Posts Tagged ‘fascia’

International Fascia Research Congress, Vancouver, BC – Day 3

| March 30th, 2012 | No Comments »

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.


International Fascia Research Congress, Vancouver, BC – Day 2, the night

| March 29th, 2012 | No Comments »

Tonight I watched a prophet perform. Not what I expected to see at a Fascial Congress but I am not sure what other words to use. Gil Hedley was the final act in our multimedia night. After three amazing, room-stilling videos that were highly anticipated, onto the stage came a wiry, kinetically unstable bundle of poetry reading anatomist.

Perhaps I have had too much coffee, not enough sleep or entirely too much mental stimulation but Gil Hedley’s presentation on his new thinking around fascia makes me what to sign up to join whatever cult he’s leading or drink whatever kool-aid he’s pouring. He brings an inspiring combination of respect, enthusiasm, joy and intellect into the world of fascial dissection.

I am someone who loves my words and concepts and rather resent having to give up a perfectly good story for a new idea. Even though Hedley’s whole presentation was a debunking of his own, infamous “fascial fuzz” speech that has become an easy, u-tube click away, introduction to fascia for the uniformed, I loved it. I now have to discover a new story to tell myself about the development of adhesions and what I am doing in my work. Daunting. I am inspired though by the enthusiasm, dance, poetry and joy that was displayed on the stage of the grand ballroom of the Sheraton Wall Centre tonight in Vancouver, BC


International Fascia Research Congress, Vancouver, BC, Day 2

| March 29th, 2012 | No Comments »

Today is a new day of learning and the overload is starting to set in.  Not in a bad way, but you can see the shiny eagerness beginning to fade, there is more movement during presentations and alternate seating is becoming more popular and the familiar seats begin to feel entirely too familiar to our posteriors.

A great day none the less with some wonderful clinical information and tonight a multimedia presentation of fascial videos that I, along with several others from the look of the bar and cafe here at the hotel, will be late for.  I admit that I have stepped away from a few presentations seeking some quiet retreat time to process some of the information.  After some dinner though I look forward to watching some highly visual presentations that I am betting won’t stress my lack of chemistry knowledge as several of the presentations today did.  

The flip side of the restlessness is an increase in casual interaction between attendees and lots of chatter.  As I sit and type several tables of congress attendees sit together chatting, eating and drinking.  I suspect many a new research project will be hatched over the next several days.

In terms of the learning there was a shift from the mechanical to the fluid as our keynote speakers focused on the issue of fluid dynamics in the interstitium and the wonderous fourth state of water – bound water.  The water talk, given by Gerald Pollack from the University of Seattle, was my third exposure to his theories and seems to have been a bit of a charm as several of the concepts seemed to sink right into my brain rather than flying inches or feet over my head.  Dr. Pollack’s research has focused around the behaviour of water at it’s edges, where it contacts hydrophilic (water lovings) substances and air, and there is the creation of an exclusion zone where the water enters the bound, or fourth state.  In this zone the water is denser, negatively charged, has a viscosity similar to honey and just generally is really different from what he calls bulk water.  Beyond the interesting implications for us manual therapy practitioners whose clients are all largely composed of water there are real world implications.  


In the real world the exclusion zone offers explanations for cloud to cloud electric activity (= lightning), why the basilisk lizard really can walk on water, why heavy objects float and offers interesting possibilities for water decontamination, perhaps even desalination, and the ability to harvest electricity from water – all using only the radiant energy of light to accomplish the task.

There is the report for today, stay tuned for the final day’s report where imaging and more anatomy and clinical discussion look to be the highlight.


International Fascia Research Congress 3 – Vancouver, BC, Day 1

| March 28th, 2012 | No Comments »

***Beware – this post is a total fascia geekfest, if you are not prepared to deal with that, read a different post!  Also, any factual errors are my faulty memory, not faulty presentations.***


Today I had the absolute pleasure of beginning my time at the 3rd gathering on scientists and clinicians who have an abiding interest in fascia in all its varied and wonderous forms.  I began the day with a flight to Vancouver and a slightly late arrival – but I got before the real geek-out stuff began, so it is all good.  

