BOOK
Fascia: The Tensional Network of the Human Body - E-Book
Robert Schleip | Thomas W. Findley | Leon Chaitow | Peter Huijing
(2013)
Additional Information
Book Details
Abstract
This book is the product of an important collaboration between clinicians of the manual therapies and scientists in several disciplines that grew out of the three recent International Fascia Research Congresses (Boston, Amsterdam, and Vancouver). The book editors, Thomas Findley MD PhD, Robert Schleip PhD, Peter Huijing PhD and Leon Chaitow DO, were major organizers of these congresses and used their extensive experience to select chapters and contributors for this book.
This volume therefore brings together contributors from diverse backgrounds who share the desire to bridge the gap between theory and practice in our current knowledge of the fascia and goes beyond the 2007, 2009 and 2012 congresses to define the state-of-the-art, from both the clinical and scientific perspective.
Prepared by over 100 specialists and researchers from throughout the world, Fascia: The Tensional Network of the Human Body will be ideal for all professionals who have an interest in fascia and human movement - physiotherapists, osteopathic physicians, osteopaths, chiropractors, structural integration practitioners, manual therapists, massage therapists, acupuncturists, yoga or Pilates instructors, exercise scientists and personal trainers - as well as physicians involved with musculoskeletal medicine, pain management and rehabilitation, and basic scientists working in the field.
- Reflects the efforts of almost 100 scientists and clinicians from throughout the world
- Offers comprehensive coverage ranging from anatomy and physiology, clinical conditions and associated therapies, to recently developed research techniques
- Explores the role of fascia as a bodywide communication system
- Presents the latest information available on myofascial force transmission which helps establish a scientific basis for given clinical experiences
- Explores the importance of fascia as a sensory organ - for example, its important proprioceptive and nociceptive functions which have implications for the generation of low back pain
- Describes new imaging methods which confirm the connectivity of organs and tissues
- Designed to organize relevant information for professionals involved in the therapeutic manipulation of the body’s connective tissue matrix (fascia) as well as for scientists involved in basic science research
- Reflects the increasing need for information about the properties of fascia, particularly for osteopaths, massage therapists, physiotherapists and other complementary health care professionals
- Offers new insights on the fascial related foundations of Traditional Chinese Medicine Meridians and the fascial effects of acupuncture
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Fascia: The Tensional Network of the Human Body: The science and clinical applications in manual and movement therapy | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| On-line video resources | x | ||
| Contributors | xi | ||
| Introduction | xv | ||
| Welcome to the world of fascia! | xv | ||
| Not only a packing organ | xv | ||
| What is fascia? | xvi | ||
| References | xviii | ||
| Section I: Scientific foundations | 1 | ||
| Part 1: Anatomy of the fascial body | 3 | ||
| Chapter 1.1: General anatomy of the muscle fasciae | 5 | ||
| Introduction | 5 | ||
| General structure and composition of muscle fasciae | 5 | ||
| Functional anatomy of the endomysium | 6 | ||
| Functional anatomy of the perimysium | 7 | ||
| Perimysial-endomysial junction zones | 8 | ||
| Perimysium and intracellular subdomains | 9 | ||
| Conclusions | 9 | ||
| References | 10 | ||
| Bibliography | 10 | ||
| Chapter 1.2: Somatic fascia | 11 | ||
| Global organization of fascia in the body | 11 | ||
| Overview of the organization of somatic fascia in the body | 11 | ||
| Architecture of fascia - the four primary layers | 12 | ||
| General approach | 12 | ||
| Four primary layers of fascia | 12 | ||
| Pannicular fascia | 12 | ||
| Axial fascia | 12 | ||
| Meningeal fascia | 15 | ||
| Visceral fascia | 15 | ||
| Summary | 15 | ||
| References | 17 | ||
| Bibliography | 17 | ||
| Chapter 1.3: Fascia superficialis | 19 | ||
| Introduction | 19 | ||
| Gross structure and distribution | 19 | ||
| Components and their relation to function | 21 | ||
| Aging changes in subcutaneous tissue | 23 | ||
