What to Expect During Physical Therapy

Depending on the injury or condition for which you are seeking therapy, you may receive a manual therapy session, an exercise session or a combination of both. Manual therapy which will include Myofascial Release, requires skin-to-skin contact and friction between your therapist’s hands and you. Therefore, please refrain from applying any lotions or creams before your treatment. If you must use cream for a medical reason, try to apply it
after your session if possible. While your therapist needs to be able to put their hands on your skin, it is not necessary for you to be completely disrobed. Therefore, for your comfort and continued modesty we recommend you wear two piece bathing suits (alternately loose shorts and a loose tank top or t-shirt will work) for women and loose shorts or bathing suits for men. Your therapist will provide towels, blankets and sheets so you do not get too chilled during your treatment.

For exercise in our gym area, please wear loose, comfortable exercise pants and top that allow maximum freedom of movement. We generally don’t wear street shoes in the clinic or gym areas, as all exercises are done barefoot, or in special toe socks, if you prefer.

In order to maintain the progress you achieve in the clinic, and further your healing process, your therapist will give you exercise, stretching and self-treatment exercises to do at home, on days you do not come for therapy. Your home program is an extremely important part of your therapy (in some cases even more important than the once or twice a week visits to the clinic!), so please report how often you do your program and any effects you notice to your therapist at the beginning of each visit.

Of course there is paper work that you will need to fill out. Please come 10 or 15 minutes early your first time, so that we can spend as much time as possible helping you get on the path to better health.

Effects of Treatment
While myofascial release is gentle, it has profound effects upon the body tissues. Do not let the gentleness deceive you. While each patient's response will be highly individual, certain common responses are seen repeatedly.
Occasionally you may leave after the first treatment feeling like nothing happened. Later (even a day later), the effects of the treatment begin to manifest themselves.

Often there is soreness after treatment for several hours or perhaps a day. The discomfort is a result of the released tissues secreting lactic acid and other trapped metabolic wastes into the intercellular spaces where it can then be excreted via the body's normal pathways. The best way to aid this process is by drinking extra water which helps flush toxins out of the body.

Frequently remarkable improvement is noted immediately during or after a treatment while at other times improvement comes after the soreness described above. Other typical responses reported by patients include: seemingly new pain in new areas, lightheadedness or nausea, and emotional responses such as joy or sadness. In any case, it is all part of the healing process.

Generally, acute cases are typically resolved with fewer treatments. The more chronic the problem, the longer it usually takes to bring lasting results. Some chronic conditions that have developed over a period of years can require two or three treatments a week to obtain optimal results. Your therapist will discuss your plan of care with you, and help you decide how often you should come for maximum benefit.

Frequently Asked Questions About Myofascial Release
  • What is Fascia?
    Fascia is another name for connective tissue, one of the four basic tissue types that comprise every organ and structure in the body.

    Fascia holds us all together and has been virtually ignored in the past. Fascia is a multidimensional web-like tissue that extends throughout the body. It is composed of two types of fibers: A) Collagenous fibers, which are very tough and have little stretchability B) Elastic fibers, which are stretchable .

    Fascia is not muscle, but muscle has fascia in and around it. In fact, muscle is approximately 80% fascia. From the functional point of view, the fascia throughout the body may be regarded as a continuous three dimensional web of connective tissue that extends without interruption from the top of the head to the tip of the toes. It surrounds and invests every other tissue and organ of the body, including nerves, blood and lymph vessels, muscle and bone. It has been estimated that some fascia has a tensile strength of as much as 2000 pounds per square inch.

    For a more in depth discussion see
    “What Is Fascia.”

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  • How does the fascial system work?
    The fascial system is made up of microtubules and marries all the other structures of the body, such as veins, nerves, other body systems (lymphatic system, endocrine system, etc.). It does not just exist in one place. It penetrates every cell from the brain to skin. Restrictions or adhesions affect the fascial system by binding it down, causing thickening, hardening and increased pressure. This may result in pain and other symptoms anywhere in the body. Working with the fascial system requires much experience and an extremely sensitive touch.

    For a more in depth discussion see
    “What Is Fascia.”

