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A detailed critical analysis of the clinical relevance of fascia science and fascia properties
11,000 words, updated Feb 20th, 2013 — What’s new? by Paul Ingraham, Vancouver, Canada
SHOW SUMMARY ZOOM
Sheets of fascia can contract a bit like muscle … but how strongly? Enough to make a difference?
Does fascia — sheets and webs of connective tissue — have any properties that are relevant to healing and therapy? Are there good
reasons to do manual therapy (massage particularly) that is “aimed” at fascia? Fascia gets discussed in therapy offices a lot these days. It is supposedly the key to many a therapeutic puzzle, and is now routinely targeted by therapists of all kinds. But is fascia actually important in therapy? More than any other soft tissue? This article questions fascia excitement from a scientific perspective.1 Fascia enthusiasts are rarely specific aboutwhy fascia matters, or how exactly “fascial work” can help people with common pain problems. They speak mainly about the complexity and ubiquity of fascia, as if those alone are good enough reasons to focus on fascia. Attempts to get more specific are usually sloppy. Poor clinical reasoning about fascia seems to be common. This problem was captured perfectly for me by something a massage therapist said to me on my 40th birthday in 2011. I was getting a
massage (because I really do love massage). The therapist was doing fascial work, of course — you can’t get a massage in Vancouver these days without getting some. She was using some mildly uncomfortable pulling and twisting techniques, trying to “manipulate” my fascia, instead of using the more satisfying Swedish styles I was craving. She launched into an awkward explanation of her technique, but words failed her: Well, your problem2 is fascia. The fascia is the thing you have to do something with. If you fix the fascia, everything gets more … well, the fascia will make everything better. Somehow.
Deja vu? Feel like you’ve seen this here before? You probably have. This is a “like new” compilation of most of the fascia writing I’ve done over the last year — about four old articles merged into one, with some re-writing
3.3Does stimulating fascia reduce post-exercise muscle soreness? 3.5Not so exotic after all NEW Jul 31 '12 10.1Fascia is 12. 7.3Ida’s 2. Sloppy fascia reasoning Rewritten Feb 20 '13 2. 8. 5. Real fascia science that supposedly matters 11.and new information.1Electrified by piezoelectricity 2. Introduction 1. 6.2Fuzzy logic: Gil Hedley’s “fuzz” speech NEW Feb 19 '13 2.4The idea about thixotropy 9. 2. TABLE OF CONTENTS 1. 3.1Barely known to science! 1.2“Release” . You can now buy a $5 lecture version from Movement Lectures. acupuncture connection: is fascia actually magic? 2.2En garde! The fascia science challenge 4. 3. NEW Feb 15 '13 much too tough to “release” may not even be real 13.
14.2What’s new in this article? 5. because none of that research is clearly clinically relevant — some of it might be. which leads to some claims that it .4Does it matter that fascia contains muscle cells? 15. However.7No clinical relevance at all? Not even a teensy bit? 18.8Is fascial contraction even interesting? 19. 3. Minor update Aug 30 '12 3.6Do weak fascial contractions matter? 17.1Further Barely known to science! There is a lot of fascia research going on these days.3Notes 23. 3.1To be continued… 22.5Fascia strong like bull! Or … mouse? 16. Conclusions Results of the Fascia Science Challenge so far… 21.9What does Dr. Appendices Reading 5. 5. Schleip think? 20. 3. Minor update Aug 30 '12 3. 25. 3. 24. 4. but it’s all quite debatable — there’s also a lot of speculating about why fascia is important.
or maybe it is the medium of a liquid crystal communication system. No one can get safe. and you’d probably be famous for pushing back the frontiers of human Exotic and new biology is not also not very useful biology. perhaps fascia can actively sinch up like a corset around muscles. effective. For instance. and what many researchers are saying about fascia . the biology wouldn’t be poorly understood anymore. knowledge. guesses tend to fill knowledge gaps — and the guesses usually turn out to be wrong. Some fascia research is truly intriguing. If you could. Who knows! In the history of science and medicine.has clinically relevant properties and functions that are still barely known to science. reliable treatment protocols out of poorly understood biology. Exotic and new biology is also not very usefulbiology. or even maybe it melts like butter when you move.
complicated experiment he had done. far too many therapists fascinated by fascia are reaching beyond what the science can actually support today — way beyond — and it is doubtful that it ever will. Please beware the implication of therapeutic significance from scraps of basic biology. Certainly a lot of fascia science is “right. In some cases. a rather pedantic experimental psychologist was telling him about a long. even if it is confirmed. incorporating all the proper controls and using considerable technical virtuosity. Few basic biology facts ever become the basis for any kind of treatment. It is easy to sound cool talking about new biology — because biology is cool. In fact. It is quite hard to make biology useful. is not really all that useful. When . in fact.” but I question whether or not itmatters that it is right. Unfortunately. we already know enough to know that a property.is reasonable and not an awkward reach beyond where the data can take us. on one occasion.
or epigenetics. for all they have to do with hands-on healing. or olfaction. However. Crick. we have got it right — we know it’s right.” Crick’s response was.S. Reader suggestions and feedback are welcome.he saw Crick’s exasperated expression he said. both critical and supportive. then it makes no sense to be fascinated by it in a therapeutic context. Ramachandran. But clinical relevance is the central question of this article: if fascia science cannot actually inform treatment in some practical ways. “but Dr. hate mail will be . You might as well get excited about the biology of the immune system. “The point is not whether it’s right. telling a story about Francis Crick En garde! The fascia science challenge Fascia is biologically interesting! All biology is. The point is: does it even matter whether its right or wrong?” V.
(That may not sound like much.Please think twice before you hit send. I could be wrong about fascia. I even hope that I am.) I will add more in time. so be careful what you wish for. Fascia enthusiasts routinely denounce this article. If such a thing exists. All three are actually good . accusing me of ignorance of the current Science of Fascia. I will be happy to publicly discuss it. However. I receive a quite a bit of hate mail on this topic. but the article is already several thousand words long.ignored. That’s understandable. direct relevance to what happens in treatment. and acknowledge my oversight. Maybe it is important to manipulate fascia specifically. This article covers three main examples of allegedly clinically relevant fascia research below. I am pretty up on massage-related research — it’s my full-time job — so I feel confident challenging critics to cite even one example of fascia researchwith clear.
Leonard Cohen. We do not have a winner yet. though. I’d like to start with a couple stranger examples of sloppy fascia science — piezoelectricity and “fuzz”! — and some of the general issues with fascial therapy. Before we get to that. Anthem PART 2 SLOPPY FASCIA REASONING Electrified by piezoelectricity A popular notion is that piezoelectric effect — an electric charge generated by flexing crystals — is at work in fascia. There is a crack in everything That’s how the light gets in. and — an extrapolation .examples of fascia science with poor clinical relevance.
— that it is also the mechanism for fascial “release.” It is hardly clear that this is actually the case. and there are plenty of problems with the idea. Wedo know that piezoelectricity “sparks” fly when bone is flexed and stressed. To get a piezoelectric “spark. In the famous 1987 book Job’s Body — which I read three times. but it’s not totally out to lunch.”3 A strong emphasis on may: this has never actually been shown to be the case. and this guides the slow .” you have to have crystals. The first part is possible but unproven. back in the day — Juhan proposes that connective tissue may behave like a “liquid crystal. Juhan was speculating. This doesn’t mean that there is no piezoelectric effect in fascia. It has never been more than speculation. Crystalline properties are a pre-requisite for peizoelectricity. The second part goes much too far and is demonstrably false and clearly contradicted by modern researchers.