| References | 23 | ||
| Chapter 1.4: Deep fascia of the shoulder and arm | 25 | ||
| The deep fascia of the shoulder | 25 | ||
| The deep fascia of the arm | 26 | ||
| The palmar aponeurosis | 27 | ||
| The myofascial expansions | 27 | ||
| The resiliency of the deep fasciae of the arm | 28 | ||
| References | 29 | ||
| Bibliography | 29 | ||
| Chapter 1.5: Deep fascia of the lower limbs | 31 | ||
| Introduction | 31 | ||
| Gross anatomy | 31 | ||
| The retinacula | 32 | ||
| Fibrous expansions and muscular insertions | 32 | ||
| Microscopic anatomy | 33 | ||
| References | 35 | ||
| Bibliography | 35 | ||
| Chapter 1.6: The thoracolumbar fascia | 37 | ||
| Introduction | 37 | ||
| Superficial lamina (Fig.1.6.1) | 38 | ||
| Deep lamina (Fig.1.6.2) | 38 | ||
| Kinematics | 39 | ||
| Overarching arguments about the anatomy of the TLF | 39 | ||
| Conclusion | 41 | ||
| References | 42 | ||
| Chapter 1.7: The deeper fasciae of the neck and ventral torso | 45 | ||
| Introduction | 45 | ||
| Neck fascia | 45 | ||
| Arrangement of the three neck fascia | 46 | ||
| Fascia colli superficialis (lamina superficialis fasciae cervicalis) | 46 | ||
| Fascia colli media (lamina pretrachealis fasciae cervicalis) | 46 | ||
| Fascia colli profunda (lamina pretrachealis fasciae cervicalis) | 47 | ||
| Fascia of the thorax | 47 | ||
| Endothoracic fascia | 47 | ||
| Pleural cavity | 48 | ||
| Parietal pleura | 48 | ||
| Pleural dome/cervical pleura | 48 | ||
| Fascial structures in the mediastinum | 48 | ||
| Fascia of the abdominal wall | 50 | ||
| Superficial layer | 50 | ||
| Middle layer with transverse fascia | 50 | ||
| Deep layer | 51 | ||
| Bibliography | 52 | ||
| Chapter 1.8: Visceral fascia | 53 | ||
| Introduction | 53 | ||
| Visceral fascia | 53 | ||
| Cervical visceral fascia | 54 | ||
| Thoracic visceral fascia | 54 | ||
| Abdominal visceral fascia | 54 | ||
| Pelvic visceral fascia | 55 | ||
| Summary | 55 | ||
| Visceral ligaments | 55 | ||
| Adhesions | 56 | ||
| References | 56 | ||
| Bibliography | 56 | ||
| Chapter 1.9: Membranous structures within the cranial bowl and intraspinal space | 57 | ||
| Embryonic growth dynamics of the dural membrane according to Blechschmidt | 57 | ||
| Intracranial membrane system | 57 | ||
| Pia mater (soft inner layer of the dural membrane system) | 57 | ||
| Arachnoidea (middle layer of the meningeal membranes) | 58 | ||
| Dura mater (hard outer layer of the meningeal membranes) | 59 | ||
| Horizontal and vertical dural system | 59 | ||
| Extracranial membranous system | 60 | ||
| Pia mater spinalis | 60 | ||
| Arachnoidea spinalis | 60 | ||
| Dura mater spinalis | 60 | ||
| Ligamenta craniale durae matrae spinalis | 61 | ||
| M. rectus capitis posterior minor and M. obliquus inferior | 61 | ||
| Interspinal ligaments of the dura mater | 61 | ||
| Vascularization of the meningeal membranes | 62 | ||
| Intracranial vascularization | 62 | ||
| Intraspinal vascularization | 62 | ||
| Meningeal nerve supply | 62 | ||
| Intracranial innervations | 62 | ||
| Intraspinal innervation | 63 | ||
| Tasks of the dural system | 63 | ||
| Reciprocal tensile membrane | 63 | ||
| Sutherland fulcrum | 63 | ||
| Possible effects of abnormal dural tension | 63 | ||
| Future tasks and open questions | 64 | ||
| References | 64 | ||
| Bibliography | 65 | ||
| Chapter 1.10: Diaphragmatic structures | 67 | ||
| Introduction | 67 | ||
| Embryology | 67 | ||
| Organization | 68 | ||
| Central part | 68 | ||
| Peripheral part | 68 | ||
| Posterior part | 69 | ||
| The crura of the diaphragm | 69 | ||
| The two arcuate ligaments | 70 | ||
| Relationships and role | 70 | ||
| Mechanics of diaphragmatic contraction | 70 | ||
| Interaction with the rest of the body | 70 | ||
| The intracavity route | 70 | ||
| Caudally | 70 | ||
| Cephalically | 71 | ||
| The peripheral route | 71 | ||
| Synergy of the contraction of the diaphragm | 71 | ||
| References | 72 | ||
| Bibliography | 72 | ||
| Part 2: Fascia as an organ of communication | 75 | ||
| Chapter 2.1: Fascia as an organ of communication | 77 | ||
| References | 79 | ||
| Chapter 2.2: Proprioception | 81 | ||
| Proprioception, mechanoreception and the anatomy of fascia | 81 | ||
| Connectivity and continuity | 82 | ||
| Architecture is different and more than anatomy | 83 | ||
| The substrate of mechanoreception | 84 | ||
| The functional role of architecture of the connective and muscular tissue in mechanoreception | 85 | ||