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  • What is Myofascial Release (MFR)?
    Authentic John F. Barnes Myofascial Release, (JFB-MFR) is a full body, hands on technique that releases the fascial system. The myofascial release approach is an intensive, generally mild and gentle form of stretching performed by qualified therapists who have been highly trained. These techniques have profound effects upon the body tissues. Because of its gentleness, many individuals wonder how it could possibly work. The simple explanation is that the facial system is interconnected, symptoms may appear in areas of the body one might assume are unrelated to the actual restricted area via the three-dimensional web of connective tissue that pervades the entire body. Unfortunately, myofascial restrictions do not show up on any of the standard tests (x- rays, CAT scans, MRI’s etc.) so these myofascial restrictions have been ignored or misdiagnosed. For example, when scars harden in one area following injury, chronic inflammation, disease, surgery, etc. it can put tension on adjacent pain-sensitive structures as well as on structures in seemingly unrelated areas. Some patients have pain patterns that at first glance seem bizarre and appear to be unrelated to the original or primary complaint. These unusual symptoms are more easily understood with a more accurate understanding of the fascial system.

    Effective MFR treatment involves various techniques that are frequently applied to different area’s of the body. Thus, MFR utilizes a whole body approach to evaluation and treatment. The therapist needs to use “skin on skin” contact to provide the friction interface necessary to release the fascia effectively. Release of these fascial restrictions includes specific, specialized manual techniques that hold the tissue in a release for a minimum 90 –120 seconds. This allows for the mechanical and biomechanical reactions to begin. Full release of a restriction may take five minutes or longer. Successive releases, through each layer, also require this time element. Our approach is successful because we treat a system in the body that no one else treats, the fascial system. John F. Barnes, PT has been developing and refining MFR over the past 40 years to make this approach the most advanced and effective hands-on care available, particularly for patients who have not responded to traditional medical or surgical interventions. Once the fascial system is addressed, these same patients begin to make progress in a matter of weeks following intensive MFR treatments and are on their way to a pain free, active lifestyle.

    For a more in depth discussion see
    “What Is Fascia.”

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  • How do you get fascial restrictions?
    Typically through (1) trauma, (2) repetitive motion or (3) poor postures over time (sitting all day), (4) surgery, and scar tissue - restrictions can form in the fascial system.

    These restrictions can exert force of up to 2000 pounds per square inch on the body’s sensitive tissues and organs. This force can literally crush any of the vital structures that are near it. Since the fascial system runs throughout your entire body, these restrictions can cause pain anywhere in the body and compromise any system. By system I mean, cardiovascular, neurologic, muscular, pulmonary, digestive, endocrine, etc. Fascial restrictions can cause digestive problems, fertility problems, circulation problems, neurological problems, etc. These restrictions can become tighter over time, literally making you feel like you are in a straight jacket and sending symptoms throughout your body.

    When the cause of these symptoms, myofascial restriction, is left untreated, these symptoms often progress to the point of some type of chronic pain syndrome. In some patients, blood vessels and nerve roots can become caught which creates entrapment syndromes and ischemic like conditions.Excessive pressure such as this can explain why some symptoms develop. Conventional treatment methods do not affect the myofascial system and at best produce only temporary symptomatic changes. MFR is a structural approach that treats the cause of the problems not just the symptoms and this is what produces long lasting results.

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  • How is Healing Motion different from traditional PT practices?
    Authentic MFR at Healing Motion Physical Therapy & Wellness Center is not forceful. It is a whole body approach tailored to each individual. The body is allowed to release, not forced to release. This does not mean that the releases will not be painful. Many times during a release pain and/or many other sensations will be felt. This is described as your fascial voice. Healing Motion MFR treatments are a minimum one hour with your therapist working with you, one on one, on your body’s restrictions. Some traditional settings feel like a production line, and are not very private. Healing Motion MFR is all encompassing ie.: mind, body and spirit. The fascial system stores memory from physical, mental, and emotional traumas.
    PT is always one-on-one

    In traditional therapy, scheduled time with each patient is dictated by the insurance carriers. Individual treatment is not the norm and it is not uncommon to have three or four patients per hour per therapist and most times you are performing your exercise program independently. Modalities have their purpose but should remain an adjunct to the therapy process to enhance healing, not become the therapy process. In traditional physical therapy settings there is sometimes overuse of modalities like ultrasound and electrical stimulation which have no effect on the cause of the symptoms which is actually ischemic pressure from myofascial restrictions.

