Fascia. The mystery of its history

While taking some holiday time, I have enjoyed re-visiting some articles on the fascia. As you all know, I am fascinated with fascia – in fact, the entire human body, but more so the fasciae. I’ve noticed that there are some practitioners new to MFR and fascia who think that fascia has just been discovered and that MFR is a new modality that has also been ‘discovered’ for the treatment of fascial dysfunction. Fascia and MFR are not exclusive to certain approaches. To really learn about fascia, I’ve looked at various opinions, approaches and research and compared and contrasted what they say to make me a better teacher and presenter. some of which is mentioned here. Screen Shot 2017-09-27 at 13.13.56

The fasciae have come into vogue since 2007 after the first International Fascia Congress and fascial research has grown immensely since then offering new insight into its role(s), responsibilities, features and characteristics so that we can better understand function versus dysfunction. Everyone knows that I have done a number of different types of training regarding the treatment of fascia but mostly Barnes training in the USA which I absolutely loved.

For those of you interested in fascia, there are now hundreds of books discussing the history, anatomy and pathology of the fascia. A. T. Still, the Father of Osteopathy, wrote about fascia being a connected system responsible for many pathologies in the late 1800’s. Connective tissue, fibroblasts and the ground substance have been discussed for decades and some reports mention that the CT’s were ‘discovered’ around the time of the French Revolution. The advent of biochemistry at the beginning of the 19th century led to the discovery and naming of the fibres of the CT’s and constituents of the ECM. John D. Godman, an anatomist and naturalist, presented anatomical drawings in his book called ‘Anatomical Investigations Comprising Descriptions of Various Fasciae of The Human Body’ (1824) and talked about ‘this continuous fascia’ (Joanne Avison, Yoga, Fascia Anatomy and Movement).

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The term ‘Myofascial’ came into vogue when Travell and Simons wrote about myofascial pain and dysfunction but the first description of Myofascial Pain Syndrome was published in German literature in 1843. The book ‘The Myofascial Release Manual’ by Manheim (3rd edition) suggests that the term ‘Myofascial Release’ as a technique was coined in 1981 when it was used as the title of the first soft tissue release courses taught at Michigan State University in the Autumn of that year. Ida P. Rolf also discussed fascia as a 3D matrix and biotensegrity in the 1950’s (maybe even earlier) and she went on to establish the ‘Rolfing Method’ of Structural Integration. John F. Barnes published ‘The Search for Excellence’ in 1990 where he discusses fascia and MFR. This book also has a chapter by Steven Levin on biotensegrity and all JFB practitioners learning JFB MFR have understood what biotensegrity is as soon as they start using John’s approach. I have to be honest, having learned about biotensegrity from JFB through his seminars and his books, I do think that all the recent hype about it is a bit late, especially here in the UK! Biotensegrity is obvious when we think about function and dysfunction.

MFR is a confusing title as we don’t really ‘release’ anything and the JFB MFR also treats the ground substance which is not (and more than) the myofascia. I also think there may be even earlier mentions of CT’s in anatomy, I just haven’t seen it. While fascia is very much ‘in vogue’ it is an ‘ancient tissue’ with a colourful history. MFR is also wide and

varied in its approaches. Many new books now discuss the fascia. Older books don’t go into detail on the fascia, but fascia is mentioned so if you are learning about fascia it is worthwhile looking at its history so that you can see how far the fascia ‘debate’ has been in existence.

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Ruth
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Biotensegrity – putting it into clinical practice

Biotensegrity is not a new concept but is one that has recently gained a lot of fame in the manual therapy world. Tensegrity essentially means ‘tension with integrity’ and of course ‘bio’ makes it alive. Tensegrity was a term used by Buckminster Fuller, an American engineer and architect, to describe architectural structures. Can we definitely say that Fuller was the ‘Father of Tensegrity’? well, that’s a little controversial as one of his students, Kenneth Snelson, was reported to design the first tensegrity structure. However, the term was born and is still used today to describe structures that have Screen Shot 2017-09-27 at 13.44.25movement but also tension such as the Forth Rail Bridge and Eiffel Tower. Biotensegrity refers to the structure of life from the individual cell to the entire being and is a word coined by Dr Steven Levin an American Orthopaedic Surgeon with a lifelong interest in human movement and design.