After some general introductory speeches we dove right into the first keynote speaker.  A anatomist from Temple University, Mary Barbe spoke to us about her research in duplicating repetitive stress injuries (RSI’s) in rats and the tissue changes that occurred in response to various types (high, low and negligable intensities) of work.  How could this possibly relate to massage therapy you ask? Well the road hasn’t fully been built, but knowing that rest doesn’t always fix the problem and that inflammatory processes have likely come and gone prior to anyone presenting at my office (they peak between week 4 and 8 of performing the task) after months or years of a repetitive task, provides me with insight into what interventions and homecare might best benefit my clients.  simply knowing that there are significant connective tissue changes that occur within weeks of undertaking an repetitive task shouts loud and clear about the importance of the fascial work that I am a huge advocate for.

After a quick break we moved our second speaker, Michael Kjaer, whose topic was the impact of exercise on tendon tissues.  We discovered that exercise (and not a lot, 1x creates 72 hours of increased collagen production which is what builds your tendons) increases the density of tendons.  Interestingly, there seems to be little issue with maladaptive changes in the tissue to repetitive exercise as there is to repetitive work activity (there’s a thinker).  More surprisingly, it turns out men exhibit greater tendon density increase than women, and that within the female population women taking oral contraceptive exhibit even lower levels of tendon response than the general population.  Further interest in gender issues came when it was revealed that in post-menopausal women being on hormone replacement heightened tendon response.  Hmmm, that estrogen, funny stuff.  


After a break for lunch we broke into three groups for presentations on specific areas of fascial research.  I chose the “biomechanics” room and got to learn about different means of trying to empirically measure different types of mechanical interventions.  From pressure sensitive pads on fingers to rather medieval looking table devices this part of the afternoon was an interesting insight into the various ways we can try to research the interventions we apply with our hands and their outcomes.  I also gained an interesting insight into the world of research.  Failure, or rather, not proving your hypothesis fully or at all.  Even in those cases it was interesting to see how that research could be used to launch into better studies.

Our next keynote speaker, Albert Banes, was a doozy.  I am pretty sure I learned so interesting things, but they went by so fast I think I might be lucky to catch up with them sometime next week – after reading the paper a few times!  He seemed to be summarizing quite an extensive array of studies in the field of fascia research and had some very interesting things to say – and showed us pictures of some lab grow tendons, but it was a lot in just a little time

The final event of the afternoon, academically, was a panel of  four clinicians presenting of “scars and adhesions”.  One of the exciting bits of us BC RMT’s was having one of our own on the panel – Susan Chapelle of Squamish, BC who talked about the benefits of integretive treatment and the need for increased research that included a manual therapy aspect.  She was preceeded by a surgeon, Dr. Michael Diamond, who discussed post-surgical adhesions (things sticking together that shouldn’t after surgery) which I was surprised to find has a 65-100% incidence rate in abdominal surgeries (though they are not limited to those surgeries).  We were then treated to a new movie by Jean Claude Guimberteau, a French physician, who has now produced several in vivo movies of fascia using endoscopic techniques (his first being “Strolling Under the Skin”, presented at the first fascial congress).  We also had a naturopathic doctor, Hal Brown, present some of his case studies of the impact of the injection of aenasthetic under the skin into scars to improve function in both near and far tissues. 

The day finished with a welcome reception that was very well attended that allowed us all to review and discuss our reactions and thoughts regarding the days flood of knowledge.  I can hardly wait for day two….


Willem Fourie, again…

| May 5th, 2011 | No Comments »

Last week I spent two wonderful days in Vancouver. With hardly any shopping to enhance the experience. I attended an advanced seminar on post-mastectomy care with Willem Fourie, a leader in the world of fascia. Willem is a physiotherapist from South Africa and has made a study of the specific impacts of breast cancer treatment, due to lump- and mast-ectomies, radiation and reconstructions.

I wrote, glowingly, about my introductory course last June. When the opportunity to attend a more advanced course arose I was quick to sign up. Out of the 75 of us who attended last year’s introductory course 11 of us returned this year to broaden our understanding of approaches to care for breast cancer patients.

