Promote What's Most Important

Over the past 10 years, assisted stretching has had an unprecedented increase in popularity and the number of assisted stretching boutiques and studios has expanded dramatically, both in the U.S. and all over the world. In the U.S., it is now a $22 billion industry and confirms that the public wants to be stretched.

Ann Frederick, creator of Fascial Stretch Therapy (FST), was one of the very few in 1995 who were making a living exclusively by providing assisted stretching, initially to professional athletes. Helping them recover faster while also improving their performance by solely using FST enabled Ann to evolve an entire system that specifically evaluated and treated many common causes of pain and injury in sports. She focused on the connective tissue system, otherwise known as fascia.

Increasingly, the public (everyone from the young to the elderly) came in to see Ann and her husband Chris for FST services. Over time, FST has been developed to include specific applications in sports, fitness, rehabilitation and wellness. Chris integrated FST with sports and deep tissue massage along with structural integration bodywork. Research in 2017 concluded that FST was effective at significantly reducing pain and improving function in chronic non-specific low-back pain.¹

Ann and Chris now teach FST to massage therapists and other professionals so that they may either integrate it with their current techniques or offer it as an additional stand-alone service. The following are excerpts from “Fascial Stretch Therapy™, Second Edition.”

A Brief Description of Fascial Stretch Therapy

Instead of isolating muscles, Fascial Stretch Therapy focuses on the connective tissue called “fascia” which wraps and connects all anatomy under the skin down to all cells of the body like a web or net. It also communicates intelligently with everything, like a computer network. Consequently, the structure and function of fascia is integral to most if not all movement and physiology of the body. Fascial Stretch Therapy™ is used to thoroughly assess and treat the entire neuromyofascial system as an all-encompassing approach to client care.

A Stretch Massage Therapists Can Perform

Also called the lateral chain of muscles and fascia, the side of the body includes the following superficial and deep structures of myofasciae: splenius capitus/sternocleidomastoid, external and internal intercostals, lateral abdominal obliques, gluteus maximus, tensor fasciae latae, iliotibial tract/abductor muscles, anterior ligament of fibula head, fibularii muscles, and lateral crural compartment.² (Figure 1)

In FST, the lateral chain is referred to as the Lateral Net (LN) which may be responsible for several postural and movement imbalances, dysfunction as well as pain. One common presentation may be a leg length discrepancy, which if not due to some genuine anatomical reason (e.g., shorter bone) is more often found in clients with myofascial flexibility imbalances when comparing side to side. This situation can often be corrected immediately after this stretch is performed and maintained by the client with a self-stretching program.

A common way to assess a leg length discrepancy, is with the client in supine. Observe whether there is a difference in superior to inferior height when comparing the medial malleolus boney landmark on each side. The ‘shorter’ leg becomes evident with a higher or more superior medial malleolus. This would be the leg targeted in this stretch, to elongate the myofasciae in the LN.

Fascial Stretch Therapy: Lateral Net Stretch

The goal of the Lateral Net Stretch is to target the tissues lying within the LN (initially focusing on the lower region of the lateral torso, low back, hip and entire lateral leg).

Contraindications:

1. Any red flags noted on the client intake form
2. Sacroiliac joint pain, hypermobility or instability
3. Acute herniated or bulging lumbar or thoracic discs
4. Any undiagnosed suspicion of possible injury, disease or other evolving conditions

Client position: Supine with arms at their side

Practitioner:

1. Lifts client’s legs for passive extension with traction at 10–20°
2. Hold both of their heels in the palms of your hands and gently wrap your fingers around their heels
3. Engage your core and bend your knees slightly
4. Double leg traction to begin

Range of motion: Move slowly to your left side until the client’s movement stops at the first soft tissue barrier

Traction: Lean back with your body, staying relaxed (Figures 2a and 2b).

Practitioner:

1. Continuing from double leg traction
2. Once their legs clear the table as you move farther to the side, place the client’s lateral malleolus (the bottom leg) on your femur or hip with your inside hand securing it to your body
3. Lift their right leg higher, cradle their heel close into your body with your outside hand
4. Lean your torso back as you press your hips into a posterior tilt to increase the stretch

Stretch: Lean away while gently increasing their lateral flexion

Re-assessment: When the stretch is completed and the legs brought back to start position, one should re-check leg length to see if the legs are now even or level. If not or it partially improved, then another option is to consider that the remaining restrictions may be in the tissues of the upper body that have not been stretched

