03 May Fascial Manipulation Key to Resolving Pain
Carol Marleigh Kline, JACA Online editor
Fascial Manipulation, Part II
J Amer Chiropr Assoc 2011 April;48(3):2-5
|Abstract: In Part II, Warren Hammer, DC, provides further insights into what makes fascia, the body’s most malleable tissue, a uniquely important focus for doctors of chiropractic. Functional coupling, myofascial “slings,” Stecco’s “Centers of Fusion,” and the formation of fascial adhesions are discussed.|
Taken from the online article: Functional Coupling As outlined in Part I, fundamental to Fascial Manipulation© is the concept that everything in the body is connected. A study by Vleeming et al. says fascia and muscles are not only connected, but blended. “Anatomic structures described as hip, pelvic, and leg muscles interact with so-called arm and spinal muscles via the thoracolumbar fascia.” [Functional coupling] “allows for effective load transfer between spine, pelvis, legs, and arms—an integrated system.”1 How these connections are made, he says, lies in Vleeming’s three main myfascial “slings” that help the body transfer force between the upper and the lower body: 1. A posterior oblique (latissimus dorsi, TLF, and the opposite gluteus maximus) 2. An anterior oblique (external oblique, abdominal fascia, and contralateral adductor) 3. A posterior longitudinal (erector spinae, long dorsal sacroiliac ligament, sacrotuberous ligament, and biceps femoris.)1 “When you have a dysfunction of the muscles down a specific myofascial sequence, it’s going to affect the tendons, ligaments, and the whole joint function because the joint cannot move in a smooth, coordinated way, which may cause distal pain. The fascia between two joints is directly involved in safeguarding preceptors and directional continuity along a specific myokinetic chain or sequence. “Fascia could be seen as a kind of sensitive transmission belt between two adjacent joints and synergic muscle groups. When fascia is densified, however, it cannot manage the proper transmission of tension among muscles, bones, and joints.” Thomas Myers talks about the tensegrity model in his book Anatomy Trains. Tensegrity refers to compression inside a net of continuous tension. With regard to the fascia and the musculoskeletal system, the fascia becomes the structural framework that creates tension within the system and holds the individual bones together. Fascia, when healthy forms a free gliding interface between and within muscles, allowing free movement to occur. When fascia, muscles, tendons, and ligaments get mechanically overloaded, injury can occur resulting in fibrosis and adhesions that disrupt the “sliding and gliding” of tissues. This can lead to difficulty with activities that require high velocity movement such as jumping or throwing a ball and can definitely cause restricted movement that can affect daily activities like walking, standing, sitting, bending and twisting. Active Release Techniques ® is a patented, state of the ART soft tissue movement based treatment that is used to locate and break down scar tissue that results from soft tissue injuries to muscles, tendons, ligaments, fascia, and nerves. Related studies can be found at www.fasciaresearch.com. Some thoughts on soft tissue treatment: What to expect form Active Release Techniques® treatment
- Initial examination usually takes 30 minutes to one hour.
- After diagnosis, treatments take 15 to 30 minutes
- Average treatment plan is typically 8 to10 visits to effectively resolve pain, rehab the problem, and get you back in the game.
- Tension is applied with the hands into the scar tissue or restricted fascia.
- The muscle is shortened, then lengthened under tension to release tissue.
- This is repeated several times to release the tissue, stretching the adhesion, restoring blood flow, improving range of motion, strength and relief from pain.
It usually takes 48-72 hours for the inflammatory process created by Active Release Techniques to subside. Usually by the third day, patients start to feel a little better. This is why it is important to use ice treatments(15-20 minutes of ice, followed by 30 minutes no ice, this can be done 3-4 times daily) to help reduce and control inflammation. This will allow for better healing. Still Practicing Chiropractic Dr. Hammer says that DCs who incorporate what’s known about fascia into their practices are not going to be setting aside what chiropractic does best. “I don’t want people to think that I don’t adjust. There’s an articular component, and there’s a soft-tissue component. And you can’t separate the two. “Unfortunately, I see a lot of chiropractors who worry only about the articular part. I’ve said this for years: The spine is a passive structure. It doesn’t move itself. It’s moved by muscles. It’s supported by connective tissue. Sometimes, a patient will come in all bent over with a sacroiliac problem, and it’s purely articular. That joint is locked. You give that patient an adjustment and she walks out a happy person. But that’s not so common. Most of the time, it’s a combination of restrictions within the joint, within the facet, the capsule, and everything else around it, near and far. To me, if the profession doesn’t get enough into the soft-tissue world, we’re going to be left behind in the Dark Ages.” References 1. Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van Windergen JP and Schnijders CJ. The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Spine. 1995;20(7):753-758. 2. Mallac C. Hamstring pain: what the slump test can reveal. http://www.sportsinjurybulletin.com/archive/hamstring-pain, accessed April 5, 2011. 3. Barker PJ & Briggs CA. Attachments of the posterior layer of the lumbar fascia. Spine 1999:24(17):1757-1764. 4. Stecco L & Stecco C. Fascial Manipulation for Musculoskeletal Pain. Padova, Italy: PICCN Nuova Libreria s.p.a.. -Available at Amazon. 2004. (English version) 5. Stecco L. Fascial Manipulation: Practical Part. Padova, Italy: PICCN Nuova Libreria s.p.a.. -Available at Amazon. 2009 (English version)