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114 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 4 Tools for Working with Fascia Differentiation, Elasticity, and Perception By Til Luchau Fascia is famous. Growing numbers of conferences, scholarly studies, magazine articles, exercise systems, and self-help books feature this suddenly popular tissue. Although fascia has had champions as far back as Andrew T. Still, the originator of osteopathy (1828–1917), and Ida P. Rolf, the founder of Rolfing structural integration (1896–1979), their emphasis on fascia was unconventional and far ahead of its time. Until relatively recently, fascia was often considered a throwaway tissue—the whitish "packing material" that anatomists took pains to remove and discard in dissections and illustrations. More recently, opinions about fascia's importance have changed dramatically. Between 1970 and 2010, the annual number of papers about fascia in peer-reviewed scientific journals grew fivefold. 1 Fascial theories are significantly influencing acupuncture, chiropractic, osteopathy, sports conditioning, yoga, and, of course, massage and other manual therapies. One sign of this is the ever-increasing number of manuals, media, modalities, and seminars focusing on fascial and myofascial approaches (including our own Advanced Myofascial Techniques seminar and DVD series). technique MYOFASCIAL TECHNIQUES FASCIAL QUALITIES Our last column, "Understanding Fascial Change" (Massage & Bodywork, May/June 2014, page 114), described fascia and its qualities in detail. As a brief review, fascia can vary from dense to loose, and from very regular fiber organization (such as tendons or ligaments) to irregular (for example, superficial fascia, Image 1, or scar tissue). These many varieties of fascia share several common qualities, which can change depending on the tissues' degree of health. Fascia can be stiff, bound, and painful when it has been distressed (through injury or disease), neglected (through lack of movement), or overused (by activity, posture, or habit). Skilled hands- on work can change each of these problematic qualities, helping the body's fascia regain differentiation, elasticity, and refined perception; this column will describe two hands- on techniques to do just that. FOREARM FLEXOR TECHNIQUE Although there are many techniques we could use to illustrate the principles of fascial work, the Forearm Flexor Technique brings together many pieces of the fascial puzzle. Preparation Prepare for this technique by palpating the layers of fascia surrounding the anterior, or palm side, of the arm. Using your fingertips or pads, feel the outermost layers of tissue over the wrist and finger flexors of your client's lower arm. Don't use oil or lubricant, as you'll actually be using the friction between layers to perceive and mobilize any adhesions or restrictions you may find. At first, move just the surface layers of the lower arm, feeling how you can slide the skin on the muscles underneath. If you slow down and feel for more detail, you'll be able to discern that there are multiple layers of wrappings, some clearly distinguishable, and others blending 1 Cross section of layers from skin to musculature, showing the fascial membranes interspersed with cells, fluids, nerves, and vessels. Note the thin layer of hyaluronic acid just under the deep fascial membrane, which allows the musculature to move freely beneath the outer layers. Image courtesy of Joe Muscolino. Originally published in MTJ, Body Mechanics column, Spring 2012. Epidermis Dermis Superficial retinacula cutis fibers Fat Superficial fascial membrane Deep retinacula cutis fibers Deep fascial membrane Hyaluronic acid layer Epimysium Muscle