I was introduced to Biotensegrity and Dr Levins work in 2000 while at Massage School in the USA. We were taught the essentials of Biomechanics and the opposing view of the human body from a Biotensegrity approach. All the soft tissue and fascial techniques I was taught addressed the whole body avoiding compartmentalising and breaking it down into symptomatic parts. I had also purchased ‘The Search for Excellence’ by John F Barnes PT which was published in 1990 as I continued my Myofascial Release (MFR)  training and it included a chapter on tensegrity written by Dr Levin. Screen Shot 2017-09-27 at 13.47.54Everything I have ever learned from a fascial point of view has been based on tensegrity and the body as a united moving structure. This is fundamental to feeling for and resolving Biotension resulting in lack integrity and vice versa.

There has been a lot written recently on Biotensgrity. However, for the practising therapist, that needs to be taken further. What happens when Biotensegrity goes wrong? If all parts of the body move together with concentric and eccentric loading, then symptoms, aches and pains would represent in a lack of integrity.

Every dysfunction in the body results in adhesive tissue. Misuse, disuse, overuse and underuse will create internal scarring and adhesions, you just can’t see them from the outside. Lack of integrity and tissue tension creates pulls and twists within the soft tissues causing irregular loading (Wolfs Law) resulting in the fascial thickening to try and support the load. There doesn’t need to be an external scar to have scar tissue and adhesion in your body.  See this video from a Channel 4 tv programme ‘Anatomy for Beginners’ by Dr Gunther von Hagens. Click on the picture below for the link.

Anatomy for Beginners

If you’re squeamish, just take my word for it, there are adhesions! This is a dissection of an unembalmed fresh cadaver. If you’ve been to a cadaver dissection, you’ll know that there is an ‘art’ to dissection but, Dr von Hagens does a bit of a butchers job here but his aim is to show you systems of the body, in this case, the circulatory system and it’s a fresh cadaver in a hot tv studio so he does the dissection part quite fast.

Everything that we do with MFR is looking for, feeling for, finding and treating internal scarring and adhesions. We assess the Biotensegrity structure, looking for lack of integrity using palpation skills, postural and movement assessments so that we have an idea of what is balanced and functional and what is not. The most useful assessment that I use in all my treatment sessions is a bilateral leg pull. I can assess the whole body with this. How far does the tissue pull and drag go up into the body, does it feel equal on both sides, does one leg seem stuck somewhere opposed to the other or not?

Tensegrity just makes sense when it comes to the fasciae. The fasciae also include the ground substance of the body, the gel that bathes and touches every cell. MFR is not just about treating the fascia around and through muscle, it is treating the entire fascial matrix which includes the ground substance. The ground substance transmits information regarding pressure and tension around the 3D matrix, therefore using light sustained pressure in our MFR approach targets the ground substance and not just the myoafscia. If we can alter the consistency of the ground substance by the heat, weight and pressure of our hands, we can address the thickening or viscosity of the ground substance so that it becomes less viscous (thinner) which in turn allows structures to glide past each other instead of sticking together.

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This picture, as good as it is for depicting the fascial system, is still not quite giving you the concept that fascia is multidimensional and multidirectional. Imagine your body is a sponge where all your bones, vessels, nerves and organs live inside that sponge. If you pull one part of that sponge, the pull and drag goes right through it and with it comes all the internal contents.

Being able to understand Biotensegrity and use that knowledge in treatment makes performing MFR so much easier yielding far better and long lasting results.

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Ruth Duncan. Advanced MFR Practitioner. Author of ‘A Hands-On Guide to Myofascial Release’

 

 

 

 

 

Myofascial Release – Lost in Translation

Myofascial Release (MFR) is a specialised physical and manual therapy used for the effective treatment and rehabilitation of soft tissue and fascial aches, pains, tension and restrictions.

