Review of The Fascial Manipulation Technique and its Biomechanical Model: A Guide to the Human Fascial System

2 weekends ago, I decided my July 3 Saturday was worth leaving our 615am Saturday morning crew a little early to drive into the City for a 1-day course on fascia.  This seminar not only caught my eye given the recent re-emergence of Thomas Myers’ Anatomy Trains concepts in some Internet communities, but also the primary speaker, Luigi Stecco.

The fascial system, particularly the science of it, the histology and cellular biology of it, is not a forte of mine.  Since getting exposed to some of Thomas Myers’ slides in Providence, I have tried to study more into those avenues.  In doing so, Luigi Stecco’s name came up time and time again, and the coincidence of him presenting in America was quite ironic.

Stecco is a PT in Italy and could be boxed into a “soft tissue guy.”  Below are 2 links I’ve found that provide background as well as the 2 books of his that have been translated to English.

http://www.fascialmanipulation.com/Info/tabid/88/Default.aspx

http://www.anatomytrains.it/?p=134

Another name that I am quite familiar with is Dr. Warren Hammer, who presented the introduction to this course.  As I chatted with his wife and him before we started, It was quite flattering that Dr. Hammer thought that he knew of me, but I think he was either confusing me for someone else or playing games.

Below is a link where Dr. Hammer summarizes Stecco’s treatment system.

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54447

Usually when I hear someone for the first time, I don’t take notes.  I just try to listen expecting that I will be learning from them again.  In this case, beyond the texts, I am not sure when I will get to hear Stecco speak again, so I scribbled the whole time.  It more challenging than normal as the presentation was in Italian and translated.  I could understand most of the Italian as it’s close enough to Spanish, but I am going to just type out bullet notes like I did when I saw Sahrmann speak in 2008.  My interpretations and thoughts are in italics.  These are few as I have not fully integrated these messages and probably won’t until I read the 1st Stecco book.

I think a lot of the things Myers said made a lot of sense particularly the neurological aspects of fascia and why he was somewhat mixed on using the foam roller.

AM was Luigi Stecco talking about the science, and the PM was his son, Dr. Antonio Stecco, talking about the methodology where I didn’t take much notes.

–message from Rolfing extends to Centers of Coordination/Trigger Points which extends to ideas of Meridians

–Body is made of 14 segments (Meridians)

–Deep Friction loosens tissues that traps and compresses free nerve endings (thought process as of 1988)

–Fascia immediately affects muscle spindles

–Myofascial Unit, after the Motor Unit, is the structural basis of the locomotor system.  The MF Unit = the group of motor units that move a segment a certain way and connects with fascia to guide forces or vectors

–Fascia is the lining that covers muscles and organs

–Superficial and deep fascia
—-Superficial is below skin; Deep is what controls locomotion
—-Deep is epimysial (1-2 layers) in the limbs and (3 layers) in trunk
—-Deep is Aponeurotic (in parallel) in the limbs and (in series) in trunk

–Most resources speak only about the superficial fascia

–Very hard to treat deep fascia in fat people

–Aponeurotic Fascia = Dense, firm, fibrous membrane of trunk and limbs

–Int J of Shoulder Surgery, 2009 defines aponeurosis as a flat ribbon; a tendon is a cord –> Fascia as aponeurosis transmits force to the tendon, not muscle; muscle transmits to fascia, not tendon

–Fascia has a function of containment of muscles in their place.  This is mechanically function and neurologically controlled.

–Aponeurotic Fascia = Deep Fascia

–Epimysial fascia = direct contact to muscles –> inserts into deep fascia
–It is less consistent than Deep Fascia

–Removing Deep Fascia, then we see Epimysial, then we see origins and insertions
–Origins and insertions are not muscles attaching to bones; they are fascia attaching to bones

–Can not describe fascia of the trunk and limbs the same way

–In trunk, no deep fascia.  There are 3 layers of epimysial starting @ lat to erectors.

–Deep fascia in limbs is oblique and longitudinal fibers running freely

–Epimysial fascia becomes aponeurotic (deep) fascia become tendons

–Glute sends 80% of fibers into fascia, not bone

–Myofibrils of muscles insert into fascia

–The doubling of the fascial layers causes the stretching of the muscle spindles

–Fascia may answer the questions of where anatomical borders lie (not where the anatomy books say they are)

–Collagen is in parallel but in different planes – important as MF unit only guides certain patterns of movements

–Fascial Layers have consistent angles

–Retinacula are reinforcements of deep fascia

–Retinaculum = Ligament

–Deep fascia is continuous through the limbs (more like a ligament than muscle)

–Unknown if link between fascia and bone density, trabeculae have not been studied

–Crossing Fascia – planes do slide @ bone and muscle insertions

–Fascial line from foot to tongue (Myers’ “definition” of the core)