It is beautifully evolved to change bone extremely slowly in response to extremely specific stimuli which. presumably. known and unknown — even if you understand them. It wouldn’t “shock” me. Indeed. as far as I can tell. That’s going to be the case for the great majority of physiological systems. .4 which is super cool. it doesn’t mean you can use them. Trying to affect that system with your hands is quite futile. But no one has ever demonstrated that it actually does. Maybe fascia does something similar to bone with piezeoelectric effect. cannot remotely be simulated by manual therapy. It has nothing to do with anything a manual therapist could ever do to a bone.remodelling of bone. or affect them with your hands. no one has even tried to find that property of fascia. It’s a terribly clever system! It’s also a great example of a clinically irrelevant biological property.
” a fact that can be used as a firm foundation for the further speculation that it accounts for the fascial “releases. A “straw man” would be an idea that no one actually believes or takes seriously — and therefore meaningless to criticize. which we do know quite a lot about. enough do that it’s no straw man! It may not represent the best thinking in the field. and there simply is no short term change in fascia to explain! It can’t respond to the pressures of massage . because it can’t and doesn’t: it’s too tough and slow-changing.Some people have run with the idea like it’s a proven fact. However.”5 Is this a “straw man”? Nope. but it is certainly out there.6 In contrast to the total absence of research into fascial piezeoelectricity. though. the properties of fascial plasticity are well studied. James Oschman states unequivocally and overconfidently that “connective tissue is piezoelectric. And it’s simply inconsistent with the reality of fascial plasticity. For instance. There’s no point in speculating abouthow fascia responds quickly to manipulation. Certainly not everyone interested in fascia thinks that fascial piezeoelectricity is real or important.
Fuzzy logic: Gil Hedley’s “fuzz” speech . if we don’t know these things. let alone the physiological intricacies of such a phenomenon? Do we know why it evolved? What it does. Do we know anything at all about it. how it does it? Can we affect it? And. In addition to the footnote.therapy any more than bone can. this will be substantiated in various ways throughout the rest of the article. Could piezoelectricity be at work in some other way in fascia? Anything’s possible. how can we possibly use it to devise a reliable therapy? Obviously we cannot. But now we’re cruising into pure guess work.
“That stiff feeling you have is the solidifying of the fuzz. but also large and precarious.” Hedley confidently explains.Another fine example of imprecise scientific enthusiasm is Gil Hedley’s extremely popular “fuzz” speech. Hedley plays fast and loose with a dissection observation: there are cobwebby layers of fine. The anatomy is interesting — anatomy is always interesting — but Gil Hedley’s interpretations are dubious. He thoroughly makes the case that fuzz explains the sensation of stiffness. loose connective tissue between thicker sheets of fascia. His leaps of logic are charismatic. In this video with a bazillon views. .
‘Strolling Under The Skin’. or the fact that he’s looking at a dead person. but note the emphasized phrase particularly: In Guimberteau’s video. It occurs within minutes of death. He does not know what happens to that tissue in a living body. The mucus booger that comes out of your nose quickly hardens and . they reconfigure with each movement. that fuzzy texture only manifests post mortem — according to biotensegrity expert. The ‘fuzz’ is connective tissue that is stiffened during rigor mortis. Dr. It starts within minutes of death.At best. Ca++ [calcium ions] flood into the cell and it stiffens — that’s rigor mortis. there is no shear. Tissues don’t ‘slide’. as soon as the circulating ATP [energy molecule] runs out. worth reading carefully. Steven Levin. The dynamics of a cell ceases with death. that is an unsafe assumption. say. what you see there is that the ‘fuzzy’ stuff is really dynamic tissue that is under constant change. and one that ignores many other highly relevant factors — like neurology. and you can almost watch it happen. It is like snot hardening. and it doesn’t happen unless you die.7 This is a very interesting passage. In fact.
Also. Almost any amount of normal movement is sufficient to sustain a normal range of motion. “Fuzz solidification” either isn’t happening or doesn’t matter. does the same. there are other explanations for the sensation of stiffness: better. evidencebased. All that ‘melting the fuzz’ is conjecture based on misinterpreted observations on dead tissue.” The idea came from . Even so called “fresh” cadavers are but poor players in the game of life. decades-old idea is still often seriously cited as the explanation for how fascial therapy works: because it softens fascia with “thixotropic effect. the mucus that connects all our tissues.becomes quite stiff. because it’s effortless to move through. Ida’s idea about thixotropy A shabby. I discuss them in some detail in Quite a Stretch. at death. and un-fuzzy explanations.
nor is it the mechanism of one. Rolf’s own explanation was that connective tissue is a colloidal substance in which the ground substance can be influenced by the application of energy (heat or mechanical pressure) to change its aggregate form from a more dense ‘gel’ state to a more fluid ‘sol’ state. near the . In her own work Rolf applied considerable manual or elbow pressure to fascial sheets in order to change their density and arrangement. Thixotropy is an obscure physical property of certain slimy body fluids that get thinner when agitated or stressed. You can easily observe thixotropic effect in beach sand. A quick look at how thixotropy works in human physiology shows that this just doesn’t add up. Fascia researcher Robert Schleip:8 Many of the current training schools which focus on myofascial treatment have been profoundly influenced by Rolf (1977). but it’s not a therapeutic effect in itself.Ida Rolf (founder of “Rolfing”). Ida’s idea was wrong. The thixotropic effect is nifty physiology.
and fascia is too tough to change.water’s edge: stamp your feet in the sand. dramatic effects on tissues that . And thixotropy just isn’t fast enough to explain the relatively speedy. and the gelatinous and poorly-named goo called “ground substance” — the stuff that gristly connective tissue fibres are embedded in like bits of coconut in Jello. What makes these substances gooey and slimy? Why. and you can’t “change their density and arrangement” quickly or easily. slow. Fascial sheets are incredibly tough. and temporary. Ground substance is the most plentiful thixotropic substance in the body. But thixotropy is minor. Also known as the snot molecule. and it starts to liquify. of course: the glycosaminoglycans. a family of carbohydrate molecules. semen. Think of any movie monster with tons of ropy saliva — that’s glycosaminoglycans! Thixotropic fluids in the human body include synovial fluid in joints. mucus.
”9 Thixotropy might slowly make fascia morepliable. Dr.Thixotropy . then we would become obviously more flexible just from sitting in a sauna — I’ve tested this repeatedly and never observed any increase in flexibility just from being hot. Schleip: “either much longer amounts of time or significantly more force are required for permanent deformation of dense connective tissues. When the stimulation stops. If thixotropy had the power to increase the extensibility of connective tissue. but not stretchier.therapists claim to achieve. and a therapy can’t work if the affected tissue immediately reverts to its previous state.10 Even if it works in some small way. thixotropic effect is going to be temporary. fading within seconds or minutes after hands are removed. so does the thixotropy.
