J. Phys. Ther. Sci.

25: 169171, 2013

Effects of Myofascial Release and Stretching

Technique on Range of Motion and Reaction Time

Hironobu Kuruma, PT, PhD, OMT1), Hitoshi Takei, PT, PhD, OMT1),
Osamu Nitta, PT, PhD1), Yorimitsu Furukawa, PT, PhD1), Nami Shida, PT, MS1),
Hiroyo K amio, PT, MS1), K en Yanagisawa, PT, PhD1)
1) Divisionof Physical Therapy, Tokyo Metropolitan University: 7-2-10 Higashiogu, Arakawa-ku,
Tokyo, Japan. TEL: +81 3-3819-1211, E-mail: kuruma@hs.tmu.ac.jp

Abstract. [Purpose] Myofascial release is a manual soft tissue technique that is frequently used in physical ther-
apy, but few reports on the effectiveness of myofascial release are available. We compared the effects of myofas-
cial release and stretching on range of motion, muscle stiffness, and reaction time. [Subjects and Methods] Forty
healthy individuals were randomly allocated to four groups: myofascial release for quadriceps; myofascial release
for hamstrings; stretch for quadriceps; and controls. [Results] Active range of motion was significantly increased
in the two myofascial release groups and the stretch group. Passive range of motion was significantly increased by
myofascial release in the quadriceps and stretching groups. No significant differences in muscle stiffness were seen
between before and after the interventions. However, premotor time was significantly reduced by myofascial release
in the quadriceps and hamstrings groups, with significant differences observed in this parameter between both the
quadriceps and hamstrings groups and controls after the interventions. Compared to controls, reaction time was
significantly lower after the interventions in the quadriceps and hamstrings groups. [Conclusion] Myofascial release
improves not only range of motion, but also ease of movement.
Key words: Myofascial release, Stretching, Reaction time
(This article was submitted Aug. 22, 2012, and was accepted Oct. 19, 2012)