    Healing Motion myofascial release is a whole body approach to treating the cause of the symptoms not just palliatively treating symptoms. MFR has long lasting often permanent effects on the body with self treatment practice daily. The decrease in pain and increase in movement and flexibility restores your bodies balance and energy leaving you feeling restored and ready to live an active life.

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  • Do you accept insurance reimbursement?
    We are pleased to announce Healing Motion is now a participating provider with most private insurance plans available in this region, including:
    • All Highmark plans
    • Any Blue Cross/Blue Shield plan, even if out of state
    • United Healthcare
    • Aetna
    • Cigna
    • Oxford
    • Humana
    We also accept auto insurance claims if the claim is currently open and we are the first physical therapist consulted on that claim.Unfortunately, we do not accept Medicaid reimbursement and UPMC continues to refuse to allow Healing Motion to join its network of healthcare providers.

    However, even if we don't accept your plan, you may still be eligible to receive reimbursement for Healing Motion's superlative physical therapy services if your policy includes out-of-network physical therapy benefits (call your health plan or plan administrator for benefit details.) Most patients with out-of-network benefits receive 80% of their out-of-pocket expenses reimbursed directly to them. We can help you fill out the claim form and provide you with invoices and documentation to speed the processing of your claim. Call (412-363-4050) or
    email Healing Motion for more details.

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  • How long will it take to feel better?
    Each person will heal and progress as at their own pace. Some patients get relief after their first treatment and others do not. This is highly individual based on diagnosis, chronicity of symptoms, motivation to heal, personal belief system of health and healing, and cultural beliefs. Rome was not built in one day and it was not destroyed overnight. Similarly chronic health problems will not turn around overnight.

    The good news is that with MFR you CAN get permanent results.

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  • Will MFR make me sore?
    Usually you will feel great after your myofascial release sessions, especially early on in treatment.

    But, there may be times when your body will respond to treatment with soreness. Once the fascial system has been affected, increased circulation enters the area through blood flow, carrying oxygen and nutrients critical to the healing
    process, as well as pushing out the stagnant blood and metabolic waste products. Remember our bodies are fluid filled and require movement of fluid in our systems to function in harmony, and maintain homeostasis. Tell your therapist about sore areas as this is valuable information for subsequent treatments. It tells us where your restrictions are, and where else your body needs treatment. We encourage all of our patients to drink more water, especially after treatments, to help your body flush out the toxins that have been built up in the tissues over time. This will also help prevent soreness after a treatment.

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  • Does MFR work for any diagnosis?
    Myofascial restrictions can create the symptoms of every diagnosis there is. At times well-meaning clinicians and patients, get caught up in finding the definitive ”diagnosis”. Remember most diagnoses are just label grouping several symptoms together. You are not the diagnosis, and the diagnosis is not the ‘disease.’ It is a label that describes your dysfunction. When one focuses on a diagnosis and not the whole body, the results will be limited.

    Here are the short answers to these questions: “Can MFR help with every diagnosis?” Well of course it can. Can it cure every diagnosis? No, it cannot.

    As MFR therapists we learn that freeing up the body from restrictions will allow the body to function more efficiently, and many times correct itself. Not only will this help for acute trauma but also systemic, neural or chronic conditions. MFR will help peel back and free up not only restrictions in the physical system, but also emotions that are helping hold the straight jacket of fascial restriction in place.

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  • Will I have ‘homework’ to do on my own?
    Yes. You will be given an appropriate, individualized self treatment and home exercise program. Your therapist will recommend simple, easy to do self-treatment techniques what will benefit you best as you begin your healing journey. Then as you progress your home program may change or be expanded upon (with therapeutic exercise and specific stretches) to help you achieve the goals you established with your therapist.

