Rowland Benjamin Osteopath

13/06/2024

Introduction to self-massage and how the book Massage Yourself came about.

Massage Yourself is a book of self-massage techniques for the muscles, tendons and ligaments of your body. It uses cross-fibre kneading, transverse friction and three massage tools; a tightly rolled-up towel, two rubber balls in a net and wooden tool called a wadi.

Self-massage can be done by anyone as part of a self-help system to improve the structural integrity of their body and help prevent injury or it can be used by manual therapists to empower their patients and help them with their treatment. By combining self-massage techniques with appropriate stretching and strengthening exercises therapists will get faster results.

My involvement with self-massage began several years ago when I was treating a patient with a rotator cuff tear following a sporting injury. He was a remote mine worker who only came home once a month and so was unable to attend my clinic for regular treatment. I gave him exercises but he really needed treatment - specifically transverse friction for 30 seconds every two or three days and some kneading of key shoulder muscles. This was usually something I did as part of a broader treatment. But as the mine worker was out of town for a month, I knew this was not going to happen, so I showed him where to position his arm to expose the rotator cuff tendon, where to locate it and how to treat it himself. The patient recovered quickly, there was no pain and over that month his cuff tear had repaired. This approach proved useful for other patients who needed to come in for short sessions but were unavailable or inconvenienced by having to come in for such a short treatment.

Massage Yourself is the product of my experience as an osteopath, lecturer in anatomy and massage technique, author of books on massage technique (Myofaction) and exercise (Safe Stretch) and my interest in self-help and teaching exercises and self-massage techniques to my patients. Over the next few weeks, I aim to post short articles about self-massage and techniques that can be either self-directed for better health or prescribed by a manual therapist as part of their treatment.

Click here to get a free Massage Yourself eBook https://massage-yourself.xyz/ The full eBook and print version is available from Amazon and other online bookstores but the video eBook is only available directly from me through my shop at Massage Yourself https://massage-yourself.com/

10/08/2023

If you are on the Medium social media platform you may be interested in my first post

What is myofaction?

14/07/2023

Palpation of and feedback from the muscle during myofaction

Unlike most stretching techniques, myofaction involves direct contact with the muscle being treated and when there is contact there can be feedback, and with feedback the therapist is better able to monitor and regulate the technique.

During the inhalation-tension phase of myofaction cycle accurate contact with the muscle is confirmed if the therapist feels an increase in muscle tension during the contraction. If this doesn’t occur, then the patient isn’t contracting enough or is contracting in the wrong direction. If the patient is contracting the muscle too hard ask them to reduce the contraction.

During the exhalation-relaxation phase of myofaction, accurate contact means you can directly apply the right amount of kneading and stretching as you feel the muscle relax. Also, accurate palpation allows you to communicate your findings to the patient and verbally encourage them to relax the muscle during the post-isometric phase of the technique by saying ‘exhale and let go of the muscle – and repeat this as you to take up the muscle tension.

Finger or thumb contact with the muscle being treated enables the therapist to compare the changes in the muscle between when start of the myofaction cycle and the end. It also tells them how much muscle tension is taken up with internal forces of contraction and inhalation so they can increase or decrease the external forces of stretching and kneading. Awareness of the muscle tension can also be verbally communicated to the patient, for example by asking them to reduce the muscle contraction if it is too great or relax the muscle more, if they are not relaxing it well.

Coming soon - a series of posts on self-massage for manual therapist who want to work with their patients as well as work on them. By empowering your patients with knowledge about where their tissues are located and teaching them self-massage skills you may help them manage their pain levels better and reduce your treatment time https://massage-yourself.xyz/ Thanks for the great feedback I have received about myofaction and all who have subscribed to my free eBook https://myofaction.xyz/

13/07/2023

Common errors when using the myofaction technique

Incorrect application of myofaction will result in a less than optimal outcome. Here are some of the most common errors, which can be equally applied to muscle energy technique (MET) or PNF stretching

When the patient contracts the muscle too hard, unwanted accessory muscles are recruited and the target muscle is missed. To target the muscle with the right amount of force, ask the patient to use a 10% contraction for muscles that pass over a single joint or between 10% and 20% for muscles that pass over two or more joints. By suggesting a percentage rather than an absolute number the actual force will therefore depend on the size of the muscle.