Another similar thought experiment: if sustained pressures or sheering could significantly change connective tissue.” Last but not least. Dr. . Massage surely does induce it a little. thixotropic effect is simply aminor effect. but just as surely much less than ordinary physical activity — like with circulation. Schleip calls this the “reversibility problem” and “definitely not an attractive implication of this model for the practitioner. the effect is much smaller than what exercise does! Perspective matters. It’s occurring a little bit all the time. Massage therapists are very fond of claiming that massage “increases circulation. then working a chair all day long — or any long-duration posture — would also deform your fascia. with or without massage.” but if it does so at all.will stop when the stimulation stops … but a therapy can’t work if the affected tissue immediately reverts to its previous state.
and trying to explain what they do. I think you would find that a great many believe that they are doing the same thing that an acupuncturist is doing — just in a different way. If you polled therapists doing fascial manipulation. it was never even a good idea in the first place. . Unfortunately.The idea of thixotropy is hardly state-of-the-art thinking about fascia. even decades ago. They believe that fascial therapy works for the same reasons acupuncture works. but it is certainly still prevalent among therapists practicing fasciallyfocussed therapy. The acupuncture connection: is fascia actually magic? Another disconcertingly popular notion about why fascia matters is that the meridians of Chinese medicine correspond directly to fascial anatomy and function.
and is simply not what it seems to be. most fascial therapists probably believe that acupuncture works. for most of history. And therein lies the problem. 1899-1957) in the early 1930s1112 For most of history. Acupuncture as we know it today is not so ancient after all: its current form is a modern invention of the pediatrician Cheng Dan’an (承承 承. good quality scientific tests for years now. acupuncture is not a good ally: it has been failing many fair. And then there’s the myth .Indeed. Unfortunately for fascial release therapy. acupuncture existed primarily as a method of bloodletting — exactly like the prescientific medieval European practice. it existed primarily as a method of bloodletting — exactly like the prescientific medieval European practice.Before that.
The proposed association between “fascial meridians” and the “chi meridians” of traditional Chinese medicine is meaningless.of acupuncture’s popularity. Acupuncture is obsolete Eastern folk medicine propped up by Western hype and wishful thinking.13 Even its alleged popularity and widespread use in China is quite trumped up — it is. though. acupuncturists are unable to demonstrate their power clearly: their needles are consistently no more helpful than placebos. why would pulling on fascia be able to do it? . Even pro-acupuncture researchers have repeatedly admitted that the effect of the needles is small at best. Even if meridians and all the other rubric of acupuncture were real. And if the acupuncturists can’t manipulate these meridians effectively enough to achieve clearly measurable effects. not actually used for anaesthesia. for instance.14These are rather embarrassing facts for acupuncture.
Acupuncture lore has no business in a serious discussion about fascia and its possible importance in therapy. fuzz. both better and worse. and discussion of genuine fascia science is still coming. But first I want to make it clear that common fascia talk often fails to even reach the level of being “science-y.” Despite all the talk of exotic properties of fascia. There are other reasons. and fascial meridians are three good examples of popular but poor reasons why fascia supposedly matters. particularly with regards to treating low back pain and other common pain problems Not so exotic after all Piezoelectricity. fascia’s clinical importance is usually expressed only in terms of a couple extremely simplistic rationales. which don’t seem exotic at all: . SY Does Acupuncture Work for Pain? — A review of modern acupuncture evidence and myths.
always making the point that pulling on any one part of fascia affects the whole body.15 .” and that therapists can achieve this by various methods of yanking on it. and it gets tight (not clear. The yanking may be extremely intense. see below).1. and needs to be “released. like clothing a size too small. like pulling on the corner of a sweater affects all the threads. Didn’t think it mattered much ten years ago.) The main idea of fascial therapy is that the stuff can get tight and restrictive. it’s everywhere and connects everything (well. A strong theme in fascial therapy is the emphasis on the interconnectedness of anatomy via fascia. actually. too — some flavours of fascial therapy are among the most painful of all hands-on techniques. (That sweater analogy appears virtually everywhere online that fascia is mentioned. It gets really tiresome. yeah). Still don’t. 2.
Consider this gem of simplistic rationalization.And that’s what fascial therapy boils down to most of the time. PT: Restricted fascia is full of pockets. in the wild. of course. Such overconfident. reported by Barrett Dorko. I have personally encountered lots of talking about fascia that is exactly this rudimentary … and even worse. When the tissue starts to release. the sensations that were trapped in them are released. poor quality clinical reasoning isn’t universal — just excessively . these pockets are opened up. When these pockets open. but low quality reasoning and communication about fascia is distressingly common (and my exposure is quite extensive. like the example I quoted in the introduction — “The fascia will make everything better!” Many therapists are perfectly capable of discussing the topic more intelligently. due to the large volume of email I receive).
common within the culture of fascia enthusiasts. The greatest enemy of knowledge is not ignorance. Stephen Hawking PART 3 REAL FASCIA SCIENCE THAT SUPPOSEDLY MATTERS Fascia is much too tough to “release” “Manual therapists need not feel threatened by the news that we cannot stretch fascia. let’s get to some real fascia science.” . Now. it is the illusion of knowledge.
underminding the clinical relevance of fascia rather than supporting it. The Chaudhry et al article is indeed “clinically relevant” to fascial therapy … but not in a . Journal of the American Osteopathic Association. p379-90. Number 8. this was the most “interesting”: “Three-dimensional mathematical model for deformation of human fasciae in manual therapy” Chaudhry et al. few readers answered my challenge directly. What Are We Doing? Alice Sanvito. Of the handful of scientific papers that were suggested to me.If We Cannot Stretch Fascia. Despite the extraordinary number of comments I received on early versions of this article. Volume 108. Aug 2008. Massage Therapist My original challenge to readers (in the fall of 2011) to suggest fascia science that supports fascial therapy was kicked off with a fine example: one that is just about the exact opposite of what I asked for.
” Although the concept of release may correspond to some other physiological phenomenon — another discussion — it certainly cannot be explained in general by physically changing the fascia. This fascia science actually contradicts the big idea of fascial therapy. The main point of manipulating fascia16 is to physically change it in some way — to achieve what is usually described as a “release.supportive way. This is consistent with well-established properties of fascia. Although they oddly imply in their summary that it might be possible to do so with the superficial nasal fascia. What Chaudhry and colleagues showed is that fascia is much too tough to “release" (mechanical deformation17) by stretching it. the main textof the paper makes it clear that even that thin tissue is extremely tough. . and would only mechanically deform if subjected to surprisingly intense forces.
