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C h e c k o u t A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 83 "We know from animal experiments that chronic lack of movement tends to change the fascial architecture and make it stiffer and more fibrotic." —Robert Schleip know?" The longing for certainty itself may be part of what is polarizing us. RS: Yes. And many things in life are multicausal. You start with one thing, it triggers the next thing and the next thing, which then, as a consequence of the first one, becomes itself something that stabilizes the whole system. Often, it doesn't matter how it started, which is often the case in self-regulating dynamic systems such as the human body. I think we should be open to look at different factors. For example, the people in the neurocentric group also strongly believe, like me, that nociception and proprioception are very often in a mutually inhibiting relationship. So if the brain is in a protection mode, it drives the proprioceptive acuity for a related body region down, and vice versa. Now, if (as Helen Langevin and other colleagues have shown) chronic lower back pain goes along with an increased adhesion (or you could call it gluing together) between adjacent layers of the lumbar dorsal fascia (whether that's a cause or an effect is another question), then it is quite likely that this increased adhesiveness is itself a factor that inhibits proprioception, because most of the proprioceptive nerve endings are in layers where you have relative shearing motion. The Golgi receptors and the muscle spindles are embedded in a fascial tissue, whether you call it tendon, muscular septum, epimysium, perimysium, or endomysium. But if, for example, your lumbar dorsal fasciae glue together, you won't have any movement there—no matter how much your brain is interested in picking it up. And then you could have a multicausal relationship. Your brain is in a protection mode that drives down your daily movement, and due to the lack of daily movement, your fascia glues together, and your proprioception goes down due to the gluing of the fascia. As research by Mense and colleagues has demonstrated, a decrease in regional proprioception will augment nociceptive sensitivity within the same region. But then, maybe because of a new girlfriend or a new sport you try, it is possible that you may move out of the previous protection mode in your brain. But I suspect that even then your proprioception will be inhibited because of the fascial adhesion. Then, you will still be not able to replace the previous pain perception with a useful functional proprioception from your lower back. Based on this, I think we should work hand in hand with the people who work with the brain and the people who ask, "How is the local tissue behaving and feeding into that?" A big interest now is to move beyond the field of passive manual therapies, where the client lies on the table and is asked to stay still while a bodyworker leans on their tissue without any active movement participation from the client. In many cases, it is more valuable to inspire our patients to move their bodies in a fascia-friendly manner in activities of daily living or during specific movement rituals, such as sport or dance or yoga, outside of our treatment rooms. TL: Can you say what you mean by a fascia-friendly manner? RS: For example, to move your hip joint in more than 90 degrees during an average day. When you stand and walk, you have approximately zero degrees in the hip joint i.e., neither flexed nor extended. Then, when you sit on the couch or in the car, you have 90 degrees of flexion and that's all. You never go into full external rotation as in cross-legged sitting position on the floor or into full flexion like in a prayer position. Advise your clients to sit on the floor once in a while, or to swing a free leg while talking on the phone when standing, or pretend to kick somebody in a friendly manner, or to go into different meditation poses. I think that these activities are more fascia friendly. We know from animal experiments that chronic lack of movement Robert Schleip, PhD Watch "When Does the Tissue Matter? " tends to change the fascial architecture and make it stiffer and more fibrotic. TL: Robert, what would you say are some ways your work has commonly been misunderstood? RS: I don't like the question so much. Maybe because I'm often surrounded by people who have something like this as a life script: "I have been deeply misunderstood." It's the story of the overlooked hero, and

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