DMR

Deep Myofascial Release

health at hand Focus – Treating Chronic Pain

In my therapy practice of more than 20 years, I have developed a form of focused pain relief that is totally manual and uses no instruments, chemicals or electrical currents.

My training includes a variety of therapeutic approaches including structural integration, Trigger Point Therapy, Active Release Technique® (ART), the Rossiter System® and others. Of course I have also experienced many other types of therapy, none of which satisfied my desire for consistency in achieving immediate relief from pain. The method I developed at health at hand is Deep Myofascial Release (DMR). My goal is to relieve pain effectively and to demonstrate that many conventional surgeries for diagnosed carpal tunnel syndrome, rotator cuff tears, hip problems, repetitive motion pain and injuries, for example, are generally both unnecessary and unproductive.

DMR therapy® begins with the knowledge that most musculosketal pain results from tight muscles and fascia rather than torn tendons, degenerated joints, worn cartilage, compressed vertebrae and so on. If these conditions are present, they are rarely the cause of pain, but rather the effects of these tight muscles and fascia. Connective tissue (fascia) serves both as the structural support of the joint and also as the lubricant between muscles. It is highly innervated and when unhealthy, can cause extreme pain.

DMR Therapy® is extremely effective and shows remarkable improvement beginning with the first session, not only to eliminate the pain but to completely eradicate the problem, which is a far more ambitious goal but necessary to eliminate continual recurrence. The key difference from other approaches is that I go extremely deep into the muscle where the pain originates. In order to achieve the depth needed to aleviate these problems, one has to balance the pain with simultaneous relief. As the client experiences this sense of pain relief, the mind directs the muscle to release rather than to tense up as is its normal reaction, and in that way allows the therapist to go deep enough to get to the real source of the physical pain or dysfunction.

With the knowledge of trigger points, but more importantly, the experience with patients, I know where to focus my work. In my practice, for example, I receive patients daily with shoulder pain or restriction, who have often suffered for months or years, have been to multiple specialists without relief and may be scheduled for surgery. It is rare that DMR therapy® does not result in at least 50% relief in the first session.

Beyond pain and injury relief, this work is important for the prevention of injuries. The muscle and fascial network in the body is also its shock absorption system. When muscles are tense and fascia is tight and restricted, the possibility of injury is greatly increased. It is important to keep the musculoskeletal system in good working condition in order to maximize free and effective movement and avoid restrictive, painful and unhealthy tension.

Some perspectives on DMR Therapy

  • The human body has an almost unlimited capacity to heal. Any process can be reversed given the right conditions. On the other hand, without the right conditions, easily corrected problems can persist for months, years or a lifetime.
  • Most pain, from neck or back pain, to sciatica or rotator cuff problems or carpal tunnel originates and manifests in the muscles and fascia. The human body is not a machine, and one must ideally look beyond the affected area to check other structural and psychological origins.
  • Trigger Points often refer pain to another area of the body, so where you feel the pain is often not where it originates.
  • Eliminating the pain normally doesn’t eliminate the problem. It can very easily return. Pain is the tip of the iceberg of a much bigger problem which must be addressed in order to eliminate pain permanently.
  • The goal of DMR therapy® is not only to eliminate pain, but also to promote awareness of one’s own body and through that awareness, feel more empowered.
  • Releasing tight muscles and fascia restores the natural shock absorption of the body, and in this way dramatically reduces injuries.
  • Tight muscles are continuously contracted and therefore working and sapping energy from the body. Tightened fascia and surrounding muscles also restrict joint function and reduce efficiency and fluidity of movement, impeding performance.
  • Stretching the fascia has an immediate effect of release and liberation. The process of working with the muscles is deeply relaxing and can feel wonderful.
  • DMR therapy® can be dramatically effective AND permanent. The goal is that clients get enough relief in the first session to convince them that their condition can be eliminated. DMR Therapy® is not only very effective for many of these conditions; but is completely non-invasive and has no negative side effects.

