Accepted Manuscript

Yoga, fascia and the second law of thermodynamics

Serge Gracovetsky

PII: S1360-8592(18)30068-8
DOI: 10.1016/j.jbmt.2018.02.002
Reference: YJBMT 1675

To appear in: Journal of Bodywork & Movement Therapies

Please cite this article as: Gracovetsky, S., Yoga, fascia and the second law of thermodynamics, Journal
of Bodywork & Movement Therapies (2018), doi: 10.1016/j.jbmt.2018.02.002.

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Yoga, Fascia and the second law of Thermodynamics

Serge Gracovetsky, Ph.D. Emeritus Professor Concordia University, Montreal,

Canada

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Some 5,000 years ago the Egyptian physician Imhotep wrote the first book of

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manual medicine - 17 pages known as the Edwin Smith papyrus (J.H Breasted,
1991) describing how to diagnose and treat physical injuries resulting from the
hand to hand battles of his time. In so doing, Imhotep crystallized several

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fundamental concepts:

1.It is not necessary to have the diagnosis and treatment (and that includes his
written incantations to the gods which we might call a “placebo effect”) to

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be logically related to the production of good results to the patient.
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2.This remarkably modern thinking has some unfortunate consequences. Good
results are often misinterpreted to mean that the diagnosis and/or its
underlying philosophy that led to it were correct.
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3.Hence good results do not necessarily imply good diagnosis but may induce
complacency or self- gratification and hence slow down the urge to
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investigate what really created the observed good results, including doing
nothing in view of the excellent natural recovery of our species.
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And so, the freedom to innovate without the burden of a proof resulted in the
development of a plethora of treatment philosophies by many visionaries with the
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best intentions. Yoga is one of these philosophies /approaches which have done
a lot of good to countless individuals. Osteopathy, Chiropractic, Physical therapy,
Rolfing, and many others, are also rehabilitation methodologies competing for the
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same clientele, with similar outcomes. Some see Yoga as prophylactic rather
than therapeutic, since its advocates commonly speak of prevention, enhanced
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function etc., rather than the direct form of treatment more specifically targeted
by the other manual therapy techniques (Chu 2014).

This created a logistical problem. Since the patient’s pathology does not depend
upon the clinicians training, one would expect the treatment to depend upon the
pathophysiology alone, something that flies directly against the reality of the
existence of several schools of thought, each with its own philosophy, diagnostic
and treatment methods. It must be noted that the impact of these plethora of
techniques is seen by many as enhancement of self-regulation, or at the limit the
removal of obstacles to self-regulation, rather than actually solving the problem.

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These views are quite generic since it could be argued, that the chemicals in a
pill are also facilitating the body’s self-regulation, and hence the therapeutic
effect, which could then appropriately be described as a treatment.

In the 80’s, in view of the numerous unsubstantiated separate but wonderful

claims made by everybody, an international effort was undertaken to review the

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available facts in an attempt to understand what was going on. This is known as
the Cochrane study collaboration study who published many reports on various
type of treatments protocols The overall conclusions for Pilate, Chiropractic
Physical conditioning Spinal manipulation for low back pain, etc., is that all

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manual therapies are fairly equal and only marginally successful (see the six
references below as examples). From the grumbling I heard in many academic

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conference settings, not everybody was pleased with these rather dry
conclusions.

This means that regardless of the claims made by the various schools of thought

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operating in the field, it would appear that none of them are better than any other.
In other words, there must exist something that either levels off the performance
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of the therapists or prevents them from improving their techniques. If that were
true, then finding what fundamental obstacle limits the therapies might open the
door to significant increases in performance.
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At that point, jumping from philosophy to physics might be useful.

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Anatomy is the end product of a long sequence of energy transformations.

Regrouping atoms into certain molecules is energy efficient because the energy
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of the molecule is smaller than the combined energy of its constituents. The
various amino acids were created spontaneously because chemistry is pushing
towards the creation of efficient molecules. For instance, the combination of
hydrogen and oxygen into water releases a lot of energy which has been used to
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propel the space shuttle into orbit. Conversely, disassembling water into its
primitive atoms demands reinjection of the considerable energy that was
released during its creation, which is admittedly something not easy to do. That
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explains the extraordinary stability of water, and why we do not evaporate easily
in warm weather on the beach.
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Living organisms represent the next step in molecular assembly. It is interesting

to note that living creatures are made of inert material that interacts by exploiting
the energies sources available around them and hence are under puts similar
energy conservation pressures. The Neanderthal used about 4 K calories per
day whereas Homo sapiens are content with 2.2K calories per day (Snodgrass &
Leonard 2009). Guess who made it in the long run? Quite simply, only the most
efficient animal, such as yours truly, will make it. When a large asteroid hit our
planet some 60 million years ago, the dust thrown up into the atmosphere
blocked the sun’s energy from reaching the ground and food production was

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severely compromised, thereby dooming the inefficient dinosaurs and opening a

golden opportunity to our rat like ancestors. In short, the theory of evolution first
proposed by the great Darwin, expresses that all species’ survival is subject to
the second law of thermodynamics. It is also called “survival of the fittest”.