INTRODUCTION sclerosis, and reported that this technique decreased pain,

Myofascial release (MFR) is a manual soft tissue
technique that stretches restricted fascia1). Connective tissue
surrounds and connects muscles, myofibrils, and every organ
in the human body2). In immobilized muscle, the connective
tissue in these muscles changes and the ratio of collagen
increases3,4). Many approaches of manual therapy focus
treatment on the fascia2). MFR is one such technique, and
appears useful in physical therapy for alleviating muscle
stiffness, reducing pain, and improving range of motion
(ROM)1, 5). Some stretching techniques are also available to
achieve these ends, but involve joint motion; thus, they require
care to avoid causing or exacerbating joint dysfunction.
MFR does not involve joint motion, and is thus widely
used for the above-mentioned purposes. Furthermore,
patients often find it easier to move after MFR treatment.
Some reports have described the effectiveness of MFR treat-
ments. Hanten et al. examined differences in the effects of
sagittal plane isometric contraction-relaxation and MFR
leg pull on the range of passive straight-leg raising. In that
study, both techniques increased ROM, but contraction-
relaxation was more effective at improving ROM than
leg pull treatment6). Tozzi et al. applied MFR for patients
with non-specific cervical or lumbar pain, and reported
significantly decreased pain in the MFR group compared to
controls7). Martin applied MFR for patients with systemic
and increased mouth-opening and ROM in all joints of the
fingers and wrists8). Thus, several articles have reported
the effectiveness of MFR for ROM or pain. Ajimsh et al.
applied MFR for patients who were computer professionals
with lateral epicondylitis and reported that the MFR group
performed better than the control group9). However, no
investigations have reported changes in reaction time (RT)
with MFR. Therefore the present study compared the effects
of MFR and stretch techniques on not only ROM, but also
muscle stiffness and RT.
SUBJECTS AND METHODS
The participants in the present study were 40 healthy
individuals (20 men, 20 women). Their mean age was
21.0years (range, 1924years), their mean height was
167.4cm (standard deviation (SD), 9.2cm), and their mean
weight was 58.1kg (SD, 9.9kg). The ethics committee of
Tokyo Metropolitan University approved all study protocols,
and each participant provided written informed consent prior
to enrollment.
Subjects were randomly divided into 4 groups: MFR for
quadriceps (MFR-Q) group; MFR for hamstrings (MFR-H)
group; stretch for quadriceps (stretch group); and control
group. Each group comprised 10 participants (5 men, 5
women), and no significant differences in age were seen
170 J. Phys. Ther. Sci. Vol. 25, No. 2, 2013
among the groups. The MFR-Q group participants lay in the
supine position and received MFR for the quadriceps muscles
for 8min. Similarly, the MFR-H group participants lay in
the supine position and received MFR for the hamstrings for
8min. The stretch group subjects lay in the prone position
and received static stretching of the quadriceps muscles for
8min. The control group participants lay supine for 8min.
Before and after these interventions, active ROM, passive
ROM, muscle stiffness, and RT were measured. Active knee
flexion ROM (A-ROM) was measured with a universal
goniometer (accurate to 1) three times with participants
in the prone position. Passive knee flexion ROM (P-ROM)
was measured in a similar manner. Muscle stiffness was
measured three times using a durometer (Type FP; Asker,
Kyoto, Japan) at points 10, 15, and 20cm above the lateral
knee joint space. RT of knee extension was measured using
an electromyogram (Polygraph RM-7000; Nihon Kohden,
Tokyo, Japan and Power Lab; AD Instruments, Nagoya,
Japan) and a Biodex system 3 (Biodex Medical Systems,
New York, USA). Subjects sat on the Biodex system with
the hip and knee joints flexed at 90, and were asked to
contract the quadriceps muscles as quickly as possible after
a sound signal. Before the signal was presented, the muscles
were at rest. Three trials were carried out at different time
periods, and mean latency between the sound signal and
electromyogram (EMG) onset, premotor time (PMT), mean
motor time (MT), and mean reaction time (RT) between
stimulus and onset of force generation were measured.
The significance of the differences between measurements
before and after intervention was analyzed using Students
t test. Differences between the different techniques used
were evaluated by two-way repeated analysis of variance.
The least squares differences method was used for post-hoc
analysis. Values of p < 0.05 were considered statistically
significant. All statistical analyses were performed using
SPSS version 15 software (SPSS, Tokyo, Japan).
RESULTS
A-ROM was significantly increased in the MFR-Q,
MFR-H, and stretch groups (Table 1), and significant
differences were evident between these three groups and
the controls after interventions. P-ROM was significantly
increased in the MFR-Q and stretch groups (Table 2).
Furthermore, significant differences were identified between
the MFR-Q, MFR-H, stretch groups and the controls after
the interventions. No significant differences in muscle
stiffness were observed among the groups (Table 3). The
results for PMT, MT, and RT are shown in Table 4. PMT was
significantly lower after MFR-Q and MFR-H compared to
the pre-intervention values. Significant differences in PMT
were observed between the MFR-Q, MFR-H groups and the
controls after the interventions. RT was significantly lower
after MFR-Q and MFR-H compared to the post-intervention
values of controls.
DISCUSSION
Many studies have investigated the effects of stretching,
and several reports have shown that this technique improves
P-ROM1012). Similar to these results, the present findings
also showed an increase in P-ROM after MFR. Furthermore,
as has been reported for stretching, MFR has also been
shown to improve A-ROM. MFR realigns the fascial planes,
resets the soft tissue proprioceptive sensory mechanism,
and ensures a normal functional range of motion13). MFR-Q
realigned the fascia around the quadriceps, allowing
increases in A-ROM and P-ROM of knee flexion.
Interestingly, MFR-H also increased the ROM of knee
flexion. Fascia represents connective tissue that is present
throughout the body in a three-dimensional web. If the
fasciae lose their pliability and become restricted, the rest
of the body becomes tense1). If fascia in the hamstring area
loses pliability, the range of knee flexion is affected. Thus,
MFR-H may have increased the ROM of knee flexion.
No significant differences in muscle stiffness were
identified among the groups. Mahieu et al. compared the
effects of static and ballistic stretching14). The training
program involved self-administered calf muscle stretching
every day for 6 weeks. The passive stiffness of the Achilles
tendon decreased significantly in the ballistic group after
treatment. However, no significant changes were found in
the static group. LaRoche et al. also investigated the effects
of stretching with a training program that involved passive
hamstring stretching using an isokinetic dynamometer for 4
weeks12). They found no changes in muscle stiffness after
treatment. Our present study investigated the effects of static
stretching and our results in terms of muscle stiffness are
in agreement with those of these previous studies. MFR
showed no effects on muscle stiffness.
The stretch group in our study showed no significant
decrease in RT after treatment. Alpkaya and Koceja inves-
tigated the effects of static stretching of the calf muscles
on RT15). They concluded that static stretching had neither
positive nor negative effects on RT, similar to the findings
of the present study. On the other hand, we found that MFR
decreased PMT and RT. MFR realigns the collagen fibers,
and may also improve the sliding of actin and myosin during
contraction. Thus, after MFR for the quadriceps, subjects
may find contraction of the quadriceps muscles easier, thus
decreasing PMT and RT. MFR-H reduced the resistance of
the hamstrings, also reducing PMT and RT.
Both MFR and static stretching improved ROM by
improving muscle and myofascial tension. Only MFR
improved RT. Since stretching exercises only increase muscle
length, only ROM is improved. MFR techniques, on the other
hand, influence fascial restrictions and realign the fascial
planes, thereby resetting the soft tissue proprioceptive sensory
mechanism, improving both ROM and ease of movement.
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 171