The diagnosis and treatment of pain

All pain has a cause and its physical origin can often be easily ascertained. It is important in these cases to be open-minded and able to question traditional diagnoses. DMR Therapy® has its origins in many different techniques and perspectives, but is completely empirical in its development. That is, it is based on what really works rather than ideas and theories. One way to do this is by showing with certainty, by palpation and patient feedback, the physical origin of the pain. For example, there are three muscles that send pain directly to the center of the shoulder joint and upper arm. If the pain comes from these muscles, (which is almost always the case with chronic pain) pressing on one or more of them will reproduce or intensify that pain. This demonstrates that the pain is probably coming from that muscle and not from the joint itself or a pinched nerve, torn tendon or degenerated joint. Then, by eliminating the spasm or trigger point the pain will disappear. It is often as easy as that.

THEORY VS. OBSERVATION: SCIATICA

One common scenario, one that I see almost every day is this: The patient arrives with chronic pain of the hip, which often extends down the leg. Surgery has been prescribed.

THE THEORY: The pattern of pain is consistent with symptoms of sciatica. The sciatic nerve originates in the lower back and extends down the buttocks and leg, so the problem seems to originate in the sciatic nerve. A scan of the lower back has been taken and some anomaly has been shown in the vertebrae.

DIAGNOSIS: Vertebra L3 or L4 of the lower back is affecting the sciatic nerve.

TREATMENT: Surgery is required to fix this problem.

DMR OBSERVATION: What reproduces or exacerbates the pain? What relieves it? Most often the problem is in the Gluteus Medius muscle, which has a pain pattern that mimics that of sciatica. If pressing on the trigger points of this muscle intensifies the pain (which is most often the case) and by holding and releasing this muscle, the pain recedes—that is the source and the solution. Muscle pain is often relieved by pressure, which relaxes the muscle. Nerve pain, on the other hand, is intensified by manipulation—something easily observable, but often overlooked.

There are other muscles that commonly are the source of this pain, but rarely the sciatic nerve. Often the area of L3 and L4 is tender. It is a common stress area of the spine, but less often the source of hip pain. Sacral fascia can also be the source. There are thick layers of fascia that cover the sacrum. It can be stiff and very sensitive to pain. Just stretching that fascia can feel greatly relieving.

DMR Therapy® doesn’t diagnose. What is most important here is to keep an open mind and try things out, to see and feel what is happening, getting constant feedback from the patient. There are other common sources: the Quadratus Lumborum or erectors of the lower back, the TFL on the side of the leg between the rim of the pelvis and hip joint, or even from the thigh or abdominal or psoas muscles, all with their characteristic pain patterns. The fact that the vertebrae look bad or the trochanter (hip joint) is deteriorated or the cartilage is worn doesn’t necessarily mean (and normally doesn’t) that that is the source of the pain.

It’s important to determine the source of pain by feel and touch and patient reaction. If the pain can be eliminated completely by this process using DMR Therapy® techniques, we usually need go no farther. I see way too many people scheduled or recommended for back or hip surgery that have no more than muscle tension and trigger points that cause their pain. Worn cartilage, stenosis, pinched nerves, damaged discs or spondylitis are often cited as the source of the pain, but these are normally also the effects of trigger points and tight muscle and fascia, not the cause.

Of course extreme pain can be generated from damage to the spine, but this is normally obvious in that the pain is very different. It may feel like an electric current shooting down to one’s knee or foot or as a hot poker. A skilled DMR therapist can identify and explain the differences, and will appropriately refer the patient for treatment.

DMR Therapy® was developed from observation of what really is occurring in the body and of feedback from the patient. What intensifies the pain? What reduces it? If the therapy feels relieving, it generally means that the source has been found and the problem is vanishing. Long standing chronic pain can often be relieved as easily as that.

Overview: DMR Therapy

The “secret”, of eliminating the majority of musculoskeletal and joint problems is simple: Stretch the fascia in the appropriate manner and know how to work with the muscles in order to comfortably get deep enough to arrive at the source of the problem.

Muscles comprise around two thirds of one’s body weight. They are vulnerable to overuse, overexertion, stress (both physical and psychological) and injury. The connective tissue, including the fascia, is the material that supports the organs and connects and protects the bones and muscles.