| Dynaments: more than ligaments or muscles | 86 | ||
| Classification of mechanoreceptors in proprioception | 86 | ||
| References | 87 | ||
| Bibliography | 87 | ||
| Chapter 2.3: Interoception | 89 | ||
| Introduction | 89 | ||
| What is interoception? | 89 | ||
| Sensual touch | 89 | ||
| new phylogenetic development | 90 | ||
| Interoception and somatoemotional disorders | 91 | ||
| Fascia as an interoceptive organ | 92 | ||
| Manual therapy and interoception | 93 | ||
| Movement therapies and interoception | 93 | ||
| References | 94 | ||
| Bibliography | 94 | ||
| Chapter 2.4: Nociception... | 95 | ||
| Introduction | 95 | ||
| Innervation of the thoracolumbar fascia | 96 | ||
| Electrophysiology | 98 | ||
| References | 100 | ||
| Chapter 2.5: Fascia as a body-wide communication system | 103 | ||
| Introduction | 103 | ||
| The fascia | 104 | ||
| Tracing the kinetic chain through the living matrix | 105 | ||
| Regulation of fascial architecture | 105 | ||
| Electrical fields and the piezoelectric effect | 106 | ||
| Light | 108 | ||
| Muscle sounds | 108 | ||
| Conclusions | 109 | ||
| References | 109 | ||
| Bibliography | 110 | ||
| Part 3: Fascial force transmission | 112 | ||
| Chapter 3.1: Force transmission and muscle mechanics | 113 | ||
| Myotendinous force transmission | 113 | ||
| Myofascial force transmission | 113 | ||
| Chapter 3.2: Myofascial force transmission | 117 | ||
| Intramuscular substrates of myofascial force transmission | 117 | ||
| Epimuscular myofascial force transmission and its substrate | 117 | ||
| Effects of epimuscular myofascial force transmission | 118 | ||
| Proximo-distal force differences | 118 | ||
| Distributions of sarcomere lengths within muscle and its myofibers | 118 | ||
| Myofascial interaction between muscles | 119 | ||
| Muscular relative position also affects muscular force exertion | 119 | ||
| Complexity of myofascial loading of muscle | 120 | ||
| Additional factors to consider | 120 | ||
| Joint movement | 120 | ||
| Levels of muscular activation | 121 | ||
| Effects on functioning of the sensory apparatus | 121 | ||
| References | 121 | ||
| Chapter 3.3: Myofascial chains | 123 | ||
| Kurt Tittel: muscle slings | 123 | ||
| Extension slings | 123 | ||
| Flexion slings | 123 | ||
| Muscle slings in static motion patterns | 123 | ||
| Muscle slings in sidebending and rotation of the trunk | 124 | ||
| Herman Kabat: proprioceptive neuromuscular facilitation (PNF) | 124 | ||
| Method | 125 | ||
| Godelieve Struyf-Denys | 125 | ||
| The vertical or fundamental chain | 125 | ||
| The anteromedian chain | 125 | ||
| Primary section | 125 | ||
| Secondary section: Connects the torso with the extremities | 126 | ||
| The posteromedian chain | 126 | ||
| Section II: Clinical application | 183 | ||
| Part 5: Fascia-related disorders | 185 | ||
| Chapter 5.1: Fascia-related disorders | 187 | ||
| References | 189 | ||
| Chapter 5.2: Dupuytren's disease and other fibrocontractive disorders | 191 | ||
| Introduction | 191 | ||
| Who is afflicted by this disease? | 191 | ||
| The basic problems of Dupuytren's disease | 192 | ||
| Basic anatomy of Dupuytren's disease | 192 | ||
| Palmar nodules | 192 | ||
| Palmar cords | 193 | ||
| Why are some fingers affected more than others? | 193 | ||
| Are all myofibroblasts the same? | 194 | ||
| What is the origin of the cells which cause the \"pits\" at the distal palmar crease? | 194 | ||
| What \"instructs\" the cells on the aponeurosis to contract? | 195 | ||
| What \"instructs\" the cells in the aponeurosis to proliferate? | 195 | ||
| Does a knowledge of the causative factors enable rational treatments to be suggested? | 195 | ||
| Surgical approach | 195 | ||
| Pharmacological approach | 196 | ||
| Peyronie's disease | 197 | ||
| Ledderhose's disease | 197 | ||
| Conclusion | 197 | ||
| References | 197 | ||
| Bibliography | 197 | ||
| Chapter 5.3: \"Frozen shoulder | 199 | ||
| Introduction | 199 | ||
| Determining the concept and classification | 199 | ||
| Epidemiology | 200 | ||
| Etiology and pathogenesis | 200 | ||
| Clinical symptoms | 201 | ||
| Imaging | 202 | ||
| Treatment | 202 | ||
| Conservative treatment | 202 | ||
| Mobilization under anesthetic | 203 | ||
| Arthroscopic arthrolysis | 203 | ||
| Treatment for secondary frozen shoulder | 204 | ||
| Summary | 204 | ||
| References | 204 | ||
| Bibliography | 206 | ||
| Chapter 5.4: Spastic paresis | 207 | ||
| Introduction | 207 | ||
