Is it Fascia or Motor Control?

……….how can you tell/verify whether or not there is a fascial or soft tissue restriction vs. a neuro-motor restriction?
Also, what strategies do you use to correct fascial tightness?

 

Brilliant stuff on Fascia

To try to get after this, I think we have to pull apart the questions within the question as I think there are good answers, but to slightly different questions than above.

Using a movement-based approach to evaluating, you can accurately determine if a vertical expression of a pattern is being limited by soft tissue restriction or a motor control.  But there are a few things to consider before the 4 approaches you can use to get this kind of information.

1) When someone has a mobility limitation, they automatically have a motor control challenge.  But of course, this only based on a standard of movement.  Arguments seem to abound because some use a weaker standard.  Stability is only required in the demand of mobility.  If you are testing a pattern of minimal excursion, the motor control will be fine.  Go bigger and challenge mobility, the motor control will be inefficient.

However, I do think that motor control at times is “peeking around the corner,” and after restoration of mobility, lower level corrections are not always required.  I have heard of scratch golfers getting some pebbles taken out of the hip, and they went right back to their great handicap.  Sometimes needling or manual therapies or even kinesiology tape or whatever neurological reset you use is the right thing for that person and holds a much larger effect than motor control training.
To suggest that you always need to intensely restore motor control with lower patterns after the reset is not consistent with every case.  It is even more inconsistent to not use a fast track to restore function by suggesting passive therapy is not of value, or you are some kind of heretic by getting someone to where you want them much faster than just using exercise.

“It Doesn’t Matter Who We Are.  What Matters Is Our Plan.”  –Bane

2)  The patterns below will help bucket an inefficient terminal pattern as a mobility (ability of a joint system to allow for uninfluenced movement) or a stability (control in the presence of change) limitation.  But as we become more familiar and skilled with quick neurological resets, it will seem like a “stability” fix does change a “mobility” problem.  Whether this is the case or not, it doesn’t matter what flavor of training you use to correct the problem.  Culling out the bucket can lead to eliminating options and refine a quick approach.  But it’s similarly correct when the old angry coaches that beat up on such things as the FMS say you can just train out of dysfunction.  In theory, this is correct too.  And the best coaches are going to be more successful than greener ones.  This is just like a great Recon Marine probably doesn’t need a compass as much as a LCpl.  Nailing down exactly what you are looking at is best practice, and when the quick fix is in, regardless what it looks like, the aggressive training catalog is opened as largely as possible with as large a buffer zone as possible.  Smart training is corrective, and it’s also slower in a lot of cases.  When you have 12-16 weeks with stud athletes, lots of slow pace can be made up.  Not everyone has this luxury.
At the same time, to suggest treating the soft tissue is all you need and motor control just always magically appears is utter bufoonery as well.
Bottom line is have a standard and get it done however logistics allow.  Call it Clinical Audit as per Craig Liebenson.  Call it Comparable Sign as per Maitland and others.  Just Test & Retest.

It is much easier to prove that something worked than why it worked.
We can say why we think it worked, but in the end, does it matter?

When you ask the question in terms of “fascial or soft tissue restriction,” I think these are very different things.

1) Mobility is a combination of soft tissue or joint-mediated restrictions.  This can be determined through utilizing the capsular patterns as per Kaltenborn and motions with different length tensions such as testing hip rotation in hip flexion and hip extension.  If they are the same, you can implicate the joint or at least not rule it out.  If they are different with prone being more restricted, you can implicate soft tissue length in terms of the hip flexors.

2) Fascia is one of many components I would consider “soft tissue,” and in movement, I do not know how to cull out fascia as the reason for limitation any more than  neural tension or muscle tone.  Now with manual therapy, given the techniques that skew to one over the other, you can make an assumed determination.  But then again, it probably should be argued that in terms of soft tissue, everything is connected neurologically through fascia.  So from my vantage point, there are clinical indications that lead to a certain passive resets, but I don’t know how anyone would win an argument that one soft tissue is affected, while another isn’t.  And ultimately, I don’t know if it matters if pain is remediated and movement is improved to a standard after passive intervention.
In terms of treating just fascia, the FAT Tool, Fascial Manipulation, and Structural Integration are reliable commercial models that are evidence-led from what we know in the literature about fascia.  I use the FAT Tool liberally.

Game Changer in Terms of Treating Fascia

Now, here are the 4 ways to determine if something is a mobility or stability/motor control bucket…..
These patterns amount to Greg Rose’s 4×4 matrix and are major tenets to the Functional Movement System.

1) Loaded vs. Unloaded
–This is quite simple and based on the position or posture of the body.  The lower or less mature the posture, the more fixed points in contact with the ground.  If there is a difference in pain or movement quality or excursion as you regress from the vertical down to kneeling, quadruped, and unloaded, then it is a motor control issue.  It’s the same joint and muscles regardless of the position.  Be aware of 2-joint muscles that cross the fixed points as this can be telling, but overall, this is a simple approach.

2) Active vs. Passive
–If there is an appreciable difference in what a motion is capable of with the individual performing it vs. the motion being passively guided, it is a motor control issue.  Keep in mind passive overpressure is worth something in passive movement, but this is like the unicorn.  You’ll know it when you see it.

It’s STILL a freakin’ horse with a horn sticking out of it’s head.

