Receiving the diagnosis of head and neck cancer (HNC) is a life changing experience. An individual who receives this diagnosis faces the possibility of undergoing surgery and/or chemo-radiotherapy (CRT). With either of these potential life-saving options, one’s ability to speak or swallow may be substantially affected. Thus, intervention from a speech-language pathologist (SLP) is needed to improve upon altered communication and dysphagia. A therapy technique that may be beneficial for individuals post HNC is myofascial release.
Myofascial release is a therapeutic intervention that involves massage to the muscles and fascia. (Kelly, 2014: Myofascial, n.d; Shah & Bhalara, 2012). Fascia is the connective tissue that surrounds the muscles. There are three layers of fascia, the superficial fascia (directly under the skin), deep fascia (embedded into muscles), and subserous fascia (lines the body cavities and organs) (Kelly, 2014: Myofascial, n.d; Shah & Bhalara, 2012). There are three types of myofascial release, direct (very intense), indirect (more gentle), and self (patient driven) (Kelly, 2014: Myofascial, n.d; Shah & Bhalara, 2012).
Personally, I have used myofascial release with individuals with dysphagia post head and neck cancer and with Parkinson’s disease. Other patient populations that may benefit include individuals with TMJ disorder/issues, chronic pain, neck and shoulder pain/tension, whiplash, post surgical and injury scarring may benefit (Kelly, 2014: Myofascial, n.d; Shah & Bhalara, 2012). Myofascial release would not be indicated for individuals with aneurysm, open wounds, or who have an active cancer (William, 2004).
Myofascial release is used in several disciplines such as with chiropractors, physical therapists, and massage therapists. Speech-language pathologists use this method typically in the treatment of dysphagia or voice disorders. Myofascial release has also been used to improve esophageal speech for laryngectomees (Marszałek et al, 2009). Check out this videos for a peak at some different myofascial release techniques!
According to American Speech-Language-Hearing Association (2007), SLPs should only engage in practice that they show competence. There are two main training places for MFR one is with John Barnes (Barnes, n.d.) a physical therapist, and the other with John Kelly another physical therapist (Ciao Seminars, 2013). The American Speech-Language and Hearing Association approved training with John Kelly for continuing education units. Personally, I attended the CEU course with John Kelly and it was wonderful, I would highly recommend it! If you know of additional training opportunities for myofascial release please post in the comment below. Have you used myofascial release with your patients? Do you find this technique useful?
American Speech-Language-Hearing Association. (2007). Scope of Practice in Speech-Language Pathology. Retrieved from http://www.asha.org/policy/SP2007-00283/
Barnes, J. (n.d.). Welcome to Myofascial Release - John F. Barnes, PT. Retrieved from http://www.myofascialrelease.com
Ciao Seminars. (2013). CIAO Seminars. Retrieved from http://www.ciaoseminars.com/searchResults.cfm
Gerwin, R. D. (2005). A review of myofascial pain and fibromyalgia–factors that promote their persistence. Acupuncture in Medicine, 23(3), 121-134.
Harden, R. N. (2007). Muscle pain syndromes. American Journal of Physical Medicine & Rehabilitation, 86(1), S47-S58.
Hodgson, L., & Fryer, G. (2006). The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. International Journal of Osteopathic Medicine, 9(1), 33.
Hutcheson, K. A. (2013). Late radiation-associated dysphagia (RAD) in head and neck cancer survivors. American Speech-Language-Hearing Association 61-72.
Hutcheson, K. A., Bhayani, M. K., Beadle, B. M., Gold, K. A., Shinn, E. H., Lai, S. Y., & Lewin, J. (2013). Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngology–Head & Neck Surgery, 139(11), 1127-1134.
Louie, K. S., Mehanna, H., & Sasieni, P. (2015). Trends in head and neck cancers in England from 1995 to 2011 and projections up to 2025. Oral Oncology, 51(4), 341-348. doi:10.1016/j.oraloncology.2015.01.002
Marszałek, S., Żebryk-Stopa, A., Kraśny, J., Obrębowski, A., & Golusiński, W. (2009). Estimation of influence of myofascial release techniques on esophageal pressure in patients after total laryngectomy. European Archives of Otorhinolaryngology, 266(8), 1305-1308. doi:10.1007/s00405-008-0861-z
Massage Sloth. (2013, August 18). Massage tutorial: Myofascial release for TMJ pain [Video file]. Retrieved from https://www.youtube.com/watch?v=Dkdk_fjRTho
Pierson, M. J. (2011). Changes in temporomandibular joint dysfunction symptoms following massage therapy: a case report. International Journal of Therapeutic Massage & Bodywork, 4(4), 37-47.
Purcell, A. (2013). Head and neck lymphoedema management practices. Journal of Lymphoedema, 8(2), 8-15.
Results Massage and Bodywork LLC. (n.d.). Myofascial release [image]. Retrieved from http://results-massage.com/myofascial-release/
Shah, S., & Bhalara, A. (2012). Myofascial release. International journal of Health Science & Reserarch, 2(2), 69-77.
Teachey, W. S. (2004). Otolaryngic myofascial pain syndromes. Current pain and headache reports, 8(6), 457-462.
Vernon, H., & Schneider, M. (2008). Chiropractic management of myofascial trigger points and myofascial pain syndrome: A systematic review of the literature. Journal of Manipulative & Physiological Therapeutics, 32(1), 14-24. doi:10.1016/j.jmpt.2008.06.012