Tense, spasmed and stressed muscles and fascia can pinch nerves, restrict blood and lymph circulation, reduce the optimal functioning of glands and organs, and generally impede the smooth flow and movement of all the systems of the body including the respiratory, digestive, skeletal and reproductive systems. Tight muscles and fascia can be painful. The pain of these tissues can be as acute and intense as any pain we experience. This pain is often referred to places other than where the actual spasm is. Neck and shoulder muscles are most often the source of headaches, for example.

Human touch can be a huge factor in treating muscle and fascial tissue. The body responds positively to touch in a way that it never will for needles, electric stimulation or pharmaceuticals. Older people who experience extensive pain in the neck, shoulders, arms, back, hips and knees, for example, respond positively to deeper muscle and fascia work. The relief is usually palpable and immediate… they feel the pain literally leaving their body.

In spite of this, the fascia is rarely considered while evaluating a patient’s problems. Muscle spasm does not show up on CT Scans or MRI’s, so in these days of diagnosis through technology, medical personnel tend to look to what shows up on these images to find the cause of a patient’s problem.

Neck, shoulder lower back and hip problems are examples. If the patient is unlucky enough to have some anomaly in the vertebrae, for example, it will normally be diagnosed as the cause, even though calcium deposits, narrowing of disc space, bone spurs or degeneration of discs generally have been shown to have nothing to do with the patient’s problem or their pain. Most healthy people have these anomalies in their vertebrae with no negative side effects. Degenerative changes rarely correlate with symptoms, which is why most back surgery is ineffective.

The shoulder, for example, is a very shallow joint, which allows for great range of movement. It is held in place, stabilized and mobilized by muscles and connective tissue. There are 18 muscles alone that attach to the scapula. Shoulder problems are, with very, very rare exceptions, muscle and fascia problems. The bad news is that they are rarely, if ever, diagnosed as such. The good news is that these problems are normally easily correctable with DMR Therapy®.

Many neck and back problems are attributed to vertebral discs. They are said to cause all types of problems that need surgery. Discs are made of some of the toughest connective tissue in the body. They are strong, tough and stable. If the muscles around the vertebrae spasm and clench down, the disc can bulge out. It can, in some instances, press against a nerve. That’s not a reason to operate on it. Relaxing the muscles and letting it revert back to its original position is a much safer and more effective strategy.

Some medical personnel have an awareness of the role of muscles and refer patients to physical therapists or massage therapists who often, unfortunately, work too superficially to get at the source of these problems.

The importance of the fascia in chronic pain

Generally we think of pain as originating in muscles, bones, joints, nerves or organs. But another tissue, fascia, has a very important role in persistant pain and does not respond to conventional treatment.

DMR THERAPY®

Tight, thickened fascia binds and impedes joint movement and causes pain. It is a factor in most joint and muscle pain as it encases and restricts muscle movement. Although it is extremely sensitive and often a huge factor in musculo skeletal pain, it is normally overlooked my most practitioners. DMR Therapy® stretches and separates the fascia in a way that can restore it to a healthy state, freeing muscles and joints and allowing lymph and blood to flow freely–aiding healing and eliminating inflammation. The physical effects can be dramatic. Fascia changes immediately, within minutes the body can enjoy pain relief, fluidity of movement, and a new sense of freedom. Through DMR Therapy® all of this can be accomplished without drugs, surgeries, or negative side effects.

WHAT IS FASCIA?

Fascia is one compontent of the connective tissue of the body. It is composed of dense fibrous tissue that covers the muscles and forms a continuous three-dimensional matrix of structural support throughout the body. Fascia surrounds all organs, muscles, bones, blood vessels and nerve fibers. It connects every part of the body to every other part, binding the human body into an integral whole. Fascia facilitates the proper movement of joints, tendons and muscles as well as supporting the skeleton and organs. It binds some structures together while permitting others to slide smoothly over each other. If you could photograph only your body’s fascia, you would have a perfect 3D model of exactly what you look like.

