Issue link: https://www.massageandbodyworkdigital.com/i/296580
116 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 4 spongelike wringing and refilling of the tissue's matrix is one modern alternative to the gel-sol thixotropy model. So what are we feeling when we perceive fascial change under our hands? Schleip lists the aforementioned hydration changes, as well as skeletal muscle relaxation being transmitted through the fascial network, as his favored explanations for apparent fascial change in manual therapy, adding that it could even be an imagined or ideomotor effect caused by the practitioner's unconscious expectations. 8 Elasticity: When fascia becomes stiff or inelastic due to strain, injury, scarring, disease, or lack of movement, our therapeutic goal is to restore its elasticity. One technique that uses this principle is the Plantar Fascia Technique ("Working with Ankle MYOFASCIAL TECHNIQUES Mobility, Part 1," Massage & Bodywork, March/April 2011, page 113). Whatever the exact mechanism involved, there is ample evidence that manual therapy can increase fascial flexibility and adaptability, with client benefits that include increased mobility and less pain. Whichever model we use to explain the tissue effects of our work, and whether we think of that model as scientific fact or inspirational metaphor, we continue to feel tissue melting under our hands. And most importantly, our clients continue to experience less pain, easier movement, and more flexibility. 3. Sensitivity If you were to visualize your own body, not as you see it from the outside, but as you feel it from the inside, what would it look like? What is your overall image of your body sensations, from the inside out? Close your eyes and take a moment to do this now. Once you have a sense of this, the next question is, "What is it you're sensing your body with?" When we look at ourselves in the mirror, we use our eyes; when we "look" at ourselves from the inside, what sense organ are we using? There is good evidence that, more than any other single source, we feel our body using the many mechanoreceptors and nerve endings in our fascia. 9 Fascia has so many sensory receptors that (depending on how you count them) their total number could equal or surpass that of the retina of the eye, which is usually considered the richest human sensory organ. 10 Skin is very sensitive, especially to exteroception (perceiving the outside world through the sense of touch), but the perception of sensation from within the body begins just under the skin's dermis. The tissues in this zone, which include the superficial and deeper fascial membranes and their adjacent spaces, are exceptionally dense with free nerve endings and mechanoreceptors (Image 5). 11 These sense pressure, stretch, shear, vibration, etc.; help us perceive, control, and coordinate our movements; and allow us to shape the felt sense of our physical selves. Fascia's sensitivity means that it is also sensitive to pain. While a benefit of pain is that it can help us avoid further injury, fascial sensitivity may play a role in chronic pain that persists longer than is biologically useful. Sometimes fascial pain is related to direct trauma. Because it is often more sensitive than the structures it envelops, the pain from tears or strains is often felt most acutely in the fascia. This is seen in the link between some kinds of low-back pain and the thoracolumbar fascia. 12 Other times, fascia seems to play a role in generating or sustaining pain, such as with myofascial pain syndrome (MPS). Though MPS is complex and not fully understood, manual therapies have been observed to help. 13 Several writers speculate that fascial stiffness plays a role in MPS and other chronic pain by stimulating embedded nociceptors. 14 Evidence for this comes from ultrasound experiments where neck pain was proportional to fascial thickness, which in turn responded to fascial manipulation. 15 In our manual therapy approach, we use fascia's sensitivity in a variety of ways: • Many of our techniques use static pressure on musculotendinous and periosteal attachments. Combining this pressure with active client movement stimulates Golgi tendon organs and other mechanoreceptors that modify the motor tonus of their associated muscles. 16 One technique that employs this principle is the Push Broom "A" Technique ("Working With Hip Mobility," Massage & Bodywork, March/April 2012, page 114). Fascial interconnections of the latissimus dorsi in a living body. About 30 percent of muscles' fascial connections are to other fascia, rather than to bone. This fascial continuity can be beneficial (such as in force distribution), or detrimental (when unnecessary connections can bind and restrict). Image courtesy Jean Claude Guimberteau, used by permission. Surgeon Jean Claude Guimberteau's microscope shows the complex and dynamic interconnections within loose fascia of the arm. Much like a taut spider's web, the body's fascial continuity is adjusted and tuned by the muscles. Courtesy of Jean Claude Guimberteau, used by permission. 3 4