……….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?
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.
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.
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.
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.
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.