Table 1. Active range of motion before and after intervention () Table 2. Passive range of motion before and after intervention ()
Before After Before After
MFR-Q 140.0 (1.7) 144.1 (1.5) * MFR-Q 148.3 (2.0) 151.9 (1.5) *
MFR-H 140.1 (2.2) 143.2 (1.8) * MFR-H 149.1 (2.5) 151.3 (2.2)
Stretch 141.5 (1.0) 145.0 (0.8) * Stretch 148.2 (1.0) 151.4 (1.1) *
Control 140.8 (2.7) 141.3 (2.6) Control 148.9 (2.7) 148.43 (2.8)
Students t test was perfomed before and after intervention (*<0.05) Students t test was perfomed before and after intervention (*<0.05)
Repeated mesures ANOVA was performed (compared control <0.05) Repeated mesures ANOVA was performed (compared control <0.05)

Table 3. Muscle stiffness before and after intervention (mN)

Distance of point above

Before After
lateral knee joint space
MFR-Q 100.0 (60.8) 90.2 (57.8)
MFR-H 88.2 (83.3) 83.3 (77.4)
10 cm
Stretch 108.8 (92.1) 110.7 (84.3)
Control 127.4 (61.7) 131.3 (61.7)
MFR-Q 127.4 (70.6) 112.7 (57.8)
MFR-H 112.7 (55.9) 105.8 (64.7)
15 cm
Stretch 123.5 (61.7) 124.5 (49.0)
Control 141.1 (77.4) 141.1 (62.7)
MFR-Q 113.7 (81.3) 97.0 (62.7)
MFR-H 113.7 (81.3) 100.0 (70.6)
20 cm
Stretch 125.4 (56.8) 103.9 (52.9)
Control 135.2 (65.7) 122.5 (56.8)

Table 4. Reaction times before and after intervention (ms)

Before After
MFR-Q 267.4 (66.5) 223.3 (46.7) *
MFR-H 267.2 (86.5) 200.7 (45.3) *
Premotor time (PMT)
Stretch 239.6 (46.6) 232.1 (53.2)
Control 247.6 (71.3) 230.3 (44.8)
MFR-Q 177.3 (49.1) 170.2 (50.5)
MFR-H 142.8 (47.2) 141.7 (22.5)*
Motor time (MT)
Stretch 149.1 (40.7) 136.4 (11.2)
Control 160.4 (22.2) 165.0 (25.9)
MFR-Q 443.9 (82.9) 383.6 (66.0) *
MFR-H 412.3 (65.5) 342.4 (48.7) *
Reaction time (RT)
Stretch 388.8 (76.9) 368.4 (56.3)
Control 408.1 (83.4) 387.9 (64.2)
Students t test was perfomed before and after intervention (*<0.05). Repeated
mesures ANOVA was performed. (compared control <0.05)

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