When the patient contracts the muscle too lightly, some or all of the Golgi Tendon Organs responsible for the post-isometric relaxation response may not discharge and the technique may not work, or the effect will be reduced.

The technique may not work or will work poorly if the patient contracts the muscle in the wrong direction, holds the muscle contraction for too short a time or does not relax after the muscle contraction. Be sure to instruct the patient how to do the actions correctly.

The technique may work poorly if the therapist does not place the patient in a position where adequate joint movement can occur to stretch the muscle. It may not work at all or will work poorly if the therapist does not provide the right counterforce or does not resist to the patients contraction in the right direction. Immediately after the patient ceases the isometric muscle contraction there is a refractory period of one or two seconds when the muscle is still relaxing. If the therapist tries to take up the muscle slack before the refractory period has finished the technique may not work.

There is one more post in the myofaction series entitled ‘Palpation and Feedback’ and then I will be taking a short break from posting to concentrate on finishing my next book Massage for Muscles, Tendons and Ligaments https://massage-technique.com/. You can still receive a free myofaction eBook and monthly eBooklets if you subscribe to https://myofaction.xyz/

08/07/2023

How is myofaction similar to Muscle Energy Technique and how does it differ?

Myofaction and MET have many things in common. Both are active techniques that treat hypertonic muscle using a patient activated isometric contraction and post-isometric relaxation, treatment systems based on the autogenic inhibition reflex. In both cases the isometric contraction involves a mild to moderate force in a precise direction, for about four seconds, against an equal and unyielding counterforce from a therapist and they both involve passive stretching of a muscle to a new resting length during a period of post-isometric muscle relaxation.

There are some differences between myofaction and MET. When the patient is asked to cease the isometric contraction and relax the muscle, a therapist using MET moves the joint to a new barrier, by stretching the muscle. A therapist using myofaction also moves the joint to a new barrier by stretching the muscle, but it also challenges the muscle barrier in other planes, using cross-fibre kneading to engage the transverse muscle barrier and torsional kneading to enage the rotation barrier. Myofaction works with transverse, torsional and longitudinal forces, whereas MET works with longitudinal forces.

Myofaction uses patient assisted inhalation to increase tension so that during exhalation there is greater muscle relaxation, whereas MET only uses breathing to treat rib dysfunctions. Myofaction uses palpation to assess changes in muscle tone, whereas MET uses palpation of bony landmarks to assess range of movement. Myofaction is a post-isometric kneading and stretching technique that primarily focuses on reducing muscle tension whereas MET is a post-isometric stretching technique that primarily focuses on increasing range of joint movement.

A free myofaction eBook is available at: https://myofaction.xyz/
My next posts are on the topic: self-massage of muscles, tendons and ligaments. Massage Yourself https://massage-yourself.xyz/

08/07/2023

How is Myofaction similar to Muscle Energy Technique and how does it differ?

Myofaction and muscle energy technique (MET) are different techniques with different goals, different tools for different tasks. They are similar to each other in some respects and different in others. One is not better than the other.

MET is useful for joint dysfunctions with associated muscle shortness and hypertonicity in otherwise healthy muscles. Myofaction, kneading and transverse friction are useful for muscles that are short and hypertonic but also muscles that are hyperexcitable or irritable (spasms) or have mild reversable structural changes such as fibrous infiltration and scaring.

Myofaction and MET have many things in common. Both are active techniques that treat hypertonic muscle using a patient activated isometric contraction and post-isometric relaxation treatment systems based on the autogenic inhibition reflex. In both cases the isometric contraction involves a mild to moderate force in a precise direction, for about four seconds, against an equal and unyielding counterforce from a therapist and they both involve passive stretching of a muscle to a new resting length during a period of post-isometric muscle relaxation.

