FASCIA AND ITS RELATIONSHIP TO
When looking at a lateral view of the spine, the first thing we notice is the curves. The (normal) forward curve in the neck and low back is known as "lordosis" or "lordotic," while the mid-back curve runs the opposite way and is known as "kyphotic" or "kyphosis". What do these curves do? For starters they allow normal movement, both segmentally and sectionally (HERE). Proper curves also create a spring-like function that allows the spine to act as a sort of shock absorber; particularly important if you work on CONCRETE or other hard surfaces.
Without proper curves your spine would take a pounding of epic proportions. The curves work to distribute weight and force as well as transferring muscle energy to where it's needed. As you might imagine from looking at the picture; when spinal mechanics are off, the end result is that there is abnormal distribution of forces to spinal discs --- or maybe more accurately, to parts of the disc where said force should not be. Allow me to give you an example.
While discs will often herniate some degree laterally, they virtually always herniate backwards (posterior), meaning that herniated discs --- mostly from the low back or neck --- have the potential to be pushed or squeezed into the spinal cord or spinal nerve roots that come from the cord. What does this have to do with maintaining normal lordotic curves?
These normal curves put an axial pressure on the backs of the discs (as opposed to the fronts of the discs). As you can see from the picture above, this squeezes down on the posterior aspect of the disc, while opening up the anterior or front of the disc and pushing it forward. This natural "wedging" of these discs makes it extremely difficult for the disc's jelly center (the nucleus pulposis) to herniate (because without a horrific trauma the disc will not herniate forward), and explains why you will sometimes see this spinal position referred to as "closed-packed". However......
Imagine what would happen to the low back or neck if there were either no curves, or even worse, a REVERSE CURVE. Now, instead of the discs having the "open" portion of their wedge to the front, the open part of the disc faces the back. This is what happens to your lumbar spine if you bend forward and touch your toes. No big deal. That is, no big deal until you start loading the spine. Imagine, however, bending forward and lifting something, while not consciously maintaining the normal curve in your back.
Not only are you opening the disc in the back, but the heavier the object you are lifting (or the more overweight you are), the more pressure you are exerting on the front of the spinal column and discs, as opposed to them carrying this force on the posterior parts of the spinal column (the facet joints). This pressure literally squeezes the disc backwards like squeezing a tube of toothpaste. When there is too much force, or more likely, too many years of poor lifting mechanics, the ligamentous fibers of the disc (the annulus fibroses) that hold the jelly-like nucleus in place begin to separate and tear. The result is that you are now in a position where disc herniations are not only possible, but increasingly probable (HERE is a basic video of what this looks like).
Let's add one more variable to this situation. Let's do some situps. After all, everyone knows that situps are good for your back because strong abdominal muscles promote strong discs ---don't they? Enter Stuart McGill. Decades ago, McGill was the lone voice in the wilderness, warning that situps were not only not good for your back, but were arguably one of the single worst things you could do to your spine. His research has shown why situps are one of the best ways to cause spinal problems, including herniated discs (HERE).
In a recent interview with Dr. William Morgan (A Conversation with the Preeminent Lumbar Spine Researcher: Stuart McGill, PhD); after discussing overuse of spinal imaging, McGill made this statement concerning what's arguably the single most common spinal finding on radiologist's reports DJD or DDD (degenerative joint disease . degenerative disc disease). "When they [radiologists] use the term degenerative disc disease, I put that in the same category as nonspecific back pain. It's a garbage term." Interesting because that is essentially what I said in THIS 2012 POST.
In the PORTION OF THE VIDEO INTERVIEW titled Mechanics of Injury For Lumbar Disk Herniations and Extrusions, those of you suffering low back pain will find some interesting tidbits as far as what put you there, as well as pointing you in the right direction to a solution. The biggest disappointment concerning this video was that two of the chief drivers of chronic back and neck pain were not really addressed; the first being SYSTEMIC INFLAMMATION, the other being micoscopic fibrosis or adhesion of the FASCIA, or more specifically, the thoracolumbar fascia (HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE, or HERE) --- a factor that increasing numbers of experts are saying is responsible for the majority (as much as 70%) of chronic back pain. I would argue that if you add these two modes of thinking to the knowledge and protocols created by McGill, your results will be better yet. Allow me to explain.
What do we know about back pain?
- We know that back pain is the world's number one leading cause of disability (HERE).