Healthy fascia is pliable and elastic. It contains collagen, a lubricant that allows fluid interaction between the muscles. Healthy fascia has a natural spring, a rebound effect, so the force you exert as you run, for example, gets returned to your body through the tensional network of the fascia. You use less muscles power, and therefore fatigue less rapidly thanks to the assistance of your fascia. This same mechanism acts as a shock absorber which is important in protecting you from injury.

Recent research has shown that the fascial network is the largest and richest sensory organ of the body with between six to ten times the sensory nerve reception than the muscles themselves. Fascia is densely innervated by myelinated nerve endings which, along with perceiving pain, also serve a proprioceptive function, that is, they process stimuli that signal the body’s position, posture, equilibrium and limb placement in order to coordinate the movements of muscles and limbs.

HOW DOES FASCIA RELATE TO MY PAIN?

Texture and composition of the fascia can change with stress and injury. The collagen, which acts as a lubricant in healthy tissue, becomes more like glue in unhealthy tissue, forming scars and adhesions, impeding the movement of the muscles and causing intense pain in the fascia itself because of its large number of sensory receptors. This important source of pain is normally unrecognized, which is why so many therapies which do not take this into account are so ineffective. Unhealthy fascia can also encase the body like a straightjacket by contracting and becoming thicker and less elastic, restricting muscle function or visceral movement. Often this develops so gradually that one is not aware of it until the restriction is released and a sense of lightness or floating ensues.

Fascia can become restricted and inelastic from trauma such as accidents and surgery, as well as from poor posture, chronic inflammation and overuse. Prolonged tension from stress or emotional upset can also cause restrictions that pull on muscles and other structures, resulting in tightness, pain and limited movement. Most musculoskeletal pain originates from tightness in the muscle and distortions in the fascia, rather than joint deterioration or nerve impingement.

This tissue is designed to glide and foster freedom of movement within the body in a healthy system. Unhealthy fascia hinders movement and causes distortions throughout the whole body. Correcting distortions, relieving pain and restoring the sliding and gliding network of fascial tissue is the goal of DMR treatments. Most patients experience significant and immediate results after receiving this noninvasive therapy.

IF THE FASCIA SO IMPORTANT WHY HAVEN’T I HEARD OF IT BEFORE?

Although fascia plays a major role in joint stability, it is an organ of support that has been largely neglected and overlooked until very recently. Fascia or connective tissue serves a universal function of support and movement throughout the body, as discussed above. But no one medical specialty studies it in its entirety or focuses on it except for its specific structures such as in the pleura of the lungs, the pericardium surrounding the heart or the meninges of the brain. In anatomic displays the fascia is generally removed, so the viewer can see the muscles, organs, nerves and vessels but fails to appreciate the role of the fascia which connects, covers and separates these structures.

THE DOMINO EFFECT

Well-hydrated and supple fascia is crucial to maintaining alignment and function of the body. It will keep small problems from snowballing into larger ones, keep injuries from becoming chronic issues, and maintain mobility and functionality throughout life. Healthy fascia can help a person avoid ineffective surgeries and unnecessary joint replacements.

Because the fascial system is a ubiquitous network throughout the body, an injury or distortion in one part of the body can directly affect another. It can be compared to a tightly knit sweater. If you tug on one part you see the tug travel long distances to other parts of the sweater.

Most people have probably experienced this domino effect without realizing it. It might start with a minimal neck injury or whiplash in a minor car accident. At that time in your life you ignore it and the pain goes away. Later you might have shoulder pain that keeps recurring but it isn’t always there and you let it go. Years later might have arm or hand pain which you might attribute to playing tennis. As you get older your knees may start to hurt as you run or go up stairs. As the years go by you begin to feel pain in your neck and shoulder or lower back and think to yourself it’s just part of growing old.

What’s actually happening is that you are experiencing a series of compensatory reactions to the fascial injury that occurred years before. Fascia registers and holds the memory of any injury you’ve had during your lifetime. By resolving these distortions one can not only experience pain relief but also feel the lightness and fluidity that had been lost over a lifetime. Of course, if you have had a very serious accident or injury the effects will be much, much greater, again with numerous seemingly unrelated chronic pains.

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