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It is traditionally accepted that myofascia is the connective tissue (fascia) in and around muscles, where muscles are the powerhouses of locomotion and posture for the body. Myofascial release is, therefore, an application used to alleviate tension, restrictions and adhesions in the myofascia in order to restore balance and function. Muscles respond well to firm deep pressure which is probably why MFR specifically targeting muscles and kinetic chains (muscle chains) uses a relatively firm force applied by the practitioner and also why therapy tools such as foam rollers, cricket balls and sports peanuts are so popular. Many people, especially sports people, like firm pressure and feel that muscular stretch and deep therapy work benefits them. When people are fit, healthy and physically active, deeper MFR approaches can be appropriate but never to the painful stage. However, consideration has to be taken in to account that excessive and aggressive deep work either by an unskilled practitioner or by the use of therapy tools by an uneducated person could actually create more restriction, scarring and inflammation and therefore damage tissue. In addition, bruising is tissue damage and any self-care or treatment approaches should never result in bruising. Using firm pressure may affect the deep muscular tissue but can have a damaging affect on the more fragile superficial tissues.

The general understanding of ‘myofascial release’ has changed over the last decade since MFR UK has been providing workshops for healthcare professionals. In the past, MFR was a treatment approach in its own right and everything else was called massage.  However, with popularity comes ambiguity and what MFR is and how it’s applied has become somewhat lost in translation over recent years. Normally the term ‘massage’ describes a fluid movement over the body using lubrication. As the popularity of MFR grows, massage treatments are being renamed ‘MFR’ to keep up with the current trends creating confusion for both practitioners seeking professional MFR training and for clients seeking resolve from their pain and discomfort. The thought is that as massage treats muscles, then myofascia must be being treated as well. This is not strictly incorrect as you can’t influence one without influencing the other. This is also why self-care approaches such as foam rolling have become termed ‘self-myofascial release’, or SMFR, yet a practitioner using their forearm on your leg in a massage is the same application of stroke but can still be called massage or soft tissue therapy. Confusingly, the term massage and MFR seem to have become interchangeable. However, it is of huge value to understand that not all fascia is myofascia and true MFR treats the entire fascial structures not only that of the muscular system.

No-one owns the term ‘myofascial release’ and it is indeed only a term just like the term massage. However, as research into fascia has increased, the awareness of what fascia is has cultivated a change of thinking as to what tissues we are actually treating when we touch the human body. Can you really touch the skin without influencing the tissues below? Can we really affect muscle without influencing the skin and the superficial fascia above and can we actually affect the visceral tissues when the muscles above are restricted?  In addition, if all fascial structures are lubricated by the viscous ground substance (gel fascia), which is a non-Newtonian fluid resisting pressure in order to protect, then fascial applications should be applied to influence more than the myofascia alone. When the fascial system is restricted, the ground substance becomes thicker (more viscous). This means less lubrication of the soft tissue and myofascial structures encouraging adhesions and internal scarring and dysfunction which affects all other structures. The fascial is a totally connected system and is the system that touches all others. Which then brings the next consideration. if the fascial system touches all other systems, then by default, all therapeutic applications which physically influence the body, have to be fascial. However, before we get carried away, it’s not what we do, it’s how we do it that makes the difference.

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Traditional MFR approaches, and certainly, those massage approaches renamed MFR, fail to address the entire 3D fascial system but maintain a myopic point of view providing short lived results for many people. Moreover, some MFR approaches have been shown to be too aggressive for chronic and persistent pain sufferers and even make their conditions worse.

As research has progressed, we have learned so much more about the fascial system where a firm, deep pressure into the system has been replaced by a cultivated kinesthetic and skilled touch refined by knowledge of mechanotransduction, fluid dynamics, piezoelectricity and viscosity. The days of ‘no pain, no gain’ are gone and is replaced by ‘pain, no gain’

The next issue we have is the term ‘myofascial release’ isn’t quite accurate either. New research has highlighted that we can’t actually ‘release’ anything with exception of releasing perceived tension. Yet, MFR is the recognised term and is probably the term that will stay in the manual therapy toolbox.

MFR does not use oils or lotions, it is performed dry so that the practitioner avoids glide over the skin but can feel deeper into the tissue. MFR UK cultivates a sense of touch so that each and every treatment is uniquely delivered with skilled ‘listening’ hands. Regardless of your client base being derived from the sports, athletic and performance field or whether you work with chronic and persistent pain, our training provides a wealth of theory, research and effective techniques and MFR approaches to suit your client base.

sphenoid 3 copy 2MFR UK teaches and promotes an integrated approach to MFR. We specialise in the sustained approach to MFR where we are targeting the fluid ground substance of the fascial system following the ebb and flow of the tissues in totality. These sustained techniques offer body wide change and tissue reorganisation as well as offer a platform for emotional release and trauma resolve. Our integrated approach teaches the practitioner the skill of feeling different layers and structures under their hands, this is the art of kinesthetic touch. This approach allows practitioners to learn which techniques are appropriate for individual clients and how to apply them in a bespoke manner. No one technique fits all, instead, the skill of learning MFR is how much pressure to use and for how long to encourage tissue change without force.

