MECHANICAL THRESHOLD & ADHESED FASCIA
WHAT YOU NEED TO UNDERSTAND IF YOU HOPE TO IMPROVE YOUR CONDITION
If you want to get a better handle on the physics of fascia, read Dr. Stecco's Functional Atlas of the Human Fascial System or Fascia: The Tensional Network of the Human Body by Schleip, Findley, Chaitow and Huijing. But for now understand that fascial adhesions are both real and potentially problematic because they alter the physical properties (physics) of the tissue (HERE). If you want to see this phenomenon in action, take a look at two 10 second videos side-by-side and note the difference between adhesed thoracolumbar fascia and normal thoracolumbar fascia (HERE --- be sure to watch them simultaneously)
The academic side of fascia physics is based on numbers and formulas. For instance, scientists are getting better and better at using computer models to figure out exactly how much mechanical loading is needed to cause tissue deformation (HERE or HERE) and either cause or overcome the "THICKENING" that always accompanies. While the academic side is necessary and vital, book knowledge doesn't always translate into better clinical results. Allow me to give you an example. Twenty five years ago next month, a team of scientists from Quebec's Biomedical Engineering Institute (Ecole Polytechnique de Montréal) published a landmark study in the Journal of Biomedical Engineering titled Viscoelastic Properties of the Human Lumbodorsal Fascia.
"The purpose of this study is to provide better understanding of the mechanical response of the lumbodorsal fascia to dynamic and static traction loadings. Since the fascia shows a viscoelastic behaviour, tests in which time is a variable were used, namely hysteresis and stress relaxation. Load-strain and load-time curves obtained from the hysteresis and stress-relaxation tests point out three different phenomena. First, an increase in stiffness is noticed when ligaments are successively stretched, i.e. strains produced by successive and identical loads decrease. Second, if a sufficient resting period is allowed between loadings, stiffening is reversed and strains tend to recover initial values. The third phenomenon, observed in stress-relaxation tests as time progresses, is ligament contraction in stretched and isometrically held samples. This third phenomenon may be explained by the possibility that muscle fibres capable of contracting spontaneously could be present in lumbodorsal fascia ligaments."
This, folks, is physics. And unless you are really into this kind of stuff (or have someone with incredible insight teaching you its relevance), it's not only boring, but in most cases it's not exactly helpful for treating your patients. Although things are rapidly changing in the field of fascia research (I just wrote about the upcoming FIFTH INTERNATIONAL FASCIA CONGRESS that will be held in Berlin in November), there are any number of reasons that the facts we learned back in the day concerning the physical properties of connective tissues are erroneous. A two year old article from the expert himself, John Barnes PT (Myofascial Release - The Scientific Rationale), did a nice job of explaining why in light of the bigger picture.
"The research on the fascial system did not match my experience with my patients and myself. I eventually realized that all of the scientific research on the fascial system was done on cadavers (dead people). This led traditional scientists to a very erroneous view of the fascial system and its importance in the physiological functioning of all of the systems of our body in life. How could science omit something so important? This error probably occurred due to the fact that Myofascial restrictions do not show up in any of the standard tests such as x-rays, MRI's, myelograms, CAT scans, electromyography, etc. Myofascial restrictions occur from trauma, surgery, and inflammatory processes. Trauma and inflammatory responses create myofascial restrictions that can produce pressures of approximately 2,000 pounds per square inch on pain sensitive structures that do not show up in any of the standard tests. This enormous pressure acts like a "straightjacket" on muscles, nerves, blood vessels and osseous structures producing the symptoms of pain, headaches, and restriction of motion, and disease. Myofascial Release allows the chronic inflammatory response to resolve and eradicates the enormous pressure exerted on pain sensitive structures by myofascial restrictions to alleviate symptoms and to allow the body's natural healing capacity to function properly. There is No Such Thing as a Disease!"
What does Barnes mean when he says that there is no such thing as a disease? He's not crazy or deluded, he's simply educating you about the new science --- the conclusions that an increasing number of the scientists and academics in fascia research are coming to (HERE, HERE and HERE) concerning the fact that all disease processes have a foundational basis in adhesed and restricted fascia. Once you begin to understand the fact that inflammation is the known cause of fibrosis / scar tissue (HERE), and that the nervous system that controls every part of you can become woven into these fascial adhesions (HERE), it starts making sense. What's the point? Only that in many ways and on many levels you have far more power over your health than you ever dreamed. It also helps explain what happens after you've been riding the medical merry-go-round for awhile (HERE).
For many of you --- especially those of you with mildly adhesed fascia --- gentle, soothing treatments might be the cat's meow (HERE). But for many of the rest, it's not enough to reach the physical threshold needed to break the adhesion. What do I mean? Look at the picture of the high-striker game at the top of the page. Hit the base hard enough with the large wooden sledgehammer, and you introduce enough force to overcome gravity and ring the bell at the top (HERE is another example). Fail to impact the striker base with enough force and the effects of gravity are not sufficiently overcome. End result is that the bell does not ring. Breaking fascial adhesions can be thought of in similar fashion.
Whether using manual methods (there are thousands of them), modalities such as ultrasound, exercise, yoga, STRETCHING, etc, etc; if there is not enough mechanical force introduced into the adhesion in the proper manner and proper direction, then the tissue never breaks and the bell never rings. My point is that a whole lot of sub-threshold treatment is just that, a whole lot of sub-threshold treatment. The tissue never breaks, and while the patient may see temporary relief and other benefits for the short term, long term improvements often prove elusive (the same thing is often seen with chiropractic adjustments ---- HERE or therapy, HERE). And don't forget that SYSTEMIC INFLAMMATION must be effectively addressed as well.
A failure to take care of said inflammation is like not turning off the faucet in a sink with a plugged drain, and then wondering why you can't mop fast enough to stay ahead of the flood deepening on your floor (HERE). Although I have shown you over and over again that the results in my clinic are different than results in many others (HERE, HERE, and HERE), I want my patients to take things to the next level. While it's undoubtedly true that some of you will need to see a specialist in FUNCTIONAL MEDICINE, the majority of you can help yourselves tremendously simply by following some of the foundational premises found in THIS POST. And if you're really into articles on fascia, I have nearly 200 of them HERE, all neatly categorized for you. If you think our site is worthy of sharing, reach the people you love and care about most by liking, sharing, or following on FACEBOOK.