| Surgical treatment of the upper extremity in spastic paresis | 207 | ||
| Spastic muscles | 208 | ||
| Observations during surgery | 208 | ||
| Epimuscular force transmission | 210 | ||
| Towards an explanation of spasticity-related joint positions | 210 | ||
| Conclusion | 212 | ||
| References | 212 | ||
| Chapter 5.5: Diabetic foot | 215 | ||
| Introduction | 215 | ||
| Methodology of testing | 215 | ||
| Assessment of fascia, tendon, and ligament | 215 | ||
| Assessment of joint mobility and stiffness | 216 | ||
| Pressure distribution measurement | 216 | ||
| Nonenzymatic glycosylation | 216 | ||
| Plantar fascia | 216 | ||
| Rupture and fasciitis | 216 | ||
| Plantar fascia thickening | 217 | ||
| Biomechanical implications | 217 | ||
| Clinical implications and treatment | 217 | ||
| Achilles tendon | 218 | ||
| Achilles tendon shortening/equinus deformity | 218 | ||
| Achilles tendon thickening | 218 | ||
| Biomechanical and clinical implications | 218 | ||
| Treatment: Achilles tendon lengthening | 219 | ||
| Limited joint mobility | 219 | ||
| Limited joint mobility in the foot and ankle | 219 | ||
| Biomechanical implications | 220 | ||
| Clinical implications | 221 | ||
| Treatment: Joint mobilization | 221 | ||
| Conclusions | 221 | ||
| References | 222 | ||
| Chapter 5.6: Scleroderma and related conditions | 225 | ||
| What is \"scleroderma\"? | 225 | ||
| Clinical features of special relevance to MT | 226 | ||
| Features affecting the neurovascular and fascial systems | 226 | ||
| Vasculitis | 226 | ||
| The myofascial system | 226 | ||
| Secondary Raynaud's phenomenon (\"Raynaud's\") | 226 | ||
| Sclerodactyly | 226 | ||
| Pulmonary sclerosis/pulmonary hypertension (PHT) | 227 | ||
| Myo- and pericardiac damage | 227 | ||
| GI tract | 227 | ||
| Other potential organ involvement | 227 | ||
| Types of scleroderma, and where SSc fits in | 227 | ||
| Localized scleroderma (LSc) | 227 | ||
| Systemic sclerosis (SSc) | 228 | ||
| Mixed connective tissue disease (MCTD) | 228 | ||
| Conventional medical management | 228 | ||
| Can MT help reduce or reverse scleroderma-related fibrotic changes? | 228 | ||
| Clinical evidence to date | 228 | ||
| Fascial release (FRT) and structural integration (SI) | 228 | ||
| Rationale for potential MT efficacy | 229 | ||
| FRT techniques, the SI process, and the KMI model | 229 | ||
| Potential mechanism of effect | 229 | ||
| Scientific basis: potential therapeutic mechanisms | 229 | ||
| Fascial changes such as softening, increased pliability, flexibility, and mobility | 229 | ||
| Restored independent sliding, gliding, and coordination between adjacent myofascial structures and associated enhanced areolar | 230 | ||
| Decreased myofascial pain | 230 | ||
| Findings arising from the 2009 2nd International Fascia Congress | 230 | ||
| Psychoneuroimmunology (PNI) | 230 | ||
| Neuromuscular technique (NMT) and muscle energy technique (MET) | 230 | ||
| Manual lymphatic drainage (MLD) | 231 | ||
| Conclusion | 231 | ||
| References | 231 | ||
| Chapter 5.7: Trigger points as a fascia-related disorder | 233 | ||
| Trigger points (TrP) | 233 | ||
| Pathophysiology | 233 | ||
| Clinical symptoms | 235 | ||
| Diagnosis | 236 | ||
| Etiology | 236 | ||
| Fascia and myofascial trigger points | 236 | ||
| Fascia-induced muscle dysfunction | 237 | ||
| Fascia dysfunction in its role in the origin and activation of mTrPs | 238 | ||
| Strain as a result of disorder of the fascia mechanics | 238 | ||
| Changes in sensory input | 238 | ||
| Autonomic disorders | 238 | ||
| Peripheral chronification | 239 | ||
| Trigger point-induced fascia dysfunction | 240 | ||
| Mechanically-induced fascia dysfunction | 240 | ||
| Biomechanically-induced fascia dysfunction | 240 | ||
| Therapeutic consequences | 240 | ||
| References | 241 | ||
| Chapter 5.8: Fascia-related disorders | 245 | ||
| Introduction | 245 | ||
| Clinical features of EDS and Marfan syndrome | 245 | ||
| Neuromuscular involvement in EDS and Marfan syndrome | 246 | ||
| Effects of TNX-deficiency on muscle characteristics in a mouse model of EDS | 247 | ||
| Intramuscular changes: increased muscle compliance | 249 | ||
| Intermuscular changes: reduced epimuscular myofascial force transmission | 249 | ||
| References | 250 | ||
| Chapter 5.9: Anatomy of the plantar fascia | 253 | ||
| Biomechanical function of the plantar fascia | 253 | ||
| Internal loading of the plantar fascia | 254 | ||