For instance. It’s also just old news that fascia is too tough to change. Therefore. Robert Schleip debunked the idea in his 2003 paper about fascial plasticity. people would be bulletproof.namely that it’s extremely tough stuff. Dr. Collagen is like that. If I could write my own conclusion to this paper. If the stuff were thicker. because it is tougher than Kevlar. you're going to have to get medieval. perhaps it was a poor choice to cite it in this context. This paper is only clinically relevant to fascial therapy insofar as it presents evidence that discourages and undermines existing common practices and beliefs. and if you don’t take his word . This directly contradicts a major popular rationale for fascial manipulation.18 CLINICAL IMPLICATIONS: If you want to physically change someone's fascia by force. it would go more like this: CONCLUSION: You cannot change the structure of fascia.
a “release” is: • a palpable. relatively quick change in tissue texture clinically meaningful (makes some kind of real difference to the patient) • . I’m not so sure… “Release” may not even be real In the context of fascial therapy. I’ll go even further. He concludes that plastic fascial change in response to moderate loading is “impossible to conceive.”19 As strongly stated as that may be. and thoroughly describes fascial toughness. Schleip (and virtually everyone else) assumes that “release” is a real thing that needs explaining. Dr.for it — a well-respected fascia researcher — then whose opinion would be credible enough? He dismisses the traditional explanations of thixotropy and peizoelectric-effect-mediated adaptation.
• somewhat lasting (if it didn’t last. Many readers accuse me of having no practical experience with patients. and this fact is readibly available in my bio. though. And what’s left of the concept of a release if you take away the clinically meaningful. • In my many years working as a massage therapist. No doubt the first thing — a quick change in texture — happens in the course of manual therapy. I have a decade of it. but it’s just so deeply ironic and amusing when people assume that the only possible explanation for my opinions is that I must not have any work experience as a massage therapist. I felt various and sundry ripplings. a bit of movement under the skin? Yes. I do have experience. when in many cases I clearly have more (and better) than they do. and predictable parts? What if it’s just a change in texture. specifically. what would be the point?) somewhat predictable (that is. that is doing the releasing. . it’s happening because of treatment) And fascial therapists more or less unanimously assume that it’s fascia. Not that it’s a contest. It is not safe to assume the rest. lasting.
Sometimes they did. just like everything else. and that this is probably mediated by sensory nerve endings in all soft tissues. occurring with great variety pretty much no matter what I did.” those movements should have correlated strongly with my intentions and with the patient’s experience. Schleip’s 2003 paper about fascial plasticity basically just said that fascia is too tough to change. I rarely thought of those changes as a meaningful “release.twitchings. but often they did not.” Dr. except insofar as fascia has nerves in it. We have no idea whether or not any of that . But in order to qualify as “releases.20 So while I certainly felt something change. and shifts under the skin. This is hardly surprising — it basically just means that people react when poked and prodded — and it doesn’t really have anything to do with fascia in particular. So I always thought they were really quite random. but muscle may react to touch and pressures. or what patients reported.
I have no objection to using “release” as a description of an experience. if they are more meaningful. an oversimplification that is more poetic than biologic. But we have trouble grappling with that. but I think it is quite misleading to pretend that it describes a particular biological event with clinical meaning and value — which is exactly how most therapists imagine it.” I can also make someone twitch their quadriceps by bonking their patellar tendon: does it matter. so we round it off to something more specific and definite and meaningful. Or. (And that’s . not a pivotal event in therapy.actually constitutes a meaningful mechanism for a “therapy. It’s not that nothing’s going on … it’s that nothing in particular and knowable is going on. which is the only thing that really needs explaining. other than as a test of the reflex itself? Releases are probably mostly just trivial tissue “noise” in the hands-on experience. they are nearly impossible to interpret.
Not actually possible. because I don’t think it’s good . But funny! (Drawing by Claude Serre. and the human habit of imposing simplistic explanations on chaotic systems.not difficult: it boils down to a thick stew of good intentions. ego.) Does stimulating fascia reduce post-exercise muscle soreness? Perhaps … but the clinical relevance of this data is tenuous at best — so low that I would never normally be interested in this paper. In fact.) Funny. I would never have chosen to read it myself.
accurate simulation of manual therapy on naked cells is an amusing notion. p162-71. Apr 2010. and it’s clear that what happened to those cells differs dramatically from what would happen in a real living body. Even if true and reproducible. who supplied the paper as an example of basic fascia science that matters. This is a test tube study showing that naked cells handled stress better (fewer signs of harm) if they were treated with “simulated myofascial release” (MFR). Volume 14. Number 2. It was probably not a good choice for that purpose.enough science. I spent some time on it only as an gesture of good faith to a critic. “In vitro modeling of repetitive motion injury and myofascial release” Meltzer et al. . this data would mainly support the rationale for MFR specifically for post-exercise soreness — something of a dead end for clinical relevance. A meaningful. Journal of Bodywork & Movement Therapies.
because exercise-induced soreness has little to do with the main claims of fascial release therapy. This isn’t a rejection of all possible clinical relevance of the data. it would have to imply that MFR might be able to treat chronic pain from other causes … not the transient annoyance of soreness after a game of soccer.22 A meaningful. My point is that there . eliminating alleged restrictions. which primarily concerns correcting postural asymmetries.For this property of fascia to be clinically relevant. accurate simulation of manual therapy on naked cells is an amusing notion. Post-exercise soreness is comparatively trivial. and treating chronic pain.21 There’s a lot of research showing that exercise-induced soreness is basically invincible anyway. and patients usually don’t seek therapy for it.
most of the time. I do concede that the paper shows some evidence that fibroblasts have interesting and perhaps positive responses to mechanical forces.are so many problems that its relevance is watered down to quite a thin sauce — way too thin. however. It’s quite likely that if neutral researchers — with no interest in . and a hallmark of low quality science. That is inherently interesting biology. with patient’s fascia. “Reach” is what the authors do.” because they seem to be seeking evidence to support their pre-conceptions — typical of The National Center for Complementary and Alternative Medicine-funded research. and perhaps well worth investigating further — but it’s a long reach to postulate any clinical relevance to what most therapists do. I suspect they are deeply interested in validating the notion that “fascia is important.
because it is something of a classic of fascia science: Robert Schleip’s 2006 dissertation on the contractile properties of fascia. I will get into much more detail about this paper than the first two. Much more interesting stuff than the previous two examples. Since he clearly believed me to be ignorant of fascia science and in dire need of educating. he recommended a paper I was already familiar with. Does it matter that fascia contains muscle cells? The next example of fascia science was suggested to me by Gil Hedley.fascial therapy — did this experiment they would not get or report the same results. As expected. I asked him to recommend some reading to me — a favourite paper showing something interesting and clinically relevant about fascia. “Fascia is able to contract in a smooth musclelike manner and thereby influence .