–Retrictions in fascia crossings will limit force via the shape changes

–Decreased sliding of the fascial layers causes pain

–Center of Coordination = Point in all components of the fascia
—-Where muscle fibers meet the tendons
—-Regulates coordination of pennation of the muscles
—-Coordinates deep fibers of common connections
—–Where all movements starts to develop

–Muscle Spindle is in the Endomysium, regulated by the connective tissue around it

–If the fascia @ the CC is not elastic, not fluid, the spindle can not shorten and 1A fibers get inflammed and not regulate impulses to contract

–If capsular receptors are hypermobile, they become nociceptors

–Without an efficient CC, it would be hard to establish uniform movement
–Muscles would work like a pocket knife instead of an adjustable light bulb

–Fascia stretches based on muscle joint position

–Trigger Point = Accupuncture Point = Center of Coordination
—–Hard to see fascia to confirm this unless the person was alive
—–This is where the theory prevails as there is don’t appear to be scientific proof for the viability of their suggestion.  But like most movement-based training methods, there is a blessing of success that can not be argued.

–Not accurate to look at insertions and origins
—–Fascia connects muscles to everything – Muscle fibers converge  on the CC.

–Facial layers must slide on each other freely to transfer to the next layer or structure.
–This is the key to synchronization.

–CNS interprets and programs in terms of spatial directions (The brain only knows movement, not muscle function)

–In normal aponeurotic fascia, there is reciprocal tension in the fascia proximally and distally.

–Thinking of pain as articular is not as accurate as fascial.
–Pain does not follow nerves but rather follows the sequence of motor control patterns.

–Center of Fusion is the director of synchronization of all the muscle fibers
—-Monitor movements between 2 planes and complex movements

–Tension in the fascia that sequences position as a result of trauma
—-Not enough time for the trauma signal to get the brain, can only happen in the peripheral fascia

–Don’t look a muscles in books
—–Fascia answers the questions of interactions and muscle tensions

–Interplay of bones do not allow for tensegrity
–The cells have tensegrity, fascia does not
–Fascia only bears tension, not compression; bones bear compression

Evaluation is movement- and Cyriax based.

Treatment is based on soft tissue mobilization @ CF and CC and retesting painful or dysfunctional movements.

Only demonstrated the painful model for manual therapy.

Pretty much laughed at the suggestion that painful manual therapy is contraindicated in a non-medical individual.  Dr. Stecco almost didn’t understand what I was suggesting when some folks think the startle response is dominant as a result of painful manual therapy.

Prevailing Thoughts
1.  Via the Rolfing and bodyworker background, the messages of the facial being enormously neural and more integral than muscles was identical to Thomas Myers.

2.  I think the actions of targeting the CF and CC was what Thomas Myers was getting at when he was down on the foam rollers.  I can clearly see that if indeed that was his thought process how it would be very hard to attack singular points with a vectored approach for different movement impairments with the foam roller.  It makes a lot of sense if that is what he was saying.

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7 Responses to “Review of The Fascial Manipulation Technique and its Biomechanical Model: A Guide to the Human Fascial System”

  1. Cheers! I just came across your site and saw you attended this seminar also! I was a lonely podiatrist/track and field coach, but I got a lot from the seminar also! It is great to see that great minds think about :)

  2. trayl says:

    Hi Charlie.
    Thank`s for all the great information you put out for all of us.
    Would you explain this a little bit more,is he saying manual therapy should be painfull?

    Thanks.

    Pretty much laughed at the suggestion that painful manual therapy is contraindicated in a non-medical individual. Dr. Stecco almost didn’t understand what I was suggesting when some folks think the startle response is dominant as a result of painful manual therapy.

  3. Charlie says:

    Yes, I think they were revealing the notion that manual therapy may not be comfortable.

  4. Thank you very much for the valuable information

  5. Thanks Charlie.. A great little review of Stecco’s work! My wife has had 2 of the Stecco books for quite some time now & some of the info in their has been a little to deep for my understanding..
    Thanks for doing this review – it’s made me want to delve back into them a little more! :)

  6. Rob Martin says:

    Hi Charlie,
    I was there also. @pain quote…my feeling is that the tissue has to be perturbed enough to create change, but not so much that the client is pulling away from me. I’m not interested in traumatizing or re-traumatizing the area being worked on. There is a balance needed and it requires communication between practitioner and client. It’s a dance, so to speak.

  7. Dr. Wilton Guillory III says:

    As a chiropractic physician that practices mainly instrument assisted soft tissue manipulation, I can’t tell you how exciting it is to read that there are others practicing this type of work! I know it may be naive and maybe arrogant to think that I was the only person doing this type of myofascial work, but reading your website and information by Stecco and Hammer, it fills me with a sense of pride and hope that there will be so many patients that can and will benefit from this type of work. I see a ton of patients that have been shuffled through the traditional forms of treatment and have had little to no improvement. Givining those patients their functional life back is so gratfiying, I can only hope and pray that this type of work and treatment will soon become the norm and not the alternative!

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