| Plantar fasciitis | 255 | ||
| Clinical signs and symptoms in plantar fasciitis | 255 | ||
| Imaging in plantar fasciitis | 255 | ||
| Radiographic | 255 | ||
| Sonographic | 255 | ||
| Magnetic resonance | 256 | ||
| Histopathology of plantar fasciitis | 257 | ||
| Etiology | 257 | ||
| Evidence for a neuromuscular deficit in plantar fasciitis | 259 | ||
| Evidence for an inherent fascial deficit | 260 | ||
| Summary | 260 | ||
| References | 260 | ||
| Bibliography | 261 | ||
| Part 6: Diagnostic procedures for fascial elasticity | 263 | ||
| Chapter 6.1: Diagnostic procedures for fascial elasticity | 265 | ||
| References | 267 | ||
| Chapter 6.2: Fascial palpation | 269 | ||
| Active versus passive assessment | 269 | ||
| When are you palpating? | 269 | ||
| Palpation tools | 269 | ||
| What is being palpated? | 270 | ||
| The need for a relaxed therapist | 270 | ||
| Layers (see Figure 6.2.1) | 270 | ||
| Communicating with the client | 271 | ||
| Palpating for information | 271 | ||
| Palpation objectives | 272 | ||
| Palpate by \"feeling\", not thinking | 272 | ||
| Physiology of touch | 272 | ||
| Filtering information | 273 | ||
| An osteopathic palpation perspective | 273 | ||
| Practical palpation | 274 | ||
| Palpation exercises (Myers 2010) | 274 | ||
| Palpation of the Superficial Front Line (Fig.6.2.2) | 274 | ||
| Palpation of the Superficial Back Line (Fig. 6.6.3) | 275 | ||
| Palpation of the Lateral Line (Fig 6.2.4) | 275 | ||
| Palpation of the Deep Front Line (Fig.6.2.5) | 276 | ||
| Conclusion | 277 | ||
| References | 277 | ||
| Chapter 6.3: Hypermobility and the hypermobility syndrome | 279 | ||
| Introduction | 279 | ||
| Pathogenesis | 279 | ||
| Testing for hypermobility and hypermobility syndrome | 280 | ||
| Marfan's syndrome | 281 | ||
| Clinical presentation of hypermobility syndrome | 282 | ||
| Musculoskeletal signs and symptoms | 282 | ||
| Osteoarthritis | 283 | ||
| Osteopenia and osteoporosis | 283 | ||
| Neurophysiological disorders | 283 | ||
| Cardiopulmonary disorders | 284 | ||
| Chronic widespread pain and fatigue | 284 | ||
| Principles of management | 284 | ||
| Gait re-education and functional rehabilitation | 285 | ||
| Balance and proprioception | 285 | ||
| Pain relief | 285 | ||
| Pacing | 287 | ||
| Psychology | 287 | ||
| General fitness | 287 | ||
| Conclusions | 287 | ||
| Acknowledgements | 288 | ||
| References | 288 | ||
| Bibliography | 289 | ||
| Part 7: Fascia-oriented therapies | 291 | ||
| Chapter 7.1: Inclusion criteria and overview | 293 | ||
| Criteria for topic inclusion in this chapter | 293 | ||
| Old methods updated and new ones emerging | 293 | ||
| Scars | 294 | ||
| Needling | 294 | ||
| Broad influences on connective tissues | 294 | ||
| Tool assisted fascial approaches | 294 | ||
| Neural mobilization | 295 | ||
| Whole-body exercise/movement systems | 295 | ||
| Whole-body manual systems | 295 | ||
| Stretching | 295 | ||
| Conclusion | 295 | ||
| References | 296 | ||
| Chapter 7.2: Trigger point therapy | 297 | ||
| Introduction | 297 | ||
| Principles of trigger point therapy | 297 | ||
| Trigger point therapy | 298 | ||
| Noninvasive trigger point therapy | 298 | ||
| Manual approaches | 298 | ||
| Modality-based approaches | 299 | ||
| Invasive trigger point therapy | 299 | ||
| Fascia and trigger points | 300 | ||
| Summary and Conclusions | 301 | ||
| References | 301 | ||
| Chapter 7.3: Rolfing structural integration | 303 | ||
| Premises of the work | 303 | ||
| Key characteristics of fascia for Rolfing Structural Integration | 303 | ||
| Facilitating integrated structure and function | 304 | ||
| The traditional Rolfing Structural Integration series | 304 | ||
| Session 1: Open the superficial fascia | 305 | ||
| Session 2: Establish a base of support | 305 | ||
| Session 3: Balance fascial span along the lateral line | 305 | ||
| Session 4: Balance the spans of the inner and outer legs | 306 | ||
| Session 5: Connect the legs to the front of the spine | 306 | ||
| Session 6: Establish posterior length, continuity and order | 307 | ||
| Session 7: Organize the upper pole | 307 | ||
| Sessions 8 through 10: Integrate the girdles within the person, and the person within the environment | 308 | ||
| References | 309 | ||
| Bibliography | 309 | ||
| Chapter 7.4: Myofascial induction approaches | 311 | ||
| Introduction | 311 | ||
| Neurophysiologic mechanisms for releasing the restrictions of the fascial system | 312 | ||
