This is part one of what will be a continuing series of posts.

Myofascial Release (MFR) has typically been categorized as a completely spontaneous exploration of the connection between symptoms and cause. Assess the entire body to gather information and never pre-judge. I was taught that if you think you know what you are doing when you walk into the treatment room, you don't know what you are doing (a bit of a confusing statement, if you can step back and analyze it). The meaning was, treat each person as a unique individual, which I do. But, certain patterns emerge, whether from the subjective history that a patient relates, or from working long enough in this field to see trends relating to cause and effect.

Knee pain is a common complaint which causes patients to seek treatment. I listen very closely to their subjective story, interjecting questions as needed. If I hear "I have difficulty getting up from a chair or climbing stairs", I'll ask if there is a pain that feels like weakness? If the response is "yes", That leads me down a path; call it differential evaluation. During assessment, I will pay particular attention to quadriceps length in prone; where is the FIRST barrier encountered during passive knee flexion? If you are meeting that subtle first barrier at 90-100 degrees, you are witnessing marked tightness of the quads. You probably can bend the knee further, but this exceed the subtle first barrier. When I flip them over to supine, I use a method of deeply assessing quad restriction. It is a deep rolling-type of assessment that isolates the deep tightness that is so characteristic of problems such as those described above. It will often feel ropy or matted down. Deep pressure will be surprisingly uncomfortable for the patient.

Treatment, for me, follows a common path as well. Extended cross handed releases and deeper Myomobilization to the quad region to normalize the restricted/dense tissue, followed by prone gentle but sustained knee flexion. Myomobilization is what I term a gentler, sustained form of soft tissue mobilization (STM) that works equally as well as STM, but is much easier to tolerate. I always teach the patient a home program of quad stretching using the yoga strap as described on my website. I teach them what that first barrier feels like and how not to exceed this barrier. I will also warn them it is not uncommon for them to feel short term weakness in the quads after this prolonged stretch.

My success rate in reducing or eliminating the original complaint is very good. This is not cookbook therapy. It is an educated awareness of patterns and trends after years of clinical experience.

Stay tuned for more!