Fascial Stretch Therapy
So what exactly is fascial stretch therapy and how does it help you?
Fascial Stretch Therapy™ (FST) is a unique manual assisted technique that was created for athletes in 1995. It’s been used successfully at the Olympic, professional and collegiate levels. More rehab and training professionals are integrating FST into their protocols and regimens to improve outcomes.
Check out this video of FST in action!
FST is primarily a table-based assisted stretch technique that adheres to 10 principles:
1. Synchronize breathing with movement, and
2. Tune the nervous system to current conditions. In FST, post-training or post-event recovery assisted stretching to regain lost flexibility commences with the tempo of breathing suited to stimulate the parasympathetic nervous system (PNS). This type of breathing is slow breathing in which a person inhales pre-stretch and exhales during the stretch. The rhythm sets up a natural tempo of breathing that improves results by reducing patients’ tendency to unnecessarily guard or hold the area being manually stretched as long as pain is avoided.
Conversely, a stimulating pre-event assisted stretch may be done with faster breathing and a more intense PNF contraction to lightly stimulate the sympathetic nervous system (SNS) and warm-up an athlete for an event (1,2). Therefore, the nervous system may be tuned to align with your client’s goals and conditions.
3. Follow a logical anatomical order. My experience as a professional dancer, martial artist and flexibility specialist has taught me that following a particular anatomical order of tissue layers when stretching produces the best results.
In general, assessing and stretching the joint capsule for specific planar hypomobility yields better outcomes in assisted stretching like FST. This makes sense because the joint capsule and surrounding connective tissue share the same basic neurological genesis. Since many athletes develop hip capsule adhesions and concomitant hypomobility, better outcomes have resulted from releasing the adhesions and restoring mobility to the joint before addressing the myofascial regions (1,3).
After the joint capsule and shorter, single-joint muscles become more flexible, you can stretch longer, multi-joint muscles more effectively as the layers of muscle and connective tissue are released (1).
4. Achieve range of motion (ROM) gains without pain. The philosophy of “no pain, no gain” isn’t part of FST. Instead, you get better results by avoiding the pain response.
Dramatic increases in functional flexibility and performance can be reached when you conduct FST sessions in an environment of quiet relaxation and trust. Under these circumstances, your tightest athletes and other clients can achieve flexibility gains between 50 percent and 100 percent after the first or second assisted stretch session.
5. Stretch fascia, not just muscles. Fascia is the soft tissue component of the connective tissue system that forms a continuous 3-D matrix of structural support across the entire body.
Much more than an organ of support, fascia is also a sophisticated communication and information network involved in all physiological systems (4). The condition of the fascial planes–their alignment, whether they’re freely mobile or adhesed, and locked long or short–is equally important than the isolated muscle, in terms of gaining more usable flexibility, along with strength and optimal function (1,5).
6. Use multiple planes of movement. Using multiple planes of stretch movements is important, especially when working the hip joint. Although the hip’s ball and socket design gives it the potential for 360 degrees of motion, many assisted and self stretch programs don’t actualize enough of this ROM.
In FST, multiple ranges of movement and circumduction during assessment and treatment address all joint capsule and myofascial regions that may be adhered, contracted, or hypo- or hypermobile (1).
7. Target the entire joint. A joint capsule is made up of fascia that encapsulates the joint and fuses with the ligaments that connect the bones to each side of the joint. Anatomical dissection shows that there’s a superficial layer of fascia covering these parts like a jacket under the skin. Deep continuous paths of fascial tissue connect the joint capsule to the ligament and bone, go on to the tendon and muscle, continue to the next tendon and bone, and proceed to the ligament and capsule of the next joint (1,5).
This repetition of fascial connections can span the entire length of the body and affect different areas. For example, tightness in the sole of the foot can cause symptoms or pain anywhere through the fascial tracks of the back, up to the base of the skull. Since the joint and its capsule are located in the deepest part of the fascial tracks, the condition of the joint capsule determines the condition of the fascial tracks that cross over and connect the joints (1,5).
It’s suggested that almost 50 percent of a healthy person’s lack of joint ROM is due to tight joint capsules. Therefore, it’s important to keep these structures optimally mobile (6).
8. Use traction. In physical therapy school I learned the proprioceptive neuromuscular facilitation (PNF) principles about joints and the muscles that cross them–compression facilitates or stimulates contraction and joint stability, while traction inhibits or relaxes them. Connective tissue responds to underactivity, overactivity and age by contracting. Recent research shows that fascia contains myofibroblasts, which supports the aforementioned observation (3).
Traction makes assisted stretching more comfortable for patients. And teaching patients how to perform self-traction aids compliance to home programs (1).
9. Facilitate body reflexes. Research demonstrates that using specific PNF techniques during stretching yields the highest ROM gains in the shortest amount of time (2). My own unpublished research shows that assisted PNF contract-relax stretching using non-traditional and individualized parameters of intensity, frequency and duration, combined with using multiple table straps to passively stabilize the stationary limb, results in better and longer ROM than traditional PNF techniques (7). I call this particular assisted stretch technique “undulating periodized contract-relax PNF.”
10. Adjust stretching to client goals. Tailoring stretching regimens to a client’s specific needs produces better results.
For example, consider professional football players. These athletes come in at least twice per week for assisted stretching to regain flexibility they lose during the season and to speed recovery through enhanced blood and lymph flow. In the offseason, we work more on increasing the plasticity of players’ connective tissues to reverse connective tissue thickening and scar tissue formation. Some football players, such as cornerbacks and wide receivers, are more “fast twitch” and reactionary to stretching, and need more oscillating, undulating movements to condition the nervous system for FST.
FST sessions should be adjusted daily to the conditions at hand. Pre-game assisted stretching should consist of 20 minutes of fast, undulating movements to get players limber up to 30 minutes before training or an event. Two days after a game, players should receive 1-hour sessions to regain lost flexibility.
While more research is needed to help clinicians practice evidenced-based therapy, FST should be considered a viable manual technique in the sports and rehab marketplace.
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About Cat McNab
Cat McNab is an Exercise Physiologist and is one of 2 Level 3 Elite FST (Fascial Stretch Therapy) practitioners in Australia. Cat has spent many years honing her craft working with athletes in the USA and Canada alike and now this amazing modality is available in Australia at USP.