Laura not only caught the pillow I threw to her, she also remained standing.  Ordinarily this would not be a great feat, but Laura is a nine-year-old child with spastic quadriplegic cerebral palsy.  When I evaluated Laura just four months prior, she had difficulty even trying to stand still without swaying or falling over.  She began a physical therapy treatment program with me, utilizing primarily myofascial release techniques, three times per week, as well as a traditional developmental treatment program with an occupational therapist, one time per week.

Laura was born thirteen weeks premature, weighing only two pounds, eleven ounces.  Shortly after birth she had a cerebral hemorrhage resulting in brain damage to the areas controlling motor function of the muscles.  From one year to five years of age, she attended an area preschool where she received physical and occupational therapy, including neurodevelopmental treatment. Surgeries included right eye surgery at two years of age, left eye surgery at three years of age, and a left heel cord release at six years of age.  At six years of age, Laura entered a regular private grammar school and maintained an A/B average.  She attended tumbling and swimming lessons, but not therapies.

When I evaluated Laura, she ambulated independently with modified AFOs, however, her gait was very precarious.  She threw her upper body, head and arms in attempts to balance herself.  She was up on her toes with her feet and legs turned in, so she looked like she would trip over her own feet.  Dynamic AFOs (AFOs that allow ankle dorsiflexion and a few degrees of plantar flexion which were developed by Nancy Hylton, RPT) were ordered to replace her outgrown AFOs. 

Just after I finished evaluating Laura, I took my first course in John Barnes’ myofascial release approach.  This approach to treatment is based on the fascial system, a greatly overlooked system of the body.  The importance of the role of the fascial system was explored and documented by Dr. John Upledger, chief of research at Michigan State University.  The fascia surrounds every cell of every system in the body including bones, muscles, organs, nerves and the brain; forming a three dimensional web from head to toe.  This makes the fascia the immediate environment of each cell.  This environment should be gelatinous in form, giving it the ability to absorb shock and cushion the cells.  When an injury occurs to the body and/or postural malalignment occurs, the fascia binds down causing pulling throughout the system.  Imagine a loosely knit sweater, and that you are pulling on one corner of it.  Depending on the direction you are pulling, the fibers throughout the sweater pull and realign along the lines of tension.  This is what happens in the body.  When bones are pulled out of normal alignment due to injury, stress or tight muscles, the fascia pull in a three dimensional pattern throughout the body.  In this way an injury to the thigh can unbalance the pelvis causing other bones, muscles, etc., to unbalance in an effort to compensate.

Think of the body as a bag of blocks stacked neatly in a well-balanced tower—if one block is moved out, another block must be moved in to counter-balance or the tower falls down.  This also occurs in the body. With a tensile strength of two thousand pounds per square inch, the fascial system cannot correct itself back into normal alignment withough help.  This constant pulling is responsible for many chronic pain problems, postural deviations, etc.  Children born with handicaps often have fascial restrictions from the body’s attempts to compensate for abnormal muscle tone and movement patterns, as well as from birth trauma.

I decided to use a myofascial release approach in Laura’s treatment.  I began with CV-4s and transverse plane releases.  Next, I tried arm and leg pulls which she tolerated with minimal discomfort, so her parents were instructed in these techniques as a home program.  I gradually introduced deep releases, releasing all aspects of the legs, trunk, shoulders, arms and neck.  The psoasis and anterior hip joints were very restricted.  After several releases over the anterior jip joints and continuing into the legs and/or the trunk, lumbo-sacral decompressions, lower back releases, and hamstring releases; the pelvis began shifting into a more normal position.  This shift in her pelvis and the increased mobility of her muscles allowed for a decrease in muscle tone, since now the muscles didn’t have to “fight” gravity to maintain an upright posture.  Her movement patterns, therefore, became more fluid, her balance improved, and the influence of abnormal reflexes began diminishing.  I continued releasing areas of fascial restrictions I found throughout her body and utilizing various cranial-sacral techniques, as well as unwinding.

By the time of Laura’s six-month re-evaluation, she had made significant progress.  Not only could she now stand still and maintain her balance, but she could actually catch an object thrown to her without falling.  Laura continues to progress in her treatment program.  Last school year, she tried out for the cheerleading squad, and made it.  Maybe she can’t do the splits or cartwheels yet, but she can stand still and maintain her balance while performing the cheers.

 Laura’s case is not an isolated one.  All of the children (and adults) I treat have made significant progress in shorter periods of time since the addition of myofascial release techniques to my treatment program.  I routinely teach parents arm and leg pulls as home programs for gaining and maintaining range of motion, while releasing fascial restrictions.  Most children tolerate deep releases and cranial-sacral techniques readily, and most children love unwinding.

I believe the children deserve the chance to experience normal posture and muscle mobility which is possible with the addition of myofascial release.