- We know that back pain and disc herniations are both considered "inflammatory" (HERE or HERE).
- We know that back pain is associated with increased potential of developing chronic neurological disorders and diseases (HERE).
- We know that in our sit-too-much society, both LOWER CROSSED SYNDROME and UPPER CROSSED SYNDROME are epidemics that are dramatically increasing in both numbers and severity.
- We know that there is an intimate relationship between chronic pain, chronic illness, adhesed fascia, inflammation, and fibrosis / scar tissue (HERE, HERE, HERE or HERE).
- We know that SCIATICA is often caused by VERY SPECIFIC FASCIAL ADHESIONS as opposed to disc herniations.
- We know that adjustments are helpful for many cases of spine-related pain (HERE). We also know that in many cases, these same adjustments don't hold very well (HERE).
Although I could have taken this list further, it helps explain why even though one cannot ignore the biomechanical aspects of back and neck pain, it's critical to realize there are other factors at play; particularly the chemical factors we refer to as "INFLAMMATION" --- a factor known to put people into a true CONUNDRUM.
If you are interested in shedding systemic inflammation and starting the process of RESOLVING YOUR BACK PAIN, be sure and take a look at THIS POST. It will at least provide a few ideas as far as creating your own personalized EXIT STRATEGY is concerned. Also, be sure to like, share or follow on FACEBOOK if you appreciated this post because it's still a great way to reach the people you love and value most.
THE LATEST IN FASCIA RESEARCH
HIGHLIGHTS OF THE FASCIA CONGRESS
Fascia is made up of FIBROBLASTS (collagen-secreting cells), MYOFIBROBLASTS (cells that give fascia the ability to contract), telocytes (extremely long fibers that give fascia the ability TO CONNECT YOUR BODY AS A WHOLE, aiding in it's ability to act as A SECOND NERVOUS SYSTEM), fasciacytes (cells that secret the gel-like HYALURONIC ACID), along with numerous other components, including the new lymphatic circulatory system called the INTERSTITIUM. These channels have already been shown to be important in LYMPHEDEMA / LIPEDEMA, the spread of CANCER, in wound healing, in HOMEOSTASIS, as well as their ability to "remove pathogens". When the authors made the statement, "Interstitial fluid flow is essential for a properly functioning immune system," I couldn't help but thinking about one of the many incredible benefits of OUR BACKYARD TRAMPOLINE!
Also talked about were THE VARIOUS TYPES OF PAIN, with mention being made to the premises underlying DR. CHAN GUNN'S WORK --- showing that when exposed to the chemicals that make up the immune system mediators we collectively refer to as "INFLAMMATION," nerves within the tissue can become hyper-sensitized, leading to problems like HYPERALGIA / ALLODYNIA, which are both characteristics of an all-too-common phenomenon known as CENTRAL SENSITIZATION (the worst kind of chronic pain).
The same research team also showed how SPONTANEOUS DISC HERNIATIONS are related to both muscular atrophy and FATTY INFILTRATION of the low back muscles and THORACOLUMBAR FASCIA, mostly the result of unbridled inflammation coupled with lack of exercise (or maybe I should say, lack of the right kinds of exercise). This section of the study also mentioned treating pain by focusing on "improving sleep, depression/stress and negative affect." Interestingly, I just showed you how light is being successfully used to address to all of these (HERE). As far as exercise, they suggested starting "gently" (especially those of you struggling with FIBROMYALGIA or similar). Maybe this explains why I've become such a huge fan of WBV and use it myself almost every day.
What I found amazing, but not surprising was that when looking at the actual causes of back pain, disc-related pain accounted for less than 5% of all back pain. OSTEOPOROSIS accounted for even less, and DEGENERATIVE ARTHRITIS accounted for only about one in ten cases. What was the major culprit in most back pain? "By far the biggest source of low back pain from what Dr. Willard has found in the literature is myofascial-ligamentous pain, which seems to contribute to about 70% of cases."
Again we see the importance of the THORACOLUMBAR FASCIA (or HERE, HERE, HERE, or HERE) as well the reasons it's important to grasp concepts like UPPER CROSSED and LOWER CROSSED syndromes. And while there was little detail provided, fascia's relationship to WHIPLASH INJURIES was also discussed, as was the importance of PROPER BIOMECHANICS on preventing musculoskeletal injuries, particularly to tendons.