One of the things that quickly became clear was that we had all, myself included, found uses for the approaches taught by Willem in the 11 month since the first course. We opened the course with each attendee describing how they had employed the techniques and what they sought to learn. Some had very emotional stories to tell of breast cancer patients who they had been able to help and who had inspired them with their strength and courage. Others, myself included, had taken the approaches and been able to apply them with great results to a number of other conditions, from abdominal surgeries to burn victims. The scope of application and success from these fascial techniques was impressive.

The intensity and integrity expressed in the opening of the course set the tone for the whole two days. Often at this type of course there is a very chatty, social atmosphere as the attendees enjoy a break from their regular routines. Schedules are often quick paced and hands on time limited. None of these was the case for this course. There was chatting for certain, but never disruptive to the course. The tone was quiet and the schedule was full of hands on time and quiet diligence. Where hands on time in other courses might become a bit raucous and unfocused in this instance it was very much about applying the techniques and learning to treat what you found in the connective tissue. Though we had no actual breast cancer survivors, we did apply the techniques to the variety of injuries and old surgeries we collectively brought to the occasion. We addressed armpits, abdomens and breasts without giggles or discomfort.

I came away with a deeper understanding of the anatomy, physiology, surgery and the humanity that are all part of treating any patient, most especially those who have faced such monumental challenges as breast cancer. I am continuing diligence of the course having already found several patients who could benefit from these techniques. I hope that they have found some benefit from those two days I spent in thoughtful pursuit of new information and new ideas.

Willem Fourie’s website


Surgery and the Body

| June 8th, 2010 | No Comments »

After surgery your body is very busy indeed. It must finish dealing with the lingering effects of whatever took you into surgery and also heal you of the damage surgery has done.

Strange to think of surgery as damaging, but it is. After all, the surgeon cuts through multiple layers of connective tissue and muscle. Disrupting blood and lymph flow by severing the vessels large and small. And they only repair the large ones!

This is NOT to advocate against surgery, just to point out that it is both a healing and a harming event. The healing benefits should greatly outweigh the harming side effects, but those side effects can still be profound.

As I mentioned, your body is still responding the the cause of the surgery itself. Whether your body was fighting a chronic illness, physical dysfunction or was thrust into red alert status to deal with an accident or injury of some kind, a surgery is generally a brief interruption in this and the body requires time realize the provoking event has stopped.

As it is becoming aware of the decreasing demands of the illness or injury, it is also becoming aware of the new insult it has suffered.

Now, this injury is generally much tidier and cleaner than any real world damage would be, but the body mobilizes the same kind of responses to heal it. Inflammation and a flood of white blood cells and resources flood into the area. Your body may also be discovering that it is stiff and sore from the, often odd, position it has been in during surgery and the minor muscle atrophy and aches of being immobilized.

So what can you do to help this process?

One, eat well and take in lots of fluid. You need to provide the resource components for healing – healthy food it the best way to do that. Keep the meals light, varied and frequent. You have lost blood and inflammation takes fluid out of the circulatory system and puts it into the swollen tissue, so lots of fluid helps the body move everything around and rebuild its blood volume.

Two, rest. Your body is working really hard inside to heal you, try not to ask it to do much else. Light activity is good. Fixing those light meals, going for a short walk. These help your body to move things around and prevent aches and pains. But take a nap, your body does lots of good healing work while you sleep.

Three, follow orders, the doctors and nurses may have sent you home with some self-care – DO IT!!! Take the medication, keep the incision clean, do any exercises (part of you light activity!). This is what the allopathic system does well, surgery and fixing problems. So let them exercise their expertise.

Four, get some massage! Soon after surgery a massage can benefit you by helping move all those resources around and making sure they don’t stagnate at the surgery site. If you are stiff and achy massage therapy can help deal with the soft tissue tension and restriction that is causing that. Should you have a lot of swelling at the surgical site find a RMT who has advanced lymph drainage training (not me!) as they can often make a huge difference. After about six weeks, when the scar has settled, a therapist with connective tissue expertise (me!) can help to ensure that your scar heals functionally.


