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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 49 outbreaks of related infections, such as in shingles or herpes simplex, are related to temporal changes in the immune system. Which factors contribute to diminished immune system control against such fascial microorganisms is not yet well understood. Apparently, systemic as well as local infections can foster such an imbalance. In addition, vigorous mechanical fascial stimulation may also function as a related trigger. When a recent lawsuit was filed against the promoters of a particularly vigorous and strong fascial manipulation method, many of the reported complaints related to sudden outbreaks of Epstein- Barr, shingles, and Lyme disease episodes after application of this vigorous method of myofascial self-treatment. 39 FROM MONO-CAUSAL MODELS TOWARD DYNAMIC SYSTEMS THINKING Most practitioners continue to realize and appreciate that most health dysfunctions in the human body cannot adequately be understood with mono-causal explanation models. While some cases of acute low- back pain may originally be triggered by an injury and/or inf lammation in a precise anatomical structure, it is quite common that subsequent responses and adjustments of the body—such as fear of movement, or neural sensitization—may contribute on their own to a longer-lasting aggravation. If the practitioner then tries to "repair" the specific structure that triggered the original response, this well-intentioned "causal treatment" may not be sufficient. Image 5 gives an example for a proposed conceptual model of the factors that impact tissue health in musculoskeletal conditions. This model was developed by a group of scientists around the Australian researcher Paul Hodges and is based on specific research data related to low-back pain, complex regional back pain, rheumatoid arthritis, and repetitive strain injury, as well as several other myofascial pain conditions. Note the strength and direction of some of the arrows in this model. It is suggested that a well-informed manual practitioner dealing with myofascial pain syndromes should consider addressing more than one of the factors shown here. In many cases, a local tissue release of a specific fibrotic Measurement of myofascial tissue properties in depressive patients revealed an increased stiffness and decreased elastic recoil capacity compared with healthy control patients. It will be promising to explore specific psychological health impairments from a fascial tissue perspective. tissue adhesion is only possible if the ANS and neuro-inf lammatory dynamics are also taken into account, as well as lifestyle factors such as adequate movement, sleep, and nutrition. NEW HORIZONS FOR THERAPEUTIC INTERVENTIONS It will be promising to explore specific psychological health impairments from a fascial tissue perspective. A related novel scientific investigation reports about a first exploration in this direction. This study, published by several German scientists, revealed an increased myofascial stiffness of the posterior neck and thoracic erector spinae area in patients with major depressive disorder, compared to healthy controls. 40 Interestingly, these tissues also had a less elastic recoil capacity, also described as higher viscoelastic creep (Image 6). 6