1. Myofascial Release Techniques for the Lumbopelvic Region
Thomas Cappaert, PhD, ATC, CSCS
Central Michigan University
GLATA 2010, Detroit, MI

2. Objectives of Presentation
Review indications for myofascial release.
Discuss common dysfunction patterns in the lumbopelvic region.
Discuss developing a treatment plan.
Describe common myofascial release techniques.
Demonstrate/practice the techniques.

3. How does fascia become injured?
Dysfunction comes (secondary to inadequate or over adequate mechanical stress) from the following sources:
ADLs
Work
Leisure/sport
Environment (i.e. furniture, shoes, cars)
Attempts to treat the structure/function continuum
Attempt to identify causative/contributing factors using the “Tight/Loose” concept
Conceptual models of fascia function/dysfunction
Fascia as a balloon
Fascia as plastic wrap
Fascia and muscle as elastic bands

4. Characteristics of Muscles Relative to “Tight-Loose” Concept
Postural Muscles
Phasic Muscles
Type
Slow twitch
Fast twitch
Respiration
Aerobic
Anaerobic
Function
Static/supportive/stabilize
Phasic/active/mobilize
Dysfunction
Shorten
Weaken
Examples
Erector spinae, pectoralis major, hamstrings, psoas
Rhomboids, arm extensors, quadriceps, hip extensors
Treatment
Stretch/relax
Facilitate/strengthen

5. Patterns of Imbalance Lengthened or underactive stabilizer
Overactive synergist
Shortened antagonist
Gluteus medius
TFL, quadratus lumborum, piriformis
Hip adductors
Gluteus maximus
Iliocostalis, lumborum & hamstrings
Iliopsoas, rectus femoris
Transverse abdominus
Rectus abdominus
Iliocostalis, lumborum
Lower trapezius
Levator sacpulae/upper trapezius
Pectoralis major
Deep neck flexors
SCM
Suboccipitals
Serratus anterior
Pectoralis major/minor
Rhomboids

6. Observation of Imbalance
Muscle inhibition/weakness/lengthening
Observable sign
Transverse abdominus
Protruding umbilicus
Serratus anterior
Winged scapula
Rectus abdominus, gluteus maximus
Anterior pelvic tilt
Scapular retractors
Forward shoulder posture
Gluteus medius
Positive Trendelenburg Sign
Gluteus maximus
Sagging buttocks

7. Patterns of Dysfunction – Lumbopelvic Region
Hip flexors
All tighten & shorten
Iliopsoas, rectus femoris
TFL, adductors
Erector spinae
while
Abdominal
All weaken
Gluteal groups

8. MFR Treatment Indications
Pain complaints have not responded to conservative treatment
Complaints are non-specific to one anatomic structure or region
Underlying chronic condition that leads to soft-tissue tightness
Postural abnormalities
Asymmetrical muscle weakness
ROM has not improved with traditional/conservative treatment

9. Developing a Treatment Plan
Basic evaluation
Posture
Joint integrity/movement
Signs of dysfunction
Flexibility/strength
Balance/coordination
Local signs/symptoms
Muscle groups involved
Source of dysfunction
Chain reactions
Gross compensations
Developing the plan
What objective information connects to the subjective information?
What’s loose, what’s tight?
What are the asymmetries?
Where are the malalignments?

10. Common Treatment Sequences
Lateral Hip/Pelvis
Iliac Crest Release
Tensor Fascia Lata Release
Iliotibial Band Release
Quadratus Lumborum Release
Posterior Hip/Pelvis
Sacral Traction
Gluteus Maximus Release
Sacrotuberous Ligament Release
Piriformis Release
Erector Spinae Release
Multifidis Release
Pelvic Roll with Lumbosacral Traction

11. Common Treatment Sequences continued
Anterior Hip/Pelvis
Quadricep/Anterior Thigh Release
Iliacus Release
Psoas Release
Rectus Abdominus Release
Standing Adductor Release

12. Practical Applications
Questions?
Demonstration & Practice

13. Iliac Crest Release Patient Position Clinician Position Technique
Sidelying with knee flexed and hip flexed to 300. Upper leg is supported by lower leg and spine is in neutral.
Clinician Position
Standing behind patient at waist level and facing toward patient’s feet.
Technique
Use a soft fist or fingers to engage the fascia along the iliac crest.
Start at the midline of the frontal plane and sink the fist inferiorly and produce tension posteriorly and move towards the PSIS as you encounter new layers of tension.
Encourage patient to produce anterior and posterior tilts of the pelvis to uncover additional tension.

