Myofascial optimization (MFO™️ © 2018 - originally NeuroMyoFascial Optimization - NMFO) is an evidence-based therapeutic technique for improving mobility, fitness and treating pain through a combination of controlled breathing, postural realignment and myofascial release. The goals of MFO are to reduce or eliminate pain and the use of opioids, restore individually optimized ergonomics, and re-introduce an appropriate activity regimen to combat the effects of sedentary and asymmetric behaviour.
MFO employs postural realignment, controlled therapeutic breathing, stretching and movement. The technique builds on tai chi and other martial arts, whole-body exercise approaches such as yoga and Pilates, and body manipulation approaches such as acupuncture, acupressure and massage therapy to rapidly reduce or eliminate pain.
As developer of MFO, Dr. Michael Kanevsky has employed and taught the technique in academic and clinical contexts ranging from urban underserved medicine in New York City at Columbia Presbyterian Medical Center and integrative and myofascial family practice in Montreal to training clinicians outside North America and consulting for the United Nations.
Background Fascia is a unitary network of connective tissue that surrounds the organs, muscles and bones. While the skeletal system provides a rigid infrastructure for the body, the myofascial network provides a flexible, dynamic infrastructure. Together, they form a tensegral system that maintains structural integrity and strength as the body moves.
In parallel, the fascia functions as a mechanosensitive signaling network. Tensional forces are transmitted globally throughout the fascial network, which plays an important role in proprioception through the Golgi tendon organs. The fascia also plays a neuroendocrine communication function conveying electrical, chemical and remodeling signals.
Myofascial Ventilatory Release Myofascial ventilatory release (MFVR) occurs when stretches are combined with diaphragmatic breathing and prolonged exhalation to achieve an extended, deeper and more rapid stretch than is otherwise possible with conventional myofascial release. It is hypothesized that MFVR is the result of several physiological factors.
The diaphragm is closely linked to the fascia at multiple connection points. Via this ventilatory linkage between the chest, abdominal cavity and distal myofascial complexes, tensional and barometric forces generated with each inhalation and exhalation are transmitted throughout the entire vasculo-lymphatic myofascial network. At end-tidal exhalation – a deep exhale lasting approximately five to seven seconds – a pressure differential is generated between the alveolar lining and the thoracic interstitium. This pressure differential creates a hydrodynamic pump effect which pulls fluid through the vasculo-lymphatic myofascial matrix. The fluid shift facilitates a relaxation of the myofascial complex.
Additionally, diaphragmatic breathing with long, slow exhalation has been shown to generate a parasympathetic relaxation response by stimulating the vagus nerve. The hypothesized impact of the autonomic nervous system on fascial stiffness through cytokine signaling and changes in pH represents a further potential mechanism for fascial release.
Treatment and Patient Education At the first visit, the patient undergoes a thorough standard medical assessment: history, physical exam and possible orders for imaging and consults to eliminate the possibility of injury or neuropathy. Along with conventional medical approaches, magnesium hydrotherapy may be prescribed to alleviate a significant component of the myofascial spasm that is generally the underlying cause of the patient’s pain. At the second visit, the history and any imaging and consults are reviewed, and the physical exam is repeated. If abnormalities are identified, additional imaging, consults or studies may be ordered (X-ray, ultrasound, electromyogram (EMG) MRI, neurology or neurosurgery).
Treatment begins with ventilatory and postural re-education, or myofascial realignment. The patient learns the basic neutral postures for sitting, standing and lying down. Realigning the pelvic, shoulder and cranial-caudal girdles with the associated myofascial complexes is the initial step to MFO and pain reduction. Ergonomically correct positions are reinforced and a significant amount of spasm is alleviated.
The next step involves ventilation in the neutral posture, either sitting, standing or lying down. Deep inhale followed by (end tidal) exhale (approximately 5 to 7 seconds) draws maximum oxygen in, generates optimal O2/CO2 exchange, and expels maximum CO2. This controlled therapeutic breathing produces the barometric pump effect in the vasculo-lymphatic myofascial matrix, stimulates the parasympathetic nervous system and increases heart rate variability. The breathing cycle is repeated usually 3 to 10 times.
Finally, guided MFVR is followed by myofascial tone re-engagement (MFTR). In the associated neutral position, the clinician guides the patient through the stretching protocol for the number of MFVR breathing cycles necessary to achieve a passive release of the affected myofascial complex. MFVR greatly speeds up the myofascial release and can be applied to any muscle stretch. MFTR completes any release in order to prevent respasm. The clinician facilitates an active, dynamic use of the treated myofascial complex to prevent the recurrence of hypertonicity.
Each component of MFO on its own facilitates pain relief. Together, they comprise an inexpensive approach to rapidly alleviating pain and improving mobility. In addition to pain management, the physiological benefits of MFO can aid in achieving other clinical goals, such as reduced length of post-surgical hospitalization, improved cerebral and cardiovascular perfusion, improved ventilatory capacity, and anxiety reduction.
Volunteer clinical and academic missions have shown that MyoFascial Optimization- MFO, applied in a COPC approach to pain in global health settings, effectively and efficiently addresses the pain as well as the social justice issue of access to care by offering a sustainable technique for pain reduction without the need for specialized facilities or costly medication.