disorder with many faces. Clin Genet. 2012 Jul;82(1):1-11. doi: 10.1111/j.1399-0004.2012.01858.x. Epub 2012 Mar 15. PMID: 22353005.
Malfait, F., Francomano, C., Byers, P., Belmont, J., Berglund, B., Black, J., … Tinkle, B. (2017). The 2017 international classification of the Ehlers-Danlos syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 175(1), 8-26.
Scheper, M., Rombaut, L., de Vries, J., De Wandele, I., van der Esch, M., Visser, B., … Engelbert, R. (2017). The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers-Danlos syndrome: The impact of proprioception. Disability and Rehabilitation, 39(14), 1391-1397.
Wang TJ, Stecco A. Fascial thickness and stiffness in hypermobile Ehlers-Danlos syndrome. Am J Med Genet C Semin Med Genet. 2021 Dec;187(4):446-452. doi: 10.1002/ajmg.c.31948. Epub 2021 Nov 6. PMID: 34741592.