Myofascial Release and Physical and Emotional Scars

What is a scar?

My experience of treating scars is based on working with both visible and invisible scars for over 15 years using myofascial release.

I often think the visible scar, the incision, from surgery or injury is only a very small part of the problem but that’s the bit we see and logically, is the bit we want to treat.

Having now got a very large abdominal scar, all 18cms of it, from just above my belly button to pubis, I can tell you from first hand experience what scars feel like. Funnily enough, the most uncomfortable part of my scar is a small part which crosses over another 20 year old 1cm long scar pulling it into a direction it has never been before. This area can be exquisitely sharp and painful when caught by clothing or when I lean against something.

I knew that because of the extent of my surgery I would need to get MFR treatment as soon as practically possible to try and avoid compensatory patterns of dysfunction and soft tissue adhesions. I had a total hysterectomy because I was carrying a watermelon. It really was an alien living inside me whom I called Wilbour, AKA, an ovarian cyst. Don’t ask me why, I have no idea, but that was Wilbour. Wilbour was on the large side. Even when the consultant saw him on the ultrasound she said ‘oh my!’ He was 22x10cm, the size of a 20-21 week old foetus and Wilbour had to vacate the premises tout suite – in case he burst.!! I looked 6 months pregnant, had morning back ache, acid reflux and intermittent stress incontinent- nice!! But what I didn’t have was any pain. So I had urgent surgery to remove everything along with Wilbour. My incision is big because he had to all be removed in one go as there was the potential risk of cancer and cutting anything apart to extricate it would have possibly spread any resident cancer.

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Wilbour 2 days  before surgery

As soon as I was back on the ward, I was doing my own style of focusing on the area, learning about my new body anatomy. I did lots of gentle leg stretches and placed my hands over my scar to connect with everything below, which I still do today 1 year on. When I was able,  I began to use my therapy ball laying on it in my hip flexor area, both sides, as well as gently treating my scar. I was almost 6 months post surgery before I could lie face down reasonably comfortably on a massage couch.

I often wonder whats going on inside my body. What happened to the gaps where my uterus and ovaries where?. What’s happened to the other structures supported by the uterus like the bladder? How much scar tissue has been created inside after they cut things out? The line of the incision really is nothing compared to the adhesions and changes in anatomical geography on the inside.

You know the analogy of the iceberg often used for the conscious and unconscious mind? The smaller part of the iceberg or consciousness is above the waterline but the biggest part of the iceberg, or unconsciousness, is below the surface. A scar is the same. Just the incision is above but all the adhesions are below the surface pulling, twisting and compressing all the structures around the surgery or injury site.

Over time, ‘creep’ develops. Creep is the delayed onset of adhesions and restrictions where the ECM becomes more viscous (thicker) stopping layers and structures gliding over each other. I think scars are like black holes where they suck and pull other structures towards them. Gradually, these adhesions affect the tensile nature of the body and you get asymmetry which has a knock on effect to balance, co-ordination and function.

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My scar at 8 weeks post op

Very often, dysfunction and pain at distant sites in the body can be traced back to surgery or injury scars. I always ask my clients if they have any scars from surgery or injury as they are often playing a part in dysfunction. Abdominal scars can often affect the lower extremities causing ankle and knee pain as well as pulling upwards into the anterior neck and jaw. Back surgery can also cause pelvic problems as well as digestion and elimination issues. Don’t under estimate the effect scars can have on the body and the older the scar, the more effect it can have.

BUT – all asymmetry, imbalance and dysfunction are caused by scarring, you just can’t see any incision. Overuse, misuse, underuse and disuse cause adhesions in the tissue and will cause pain and compensatory patterns. Scar tissue work is something myofascial therapists do every day in practice. We assess for soft tissue and fascial dysfunction and treat it accordingly. We feel, follow and treat all fascial adhesions visible or invisible.