| Method description | 313 | ||
| General observations for clinical applications | 313 | ||
| Clinical procedure principles | 313 | ||
| Scientific evidence related to the results in Myofascial Approach | 314 | ||
| Summary | 315 | ||
| References | 315 | ||
| Chapter 7.5: Osteopathic manipulative therapies and fascia | 319 | ||
| Introduction | 319 | ||
| Fascia in the perspective of OMT | 319 | ||
| High-velocity low-amplitude (HVLA) thrust or impulse techniques | 319 | ||
| Muscle energy technique | 320 | ||
| Strain-counterstrain technique | 320 | ||
| Balanced ligamentous tension and ligamentous articular strain techniques | 320 | ||
| Myofascial release techniques | 321 | ||
| Osteopathy in the cranial field | 321 | ||
| Osteopathic manipulative treatment - summary | 321 | ||
| Osteopathic contributions to the understanding of fascia | 321 | ||
| Common compensatory pattern | 321 | ||
| Bioelectric fascial activation and release | 323 | ||
| Research | 323 | ||
| References | 325 | ||
| Bibliography | 326 | ||
| Chapter 7.6: Connective tissue manipulation | 327 | ||
| Viscerosomatic reflex | 328 | ||
| Superficial to muscles with myofascial trigger points | 328 | ||
| Dermatomes of inflamed neural structures | 329 | ||
| Superficial to areas of joint dysfunction | 329 | ||
| Physiology of connective tissue manipulation (CTM) | 329 | ||
| Connective tissue manipulation | 329 | ||
| Evaluation | 330 | ||
| Treatment | 331 | ||
| Contraindications | 331 | ||
| Evidence of clinical benefit | 331 | ||
| References | 333 | ||
| Bibliography | 334 | ||
| Chapter 7.7: Fascial manipulation | 335 | ||
| Introduction | 335 | ||
| The biomechanical model | 335 | ||
| The myofascial unit | 336 | ||
| The sequences | 337 | ||
| The spirals | 339 | ||
| Treatment | 339 | ||
| References | 341 | ||
| Chapter 7.8: Managing dysfunctional scar tissue | 343 | ||
| History | 343 | ||
| The 'active scar' a model of soft tissue lesions | 343 | ||
| References | 346 | ||
| Chapter 7.9: Acupuncture as a fascia-oriented therapy | 349 | ||
| Introduction | 349 | ||
| Historical background | 349 | ||
| Yin and yang | 349 | ||
| Qi | 349 | ||
| Acupuncture points | 349 | ||
| Meridians | 350 | ||
| Internal organs (zang fu) | 350 | ||
| Physiologic background | 351 | ||
| Techniques | 352 | ||
| Start with distant points and/or microsystem points | 352 | ||
| Look for tender regional/segmental points | 353 | ||
| Treat myofascial trigger points | 353 | ||
| Supplement with local meridian points or ah shi points | 353 | ||
| Treat internal organs in chronic diseases | 353 | ||
| Dry needling | 354 | ||
| Direct dry needling | 354 | ||
| Dry needling of the muscular fascia | 354 | ||
| Superficial dry needling | 354 | ||
| Evidence | 356 | ||
| Summary | 356 | ||
| References | 356 | ||
| Bibliography | 357 | ||
| Chapter 7.10: Gua sha | 359 | ||
| Introduction | 359 | ||
| Gua sha terms | 359 | ||
| How to Gua Sha | 361 | ||
| Indications | 361 | ||
| Contraindications | 361 | ||
| Biomechanism/physiology | 362 | ||
| Observation | 362 | ||
| Research | 362 | ||
| Gua sha and connective tissue | 362 | ||
| Models | 362 | ||
| Safety | 364 | ||
| References | 364 | ||
| Chapter 7.11: Prolotherapy | 367 | ||
| Introduction | 367 | ||
| History | 367 | ||
| Wound healing, repair and regeneration | 368 | ||
| The inflammatory phase | 368 | ||
| The matrix deposition phase | 368 | ||
| The remodeling phase | 368 | ||
| Mechanism of action and substances injected | 369 | ||
| Indications, contraindications, complications, and risks | 370 | ||
| Techniques | 370 | ||
| Outcomes and clinical evidence | 371 | ||
| Future challenges | 372 | ||
| Summary and conclusion | 372 | ||
| References | 372 | ||
| Chapter 7.12: Neural therapy | 375 | ||
| Introduction | 375 | ||
| Neuroanatomy | 375 | ||
| Procedure | 376 | ||
| Local therapy | 376 | ||
| Segment therapy | 376 | ||
| Extended segment therapy, ganglia therapy | 377 | ||
| Therapy via the interference field (Störfeld therapy) | 377 | ||
| Therapy via functional chains | 378 | ||
| Systemic therapy | 378 | ||
| Indications, contraindications, complications | 378 | ||
| Summary | 379 | ||
| Research | 380 | ||
| Acknowledgement | 380 | ||
| References | 380 | ||
| Chapter 7.13: Dynamic fascial release - manual and tool assisted vibrational therapies | 383 | ||
| Introduction | 383 | ||
| History of manual and mechanical work involving fascia | 383 | ||