14. Tensor Fascia Lata Release
Patient Position
Sidelying with knee flexed and hip flexed to 300. Upper leg is supported by lower leg and spine is in neutral.
Clinician Position
Standing behind patient at waist level and facing toward patient’s feet.
Technique
Use a soft fist or elbow to engage the muscle just anterior to the gluteus medius.
Engage the initial layers of tension and as tension releases, sink the fist deeper.
When a noticeable change to tone has occurred, add a line of tension inferiorly towards the feet.
Encourage patient to produce anterior and posterior tilts of the pelvis to uncover additional tension.

15. Iliotibial Band Release
Patient Position
Sidelying with knee flexed and hip flexed to 300. Upper leg is supported by lower leg and spine is in neutral.
Clinician Position
Standing behind patient at waist level and facing toward patient’s feet. Move toward the foot of the table as the release progresses.
Technique
Use a soft fist or elbow to engage the fascia at the greater trochanter.
Engage the initial layers of tension lightly.
When a noticeable change to tone has occurred, add a line of tension inferiorly towards the feet.
Divide the band into sections and repeat the release for each section all the way to tibia.
Work within tolerance levels (if they are visibly in pain or guarding, the work is too deep)

16. Quadratus Lumborum Release
Patient Position
Sidelying with knee flexed and hip flexed to 300. Upper leg is supported by lower leg and spine is in neutral.
Clinician Position
Standing behind patient at waist level and facing toward patient’s feet.
Technique
Use a soft fist or fingers to engage the muscle just superior to the iliac crest.
Start at the midline of the frontal plane and sink the fist inferiorly towards the transverse processes of the lumbar spine. Increase pressure as you encounter new layers of tension.
Encourage patient to produce anterior and posterior tilts of the pelvis to uncover additional tension.
You may add a posterior line of pressure to also engage the posterior layers of the thoracolumbar fascia.

17. Sacral Traction Patient Position Clinician Position Technique Prone
Standing at head of patient and facing patients feet.
Technique
Place one hand flat on skin at thoracolumbar junction to stabilize
Place other hand flat on sacrum with heel of hand at lumbosacral junction
Using hand at sacrum, apply tension on an inferior line towards the feet while the hand placed superiorly acts as a counter-force
Continue the inferior tension as tissues release

18. Gluteus Maximus Release
Patient Position
Prone
Clinician Position
Standing beside the patient at waist level, working on the contralateral side
Technique
Place pads of fingers on both hands at tissue over the PSIS and intermediate iliac crest.
Create a line of tension toward the greater trochanter.
Maintain a consistent depth of pressure as you work laterally. Increase tension as superficial tension dissipates.
Slight anterior and posterior tilts of pelvis will deepen the release.

19. Sacrotuberous Ligament Release
Patient Position
Prone
Clinician Position
Standing beside the patient at waist level, working on the ipsilateral side
Technique
Using an elbow, fingers or thumb, sink anteriorly through the gluteus maximus. The ligament can be located midway along its attachment to sacrum and 2 cm lateral and inferior to the coccyx.
Create downward/anterior pressure until the ligament is contacted.
Create a line of tension inferiorly toward the ischial tuberosity.
Maintain consistent pressure until tension dissipates and ligament softens.
Slight internal rotation of the ipsilateral leg will deepen the release.

20. Piriformis Release Patient Position Clinician Position Technique
place patient side lying with affected leg uppermost and both legs flexed at hip and knee
Clinician Position
Face patient at hip level
Technique
place elbow tip at piriformis insertion (behind greater trochanter) and stabilize pelvis against your trunk
With other hand grasp ankle of affected leg and place into internal rotation to remove slack in the piriformis
Apply moderate pressure with elbow while piriformis is stretched for 5-7 seconds
Then perform an isometric contraction of piriformis (25% of max) for 5-7 seconds
After contraction ceases, take muscle to new barrier and reapply compression with the elbow

21. Erector Spinae Release
Patient Position
Patient prone with pelvis and feet supported
Clinician Position
Standing to the side at waist level
Technique
use light to moderate, diffuse pressure (soft fist or heel of hand or thumb) at the laminar groove at level of T12
Treating unilaterally, once tissue slack is removed, add a line of tension inferiorly.
Treat tissue in sections and repeat the release for each section all the way to the sacrum.

22. Multifidis Release Patient Position Clinician Position Technique
Patient prone with pelvis and feet supported
Clinician Position
Standing to the side at waist level
Technique
use moderate direct pressure with thumb or finger just lateral to the lumbar spinous processes
Treating unilaterally, once tissue slack is removed, add a line of tension anteriorly.
Treat tissue in sections and repeat the release for each section all the way to the sacrum.