Fascia – the undiscovered tissue

| June 2nd, 2010 | 1 Comment »

PLEASE NOTE  – Originally published November/09 on “Your Body.  Yourself?” my old blog…

This last week the 2nd International Fascia Congress went ahead in Amsterdam. For four days the leading researchers presented their most recent findings to a mixed group of scientists and clinicians. After the congress there were a series of workshops, many of them very practical in nature. I am very excited to learn that the 2012 the fascial congress will be hosted by my professional organization, the British Columbia Massage Therapy Association of BC in Vancouver. To heighten my delight the 2012 congress will focus on the clinical application of current fascial research. I will be at that one, doing a little happy dance.

I expect many of you are trying to figure out what this fascia stuff is and why I am all giddy about it. Well, to steal the explanation my first fascial instructor gave me – fascia is the bag we walk around in. Imagine all the different bits in your body that you know about as being what is in the bag and that fascia is the bag. Recent research has shown that these are contractile bags – something that wasn’t known when I first started studying fascia. A type of cell called a myofibroblast is responsible for this type of constriction – more on this later.

Fascia surrounds all nerve fibres, nerves, muscle fibres and muscles, organs, bones, joints and underlies our skin. Fascia acts to protect and separate structures, help maintain posture, and allow structures to glide upon one another. Problems in the fascia therefore create all sorts of problems in the body and often create mobile pain, pain that migrates far from its source and or moves around in the body without apparent cause.

The term fascia encompasses most of the connective tissue in the body and is the most pervasive substances in our bodies. Yet many people have never heard of it and our scientific exploration has just begun to bring fascia into the light. The western reductionist approach to our bodies and the treatment of them has allowed fascia to languish unexplored. Fascia coexists in form and function with all of our bodies systems and our piece-by-piece, system-by-system approach to treating our bodies meant that there has been virtually no exploration of this fascinating tissue. Basically, no one owned fascia because everyone owed fascia.

They owed fascia for the protection, lubrication and separation of the system in which they specialized. Fascia is the ultimate in multi-taskers. It can be thick, dense and organized, lending support to and separation between structures. It can be gossamer thin and allow structures to glide over one and other smoothly. It can be almost free of blood vessels and nerves or richly supplied with blood and sensory functions. Fascia can be so many things that initially anatomists did not realize it was all the same thing. So we have many names for the structures that are composed of fascia and a dearth of understanding of how all these different structures with their different compositions and functions can be discussed together.

On the bright side, there is a huge amount of research being done to increase our understanding of fascial tissue and its myriad impacts on the body. Some of the interesting directions that are being explored include the contractile nature of fascia, how tension is transmitted into the lumber fascia and how healthy fascia can move the way it does in the body without tearing.

Current research by Dr. Robert Schleip of the University of Ulm in Germany is exploring variability of myofibroblast density in fascia. Myofibroblasts are a contractile cell that are found in fascia and at wound sites. At wound sites the myofibroblast aid in wound closure, which speeds healing. However, in scar tissue these myofibroblasts sometimes stay around and continue to create contraction where it is not needed or wanted. What does this mean to fascia? If these cells are too active would they create undue restriction in the tissues they surround? Would this create tension and perhaps pain the the surrounded tissue?

Priscilla Barker and her associates have shown that contraction of various trunk muscles, including the transversus abdominis, create tension in the lumbar fascia, which then contributes to stability in the lumbar spine. Which explains why you are told to contract your tummy when you lift heavy objects.

One of the most visually arresting explorations of fascia comes to use from Dr. Jean Claude Guimberteau. Dr. Guimberteau has collected images, via laproscopic camera, of live fascial tissue and recorded the movement that occurs in the fascia and the neurovascular (nerves and blood vessels) tissue when a tendon is pulled on. The result is a video called “Strolling Under the Skin” and a book of the same title.

As a manual therapist I am excited by this research and what it tells us about one of the most frustrating things manual therapists experience. I have a client come in, I do all the indicated treatment and they leave feeling great – only to have the same pain and discomfort return almost immediately. Often, though not always, this type of pattern indicates fascial distortion or restriction. The good news is all this research that tells us about the function, structure and responses of fascia helps us to more easily recognize and successfully treat fascial issues and leave our clients with long term improvement in the performance and comfort of their bodies.

