You can obtain amazing results by integrating “Specific customized” fascial release procedures into any of your current techniques.
To get a better understanding of why fascia is so important let us first consider the many roles of fascia. Fascia plays a critical role in communication, in maintaining a memory of our body’s history, and acting as both a tensional network and as a living matrix.
1. Communication: We all know that our nervous system is our body’s communication system. Now, research has now show that the body’s fascial network contains ten times the number of sensory nerve receptors as those that innervate muscle. This includes many different types of sensory receptors, including both myelinated proprioceptive endings (Golgi, Paccini, and Ruffini), as well as un-myelinated free nerve endings. This knowledge has transformed our perceptions of fascia from being a static packaging material into a realization that, when you consider the incredible number of nerve receptors, that the fascia is the body’s most important perceptual organ. (1,2,3)
2. Our Fascia Contains Our History: Our fascial network is like a written history of our life! Every injury or physical force that we experience transmits mechanical forces throughout the body. Over time, these forces eventually produce transcriptional (RNA) changes in the body, which in turn produce changes in our fascial architecture. These changes can cause imbalances, adhesion formation, thickening, or decreases in mobility. This is amazing since we are literally talking about how mechanical forces initiate transcription – the process of making an RNA copy of a gene sequence,(4) and producing corresponding proteins – based on the physical history of the body. As practitioners, who use our hands to evaluate the affected tissues, fascia is capable of providing us with a massive amount of information – which we can then translate into appropriate and effective treatments for our patients.
3. The Tensional Network: Fascia is often defined as “one interconnected tensional network that adapts its fiber arrangement and density according to local tensional demands.”(5) When fascial tension is in good balance, fascia acts to distribute force throughout the body, and allows us to store and release energy for propulsion. When fascial tension is out-of-balance, hypertensive, or restricted, fascia can become the source of various dysfunctions.
The photo above, is the copyright of Professor Jaap Van Der Wal, MD, PhD University Maastricht whom I met at the Second International Fascia Congress in 2009. It shows the proximal lateral elbow region with the muscles dissected away. When you consider the convergence of all the surrounding fascial fibers into the lateral elbow and how they must inter-relate, it is easy to grasp the concept of a tensional network. Now expand this view to include all the parts of the body, and you will quickly realize the important role that fascia plays in all movement.
4. Fascia is a Living Matrix: Fascia is far from a simple arrangement of packing material surrounding our internal organs. Instead, fascia is a living matrix that surrounds, supports, and penetrates every muscle, tendon, ligaments, bone, joint, cardiovascular, and neurological structure in the body.
Fascia is a dynamic web that maintains tension for force transmission, shock absorption, and communication. In reality, your fascial network is the ultimate physical manifestation of a kinetic chain. These functions are intimately related to the cells that are contained within the fascia.(6)
Although individual cells form just a small portion of the entire volume of fascial material, certain cells play very important roles in the architectural design, repair, and setting of fascial tension. These dynamic cells are called fibroblasts.
Fibroblasts are important because they form the foundation of the fascial system. Fibroblasts are dynamic cells that (within moments) can change in length when fascial tissue lengthens under compressive loads. What is amazing about fibroblasts is that they don’t just change in shape, but they also have the ability to turn into another type of cell known as myofibroblasts. Myofibroblasts have the ability to contract, and have a direct influence on fascial tension, which in turn influences force transmission, energy storage, and communication. The contractibility of myofibroblasts is four-times stronger than that of regular fibroblasts.(7) (Fibroblast images https://www.youtube.com/watch?v=kgnp0ZU51vc)
Myofibroblasts are formed when mechanical strain increases in the body. This could be as a result of injury, repetitive stress, muscle imbalances, or even a lack of physical activity. Myofibroblasts play both positive and negative roles. For example, myofibroblasts serve an important role in wound healing, but they are also involved in fascial contractures and scar-tissue formation in conditions such as Frozen Shoulder or Dupuytren’s contracture. 7
This is where it gets interesting! Researchers have long speculated about an association between increased myofascial tension systemically and chronic states of anxiety (increased sympathetic nervous system activity). However, researchers initially did not understand the relationship that myofibroblasts have on increasing fascial tension and dysfunction. Now research has demonstrated that there is indeed a link between myofibroblasts, the sympathetic nervous system, and small proteins known as cytokines.(8)
The correlation between the sympathetic nervous system and myofibroblasts is an interesting one. Initially, researchers hypothesized that increased levels of myofibroblast contraction was related to sympathetic neurotransmitters (epinephrine, adrenaline, and acetylcholine) but later this was found not to be true. What researchers did find was that the cytokine TGF-B1 (produced during increased sympathetic activity (stress), was the connecting factor. TGF-B1 results in a very high level of myofibroblastic contraction, which leads to increased myofascial tension and related dysfunctions. (7,9)
This is really important from a practitioner’s perspective. It means that by bringing the fascial system into balance, we could have a positive systemic effect on myofibroblast activity. Which in turn could decrease overall myofascial tension. For example, by performing procedures such as the MSR™ Diaphragmatic Release (combined with appropriate breathing exercises) we could quickly see a decrease in overall sympathetic nervous system activity. Treatments that integrate this perspective could provide considerable relief for the many patients who suffer from chronic pain and a host of stress-related conditions.
Motion Specific Release & Fascial Expansions
At the beginning of this article I mentioned integrating “Specific customized” fascial release procedures into your current techniques. To do this you must start thinking about the body as a single, integrated, functional unit – one that works in synergy with all its other components.