Munich. That is undeniably interesting biology! But the point of this analysis is to ask: Does it even matter whether its right or wrong? Is it clinically relevant? Does it improve how we do therapy? Can we use the knowledge to affect the body with hands? That is the question.de. However. Number . Volume . Schleip and his colleagues have addressed themelves on their website. 2006. answering questions like “Does fascia contract in response to emotional stress?” and “Can fascia contract on its own?” .musculoskeletal mechanics” Schleip et al. Schleip and colleagues convincingly showed that fascia contains muscle cells and that they can contract — slowly and weakly. FasciaResearch. interested readers should definitely have a look at theirarticle: it is readable and chock full of useful perspective. It is also a question that Dr. which is generally consistent with theirs. Proceedings of the 5th World Congress of Biomechanics. p5154. What follows is my own analysis.
fasciaresearch. which they described as “rather unexpected. I’ll quickly explain what Schleip et al. found: a kind of muscle cell in rat fascia. I invited him to make a statement for my readers about this: look for it at the end of this part of the discussion. and he shares my frustration with clinical overconfidence in fascia. we agree on what matters. Although he also had some thoughtful criticisms. and expressed clear agreement with my main point. Schleip has read this article and corresponded with me about it amiably.de.“Fascia Contractility FAQ. Important update: Dr.”23 They also tried out various methods of stimulating them in vitro (test tube) and found that. Fascia strong like bull! Or … mouse? Before we get to clinical relevance.” a webpage on www. those . by golly.
fascial contractions are dramatically less powerful than muscular contractions. . this diagram gives far too much credit to the power of fascia. It’s certainly not difficult research to understand. But they contracted. Perspective By any measure. which would barely register at all if depicted more accurately. If anything.muscle cells did what muscle cells do: they contracted! Slow. weak contractions.
massage therapists and chiropractors (in particular) are prone to swinging to the opposite extreme and talking about fascia as though it is more interesting than a lifetime subscription to National Geographic. you’d be disappointed — not enough blueberries! It’s just a few muscle cells scattered throughout the fascia. If you had blueberries with your cereal in the same proportion. the Saran Wrap of biology. inert substance. Schleip’s research demonstrates this. I still hear various educated people referring to it in this way. However. We are not talking about a lot of muscle cells here.Some important context that fascia fans will appreciate: for a long time. But neither is it all that lively — at least not in terms of contractility.24 Dr. There’s so few that they are visible only when you look very closely and in just the right way. Fascia is not inert. fascia was and often still is incorrectlythought of as a fairly lifeless. . The truth is somewhere in the middle.
Nor are we talking about particularly strong contractions. The maximum force generated by a small bundle of contractile rat fascia was around 35mN. because it’s not just a matter of strong versus weak. Fascia isn’t going to be ripping apart any chains with its bare hands. Although fascial contractions may be weak compared to muscles. I have a weird job. perhaps.” (It took me a long time to work that out. they could nevertheless be powerful in another way — their effects .) That’s not bad for a bundle of rat fascia. The “bull versus mouse” comparison is a little unfair though. but it doesn’t really hold a candle to middle-of-thenight charlie horses either. Compared to the power of muscle contraction.25 In plain English that’s “not very dang much” or the somewhat more precise “about what it takes to set an AA battery rolling on a nice smooth surface. fascia power barely even registers.
but let’s start with it mattering in the first place.might. for instance. and I see no reason at this time to dispute the observation that fascia can contract. I don’t know what it is. But for the property they described to matter to therapists who are choosing to focus their therapeutic attention on fascia — for anybiological property to be clinically relevant — it must be significant enough to have an effect on health. Do weak fascial contractions matter? Schleip et al.’s basic finding seems sound enough. If there’s anything wrong with their research methods. So it’s still worth considering how these contractions might be clinically relevant.) . accumulate over time to produce contractures (permanent “seizing up” of tissues). (It then must also be something that we can do something about.
Schleip et al. the contraction could be “strong enough to influence low back stability and other aspects of human biomechanics. characterized the raw power of fascial contraction quite differently than I just did.26 In their words. never mind the generally mind-blowing structural toughness and resilience of the human spine. thickest blankets of fascia in . however. they would still only account for a small fraction of the postural muscle power involved in dynamic spinal stabilization.” Stability? Even if you exaggerate their numbers. within the bounds of their numbers. I deliberately made it sound trivial. The idea that low back stability could be affected in any way by such a small. in the large sheets of fascia in the low back.2728 And that’s based on an estimate of the theoretical maximum force generated by the biggest. slowmotion force is a bit much for me to swallow.
human anatomy. but mostly quite thin and wispy. fascia is much less substantial — tough for its weight. A general example of such “aspects” might be that contracting fascia could be involved in biomechanical asymmetries — tighter on one side than the other. The validity of such a concern depends on just how sensitive you think human biomechanics are to forces so subtle that no one really had any idea that fascia contraction was even happening before this study. As regular readers here will know. I think biomechanics are over-rated as a factor in all kinds of pain problems. That fascial contractions might influence “other aspects of human biomechanics” is a bit vague.29 The forces generated must be dwarfed by that of muscle itself — in rough proportion to the number and size of contractile cells involved. In most places in the body. and a lot of it even microscopic. and there’s extensive evidence that human beings are wonderfully adaptable and cope surprisingly .
’s paper is synonymous with saying that fascial contraction is relevant only if structuralism is a useful mode for doing and thinking about therapy. Also. And the study was funded by the International Society of Biomechanics.31 Weak. and the European Rolfing Association. . their phrasing shows a strong bias in favour of the “importance” of fascia. Once again. but clinically minor. far from making me interested in fascia as a target for therapy.30 The wording of the conclusions of Schleip et al.” I make that case in great detail in another article. the Rolf Institute of Structural Integration. fascia science is convincing me of just the opposite.well even with gross deformities. never mind subtle assymetries and “imbalances. slow fascial contractions strike me as being scientifically valid and interesting.
To make my point. all I have to establish is that the clinical relevance is debatable and probably minor at best. I’m happy to concede that fascial contractility might be a little bit clinically relevant. I explore this specific claim of clinical relevance in detail in my trigger points tutorial. but this clinical concept suffers even more than other examples from the relative weakness of fascial contractions.32 What about fascia and trigger points?Schleip et al. It doesn’t hurt my main point to make these concessions. don’t bring trigger points (muscle knots) into this discussion. The notion is that a trigger point is being squeezed and sustained by clenching fascia. In his original dissertation. but a lot of other people certainly have. Schleip limited his speculation about clinical implications to the .No clinical relevance at all? Not even a teensy bit? If it makes anyone feel better about all this. rather than the slam dunk it would have to be to support even half of the “excitement” about fascia you see in the therapy industry today. Other evidence might even reveal something important — although that would surprise me.
such as in back pain due to segmental spinal instability.” such as spinal stability.broad generalization that it can “influence musculoskeletal mechanics. In a follow-up paper for Medical Hypotheses. peripartum pelvic pain. and others. tension headaches. Examples include conditions such as torticollis. The high water mark for potential clinical relevance is spelled out in this passage: This offers the possibility of a new understanding for many pathologies that involve a chronically increased myofascial tonus. Similarly a decreased fascial tone could be a contributing factor in conditions that are often associated with decreased myofascial tension. low back pain associated with paraspinal compartment syndrome. it is possible that their progress could be influenced additionally by the regulation of fascial tissue tone … .33 he and several colleagues generally suggest that fascial contractility is a factor in muscle stiffness. or fibromyalgia. While usually other factors play a major role as well in these pathologies.
I’ve already mentioned how hyperbolic it is to suggest that fascia could have any serious impact on spinal stability. Suggesting it as a main example34 of how fascial contraction might matter makes about as much sense to me as saying that people with cancer might have some contracted fascia — would it matter if they did? .The emphasized phrase is key — it’s an understatement. For instance.” but probably nearly total — relative to the presumably minor(and still unconfirmed) contribution of a little fascial tension. Another peculiar item here is fibromyalgia. they always do. Some of the items listed are particularly implausible to me. other factors don’t “usually” play a major role in those conditions. And the role of those factors isn’t just “major. a fascinating condition that might conceivably be affected in some small way by fascial contraction. but which is overwhelmingly a nasty disease of the nervous system.
