Today began with a keynote speech by Carla Stecco who spoke on the nature of fascial anatomy. One of the most amazing pieces of information I took from this was the fact that the sheaths of the limbs and trunk (aponeurosis of the deep fascia) that are traditionally classified as “disorganized” can actually be dissected into 2-3 layers of highly organized, aligned collagen fibers that are each oriented in discrete directions in each layers whose fibers are shifted 78 degrees from each other throughout the body and are capable of gliding on each other. The other aspect, which actually came up several times over the last days is that there are penetrating collagen fibers that bind across various levels of fascia to affect sensory organs and allow force transmission across nested fascial layers.
I chose not to attend the discussion of imaging techniques and devices that followed, but from the tweets that I have seen there is a huge desire for a 4D sonograph now. I have no idea what that is nor why it is so lusted after but I am glad that those that stayed had a good time. I was not alone in missing some of the events of the day, I think overload was being reached by many of us and I know I enjoyed the time to be quiet with my thoughts and organize myself for the trip home.
In the afternoon I returned to congress-land and heard some very interesting presentations, one on plantar fasciitis, one on immobilization of rats (which requires metal harnessing and ankle cuffs, those rats are apparently very much not keen on bondage), one on trigger point release using myofascial techniques and finally a study designed to demonstrate the actual force generate with different applications of Swedish massage. This last one was an amazing demonstration of several important facts. One, that the Fascial Research Congress model is generating clinically relevant research (the study was conceived after the presenter attended the second congress in Amsterdam. Two, that there is a lot of very basic research to do on clinical application of manual therapy – after all, we cannot actually say with any scientific certainty the amount of force that we are generating on the tissue of our clients. Three, that research is a rough go. The presenter, brave soul that she was, led us through an elegantly designed trial to determine the compressive force generated by Swedish massage technique. She covered the various challenges she faced and how she managed to overcome many of them. She showed us some lovely, very tidy printouts of force generation waves generated by the strokes, and then she had to tell us she had no data to share. All of her data was invalid due to faulty calibration of the testing equipment. Oh my. Despite this I would say she did in fact share quite a lot of data, just no outcomes. I was relieved to hear she hasn’t given up and she may be able to salvage some of the data she had acquired through the magic of algorithms (okay, I think they are magic, some people think of what I do as magic, I think of algorithms as magic, we each have our own perspective).
After the bittersweet conclusion of the parallel panel presentations we concluded the afternoon with a panel entitled “Art & Science/ Research & Practice”. Here was our opportunity to hear the thoughts and hopes of a few that I think reflected the hopes and dreams of many of us.
Maureen Simmonds and Paul Standley both spoke about the importance of clearer, more standardized language and communication between clinicians and researchers to aid in the development of a greater understanding of whether what we do in the clinic is actually doing what we think and if it can create the kinds of impacts in the real world that simulated work in the lab does in petri dishes and research animals.
Robert Schleip likened himself to Alice in Wonderland as he as a clinician who has entered the world of the scientist and continues to find both worlds “curiouser and curiouser” (I think I have applied the analogy a bit differently than he did, but I think the idea is the same). He also pointed out the fact that he is not the only person to have shifted their position on the continum of clinician and scientist, nor is there only one direction to go on that voyage. the rabbit hole goes both way and it is the both the people that switch burrows and those that simply reach a hand into the other hole to give or receive, or perhaps to join with a hand reaching back, that enrich and invigorate the worlds of fascial research and manual therapy.
Geoffrey Bove concluded the panel with an case study of his experience in reaching hands across the divide, and switching rabbit holes both. Initially a clinical practitioner, he is now the researcher stretching his hand out to the clinician, in the person of Susan Chapelle, to bridge the gap and create new and fascinating (fascia-nating?!?!) discoveries regarding the outcomes of rubbing rat adhesions. He presented with an interesting combination of practicality and emotionalism as he discussed the challenges of research and collaboration clearly demonstrating the passion that is brought to the work.
I departed prior to the final remarks to catch a ferry but I left feeling full of knowledge and enthusiasm and hopeful for the future of my profession.