There are some important differences between myofaction and MET. When the patient is asked to cease the isometric contraction and relax the muscle, a therapist using MET moves the joint to a new barrier, increasing the length of the muscle by stretching it longitudinally. A therapist using myofaction also moves the joint to a new barrier and increases the muscle length by stretching it longitudinally. But myofaction also challenges the muscle barrier in other planes, using cross-fibre kneading to engage the transverse muscle barrier and torsional kneading to engage the rotation barrier. Myofaction works with forces directed along transverse, torsional and longitudinal planes, when they are available, whereas MET only works with forces directed along the longitudinal plane.

Myofaction uses patient assisted breathing with inhalation creating muscle tension so that during exhalation there is greater focus on muscle relaxation, whereas MET mostly uses breathing to treat rib dysfunctions. Myofaction uses palpation of muscles to assess changes in muscle tone, whereas MET uses palpation of bony landmarks to assess for range of movement. Myofaction is a post-isometric kneading and stretching technique that primarily focuses on reducing muscle tension, whereas MET is a post-isometric stretching technique that primarily focuses on increasing the range of joint movement. A myofaction treatment usually involves one or two myofaction cycles followed by a few cycles of kneading, whereas a MET treatment usually involves three to five repetitions, that may or may not be followed by joint mobilisation and passive stretching.

Myofaction involves direct finger or thumb contact with the muscle being treated and immediate feedback so the therapist can monitor and adjust the technique throughout the whole of the myofaction cycle, whereas MET involves a change in the motion barrier measured by a change in the position of a bony landmark between the start of the technique and the end, the result of a decrease in longitudinal muscle tension and an increase in the length of the muscle.

In summary, myofaction and MET both involve isometric muscle contraction and post-isometric relaxation and require patient cooperation. Myofaction uses patient focused breathing and a mixture of stretching and kneading to challenge longitudinal, transverse and torsional barriers, whereas MET just uses stretching to challenge the longitudinal muscle barrier and the joint motion barrier.

I have two more posts on myofaction and then I want to stop and focus on finishing my next book: Massage for Muscles, Tendons and Ligaments https://massage-technique.com/.
You can still receive a free myofaction eBook and monthly eBooklets at https://myofaction.xyz/
Soon I plan to start posting on the topic: self-massage of muscles, tendons and ligaments, which is the subtitle of my most recent book Massage Yourself https://massage-yourself.xyz/

29/06/2023

Isometric muscle contraction, post-isometric relaxation and the myofaction technique

The isometric contraction and post-isometric relaxation part of the myofaction technique is based on a physiological principle known as autogenic inhibition. Autogenic inhibition is part of a system of reflexes and occurs when a muscle contraction causes Golgi tendon organs (GTOs) to inhibit the (agonist) muscle contraction and contract the opposing (antagonist) muscle. GTOs are mechanoreceptors inside tendons that detect increases in tension when a muscle contracts or is stretched. Within the tendon the GTOs are surrounded by collagen fibres and when the muscle contracts the pull on the tendon straightens out the collagen fibres, causing the GTOs to discharge.

Information from the GTOs about the muscle contraction passes to the spinal cord, and information from muscle spindles and other receptors goes to the spinal cord and brainstem, and all this is processed with information from higher centres in the brain to regulate the contraction.

Reflexes are pre-programmed, automatic and involuntary responses to a range of different stimuli but mainly to threats to the body and they help protect the body from harm or injury by initiating a fast response to the stimulus. GTOs are pre-programmed to discharge and inhibit contraction when a muscle over-contracts, to prevent the muscle from tearing itself apart or tearing off the bone. It acts like a safety brake on the muscle, so it doesn’t destroy itself. Similarly, muscle spindles protect muscles from injury caused by forceful overstretching.

GTOs discharge and inhibit muscle contraction during the contraction and for a few seconds after the contraction stops. During these few seconds, the muscle is at a resting level of tension because it is not contracting, but the GTO is still discharging and inhibiting the muscle. This results in the muscle moving to a heightened state of relaxation known as post-isometric relaxation.