And by the way, that energy is neither cheap nor free. It is generated by fusing

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hydrogen into helium in the nuclear furnace of the sun and passed on to us via
complicated routes. But at the end of the day, leaving our egos aside, we are
simple heat machines regulated by the second law of thermodynamics. The
consequences are very interesting.

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Since activating a muscle uses a lot of energy, the animal must be designed to
roam in the most efficient way in the earths’ gravitational field, to eat, avoid being

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eaten, or reproducing. Since the earths’ gravitational field is constant all over the
planet, nature uses that reliable resource to ensure that every creature is
structured to benefit from an energy efficient locomotion process. That implies

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avoiding using a muscle unless it is absolutely necessary. The question then is to
find the component capable of transferring (with the greatest possible efficacy i.e.
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using the absolute minimum of energy) the muscle-generated forces from its
generator to its anatomical converter, so that we can stand up and walk at
minimum energy cost.
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That transport system involves the collagenous structures collectively referred to

as fascia. A working fascial structure permits, in collaboration with the
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musculature, movement of the animal at minimum energy expenditure, but at the

same time, as a corollary, in such a way that all joints and tissues are loaded at
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minimum stress. Indeed it would be disastrous if, when climbing a tree to collect
a banana, we end up breaking a bone and/or the spine.

In fact, it can be shown that when lifting a load with a working fascial system, the
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stress in the collagen and that of the muscles never exceeds 2/3 of the value that
would rupture their respective tissues (Gracovetsky 1988) Not only does nature
protect the individual against herself (or himself for good measure in this gender
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sensitive era), but nature keeps a reserve that may be tapped in case of
emergency. Can we say that superhuman achievement (think Jean Valjean of
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“Les Miserables”, lifting the horse cart to save a crushed man) may be the result
of the activation of the last 1/3 of reserve? Of course doing that implies that the
individual is taking the risk of breaking something since s/he will not recover from
any mistake. There is no free lunch.

So now a better appreciation of the impact of Yoga and physiotherapy emerges.

If the fascial system does not work efficiently (say the collagen fibers do not glide
well over each other), not only does the animal waste energy, but the stress
within its musculo-skeletal tissues is higher (sometimes much higher) than it
should be. This results in pain, possibly located at a place different from the

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damaged fascia, from a tissue that has been negatively affected by the overall
stress level. Hence the therapist’s objective aims at restoring the proper
myofascial mechanics to reduce the overall stress (within all tissues, be it
muscles bone or collagen) and therefore the pain, using, for example, what is
termed “myofascial release techniques”. Once that is done, and the stress
everywhere is as low as it can be, the patient feels relief and functions better.

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It would then appear that the common ground between all manual therapy
techniques is the restoration of the normality of the fascia’s function. That would
neatly explain the conclusions of the Cochrane collaboration studies.

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It is hoped that the various schools of thoughts put aside their semantic
differences and work together to find a patient-dependent therapy that is only

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related to the patient‘s pathophysiology, rather than some vaguely defined,
unproven, philosophical conjecture.

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This however is a tall order. Medicine is perhaps the only human activity in which
an attractive idea will survive experimental annihilation
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References

1. J. H. Breasted, 1991 - The Edwin Smith Surgical Papyrus, Volume 1: Hieroglyphic

Transliteration, Translation, and Commentary. Oriental Institute
Publications 3 Chicago: The University of Chicago Press, 1930 ISBN 0-
918986-73-7

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2. Josh Snodgrass William r. Leonard, 2009 - Neanderthal Energetics Revisited:
Insights Into Population Dynamics and Life History Evolution - Department of
Anthropology - U of Oregon - Paleo Anthropology - 220−23 - DOI

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10.4207/PA.2009.ART31

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3. Gracovetsky S, 1988 reedited 2010 - The Spinal Engine (page 98). ISBN 978 1
4276 2997 5 - Amazon.

4. Chu P et al, 2014 – The effectiveness of yoga in modifying risk factors for

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cardiovascular disease and metabolic syndrome: A systematic review and
meta-analysis of randomized controlled trials – European Journal of
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Preventive Cardiology, Volume: 23 issue: 3, page(s): 291-307 -
https://doi.org/10.1177/2047487314562741
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5. Cochrane studies:

• Yamato et al, 2015 - Pilates for low back pain - Cochrane Back and
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Neck Group - DOI: 10.1002/14651858.CD010265.pub2 Franke H et

al, 2015 – Muscle energy technique for nonspecific LBP - Cochrane
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Back and Neck Group - DOI: 10.1002/14651858.CD009852.pub2

• Walker B, 2010 - Combined chiropractic interventions for low-back pain -
Cochrane Back and Neck Group - DOI:
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10.1002/14651858.CD005427.pub2
• Frederieke G Schaafsma et al, 2013 - Physical conditioning as part of a
return to work strategy to reduce sickness absence for workers with back
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pain - Cochrane Back and Neck Group - DOI:

10.1002/14651858.CD001822.pub3
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• Rubinstein SM et al, 2012 - Spinal manipulative therapy for acute low-

back pain - Cochrane Back and Neck Group - DOI:
10.1002/14651858.CD008880.pub2
• Rubinstein SM et al, 2011 - Spinal manipulative therapy for chronic low-
back pain - Cochrane Back and Neck Group - DOI:
10.1002/14651858.CD008112.pub2