Options: If tolerated, have the client reach overhead to either increase the stretch in the lower, upper, or entire LN from the highest to lowest regions. Different overhead arm positions as well as adding slight rotation to the head/neck and/or torso will help target more specific local or global tissues in the fascial net (Figure 3). Re-assess leg length measurements again to see if now level. If not, other regions like the Spiral Net may need specific assessment and stretching

Lateral Net Stretch Tips

1. Less is more, work smarter not harder
2. Use your body more than your hands
3. Avoid any pain in you or the client
4. If you are uncomfortable, then so will your client so readjust positions of hands, feet or body before trying again

Guidelines for More Effective and Safe Stretching

As the popularity of stretching has rapidly grown over the last 5-10 years, unfortunately so have the injuries. Similar to the knee jerk reflex which is elicited when a physician, therapist or trainer taps the patella tendon, muscles will contract if over-stretched. If assisted stretching is continued by the therapist when the client is either holding or has been over-stretched then they are at increased risk for muscle strain, tears, and nerve palsy among other injuries.

Fascial Stretch Therapy is based on the following Ten Fundamental Principles

1. Synchronize breathing with movement
2. Tune nervous system to current needs
3. Follow a logical order
4. Range of motion gains without pain
5. Stretch neuromyofasciae, not just muscle
6. Use multiple planes of movement
7. Target the entire joint
8. Get maximal lengthening with traction
9. Facilitate body reflexes for optimal results
10. Adjust stretching to current goals

Traditional Stretching Contrasted with Fascial Stretch Therapy

Traditional stretching is commonly performed as a static stretch for one isolated muscle held at a point of slight discomfort for 15-30 seconds (and sometimes longer). It is often performed for 2-3 repetitions per muscle and in linear planes.

Fascial Stretch Therapy does not include static stretching or holding a stretch of any kind and instead of isolating a muscle, focuses on functionally stretching muscles within their fascial net connections. Duration of stretches are not counted but are breath guided to down regulate the nervous system where and when tension is excessive. The intensity of any stretch is initially limited to a very gentle tissue barrier called “R-1” (i.e., first resistance felt by the therapist) to ensure client safety and best response. Instead of linear movements, FST is performed with what is called the StretchWave™, which is a gentle and slow oscillating side to side and/or up and down motion coordinated with breathing to render three-dimensional, multi-planar movement more effectively. This technique ensures more thorough tissue access and whole-body response.

Integrating Fascial Stretch Therapy Within a Massage Practice

Massage therapists who offer FST as an additional or alternative service report that FST is the ‘missing link’ that now provides complete care for the public. They also state that FST reduces the amount of massage needed to penetrate dense tissue, thereby preventing strain or injury to the therapist’s hands, fingers, neck, shoulders, and low back.

Clients report that they love the combination of massage and stretching, so they get the benefits of muscle pliability with increased flexibility and mobility. While some clients are more than willing to book both a massage and a stretch in the same day, others prefer separate days. If both sessions are scheduled for the same day or if stretching is integrated within a massage session, it is more convenient to stretch the client with their clothing on before getting a massage.

With no end in sight for the growth of the stretch industry, massage therapists should give serious consideration to getting additional training in assisted stretching. If already stretching clients, consider upgrading and advancing skills to FST, now largely considered the gold standard in assisted stretch training for massage therapists and other professionals.

Footnotes

1. Ayotunde, O., Standley, P., Kang, P., Frederick, A., Frederick, C. (2019). Effects of fascial stretch therapy on pain index and activities of daily living in patients with chronic nonspecific low back pain. Journal of Investigative Medicine, Vol. 67(1), abstract 394. http://dx.doi.org/10.1136/jim-2018-000939.224.

2. Myers, T.W. (2021). Anatomy Trains: Myofascial Meridians for Manual Therapists and Movement Professionals, Fourth Edition. Elsevier.

This article was adapted from Fascial Stretch Therapy™, Second Edition by Ann Frederick and Christopher Frederick (2020, Copyright © Handspring Publishing, handspringpublishing.com).

About the Author:

Chris Frederick is a Fascial Stretch Therapy practitioner, physical therapist and co-director of the Stretch to Win Institute in Arizona. He is author of the books “Stretch to Win, Second Edition” and “Fascial Stretch Therapy, Second Edition.” Chris loves his wife, his five cats, practicing Qigong and applying Taoism to all things in life.

As a special offer to MASSAGE Magazine readers, order “Fascial Stretch Therapy™, Second Edition” from Handspring Publishing and save 20% off the list price. Order direct at handspringpublishing.com/product/fascial-stretch-therapy-second-edition/ and use discount code MMFST22. Offer expires April 30, 2022. Free shipping to U.S. and UK addresses.