During the first theoretical part of the FM course, we will illustrate new studies of the gross and histological anatomy of the human fasciae, and explain the biomechanical model for the human fascial system currently applied in the manual technique known as Fascial Manipulation©. The model represents a three dimensional interpretation of the fascial system. Its hypothetical foundations are fruit of more than thirty years of analysis of anatomical texts and clinical practice. More recently, dissections of unembalmed bodies have provided anatomical verification of numerous hypotheses including the fascial continuity between different body segments via myotendinous expansions and the possible distribution of tensional forces. This workshop will also propose new studies concerning the histological characteristics of superficial and deep fasciae (fibre content, structural conformation, and innervation) and debate the role of deep fascia in proprioception. The Fascial Manipulation© technique is based on the concept of myofascialunits (mf units) united in myofascial sequences, and involves manual friction over specific points (called Centres of coordination and Centres of fusion) on the deep muscular fascia. This underlying rationale and the resultant analytical process guides the therapist in the combination of points to be treated and allows therapists to work at a distance from the site of pain, which is often inflamed due to non-physiological tension. Musculoskeletal disorders commonly treated include low back pain or sciatic-like pain, carpal tunnel syndrome, tendinitis, sprains, peripheral nerve compressions, neck pain syndromes, frozen shoulder, whereas visceral dysfunctions can include gastritis, irritable colon syndrome, constipation, and dysmenorrhoea

Short presentation of the Fascial Manipulation technique©

Fascial Manipulation© is a manual therapy that has been developed by Luigi Stecco, an Italian physiotherapist from the north of Italy. This method has evolved over the last 30 years through study and practice in the treatment of a vast caseload of musculoskeletal problems. It focuses on the fascia, in particular the deep muscular fascia, including the epimysium and the retinacula and considers that the myofascial system is a three-dimensional continuum. In recent years, via collaboration with the Anatomy Faculties of the René Descartes University, Paris, France and the University of Padova in Italy, Dr. Carla Stecco and Dr. Antonio Stecco have carried out extensive research into the anatomy and histology of the fascia via dissection of unembalmed cadavers. These dissections have enhanced the pre-existing biomechanical model already elaborated by Luigi Stecco by providing new histological and anatomical data. This technique presents a complete biomechanical model that assists in deciphering the role of fascia in musculoskeletal disorders. The mainstay of this manual technique lies in the dentification (alteration) of a specific, localised area of the fascia in connection with a specific limited movement. Once a limited or
painful movement is identified, then a specific point on the fascia is implicated and, through the appropriate manipulation of this precise part of the fascia, movement can be restored. In fact, by analysing musculoskeletal anatomy, Luigi Stecco realised that the body can be divided into 14 segments and that each body segment is essentially served by six myofascial units (mf units) consisting of monoarticular and biarticular unidirectional muscle fibres, their deep fascia (including epimysium) and the articulation that they move in one direction on one plane. Numerous muscle fibres originate from the fascia itself and, in turn, myofascial insertions extend between different muscle groups to form myofascial sequences. Therefore, adjacent unidirectional myofascial units are united via myotendinous expansions and biarticular fibres to form myofascial sequences. While part of the fascia is anchored to bone, part is also always free to slide. The free part of the fascia allows the muscular traction, or the myofascial vectors, to converge at a specific point, named the vectorial Centre of Coordination or CC.The location of each CC has been calculated by taking into consideration the sum of the vectorial forces involved in the execution of each movement. The six movements made on the three spatial planes are rarely carried out separately but, more commonly, are combined together to form intermediate trajectories, similar to the PNF patterns. Deep fascia is effectively an ideal structure for perceiving and, consequently, assisting in organizing movements. In fact, one vector, or afferent impulse, has no more significance to the Central Nervous System than any other vector unless these vectors are mapped out and given a spatial significance. In human beings, the complexity of physical activity is, in part, determined by the crossover synchrony between the limbs and a refined variability in gestures. Whenever a body part moves in any given direction in space there is a myofascial, tensional re-arrangement within the corresponding fascia. Afferents embedded within the fascia are stimulated, producing accurate directional information. Any impediment in the gliding of the fascia could alter afferent input resulting in incoherent movement. It is hypothesised that fascia is involved in proprioception and peripheral motor control in strict collaboration with the CNS.

Therapeutic Implications

The fascia is very extensive and so it would be difficult and inappropriate to work over the entire area. The localisation of precise points or key areas can render manipulation more effective. An accurate analysis of the myofascial connections based on an understanding of fascial anatomy can provide indications as to where it is best to intervene. Any non-physiological alteration of deep fascia could cause tensional changes along a related sequence resulting in incorrect activation of nerve receptors, uncoordinated movements, and consequent nociceptive afferents. Deep massage on these specific points (CC and CF) aims at restoring tensional balance. Compensatory tension may extend along a myofascial sequence so myofascial continuity could be involved in the referral of pain along a limb or at a distance, even in the absence of specific nerve root disturbance.In clinical practice,cases of sciatic-like pain and cervicobrachialgia without detectable nerve root irritation are common. This technique allows therapists to work at a distance from the actual site of pain, which is often inflamed due to non-physiological tension. For each mf unit, the area where pain is commonly felt has been mapped out and is known as the Centre of Perception (CP). In fact, it is important to place our attention on the cause of pain, tracing back to the origin of this anomalous tension, or more specifically to the CC and CF located within the deep fascia.

The aim of the Fascial Manipulation therapy is to restore gliding between the intrafascial fibers. Raising the temperature of selected areas of the fascia (corresponding to the CC points) could allow for transformation of the ground substance, transforming it from a pathological status of GEL (dense fascia) to a physiological status of SOL (fluid fascia). This variation in density probably allows for two events. Firstly, during the application of manual pressure, the connective tissue adapts and the intrafascial free nerve endings may slide within the fascia more freely, which could explain the sudden decrease in pain during massage in the treated area. The second event could evolve over the following days: with enhanced fluidity of the ground substance (HA, GaG) physiological tensioning of the fibers within the fascia during muscular contraction could allow for correct deposition of new collagen and elastic fibers according to the lines of applied force. Subsequent restoration of gliding between connective tissue layers of the fascia would enable tensional adjustments during muscular contraction, resulting in appropriate tensioning of periarticular structures such as tendons and capsules. This restitution of elasticity to the fascia could also explain the satisfactory results maintained over time.

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Click here for a list of Fascial Abstract Articles to read.