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to be far greater than is possible in a manual therapy setting. 5 Schleip makes the droll observation that in the time it takes to read an article like this one, your own bottom has been subjected to more pressure for a longer duration than most therapists ever use with their clients. Yet, when we stand up after hours of sitting, our behinds are not flattened or deformed. Fascial change and plasticity clearly involves more than just mechanical pressure. However, influential teachers and writers continue to use thixotropy as a conceptual model. Italian physiotherapist Luigi Stecco uses a combination of pressure and friction- produced heat to "maintain the fluidity of the ground substance of the deep fascia, in such a way that the bundles of collagen fibers glide independently." 6 Other researchers have speculated that changes in the ground substance's hydration produce the effects felt by manual therapists. Using nuclear magnetic resonance imaging, water droplets can be seen emerging from the surface of tendons during stretching. 7 Since water plays an important role in fascial stiffness via the elastic interactions between protein fibers, a 2 Three interconnected fascial qualities relevant to hands-on work. Each quality has a beneficial and a detrimental aspect. For example, dysfunctional continuity leads to over-connection, binding, and restriction. Unhealthy plasticity takes the form of tissue that is either too dense, or too loose. And one of the downsides of fascia's sensitivity is that it can become overly sensitive to pain. Image courtesy Advanced-Trainings.com, used by permission. I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 115 In spite of being a good connector, healthy fascia is also very good at facilitating movement. It does this by being springy and elastic, and by interspersing its tough, collagenous fibers with layers of slippery proteins like proteoglycan gel, which both connects and lubricates movement between the structures that the fascia envelopes (Image 4, page 116). However, when there is strain, injury, disease, or lack of movement, fascia responds by connecting even more, forming adhesions, restrictions, and scars. In these situations, fascia becomes overly linked with its surrounding structures, and binds, pulls, and restricts like a too-tight garment. Clients feel this when they move, and to a trained practitioner, fascial binding can be perceived as a mobility restriction, or palpated as thicker, denser, or less-plastic regions of fascia. When fascia has become overly connected, our therapeutic goal is to restore differentiation—that is, to separate fascial structures and reestablish their ability to move independently from one another. Examples of techniques for restoring fascial differentiation include the Hamstring Technique ("Working With Hamstring Injuries," Massage & Bodywork, January/February 2014, page 116). Our next column will include additional techniques that help reestablish a balance of fascial continuity and differentiation. 2. Plasticity Practitioners can feel fascia changing. With appropriate pressure and patience, tissues soften, lengthen, and separate; harder and denser areas melt away and become more pliable. Clients feel these changes, too, and report tangible therapeutic effects: less pain, greater flexibility, and easier movement. "Fascial plasticity" is commonly cited as the reason for these results. And yet, the scientific explanation remains under debate. Ida Rolf, who had a doctorate in biochemistry, taught that the changes her deep work produced resulted from a gel-to-sol melting in fascia's extracellular ground substance: the thinning, or thixotropy, of the tissues' matrix allowed for remodeling and reorganization of the tissues. 4 Generations of structural integration practitioners (this author included) learned and taught this mechanical model of tissue change. Many fascial researchers, though not all, now doubt the thixotropy explanation, at least as a literal explanation for permanent tissue change. As tissue research has progressed since Rolf's time (she earned her doctorate in biochemistry in 1920), several researchers have concluded that the pressure and time needed to produce tissue changes would need