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Exercise 3 Testing skin elasticity • Now gently hold a pinch of skin between your index and middle finger pads, and your thumb in an area already tested for skin "slideability," as in Exercise 2. • Lift this to sense its degree of elasticity, which will differ greatly in different areas of the body. • What you are holding is skin and superficial fascia, together with some of the adipose/areolar/loose connective tissue that lie between those layers and the underlying dense connective tissue. This "loose" material includes a variety of cells and substances, such as proteoaminoglycans, which facilitate the slideability of the various layers of tissue on each other. • When this facility is reduced or lost, dysfunction, restriction, and pain are almost inevitable consequences. Repeat this light pinch-and-lift in various parts of the thigh, both where there is a thick layer of muscle and also where there is minimal muscle and more fascial tissue. • Now see if you can "roll" the skin and superficial fascia between fingers and thumbs, in the different areas you are testing, in various directions. • Did you notice that where reduced sliding (Exercise 2) was observed, skin is less easy to lift/stretch and roll? • In general, the greater the degree of underlying hypertonicity and shortening, the greater will be the resistance to free sliding on underlying structures of the skin/superficial fascia. • In many instances, there will be a correlation between drag, and lack of easy sliding capacity, and loss of elastic quality. Note that several elements of ARTT are being demonstrated via this exercise. A degree of increased tenderness is also likely in areas where drag is noted, where there is reduced ability to slide and to roll. Sometimes rolling the tissue will be more uncomfortable, adding the final element of ARTT (tenderness). Exercise 4 Apply tests 1, 2, and 3 to somebody else's sacrum and/or lower back and, as you do so, try to evaluate directions of relative restriction in the ability of superficial tissues to slide. You are now on your way toward palpatory literacy. CLINICAL SUMMARY • Global evaluation via observation— static and during movement— offers indications of areas that are restricted or dysfunctional. • Functional assessments allow you to identify specific structures that deserve further investigation. • Direct palpation isolates local areas of tissue change. Your only remaining concern is what to do about what you have identified. Fascia in Sport and Movement (Handspring Publishing, 2015), from which this article was adapted, offers solutions to those concerns. Notes 1. Helene Langevin et al., "Ultrasound Evidence of Altered Lumbar Connective Tissue Structure in Human Subjects with Chronic Low-Back Pain," presentation at 2nd Fascia Research Congress, 2009. 2. F. Grinnel, "Fibroblast Mechanics in Three- Dimensional Collagen Matrices," Fascia Research II: Basic Science Implications for Conventional and Complementary Health Care (Munich: Elsevier GmbH, 2009); W. Fourie and K. Robb, "Physiotherapy Management of Axillary Web Syndrome Following Breast Cancer Treatment: Discussing the Use of Soft-Tissue Techniques," Physiotherapy 95 (2009): 314–20. 3. L. Stecco and C. Stecco, Fascial Manipulation: Practical Part (Italy: Piccini, 2009). 4. Thomas Myers, Anatomy Trains, 2nd ed. (Edinburgh: Churchill Livingstone, 2009). 5. V. Janda, "Evaluation of Muscular Balance," in Craig Liebenson, ed: Rehabilitation of the Spine (Baltimore: Williams & Wilkins, 1996). 6. P. E. Greenman, Principles of Manual Medicine, 2nd ed. (Baltimore: Williams & Wilkins, 1996). 7. J. Key, Back Pain—A Movement Problem: A Clinical Approach Incorporating Relevant Research and Practice (Edinburgh: Churchill Livingstone, 2010). 8. P. Huijing, "Muscular Force Transmission: a Unified, Dual, or Multiple System," Archives of Physiology and Biochemistry 107 (1999): 292–311. 9. A. Franklyn-Miller et al., in Fascial Research II: Basic Science and Implications for Conventional and Complementary Health Care (Munich: Elsevier GmbH, 2009). 10. V. Janda, 1996. 11. G. Fryer, T. Morris, and P. Gibbons, "The Relationship Between Palpation of Thoracic Paraspinal Tissues and Pressure Sensitivity Measured by a Digital Algometer," Journal of Osteopathic Medicine 7 (2004): 64–9. 12. G. Fryer, T. Morris, and P. Gibbons, "The Relationship Between Palpation of Thoracic Tissues and Deep Paraspinal Muscle Thickness," International Journal of Osteopathic Medicine 8 (2005): 22–8. 13. G. Fryer, T. Morris, and P. Gibbons, et al., "The Activity of Thoracic Paraspinal Muscles Identified as Abnormal with Palpation," Journal of Manipulative and Physiological Therapeutics 29, no. 6 (2007): 437–47. 14. Leon Chaitow, Palpation and Assessment Skills (Edinburgh: Churchill Livingstone, 2010). Leon Chaitow, ND, DO, is a director of the Ida P. Rolf Research Foundation and Honorary Fellow of the University of Westminster in London. For more information, visit www.leonchaitow.com. F r e e S O A P n o t e s w i t h M a s s a g e B o o k f o r A B M P m e m b e r s : a b m p . u s / M a s s a g e b o o k 71 FASCIA-REL ATED DYSFUNCTION