Cookbook procedures do not address the reality of a body that functions as one synergistic unit. Fascia is tightly integrated into every part of your body, it is dynamic, and forms a web as individual as you are. This is why “specific customized” procedures must be developed for each individual. This does not mean that standard treatment protocols need to be eliminated. Instead it means that in order to reach the highest level of success in treating musculoskeletal dysfunction, we will often need to become more clinically creative.
Our MSR program has been designed to tap into that clinical creativity. Our Whole-Body Motion Specific Release Certification Program starts out by teaching over 40 basic procedures. Even at this basic level we start engaging your clinical creativity, each of these techniques involve multiple structures (6 to 10 anatomical structures). These basic procedures build on a foundation of diverse evidence-based, musculoskeletal techniques, and our own innovative ideas.
These highly effective, basic MSR techniques are the letters or syllables in your alphabet. In some cases, all that is required to achieve excellent results. In other cases, excellent results do not always equate to a full resolution of a condition.
This is especially true of long-standing chronic syndromes where basic procedures may not achieve the desired goals. This is where it is essential to tap into your clinical creativity. Think of this process as moving from alphabet and syllables into being able to articulate ideas and concepts; concepts your patient’s body will respond to.
Engaging Clinical Creativity with MSR Fascial Expansions
Using MSR we begin this creative process by considering some standard kinetic chains that may involve both soft-tissue and joint dysfunction. The kinetic chain we focus on are based on peer review research, along with the integration of information derived from functional MRI analysis, and our own clinical experience. We encourage you to address the structures in these identified kinetic chains. If you achieve the desired results, great! If not then you have to delve even deeper. (10,11,12)
Our next step is to consider the lasting effects of previous injuries, and how these injuries may have created restrictions and thickenings throughout the fascia of the body (RNA transcription under mechanical loading). This is when you would perform an even more extensive analysis: palpation with motion, muscle testing, and functional testing until a pattern begins to emerge. Now you can create a customized procedure to release that restriction, addressing all the fascial restrictions you have identified.
Motion Specific Release™ helps you to tap into the power of fascial expansions, but it also goes far beyond that. I look forward to seeing you in one of our upcoming courses, or perhaps at the 2018 Fifth International Fascia Congress in Berlin.
Check out the MSR course schedule at. www.motionspecificrelease.com
Dr. Brian Abelson DC.
Kinetic Health
Bay #10 – 34 Edgedale Dr. N.W.
Calgary Alberta, Canada
T3A-2R4
References:
1. Mitchell JH, and Schmidt RF. (1977). Cardiovascular reflex control by afferent fibers from skeletal muscle receptors. In: Shepherd JT, et al, eds, Handbook of physiology, Section 2, Vol. III, Part 2. Bethesda: American Physiological Society, pp. 623-658.
2. Schleip R. (2003). Fascial plasticity— a new neurobiological explanation. Part 1. J Bodyw Mov Ther, 7(1), pp. 11-19.
3. Van der Wal J. (2009). The architecture of the connective tissue in the musculoskeletal system: An often-overlooked functional parameter as to proprioception in the locomotor apparatus. In: Huijing PA, et al, eds. Fascia research II: Basic science and implications for conventional and complementary health care. Munich: Elsevier GmbH.
4. Chen C, and Ingber D. (2007). Tensegrity and mechanoregulation: from skeleton to cytoskeleton. In: Findley T, and Schleip R, eds. Fascia research. Oxford: Elsevier, pp. 20-32.
5. Findley T, and Schleip R. (2009). Introduction. In: Huijing PA, Hollander P, Findley TW, and Schleip R, eds. Fascia research II. Basic science and implications for conventional and complementary health care. München: Urban and Fischer.
6. Schleip R, Findley TW, Leon Chaitow L, and Huijing PA. (2012). Fascia: The Tensional Network of the Human Body – E-Book: The science and clinical applications in manual and movement therapy. Canada: Elsevier
7. Schleip R, Klingler W, and Lehmann-Horn F. (2006). Fascia is able to contract in a smooth muscle-like manner and thereby influence musculoskeletal mechanics. In: Liepsch D, ed. 5th World Congress of Biomechanics, Munich (Germany) 29 July– August 4, 2006. Bologna: Medimond International Proceedings, pp. 51-54.
8. Bhowmick S, Singh A, Flavell RA, et al. (2009). The sympathetic nervous system modulates CD4(+) FoxP3(+) regulatory T cells via a TGF-beta-dependent mechanism. J Leukoc Biol, 86, pp. 1275-1283.
9. Stefano GB, and Esch T. (2005). Integrative medical therapy: examination of meditation’s therapeutic and global medicinal outcomes via nitric oxide (review). Int J Mol Med, 16(4), pp. 621-630.
10. Yahia LH, Pigeon P, and DesRosiers EA. (1993). Viscoelastic properties of the human lumbodorsal fascia. J Biomed Eng, 15(5), pp. 425-429.
11. Langevin HM. Fibroblast cytoskeletal remodeling contributes to viscoelastic response of arealoar connective tissue under uniaxial tension. [DVD Recording] Boston MA: Second International Fascia Research Congress; 2009.
12. Sahara W, Sugamoto K, Murai M, et al: Three-dimensional clavicular and acromioclavicular rotations during arm abduction using vertically open MRI. J Orthop Res 25:1243, 2007.