For more information see https://myofaction.xyz/

29/06/2023

Rowland Benjamin is an osteopath treating muscle and joint pain with manipulation, stretching and other exercises. He treats pain in the back, neck, shoulders and hips. His clinic is in Bridgetown, Western Australia. He is the author of Safe Stretch, Massage Yourself and Myofaction.

28/06/2023

The use of movement for passive stretching in treatment

Stretching is a key part of manual therapy and to stretch a muscle effectively you need to start the technique with the patient placed in a position that will enable adequate movement to occur and in the right direction. When you have the enough of the right movement then you can develop rhythmic stretching and synchronise it with kneading and the patients breathing.

Choosing the right starting position for getting good movement will vary with the area of the body and the muscles you are treating. Sidelying or seated positions work well for treating the erector spinae muscles of the lumbar and thoracic region. Sidelying allows moderate amounts of sidebending, rotation and flexion and some extension of the lumbar spine, and it is useful for getting shoulder, hip, upper thoracic and lower cervical movement. The main disadvantage with sidelying is that it involves a pulling action rather than pushing, and since you are not using your body weight, sidelying is harder physically on your body.

Sitting is a good for facilitating movement in the thoracic and thoracolumbar spine. Starting the technique with the patient in the seated position allows you to induce sidebending, rotation, flexion and extension or combinations of these movement.

Starting the technique with the patient in the prone position is useful if you want to produce lumbar and lower thoracic rotation, for treating the multifidi and rotatores. These muscles need a firm thumb tip or elbow pressure. The patient is asked to actively lift their opposite side pelvis or shoulder off the table as you resist their effort with your applicator. The prone position is also useful for conserving energy, but not for getting lumbar movement.

Repeating patterns of movement or rhythmic movement is important because it helps relax the patient. When the patient knows the rhythm, and has a good idea what is coming next, then they are in a better position to help with the treatment.
A free ebook containing this technique, the anatomy of the suboccipital region and a video are available at https://myofaction.xyz/

27/06/2023

Breathing and the myofaction technique

The inhalation phase of breathing and isometric contraction both increase internal muscle tension in the first phase of the myofaction cycle so that a short period of heightened relaxation is produced in the muscle in the second, exhalation phase of the cycle. This relaxation is then available for lengthening short muscles, releasing tight muscles and calming irritable and painful muscles using a combination of kneading and stretching.

The diaphragm is the main muscle of respiration during normal breathing at rest and is assisted by the intercostal muscles during deeper breathing. During inhalation the diaphragm contracts, moves downwards and compresses the viscera while the intercostal muscles contract and pull the ribs upwards and against gravity, and this draws air into the lungs. Inhalation is an active process and depending on the intensity and duration of the inhalation will increase muscles tone and joint movement in many different parts of the body but especially in the rib cage, spine, shoulders and hips.

In contrast to inhalation, exhalation is an almost totally passive process. During exhalation the relaxation of the diaphragm, elastic recoil of the lung, push of the viscera, relaxation of the intercostal muscles and force of gravity acting on the ribs, combine to force air out of the lungs.

Muscle tension increases throughout inhalation and reaches a maximum at the end of inhalation. It decreases during exhalation and reaches its lowest point at the end of the exhalation. Breathing is a natural physiological mechanism, but it is also a useful tool that can be used with other tools, as part of the myofaction technique to help treat muscle problems.

During normal breathing at rest, a 1.5 second inhalation is immediately followed by a 2 second exhalation and then a 2 second pause of no breathing. During the deeper breathing of the myofaction cycle, a 2 second inhalation is followed by a 4 second held inhalation and a 6 second exhalation and there is no pause.

The major difference between normal breathing and myofaction breathing is the longer inhalation-exhalation cycle, greater depth of breathing and the lack of pause at the end of exhalation in the myofaction breathing. Deeper breathing will recruit more muscles and create more muscle tension, and longer breathing cycles will give you more time to complete the technique.