But what about emotional scarring? If you have ever read books by Stanley Keleman you will know a little about emotional anatomy. There are other books as well discussing trauma like Pete Levine’s Waking the Tiger. These books discuss emotion and how that emotion manifests its self in body dysfunction. Emotional trauma is common, more common than you think and leaves its scars on the body, you just can’t see them but you can feel them.  Myofascial release is one of only a few treatment approaches that help clients to focus on their own bodies and to feel whats going on. Often emotions surface as the tissue reorganises from the hands-on treatment and the parasympathetic nervous system compensates for the ‘fight and flight’ response. Emotions such as grief, anger, frustration, hate and fear are scars and the skill of the MFR therapist is to work with the client helping them to process what they are feeling without judgement or force.

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Fascial adhesions

Over the years, I have had the privilege of working with many clients who have been able to work through horrendous memories of trauma including abuse, death, ill health, car accidents, falls, surgery and many others. Emotional scarring not only comes from a physical component or feeling but it can also come from a symbolic component. For example, the client who constantly struggled to breathe. It transpired that she had a constant feeling of being crushed, of not being good enough, and that the wind was constantly being taken away from her sails. Her emotion had manifested itself physically and myofascial treatments were able to help her build confidence and helped her to get rid of the feeling of not being able to breathe. Or the client who had unrelenting hip and leg pain. She felt that she had to walk on eggshells daily as she had been in an abusive relationship. Her fears and physical manifestations of them had become such an unconscious habit pattern, the awareness of the cause was outwoth her conscuousness so she didnt know how to change the pattern. Once the awareness was in her consciousness, she was able to remind herself that she was now safe and that it was ok to stand on her own two feet.

Even the oldest scar can be treated and a positive result can be gained. But, like everything else, scar tissue work is part of the bigger picture. MFR therapists always look for a treat visible scars and often find emotional scarring along the way, they go hand in hand. Emotion and physicality cannot be separated.

If you want to know more about MFR and emotions, I have a chapter in my book called ‘myofascial unwinding’ which discusses the spontaneous movement and emotional release as a response to myofascial treatments. ‘A Hands-On Guide to Myofascial Release’ published by Human Kinetics.

Ruth

Duncan high res book cover 25pc

 

 

 

 

 

Myofascial Release, the energetic component

I often describe to students that the energy which some clients ‘release’ as a response to myofascial release therapy is like the electricity from a lightning bolt. Not that it is in any way as powerful as that energy obviously, but it’s as haphazard, quick and sometimes feels quite focused and determined under your hands.

I have just spent the day with a great friend and colleague, Carol Davis, who is an expert in myofascial release both as a lecturer and practitioner. Carol was the professor of physical therapy at the University of Miami, has authored books on complementary and alternative therapy, has lectured in various countries around the world and teaches on the John F Barnes myofascial release seminars in the USA.

Carol is passionate about myofascial release, the promotion of the understanding of the role and responsibilities of the fascial system and how this knowledge can help us as practitioners help those with pain and dysfunction.

It was a joy today to discuss not just the techniques and practical application of myofascial release (MFR) but also the energy work brought from communication and resonance, verbally and physically, throughout the treatment session.

When you first learn to apply MFR techniques, we all learn by repetition. However, on our workshops, we teach that the techniques are only a part of the bigger picture. A technique is nothing if you can’t feel what’s happening under your hands. I hear so many students ask ‘how long do we apply this technique for’. It’s not about how long, it’s about what you feel and sense through your hands that tell you what’s happening, how to dialogue with the client, where to go next and what pressure to use.

‘It’s not how much pressure you use, it’s how much resistance you feel’

MFR is not about doing techniques like a recipe. When you are learning, that recipe and repetition will get you started but when you become experienced with the responses and feelings elicited with MFR, the techniques blend into insignificance and the energy of the work takes over.

Back to the lighting bolt.

Have you ever seen an electricity cable swirl with the force of the electric current? Remember the movie Back to the Future where Doc Brown is trying to plug the electric cable together so that Marty can go back to the future? The lightning bolt hits the clock tower, goes down the cable, hits the DeLorean and back to the future, he goes.

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