3) Assisted vs. Unassisted
–Assistance can mean nearly anything, but if that assistance allows for the pattern to be more capable or changes pain, then the proprioceptive input allowed for the desired motor control.  If it worked, it could not have been a mobility issue.  Assistance can be in form of coaching, RNT, DNS support or Reflex Locomotion, among anything else you so chose.

4) Resisted vs. Unresisted
–Adding load to a pattern can often allow for the proprioception to “unlock” the pattern as well.  The difference in the semantics of resistance and assistance would be resistance is IN the pattern (KB in the goblet that lets you down in the squat) where assistance is OUT of the pattern (band around the knee that lets you get in the hole).  Something to not be confused with is the bodyweight squat that gets to about an inch above parallel with 4 wheels on the bar.  This is not mobility vs. stability.  This is dumb.

If You Need These Wheels To Get to Slightly Above Parallel………….

  • September 16, 2012

Leave a Reply 16 comments

Anthony Distano Reply

Hi Charlie:

Just to clarify, do you feel you can treat “just fascia”? Is there literature out there that any of these models you listed treat “just fascia”?

Charlie Reply

I think there are some techniques that follow the mechanical deformation of fascia, so that is closest we can get to it. In terms of the superficial and profundus layers moving on each other, the transverse “shaking” of the superficial layer is as close as we can get to suggest we are “treating” fascia.

Anthony Distano Reply

Thanks. So you do you think we can treat “just fascia”, as mentioned in your post, in any way?

Charlie Reply

I don’t know.

Anthony Distano Reply

Not my blog (obviously) but just for conversation sake I would say we cannot treat “just fascia” because techniques aimed at “just fascia” involve the skin and other layers of richly innervated tissue. Unless we are working on cadavers, in which the skin and other layers may not be a problem, of course. Thanks for your reply.

Charlie Reply

I agree. Interesting that you are pretty much repeated my point in the article.
Did you read it?
We can say what we are thinking we are doing.
It is inherently difficult to prove what we are doing, but we can prove that it works if movement and pain are changed.

Charlie Reply

If the FAT Tool improves movement and changes pain, who cares what it really does?

Anthony Distano Reply

Yes I read your post. I do agree that you pointed out you can not isolated the fascia from other soft tissue on assessment. I was confused at the end of the post when mentioning the fascia models you state ‘in terms of treating just fascia”. Which led me to my original question.

dsomerset@worldhealth.ca Reply

Loved that last line. Awesome post Charlie.

scott Herrera Reply

Yes you can treat fascia. There a many techniques to do so and many good osteopaths can attest to this. The book, “Fascia” is co-written and M. Lindsay is actually studying to do this work from one of the best in the world, Guy Voyer. In fact, the exercise (photos) used in the gym are from several of his students in NYC. Not only are there techniques to treat the fascia, which do not involve the skin or skin rolling, there are many exercises to support the treatments. I have followed the work of Voyer for 9 years now. My suggestion is to look into for yourself… attend one of his lectures or seminars. Find a practitioner who he has taught- trainer, therapist or osteopath and see firsthand.

Anthony Distano Reply

Scott,

Are you suggesting one can treat “just fascia”. If so, would you be so kind to provide references that shows that. I would really be interested to know what techniques exist that involving treating “just fascia” without involving the skin in someway. Sounds interesting.

Martha Peterson Reply

Hi Charlie,

When you talk about a neurological re-set sometimes having a great effect than motor control training, isn’t it impossible to have greater motor control without a neurological re-set? All movement is sensory motor learning, so the brain needs increased sensory input in order to change its motor output. Low level tweaks (I teach Hanna Somatics, and I’d say that some of the simple somatic exercises we teach – derivations of Feldenkrais ATM – are low level and very simple) can often have a profound effect on sensory awareness, thus leading to a change in sensory motor control.

I’m enjoying reading your blog; thanks for some great information.

Charlie Reply

While I guess by definition, a reset should be passive, active approaches like Feldenkrais, DNS, or maybe even NDT and TAMO all can certainly facilitate the nervous system to uptake sensorimotor inputs through the conditioning process.

Massage In Natic Reply

I have followed the work of Voyer for 9 years now. My suggestion is to look into for yourself… attend one of his lectures or seminars.

scott Herrera Reply

Yes it is possible to treat just the fascia and fascial chains… and it is does not involve the use of “tools”. In fact using tools like is NOT treating the fascia precisely. Foam rollers are the “rage” these days. When I visit a local track for workouts form time to time I see all the sprinters with these handheld “rollers” using them in between sets and after workouts. Exactly what are they treating? The fascial chains are at many different levels in the body and the fibers run a mix of directions. To roll the skin like a “dough roller” doesn’t make any sense. In April of this year there will be a course in NYC hosted by Sportslab. The course is “Fascia of the Trunk”. There are numerous courses and 100’s of techniques to treat the fascia and the fascia alone. As soon as finish with the ELDOA project on our website I will begin to write and share more on the fascia with respect to treatment, and exercise be it myo-fascial stretching, general postural stretching, ELDOA and analytic re-enforcment training. The Fascia book posted above is good. One of the authors is enrolling in the Fascia Fellowship organized by the NY-group so if you think that book is good just wait… the book’s content is only the surface.

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