Visualize a hot water heater that isn’t venting pressure — the valve is busted. direct and logical connection between “fascia can contract” and a way that it could contribute significantly to a health problem. but certainly is a problem (especially in the shins). And yet there is still a clear problem with the scale of the forces here. and it’s in danger of blowing. probably dramatically exceeding the maximum force with which fascia could squeeze the compartment. Compartment syndrome is by definition only a problem when the pressure is significant.35 Compartment syndrome is excessive pressure in a fascial compartment. . like a sausage swollen in its wrapping. It is the one item listed where there is a clear.” which is decidedly not a common complication or cause of back pain.The most interesting item listed is “compartment syndrome. That is clinical relevance. If fascia were to start squeezing a compartment for some reason. it might be a problem.
they thought. at least it’s easy to see how it could matter in principle. “Yeah. and the numbers might favour fascial contraction as factor. The first time anyone with a scrap of imagination heard that. right. Still. Again. So you see how this goes: for one candidate example after another.” As biologists slowly figured out what all that “junk” is for. and it would make no practical difference if the hot water heater itself was a little larger or smaller. Is fascial contraction even interesting? One of the lower moments in biology history was the labelling of non-coding DNA as “junk DNA” in 1972. the clinical relevance of fascial contraction is dubious or minor.36 there was a lot of .The pressure inside is immense. fascial contraction is probably not nearly strong enough to matter.
That connective tissue has a small population of muscle cells strikes me as blindinglyunsurprising. it quickly becomes apparent that there are no sharp lines or divisions. If you spend much time studying biology. but in some ways those discoveries are still overshadowed by the way we’re all not so very surprised.” It’s interesting science. I never believed fascia was entirely inert any more than I believed in the junkiness of any DNA. okay.Muscle blends exquisitely into tendon. Of course. it’s like walking through the overlapping zone of two heavily integrated adjacent neighbourhoods. that’s more like it. Similarly. the presence of muscle cells in fascia is no shocker.“Well. and the further you . and that we consist of an incomprehensibly diverse and interconnected community of cells. with no clear demarcation at the cellular level: at the microscopic level. yeah.
I’m not saying . for crying out loud — how could it not have a few muscle cells and overlapping properties? I didn’t know that before it was confirmed. but they are subtle and arcane and ultimately just a slight variation on the biological theme of muscularity. but I certainly don’t find it particularly surprising. the fewer muscle cells you see.go away from the muscle. Fascia surrounds and fractally wraps every muscle inside and out. I suspect that the slightly contractile properties of fascia are simply at one end of a continuum of motor function. That connective tissue has a small population of muscle cells strikes me as blindingly unsurprising. There are probably some subtle differences. a little bit more of the same. Our muscular system is overwhelmingly our primary means of reacting to stimuli — the major output of our nervous systems — and in general terms the slight contractility of fascia is probably just the fringes of that functionality. and the more fibroblasts and their fibres.
Schleip read my article and wrote to express his basic agreement with my key point about his research: “Your comments on the small size of fascial contractions are right on. but it’s overshadowed by the much more interesting muscular system as a whole.it’s completely uninteresting. at least when viewing these within the periods of seconds to minutes. What does Dr. the muscular system itself is in turnovershadowed by neurology. in terms of clinical relevance. Schleip think? Recently Dr. about which fascia is simply a mildly intriguing subtopic. He is not thrilled with the way his research is . And.” He also wanted me to know that he shares my annoyance with the “over-zealous claims and projections” of therapists doing fascial work. as is usually applicable for bodywork techniques.
with some emphasized highlights: I share your emotional frustration with the current trend among bodyworkers of attributing anything wonderful or astonishing to the properties of fascia. Most of the people who criticize you have not done a portion of your reading work and could certainly learn a lot from the debate you started. In fact. our Fascia Research Group at Ulm University has been receiving an almost exponentially increasing number of inquiries .” I invited him to make a statement for my readers about this. and will probably make more). He also offered some thoughtful criticism on some specific points (and I made some changes. Here is it in full.being used to justify premature overconfidence in fascial therapy. Nevertheless. and was generally pleased with what he read here: “You have my respect for your detailed and critical analysis of the present work on fascia. he had no major objections.
such as P.from enthusiastic healers (and martial art teachers) worldwide who wish that we would sanctify their claims that fascial contraction provides the explanation for their observed miracle powers. . Findley. T. Huijing. While I do tend to believe that the fascial net plays much larger roles in human functioning than previously assumed in orthopedic medicine. Standley and A. “There is hardly a more dangerous attitude among therapists than the hero healer who is most of which are still unproven. I am afraid that such over-zealous claims and projections are undermining the seriousness of the investigationand academic rigor that characterizes the work of the current leaders in fascia research. H. This of course applies as much to fascia-oriented therapists as it does to those who base their work on supposed neuromuscular or other physiological effects. P. As a bodywork clinician myself. I have learned that there is hardly a more dangerous attitude among therapists than the hero healer/manipulator who is damn sure about his diagnosis and supposed treatment effects . Langevin. Vleeming.
”While scientists can learn a whole lot from the intuitive and experiential wisdom of complementary therapists. I fully support and endorse his enthusiasm to explore . we bodyworkers can learn at least as much from the careful. but not closed our minds. questioning approach of good scientists. particularly about the nonfragmented and connecting properties of the fascial net. Again. Schleip and I do not agree about everything — but that is unimportant compared to our shared values and commitment to cautiously reserving judgement. as expressed in the international Fascia Congress series and associated activities. Dr. It is this mutual learning and interdisciplinary enrichment which in my opinion characterizes the best qualities of the current fascia research field.damn sure about his diagnosis & supposed treatment effects. who are willing to doubt their own assumptions and to refrain from premature confidence and over interpretation of their findings. We have each placed our bets on this topic.
It is not a plausible explanation for the sensation of stiffness. which don’t exist or — even if they do — can’t actually be exploited for any therapeutic effect even by acupuncturists. Chaudhry et al showed that fascia is too tough to “release. but its clinical relevance is nil — not enough is known about it to even speculate about how it could be exploited in manual therapy.the biology … and he supports and endorses the value of my critical analysis.” Indeed. PART 4 CONCLUSIONS Results of the Fascia Science Challenge so far… • Piezeoelectricity may occur in fascia. Gil Hedley’s theory that congealing fascial “fuzz” causes stiffness is simplistic and wrong. Fascial “meridians” relate fascial therapy to the “meridians” of acupuncture. or a mechanism of action for fascial therapy or stretching. even thin fascia is so tough that it is basically • • • .
loosened) without vice grips. it is a long reach from a test tube study to clinical reality. • . It is somehat unsurprising biologically. and is only clinically relevant to fascial therapy insofar as it presents evidence that discourages and undermines existing common practices and beliefs. but not that it matters. • Meltzer et al concluded that stimulated fibroblasts might be happier fibroblasts — specifically. The results of this test tube study are questionable. Treating post-exercise muscle soreness is not even a common goal for manual therapy.inconceivable that it could be physically changed (stretched. but even if you take the data and interpretation at face value. This directly contradicts a major popular rationale for fascial manipulation. It is not a factor in any of the common problems most manual therapists work with — maybe none at all — and even if it was it is somewhat unlikely that hands-on therapy could relax it. Schleip et al established that fascia is contractile to a trivial degree. they might be more resistant to post-exercise soreness. and clinically trivial.