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  • Why are my symptoms feeling worse? Shouldn’t this be taking my pain away?
    What you are experiencing is the healing crisis—sometimes you feel worse before you feel better. Why does this happen? This occurs as you begin to release into the deeper layers of restrictions. Not only can the symptoms intensify, but also other sensations or emotions may come to the surface. Usually this process lasts around 48 hours, but can go on longer. This is your body's way of bringing your awareness into what you are actually dealing with everyday, but you "tune out" and don't feel. At times, it can feel like you are taking two steps forward and one step backwards.

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  • What should I do if I have a flare up, or go into a healing crisis?
    It can be very scary when your body goes into a healing crisis. Always remember that myofascial release is never injurious. Use the self-treatment techniques that your therapist taught you. A regular self-treatment program combined with your therapy sessions will help progress your healing process much faster. What also helps is spending some quiet time bringing awareness into your body. Try to sink deeper into whatever feelings come up. Let yourself feel your symptoms fully and get in touch with what lies underneath. Give your body permission to let go of anything that is no longer serving you, and give yourself permission to do and feel whatever you need in order to heal. This may bring up memories, emotions, shaking, sweating..... the list could go on and on. The key is to let yourself go without any judgment or holding back.

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  • I don't want to have to feel or remember that again.
    The fact is, on the subconscious level, you are experiencing this all day and all night long, like a broken record. To your subconscious the trauma continues to happen continuously. The truck is about to hit you, the surgical knife is cutting you or you are still experiencing the trauma. In the safety of the
    therapeutic environment it is better to feel intense therapeutic pain or fear, etc for a short period of time than to spend the rest of your life "coping" with it. "Coping" is a losing battle, because your subconscious is controlling you by constantly bracing against the unresolved trauma which then solidifies the ground substance of the fascia. This constant subconscious bracing worsens and spreads the symptoms over time.

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  • I've already dealt with that issue; I don't want to be re-traumatized.
    Myofascial Release never injures or re-traumatizes! Myofascial Release allows for the discovery of unresolved physical/emotional trauma. The mind/body then processes this information through the conscious mind completing what was a fragmented experience allowing for resolution. Myofascial release allows for healing on its deepest level.

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  • Why are my therapists treating my whole body rather than my specific area of pain?
    Traditional doctors and therapists were taught to futilely try to "fix" symptoms instead of looking for the cause of the problem. Also, they usually overlook the effect that the consciousness has on the healing process. The MFR philosophy is to look at the entire being, not to just focus on where the symptoms are. This way the therapist can focus on finding the root of the problem, and facilitate true healing in their patient.

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  • My therapist has talked about the mind–body connection, of how the mind affects the body, but I don’t think I really understand what they mean.
    Many times patients are progressing along, and they have a flare up(of course this goes for all of us too!). As we know, it could be what is called a healing crisis- things many times get worse before they get better. It can be very frustrating when this occurs, but it is part of the healing process. This phase has part to do with the mind–body connection or the mind–body communication. In reality there is no separation of the mind and the body, but for now let’s assume that this separation exists. This is the mind’s prospective:

    “So, here I am progressing along in therapy. The body is finally starting to open up. I can feel the shifts, I am starting to feel good! The body is finally starting to let me do the things I want to do! Then I do something that I think is insignificant—like walk 5 more minutes, or do some extra household chores—and wham! That crazy body has a full blown flare up! I even feel signs and symptoms that I haven't felt in months. What is up with that!?”

    Well, lets look at this from our body’s perspective. If it could use words, it might be saying something like:

    “I am finally starting to get some release from the restrictions that have been crushing me. Then, the mind decides to push me more then normal, and then I get scared. Here I am, finally starting to make some progress and that darn mind is trying to get me to do something that feels bad again. I have learned over time that the only way to get the mind to stop, is with a full blown sensory overload. In other words, I 'm sending out the full alarm, or the full pain, signal. Because I know that the only way the mind will stop is if it is really hurting. And I am tired of hurting, I'm ready to heal.”

    Most of us over the years have learned to shut down the communication between our mind and our body. We are taught not to show emotions, to push through pain, to discount our intuition, etc. The only form of communication that can get our attention anymore is pain. And we've gotten so good at tuning that out, that the pain has to spread and become more intense to get our attention.