23. Pelvic Roll with Lumbosacral Traction
Patient Position
Supine with knees flexed and the feet flat on the table.
Clinician Position
Standing beside the patient at mid-thigh level facing toward the head of the table.
Technique
Position at patient with one arm between patients legs resting on the elbow with the forearm supinated and hand resting on the table.
Patient initiates a posterior pelvic tilt and clinician slides hand superiorly so that the hand reaches up under the sacrum. Continue to encourage the pelvic roll, so the hand can be positioned with the fingers at the L1-L2 region with two fingers on each side of the spinous process.
Patient is then instructed to let spine and pelvis rest back fully onto clinicians hand.
Clinician leans on elbow creating a flexion of the fingers and engagement with the tissue.
Clinician then “lifts” through the fingertips and pulls inferiorly towards the feet.
Treat the lumbar spine in sections and carry through treatment to the coccyx.

24. Quadricep/Anterior Thigh Release
Patient Position
Supine
Clinician Position
Standing at the patients side at hip level
Technique
Use an elbow or soft fist to engage the tissue inferior to the ASIS. Create tension in an inferior direction. Work incrementally toward the knee, dividing the muscle into 3-4 segments.
Abduct the leg to 150. Use fingertips or elbow to sink slowly into the tissue of the femoral triangle in a posterior direction and then create a line of tension in the same direction as the sartorius.
Locate the greater trochanter and the ITB. Using fingertips, palpate for the seam between the ITB and vastus lateralis. Create a line of tension in an inferior direction and treat incrementally.
Have patient perform hip hiking against the line of treatment.

25. Iliacus Release Patient Position Clinician Position Technique
Supine with knees supported on bolsters.
Clinician Position
Standing at the patients side at hip level
Technique
Treating one side at a time, use fingertips to locate the medial aspect of the ilium at the ASIS.
Keep the fingerpads touching the bone (with a slight lateral direction) while the tips sink in an inferior/posterior direction.
Engage the first layer of restriction and wait. Once the release occurs, sink to the next layer and continue to treat as appropriate.
Slight posterior pelvic tilt (abdomen drops posteriorly) will improve release.

26. Psoas Release Patient Position Clinician Position Technique
Supine with knees supported on bolsters.
Clinician Position
Standing at the patients side at hip level
Technique
Treating one side at a time, locate the psoas by drawing an imaginary line between the umbilicus and the ASIS.
Use the fingers to make contact on this line about halfway between the ASIS and the edge of the rectus abdominus.
Sink in a medial/posterior line and angle in from the lateral edge of the psoas.
Engage the first layer of restriction and wait. Once the release occurs, sink to the next layer and continue to treat as appropriate.
It may take several minutes and a few treatment sessions to get full benefit from the treatment.

27. Rectus Abdominus Release
Patient Position
Supine with knees extended.
Clinician Position
Standing at the patients side at mid-thigh level
Technique
Treat both sides simultaneously.
Use the fingertips to engage the lateral margins of the rectus abdominus about 2 cm above the pubic bones. Make a “scooping” motion that begins by first sinking posteriorly into the abdominal wall to engage the aponeuroses of the external and internal oblique.
Once the connection is established, lift under the margins of the rectus to put a line of tension in a medial, anterior and superior direction. This completes the scooping action. Maintain this triplanar line of tension and move superiorly. Initially a local stretch will be felt that will progress deeper as tissue relaxes.
Then, span each iliac crest with the fingers and rest the thumbs on the pubic tubercles. Palpate the pubic symphysis. Maintain this contact at the pubic bones and spread the contact through the whole of both hands (not just the thumbs) in a posterior direction.
As the release occurs, bring feet to flat on the table and ask for a posterior pelvic tilt. As the abdomen relaxes and “opens up” release pressure to maintain a lighter contact as the tissue relaxes further.

28. Standing Adductor Release
Patient Position
Standing with feet about shoulder width apart.
Clinician Position
Kneeling or seated on a stool beside the patient.
Technique
Use the fingerpads of both hands to grasp the adductors about a hand’s width below the ramus of the ishium. Sink into the tissue by pulling toward yourself (laterally) and then creating a line of tension inferiorly.
Have the patient flex the knee to As they return to standing, maintain the tension in the same line and work as a counterforce to their movement.
Repeat at 2-3 more sites down to the knee.

29. Resources
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