The claim that fascia is a “liquid crystal. I honestly hope that there is clinically relevant fascia science — that would be terrific. however. the relevance to therapy is extremely dubious.” While it certainly has some elements of truth in it. So far.To be continued… There is more fascia science. and that this is the basis of a therapeutic “release.” Done February 2013. and I will extend this article with more analysis in the future. Other alleged fascial properties and clinical relevance issues I intend to address eventually (definitely not a complete list): • The claim that connective tissue is a colloidal substance in which the ground substance can be “melted” by heat or mechanical deformation (thixotropy). This is closely related to the piezeoelectricity claim already covered by the article. I see no good reason for therapists to be fascinated by fascia and to make it a target tissue. but there is more to say about • .
Done February 2013. • PART 5 APPENDICES Further Reading • Length is Fine — The story of the obsession with crookedness in physical therapy and treatment for chronic pain. The claim that fascia is structurally important and tensegrity is interesting (agree). I will likely dispute both the property and its relevance. Much of my rebuttal on this score already exists in my article about structuralism.the liquid crystal idea specifically. SY Your Back Is Not “Out” and Your Leg . • The claim that fascia contains “memories” in some sense. and that this is clinically relevant (disagree).
a chiropractor and physiotherapist has a thoughtful new fascia article.” Todd Hargrove. • SY Trigger Points & Myofascial Pain Greg Lehman. a Rolfer and writer (BetterMovement.• SY Pain is an Opinion — What recent pain science can do for your chronic pain right now.org).” a webpage on www. What Are We Doing?. has a good post onfascia and foam rolling and fascia under the microscope. “If We Cannot Stretch Fascia. • SY Does Massage Therapy Work? — A review of the science of massage therapy … such as it is. It has much clearer clinical relevance.massagestlouis.com. “Fascia Science: Stretching the power of manual therapy. Massage therapist Alice • • . The role of the nervous system in chronic pain is the major alternative to focussing on fascia. even for the most difficult cases. with reviews of every possible self-treatment and therapy option. • Syndrome — A guide to the science of muscle pain. Includes a section on the relationship between fascia and trigger points (e-book customers only).
Just a new section.Sanvito’s clear summary of Dr. New section (Feb 19 '13. and not by plastic deformation of fascia.Ida’s idea about thixotropy.2) — No notes.2.1. What’s new in this article? Rewritten (Feb 20 '13. section #3. See section #2. section #2.Electrified by piezoelectricity. Just a new section. See section #3.“Release” may not even be real.1) — A major editing job. New section (Feb 15 '13. Robert Schleip’s theory that fascial “release” may be attributable to changes in muscle tone stimulated by mechanoreceptors in fascia and other soft tissues.3. Minor update (Jan 31 '13) — Several minor additions and edits. See section #2. section #2. particularly to include the much more specific idea that piezoelectricity accounts for releases. .3) — No notes.
section #2.4) — Added a very useful link to FasciaResearch.4) — No notes.Minor update (Aug 30 '12.4. See section #3. Does it matter that fascia contains muscle cells? New section (Jul 31 '12.5) — Added some acknowledgement that fascia contractility may still have some slowmotion “power” even if it is quite weak.de.4. with revisions and some new information. Notes .The acupuncture connection: is fascia actually magic? Major update (Jul 25 '12) — Article launched as a compilation of about four previous articles on this topic. I’ll probably expand on this soon. section #3. section #3. See section #2.5. Just a new section. Fascia strong like bull! Or … mouse? Minor update (Aug 30 '12. See section #3.
BACK TO TEXT 3. 1998.1. Job’s Body.BACK TO TEXT 2. And that’s probably exactly why she felt compelled to strut her stuff and “troubleshoot” my case and talk about fascia. For more information. Yes. in a spa. The full details of how bone responds to stress are spelled out in Dr. Juhan. Harold Frost’sMechanostat model.com Job’s Body is essentially a physiology textbook with imagination and a soul. see Tissue Provocation Therapies.BACK TO TEXT . I didn’t actually have any problem. Criticism and deconstruction of ideas is normal and healthy and necessary for therapy professions to grow and change. On the other hand. amazon.” I have fun taking therapy seriously. but equally rewarding. Juhan probably takes some his speculation too far too be useful or accurate. It was supposed to be a relaxation massage. she was a Registered Massage Therapist — a well-trained and fully certified massage therapist. It’s a hard read. This kind of (wild) speculation is hardly unusual for Oschman: his writings are laced with much stranger ideas. It is quite “negative.BACK TO TEXT 5.BACK TO TEXT 4.
Schleip’s full reasoning from his article. BACK TO TEXT 7. While it is definitely conceivable that the production of both materials could be influenced by piezoelectricity. the duration of an individual ‘stroke’ or technique on a . “Fascial plasticity: a new neurobiological explanation”: In most systems of myofascial manipulation. both life cycles appear too slow to account for immediate tissue changes that are significant enough to be palpated by the working practitioner. Fascial plasticity: a new neurobiological explanation. For information about Dr. and the half-life of ground substance 1. Here’s Dr.BACK TO TEXT 9. Levin.7–7 days (Cantu & Grodin 1992). see Biotensegrity: A new way of modeling biologic forms. and is used with his permission. from his 2003 article. Schleip. 2003. Robert Schleip. Levin’s work.6. Dr.BACK TO TEXT 8. Journal of Bodywork & Movement Therapies. The quoted passage is from my personal correspondence with Dr. “Fascial plasticity: a new neurobiological explanation”: The half-life span of non-traumatized collagen has been shown to be 300–500 days.
BACK TO TEXT .org. Ramey. The Acupuncture and Fasciae Fallacy. Some people will undoubtedly protest this. As will be shown later. claiming that they certainly get more flexible in a sauna. Heat alone. Acupuncture and history: The “ancient” therapy that’s been around for several decades. will definitely make us feel less stiff(a change in sensation). ScienceBasedMedicine.BACK TO TEXT 11. 2010. I’ve tested this very carefully myself: see A Stretching Experiment.org . Such rapid — i. without stretching.BACK TO TEXT 12.particular spot of tissue is between a few seconds and 1½ minute. 2011. Kavoussi.sciencebasedmedicine. below 2 minutes — tissue transformation appears to be more difficult to explain with the thixotropy model. but does not actually increase flexibility. www. BACK TO TEXT 10.e. Yet often the practitioners report feeling a palpable tissue release within a particular ‘stroke’. Rarely is a practitioner seen — or is it taught — to apply uninterrupted manual pressure for more than 2 minutes. studies on the subject of ‘time and force dependency’ of connective tissue plasticity (in terms of creep and stress relaxation) have shown that either much longer amounts of time or significantly more force are required for permanent deformation of dense connective tissues (Currier & Nelson 1992).