    So, now you are starting to gain some awareness and tune into our bodies. Well, lets just say that this new communication can be a little fragile. At times, it may seem like your mind and body have been at war with each other. The mind feels the body let it down because the body can't do the things the mind wants to. The body feels the mind has let it down because it makes it do things that hurt it.

    It's going to take time before these two systems are going to trust each other again. And in the process, there will be battles for control, and also emotions that will come to the surface. The only way the body will start trusting the mind again, is by the actions that you take. When the body starts sending out signals, do you listen or ignore it? Do you take time to self treat and to really give full attention to your body?

    As this communication improves, and trust is established, the body won't need to hit the full alarms. The body will start sending more subtle messages—like pressure, or tightness—and you will now be open enough to feel these sensations and use them for guidance. Again, the key is feeling. Feeling the sensation fully and letting it guide you where you need to go. This may mean doing self treatment, journaling, or feeling some emotion that needs to be felt.

    Embrace the struggles, and remember to feel the hurt. Both sides in this battle feel they have been wronged, and they both need some love and healing. The end result is definitely worth it!

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  • My therapist keeps asking me to ‘let go’, to tell myself ‘it’s safe to let go’, but that seems like giving up, what do they mean?
    Here are some points to consider, originally posted to MFRTalk (www.mfrtalk.com) by advanced MFR therapist, Robert Mollica:

    "Letting go..."
    To 'let go' does not mean to stop caring, it means I can't do it for someone else.
    To 'let go' is not to cut myself off, it is the realization I can't control another.
    To 'let go' is not to enable but to allow learning from natural consequences.
    To 'let go' is to admit powerlessness, which means the outcome is not in my hands.
    To 'let go' is not to try to change or blame another, it is to make the most of myself.
    To 'let go' is not to care for, but to care about.
    To 'let go' is not to fix, but to be supportive.
    To 'let go' is not to judge, but to allow another (or myself) to be a human being.
    To 'let go' is not to be in the middle arranging all the outcomes, but to allow others to affect their own destinies.
    To 'let go' is not to deny but to accept.
    To 'let go' is not to nag, scold, or argue, but instead to search out my own shortcomings and to correct them.
    To 'let go' is not to adjust everything to my desires but to take each day as it comes, and to cherish myself in it.
    To 'let go' is not to criticize and regulate anybody but to try to become what I dream I can be.
    To 'let go' is not to regret the past, but to grow and to live for the future.
    To 'let go' is to fear less and to love more.

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  • In your advertising, you say that MFR can help infertility problems, how can that possibly be?
    The following is from Valerie McGraw, PT, Chief Physical Therapist at the Paoli Myofascial Release Center:

    Myofascial Release is highly indicated for infertility problems. According to the American Society for Reproductive Medicine, the most common female infertility factor is an ovulation disorder. When blocked fallopian tubes occur, they are often caused by pelvic inflammatory disease or endometriosis which can cause pelvic adhesion and cysts. The Myofascial system surrounds and interpenetrates every organ, nerve, blood vessel, and duct within the pelvic floor. Trauma, inflammation, and surgical scars very commonly tighten the myofascial system and the delicate structures of the reproductive and endocrine systems that can contribute to infertility problems. A large number of women experience infertility as a result of fascial restrictions from scar tissue , endometriosis or inflammatory processes. These fascial restrictions interfere with fertility by compressing the reproductive structures such as the fallopian tubes or ovaries and can be helped with Myofascial Release.

    In addition, because the fascial system surrounds every system of the body, including the endocrine system, fertility problems related to hormonal imbalance can be helped by using Myofascial Release. We have seen many women who have gone thru all types of fertility treatments and had given up on ever becoming pregnant and then become pregnant after receiving Myofascial Release.

    At Healing Motion we have physical therapists trained in advanced level Myofascial Release and the manual therapy techniques used for women’s health issues. In addition, it is the official position of the American Physical Therapy Association that manual therapy can be effective and appropriate treatment for infertility and other women’s health issues pertaining to the abdominal and pelvic regions.

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