| Hebb's hypothesis, harmonic function and oscillation | 384 | ||
| Rhythmic reflexes - Tonic Vibratory Reflex (TVR) and related effects | 385 | ||
| TVR background | 385 | ||
| TVR application | 385 | ||
| Extrapolation to other clinical applications | 386 | ||
| The percussion vibrator | 386 | ||
| Facilitated Oscillatory Release (FOR) | 387 | ||
| Other mechanical devices | 388 | ||
| Vibrating platforms | 388 | ||
| Deep oscillation | 389 | ||
| References | 389 | ||
| Bibliography | 390 | ||
| Chapter 7.14: Graston technique... | 391 | ||
| Introduction | 391 | ||
| Rationale | 392 | ||
| Applications | 392 | ||
| Plantar fasciopathy, Achilles tendinopathy, lower extremity disorders | 393 | ||
| Knee | 393 | ||
| Hip/pelvis | 393 | ||
| Spine | 393 | ||
| Shoulder | 394 | ||
| Elbow, wrist, and hand | 394 | ||
| Use of GT with movement and load | 394 | ||
| Local and global approach | 395 | ||
| References | 395 | ||
| Chapter 7.15: The fascial distortion model | 397 | ||
| Introduction: connective tissue as mechanosensory system | 397 | ||
| The patient as expert - the Typaldos model | 397 | ||
| The fascial distortions | 398 | ||
| Trigger band (TB) | 398 | ||
| Herniated triggerpoint (HTP) | 398 | ||
| Continuum distortion (CD) (see Fig7.15.1) | 399 | ||
| Folding distortion (FD) (see Fig.7.15.2) | 399 | ||
| Cylinder distortion (CyD) (see Fig.7.15.3) | 400 | ||
| Tectonic fixation (TF) | 400 | ||
| The diagnosis of fascial distortions | 401 | ||
| General considerations | 401 | ||
| Trigger band (TB) | 401 | ||
| Herniated triggerpoint (HTP) | 401 | ||
| Continuum distortion (CD) | 401 | ||
| Folding distortion (FD) | 401 | ||
| Cylinder distortion (CyD) | 402 | ||
| Tectonic fixation (TF) | 402 | ||
| General treatment of fascial distortions | 402 | ||
| Final statements | 402 | ||
| References | 403 | ||
| Bibliography | 403 | ||
| Chapter 7.16: Frequency-specific microcurrent | 405 | ||
| History of frequency-specific microcurrent (FSM) therapy | 405 | ||
| FSM and inflammation | 406 | ||
| FSM and scar tissue | 406 | ||
| Equipment | 406 | ||
| Clinical outcomes in the treatment of myofascial pain | 406 | ||
| How FSM treatment differs from other fascia therapies | 407 | ||
| The model to explain the frequency-specific effect | 408 | ||
| Conceptual model | 409 | ||
| References | 410 | ||
| Bibliography | 410 | ||
| Chapter 7.17: Surgery and scarring | 411 | ||
| Introduction | 411 | ||
| The extent of the problem | 411 | ||
| Understand fascial relationships | 412 | ||
| Anatomy of tissue layers | 412 | ||
| Surgery | 412 | ||
| Treatment | 413 | ||
| Therapeutic intention | 414 | ||
| Before we start | 414 | ||
| The barrier phenomenon | 414 | ||
| Depth and grading of touch | 414 | ||
| Evaluation | 414 | ||
| Treatment | 415 | ||
| Principles | 415 | ||
| How to treat | 415 | ||
| Basic techniques | 415 | ||
| Gross stretch | 415 | ||
| Gentle circles | 416 | ||
| Firm upside down `J´ stroke | 417 | ||
| Vertical lifts | 417 | ||
| Skin rolling | 417 | ||
| Conclusion | 418 | ||
| References | 418 | ||
| Bibliography | 419 | ||
| Chapter 7.18: Temperature effects on fascia | 421 | ||
| References | 423 | ||
| Chapter 7.19: Neurodynamics: Movement for neuropathic pain states | 425 | ||
| Introduction | 425 | ||
| Structure, function and pathophysiology of the peripheral nervous system | 425 | ||
| The double crush theory | 426 | ||
| Movement for neuropathic pain states | 427 | ||
| Neurodynamic exercises: 'sliders' slide and 'tensioners' tension | 427 | ||
| Neighboring structures | 430 | ||
| Evidence of clinical effectiveness | 430 | ||
| The bigger picture | 431 | ||
| References | 431 | ||
| Chapter 7.20: Stretching and fascia | 433 | ||
| Introduction | 433 | ||
| Definition | 433 | ||
| Mixed evidence | 434 | ||
| Stretching: the evidence for tissue change | 434 | ||
| Mechanical lengthening | 435 | ||
| Tissue hydration | 436 | ||
| Proprioceptive stimulation | 437 | ||
| Direct cellular effects | 437 | ||
| Conclusion | 438 | ||
| References | 438 | ||
| Bibliography | 439 | ||
| Chapter 7.21: Fascia in yoga therapeutics | 441 | ||
| Yoga as a fascial therapy | 441 | ||
| Goals | 441 | ||
| Techniques | 441 | ||
| Yoga and fascia | 442 | ||
| Yoga asana and myofascial meridians | 442 | ||
| Forward bends/Superficial Back Line | 442 | ||
| Back bends/Superficial Front Line | 443 | ||
| Lateral Line/Side bends | 443 | ||
| Spiral Line/twists | 444 | ||