So there is a quick overview of the world of fascia and the reason I get so excited about this coming congress in Vancouver. What a wonderful opportunity to engage with and learn from the leading lights of fascial research. What a wonderful opportunity for the growth of understanding and good clinical application of that research by bringing together those who are exploring the science and those who are applying that science for your benefit.

Stay tuned for more on you and your body. Please let me know if there are wellness topics you are interested in or confused by.


Massage Therapy as part of Breast Cancer care

| April 12th, 2010 | No Comments »

I have been working with a client who is in recovery from breast cancer and from the effects of the treatment for breast cancer. In many ways the latter is the larger piece. Her body bears the surgical scars of her lumpectomy, the internal effects of chemotherapy and damaged tissue from her radiation therapy.

The portion I have had the opportunity to support is her return to fitness and reducing the impacts of scarring from her lumpectomy and her radiation. Her return to fitness I am supporting by keeping her muscles healthy and in balance and relieving whatever aches, pain and restrictions occur as she begins to return to the vital physical health she had previously.

It is my work with her scars and adhesions is what I wish to focus on though. Any trauma inflicted on the body will cause scarring. In the case of breast cancer treatment you generally have two major traumas inflicted on your chest wall. First, some sort of surgery to remove the cancerous tissue. The second chest wall trauma comes from the radiation. Although no physical invasion occurs, the intense light energy can create burns and always creates an inflammatory response in the body.

These scars can be focal or broad but they, in conjunction with the surgical scars, tend to leave the skin and muscles of the chest wall constricted and tight. The close proximity of the shoulder and the fact that the chest muscles contribute to shoulder movement means that normal movement can be reduced and there can be a pulling pain with any attempt to open up the arm movement.

Now we know the mechanism, lets look at what is done about it. A couple of decades ago the answer would have been nothing, do NOTHING. Fortunately this thinking has fallen by the wayside. Active use of the arm, with such activities as dragon boating, is encouraged. But what happens if you need some help? If, as my client found, the process of simply using the arm is not sufficient to restore the mobility you crave? Or if you restore movement but can not quite relieve the pain the occurs with the extremes of movement? What are your options?

Perhaps the best option is myofascial release. Now, if you have found this, you have found my blog. If you scroll through you will find other pieces dedicated to the wonders of fascia. For those of you interested, I encourage you to read them in full. For now, I will just say that fascia is a form of connective tissue that pervades the body’s structure giving both separation and form. Myofascial release is the practice of releasing restriction in the fascia to restore movement and function to tissue.

Think of a scar as a place where a drop of glue landed and started sticking everything to it. This sticky point continues to adhere things together and in doing so tends to draw the surrounding tissue in tight around it. For some, their determination to move, and/or their own physiology, ensures that they maintain reasonable movement and limited amounts of pain and are able to continue much as they wish in their life. For others we see a progressive advancement of restriction in movement and a concurrent increase in pain with movement. When this is the case some live with that pain their whole live. Myofascial release can change that.

As a Registered Massage Therapist I am one of the best options someone can choose for help. I use my hands to bring tension and stretch into the restrictions and unstick those glued down bits. Over a series of treatments more and more stuck pieces are released, increasing pain-free movement. This encourages more movement, which in turn encourages more release. Then, instead of slowly decreasing movement with increasing pain, we see the opposing trends develop.

Who and when can this intervention help? Though we must wait until the scar has settled, a matter of a few weeks to a couple of months for most, there is no other real limit. Even for those who might be able to self-release these restrictions, a few treatments can hugely speed their recovery. Even if a scar is years old, significant progress can be made to improve function and reduce pain. Though results are often slower with older injuries the impact can still be profound.

Having breast cancer, or any kind of cancer, has a profound impact on your life. There is no way to prevent this impact. Your life will change in ways that you can not predict, or even imagine. What you can impact though, is how you choose to proceed through the course of your illness and, hopefully, recovery. One thing you can choose is getting care for your body that goes beyond treatment for cancer to treating the whole body and ensuring yourself maximal function. Myofascial release can help with the scars of cancer treatment. Generally, Registered Massage Therapy can help relieve pain and improve whole body function.