According to a great many therapists. I prefer gentler therapy and usually request it.ScienceBasedMedicine. This is just a small sample: . he repeats the basic idea of tissue stuckness in need of releasing in an impressive array of fancier terms.)BACK TO TEXT 14. Despite being a confident and assertive communicator about my preferences. I have still had many unpleasantly intense fascial therapy experiences. Acupuncture Anesthesia: A proclamation from Chairman Mao.org. In a review of the rationale for a workshop. Not all.BACK TO TEXT 16.13. 2011. but I have personally encountered intense fascial therapy in the wild on numerous occasions.sciencebasedmedic ine. It’s spelled out clearly by a prominent fascial therapy pioneer. Atwood.BACK TO TEXT 15. www. 2009. his thinking about how fascial therapy works can be considered strongly representative not only of common thinking about fascial therapy. but probably most. How popular is acupuncture? McKenzie. but also of its bleeding edge. Luigi “Inventor of Fascial Manipulation” Stecco.org. This is someone who has the respect of large numbers of fascial therapists. Some fascial therapy is gentle.
” it’s not that. Fascia is mostly much too thin to actually be bulletproof.e. This is just like how spider silk is “stronger than steel cable” — pound for pound. Whatever therapists are feeling when they claim to detect a “release. like working clay. then a specific point on the fascia is implicated and. The catch in the comparison is that fascia most likely doesn’t have the same “puncture resistance” property that Kevlar does. If fascia was just as thick as a Kevlar vest.BACK TO TEXT . it is. The point was simply that the research showed quite clearly that the forces required for plastic deformation of fascia significantly exceed what can be applied to it with hands. through the appropriate manipulation … movement can be restored. where the tissue snaps back to its pre-manipulation state.Once a limited or painful movement is identified.BACK TO TEXT 18. but a change in form — the goal that therapists generally have. or a little less). but are quite vulnerable to torsion). To “deform” in this context is not a bad thing (as in deformity). alas — wouldn’t that be handy! And yet the hyperbole is definitely true in a sense. in fact. This is in contrast to elastic deformation. BACK TO TEXT 17. There are many kinds of toughness (i. bones resist compression exceedingly well. “Mechanical deformation” is lasting change in the shape of the tissue. it might well be just as bulletproof (or a little more. People are not bullet proof thanks to their fascia.
Schleip. Fascial plasticity: a new neurobiological explanation. Journal of Bodywork & Movement Therapies. 2003.
While high-velocity thrust techniques might create forces within that range, it seems clear that the slower soft tissue manipulation techniques are hardly strong enough to create the described tissue response [plastic deformation of fascia]. This research leads to a simple thought experiment. In everyday life the body is often exposed to pressure similar to the application of manual pressure in a myofascial treatment session. While the body naturally adapts structurally to long-term furniture use, it is impossible to conceive that adaptations could occur so rapidly that any uneven load distribution in sitting (e.g. while reading this article) would permanently alter the shape of your pelvis within a minute.
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Sometimes I felt things that seemed “big” that the patient seemed not to notice at all. Sometimes the patient had a profound sensory experience when I had noticed no change in the tissue whatsoever. I could not consistently elicit anything clearly. I am not a dumb guy, but I found it all quite uninterpretable and mostly unpredictable. I got tired of trying to find meaning in my sensations, and by my last three years in practice I abandoned all conceit that I could induce specific changes in tissue, and focussed
pretty much exclusively on my patients’ sensations — not mine.BACK TO TEXT
If it’s bad enough to think that you need help, you’re also too sore to want anyone to touch you (let alone push on you). In any case, post-exercise muscle sorness is usually all wrapped up before patients can get to an appointment.BACK TO TEXT
SY Ingraham. Delayed Onset Muscle Soreness
(DOMS): The mysteries of muscle fever, nature’s little tax on exercise. SaveYourself.ca. 5662 words.BACK TO TEXT
Is it really surprising? I’ll return to that question below. That phrasing doesn’t actually come from the paper, so you won’t find it there, but from a poster they made to summarize the paper.BACK TO TEXT
Or perhaps somewhat to one side of the middle…BACK TO TEXT
A millinewton is 1000th of Newton, which is a measurement of force. A full Newton is not a lot: enough to accelerate a mass of one kilogram at a rate of one meter per second squared, without friction. Imagine what it would take to get a small
weight moving a little bit … in space. Now divide by a thousand.BACK TO TEXT
I’d like to think I made it sound “accurate,” and the result just happens to be trivial.BACK TO TEXT
A little personal perspective: my lovely wife has titanium in her back, installed to stabilize a massive fracture of her T12 vertebra in 2010. Such is the toughness of spines that the titanium fixations installed to protect her actually broke on both sides — came loose from the brackets screwed into her bones. Similarly, severe scoliosis can twist titanium fixations like pretzels as it advances. Those are the kinds of forces involved in the back. Fascial contractions are a miniscule part of such impressive equations.BACK TO TEXT
It is also noteworthy that the contractions they described were slow motion contractions, taking many seconds to develop at their fastest.BACK TO TEXT
Analogy: in the circulatory system, there are only a few gigantic blood vessels, but countless fine and microscopic ones. The fascial system is similar: a few large, obvious sheets of fascia, a bunch of more modest and delicate structures, and then a nearly infinite network of extremely
Your Back Is Not “Out” and Your 31. It’s safe to say that these organizations probably would not fund — or continue to fund — research that came to the oppositeconclusion. and funding sources affect science in muddy. This seems like a borderline case to me. i. Despite what it seems like.”BACK TO TEXT 32. not “strong enough to influence low back stability and other aspects of human biomechanics. I am not actually accusing Schleip et al. madly.thin and microscopic structures. SaveYourself. In general. such is life. This is why I say that we are wrapped in fascia “fractally.”BACK TO TEXT 30.ca. Leg Length is Fine: The story of the obsession with crookedness in physical therapy and treatment for chronic pain.e.” Usually I bring that up to make the point that there needs to be strong evidence that treatments works before they can be considered “proven” — small and temporary treatment effects should not impress anyone. complicated degrees ranging fromnot really at all to truly.BACK TO TEXT SY Ingraham. of having any overt or serious conflicts of interest. This is another form of what I call failing “the impress me test. 10040 words. COIs are more common and less of a big deal in science than people think: where there is science there is funding. somewhere on the edge of being a problem. In . deeply.
Basically.BACK TO TEXT 33. If fascial compartments were prone to problematic contraction. Medical Hypotheses.this case. though. Passive muscle stiffness may be influenced by active contractility of intramuscular connective tissue. 2006.BACK TO TEXT 36. If you’re not going to list really good. both in the shins and the calf. PubMed #16209907. relevant examples here. I have written quite a lot about compartment syndrome with regards to their role in shin splints (see Save Yourself from Shin Splints!). but that important minority is regulated and tweaked by the rest of the noncoding DNA. it’s the clinical relevance of fascial contractility that is failing to impress. So a (very rough) analogy is that the coding DNA is like software that makes you who . where are you going to do it?BACK TO TEXT 35. They are more or less unheard of elsewhere in the body — rare and generally minor and self-limiting. we’d constantly be getting “compartment syndromes” all over the body. The lower leg is by far the most common place in the body for compartment syndromes. Schleip et al. BACK TO TEXT 34. only a fraction of the genome is for coding proteins.
you are. Not so junky. . but the “junk” DNA is the operating system that it needs to run on.