| Arm Lines/shoulder and arm stretches | 444 | ||
| Functional Lines | 444 | ||
| Deep Front Line | 444 | ||
| Yoga therapeutics training standards | 445 | ||
| Referral | 445 | ||
| References | 446 | ||
| Bibliography | 447 | ||
| Chapter 7.22: Pilates and fascia... | 449 | ||
| Introduction | 449 | ||
| The blend of Eastern and Western philosophies | 449 | ||
| Fusion and integration of various disciplines | 449 | ||
| Fascia, bound by lifestyle, can Pilates make it move? | 450 | ||
| Pilates principles and fascia | 451 | ||
| Concentration | 451 | ||
| Control or contrology | 452 | ||
| Precision | 452 | ||
| Flowing movement | 452 | ||
| Centering | 452 | ||
| A well-designed corset of support | 453 | ||
| The breath in Pilates | 453 | ||
| Well connected | 453 | ||
| From foot to core | 454 | ||
| Alignment support from within | 454 | ||
| 'As within, so without': movement perceived from the inside reflects what happens on the outside | 454 | ||
| Specialized equipment: reformer or transformer | 455 | ||
| Reformer versus machine | 455 | ||
| Summary | 456 | ||
| References | 456 | ||
| Chapter 7.23: Nutrition model to reduce inflammation in musculoskeletal and joint diseases | 457 | ||
| Inflammatory response | 457 | ||
| Fatty acids: anti-inflammatory properties | 457 | ||
| Fatty acid dietary supplements: anti-inflammatory properties | 458 | ||
| Culinary spices and herbs: anti-inflammatory properties | 459 | ||
| Fruits and vegetables: anti-inflammatory properties | 459 | ||
| Beverages: anti-inflammatory properties | 461 | ||
| Anti-inflammatory diet | 461 | ||
| References | 462 | ||
| Chapter 7.24: Fascial fitness... | 465 | ||
| Introduction | 465 | ||
| Fascial remodeling | 465 | ||
| The catapult mechanism: elastic recoil of fascial tissues | 466 | ||
| Training principles | 468 | ||
| Preparatory countermovement | 468 | ||
| The Ninja principle | 468 | ||
| Dynamic stretching | 469 | ||
| Proprioceptive refinement | 471 | ||
| Hydration and renewal | 472 | ||
| Sustainability: the power of a thousand tiny steps | 473 | ||
| References | 474 | ||
| Section III: Research directions | 477 | ||
| Part 8: Fascia research: Methodological challenges and new directions | 479 | ||
| Chapter 8.1: Fascia: Clinical and fundamental scientific research | 481 | ||
| References | 482 | ||
| Chapter 8.2: Imaging | 483 | ||
| Introduction | 483 | ||
| Imaging of extramuscular fascial structures and additional analysis | 485 | ||
| References | 486 | ||
| Chapter 8.3: Advanced MRI techniques for in-vivo biomechanical tissue movement analysis | 489 | ||
| Introduction | 489 | ||
| Dynamic MRI and in-vivo movement analysis | 490 | ||
| Using MRI to quantify deformations caused by mock manual therapy | 491 | ||
| Methods | 491 | ||
| Results | 491 | ||
| Advanced motion imaging tools of MRI | 493 | ||
| References | 494 | ||
| Chapter 8.4: Roles of fascia in molecular biology of adaptation of muscle size | 497 | ||
| Introduction | 497 | ||
| Mechanical loading-induced muscle adaptation in vivo | 497 | ||
| Training | 497 | ||
| Muscle strain | 498 | ||
| Molecular mechanisms of adaptation of muscle size | 498 | ||
| Machinery for protein synthesis | 498 | ||
| Transcription of the deoxyribonucleic acid (DNA) of the genome | 498 | ||
| Translation of mRNA | 498 | ||
| Completion of the protein synthesis | 498 | ||
| Machinery for protein degradation | 499 | ||
| Mechanochemical signaling and mechanotransduction for protein synthesis and degradation in muscle | 499 | ||
| The roles of fascia in the regulation of myofiber size | 500 | ||
| Ex-vivo culture of mature, single myofibers | 501 | ||
| Summary | 501 | ||
| References | 502 | ||
| Chapter 8.5: Mathematical modeling | 503 | ||
| Introduction | 503 | ||
| In-vitro experiments | 503 | ||
| In-situ experiments | 503 | ||
| Mathematical models | 503 | ||
| Modeling fascia and muscle tissue using the finite element method | 504 | ||
| Description of the model for isolated muscle: modeling to account for intramuscular myofascial loads | 505 | ||
| Muscle operating within the context of fascial integrity: modeling effects of intra- and epimuscular myofascial loads, simultan | 506 | ||
| Contribution of LFMM model to muscle mechanics | 506 | ||
| Modeling of deformations caused by manual therapies | 506 | ||
| Approach | 506 | ||
| Deformations caused by such loading | 507 | ||
| References | 508 | ||
| Glossary | 511 | ||
| Index | 515 | ||
| Color Plate | 536 |