Breathing is a useful timekeeper and helps the patient to organise their attention on the treatment. Respiratory force is the use of respiration and injunction to induce relaxation.
Forewarn the patient at the start of treatment that they will need to focus on the technique by contracting and tensing their muscles during inhalation and relaxing their muscles while you apply kneading and stretching during exhalation.

Coordinate your kneading and stretching actions with the patients breathing, increasing your forces during the longer period of relaxation and deeper exhalation. When one or two cycles of myofaction have been completed move into kneading with its breathing cycle closer to the normal, at rest breathing.

There are three more posts remaining in the myofaction series - The use of movement for passive stretching, Isometric muscle contraction and post-isometric relaxation and How does Myofaction differ from Muscle Energy Technique?
Several short free videos are available of the myofaction technique at https://myofaction.xyz/

26/06/2023

The external forces of myofaction

Muscle manipulation and direct massage techniques in general comes down to either pushing or pulling a muscle. Twisting is really just a combination of pushing and pulling. You do this with your applicator, which is usually your fingers or thumb. When you pull, push or twist a muscle you distend its fibres and you move fluids around the muscle fibres, which means more nutrients and oxygen go to the muscle and more waste is removed. Stimulating the movement of fluid around muscle fibres is analogous to squeezing a wet sponge.

You can pull on a muscle in two ways, by pulling the ends of the muscle apart (stretching) and by pulling across the middle of the muscle (kneading). With stretching you apply your force along the muscle fibres and distend them longitudinally. Passive stretching is analogous to pulling on either ends of an elastic strap.

Kneading can be done by pulling across a muscle or by pushing across a muscle. Both involve a force perpendicular to the muscle fibres which distends them transversely. Cross-fibre kneading is analogous to bending the string on a bow or guitar string.

Compression is a type of cross-fibre kneading. Compression involves pushing directly into a muscle and onto a bone kneading whereas cross-fibre kneading involves pushing across a muscle and across a bone. In both compression and cross-fibre kneading there is a transverse force acting perpendicular to the muscle fibres.

Pushing can be combined with pulling to produce tortional kneading. This is done with a twisting action with your fingers and thumb. The muscle fibres are distended using a torsion or rotation force and the action is analogous to kneading dough or putty.

Pushing can be combined with pulling when a bone is used as a lever to counter the force made by the kneading action. The lever acts in the opposite direction to the primary force to amplify the force of the kneading process. I have grouped tortional kneading and manipulation using leverage together and call them secondary forces.

24/06/2023

How myofaction integrates with other techniques.

Myofaction belongs to a family of massage techniques that involve repeating patterns of movement that can be integrated with the patients breathing cycle. Cross-fibre and torsional kneading, passive stretching and some joint articulation techniques use repeating applicator pressure, joint movement and focused breathing. These common features help them to work together and the therapist can easily move between them.

Start with a cycle of myofaction to align the speed and rhythm of the technique with the patients breathing. When one breathing cycle of myofaction has been completed, follow it with several cycles of kneading, stretching or joint articulation. Use the myofaction technique to launch a new cycle of rhythmic movement, synchronised with the patients focused breathing and get the patient to follow the movement.

Specifically ask the patient to focus on the technique and their breathing and actively help with the treatment. Tell them to tense their muscle during their inhalation and then relax it during their exhalation. Use the tension to create relaxation, and then take advantage of the greater level of relaxation to take up tension in the muscle with kneading and stretching. After one cycle of myofaction follow the patients breathing with several cycles of pure kneading or stretching. Maintain light kneading and stretching during the inhalation but increase them during the exhalation.

Treatment can be a dual responsibility, a partnership between the therapist and the patient and when there is patient engagement and cooperation, the treatment will be a richer and more rewarding experience for the patient, and it will save time for the therapist.

One really useful direct technique that does not fit into this family of techniques is transverse friction. Transverse friction uses repeating patterns of movement, but they are fast movements with firm pressure and small amplitude, and not aligned with the breathing cycle. For a free Ebook go to https://myofaction.xyz/

Image of myofaction for serratus anterior