Along these same lines, there were biomechanical discussions about the fact that one of PLANTAR FASCIITIS' chief characteristics is that the fascia "THICKENS" --- something they now believe is likewise happening to the Tensor Fascia Lata muscle in people (mostly runners and jumpers) with ITB problems. The authors also discussed the relationship between weak feet and PF, suggesting that in societies where no one wears shoes, the population has better arches --- still another reason to start a "GROUNDING PROTOCOL" (not to mention it's benefits your proprioception --- one of fascia's primary functions --- HERE or HERE).
One last thing I must mention before winding down is the relationship of fascia to hormones, particularly FEMALE HORMONES. Dr. Carla Stecco of Italy is one of the world's leading experts on this relationship between FASCIA AND HORMONES, and had this to say.....
"Another finding important to facial tissue composition is that fascial fibroblasts contain sex hormone receptors, which can affect collagen expression. Dr. Stecco's team has focused so far on female hormones and found receptors for estrogen, relaxin, and estradiol. These sex hormones, in particular estradiol, stimulate secretion of collagen type 3, which is elastic and organized more like a web; they also seem to decrease secretion of collagen type 1, which produces large bundles of strong collagen fibers to create stiffer and stronger fascia. In addition, fibrillin (a glycoprotein secreted by fibroblasts) was found to increase expression during the peri-ovulatory phase and pregnancy, making fascia more elastic. Increased elasticity in response to sex hormones makes the fascia of the trunk more adaptable to change of volume during pregnancy, and it is valuable to understand the biochemical mechanisms by which these changes occur. Looking at postmenopausal women, Dr. Stecco's lab found decreased expression of sex hormone receptors, making fasciae less receptive to hormonal input and more likely to develop and maintain stiffness."
Because fascia is often at the root of any number of PAIN SYNDROMES, what kind of research is being done to help suffering humanity with problems that may very well be fascia-related? Because "endocannabinoid receptors have been recently identified in fascial fibroblasts," there is a great deal of work being done trying to influence the INFLAMMATION / FIBROSIS / SCAR TISSUE CONUNDRUM using CBD and similar. There is also research into using specific enzymes that break down hyaluron to lessen "FASCIAL DENSIFICATION" (something we seem to be doing a pretty good job of her in our clinic --- HERE).
"Clearly, much progress has been made and is being made in this direction. In the meantime, there are many scientifically validated options immediately available to reduce pathology and pain and improve wellness, including manual therapy and exercise."
Although I would never for even a moment call it comprehensive, at least on some level MY INFLAMMATION-REDUCING PROTOCOL addresses each and every one of the points brought up in this post. If you are looking for more posts on fascia, HERE THEY ARE (or HERE if you want them organized), just follow the links. And if you enjoyed today's post, don't forget to like, share or follow on FACEBOOK as it's still one of the best ways to reach the people you love and value most. After all, there are growing numbers of researchers touting fascia as both the beginning and the end of all disease and chronic pain processes (HERE).
CHRONIC BACK PAIN AND FASCIAL ADHESIONS OF THE THORACOLUMBAR SPINE
MIGHT THERE BE A SOLUTION FOR YOU?
"The diagnosis of chronic low back pain is a scourge of society that does not take into account the pathoanatomical cause of pain. Low back pain is one of the most challenging conditions to treat, as it is a symptom of an underlying disorder. Low back pain is incredibly frustrating for clinicians to treat, as over 100 conditions can result in back pain. It is one of the most prevalent musculoskeletal disorders in developed countries, affecting up to 85% of the adult chronic pain population. Also, a precise pathoanatomical diagnosis cannot be determined in up to 85% of patients with low back pain, so treatment is based on the classic step-wise approach. For those unfortunate patients who do not respond, chronic pain management is advised to mitigate the effects of the pain on patient function with an attempt to approximate as close to a normal lifestyle as possible."
Think about what's being said for a moment because it flies in the face of everything the average person is led to believe about back pain. First, despite what you've been told (and just as I've shown you before --- HERE), it's virtually impossible to look at an orthopedic test --- any orthopedic test, including MRI --- and determine with any degree of certainty whether or not the findings on said test are in any way related to your pain. Secondly, whether we are talking about MRI or modern digital x-rays, telling people their pain is due to "degeneration" (arthritis, osteoarthritis, degenerative arthritis, DJD, DDD, etc, etc, etc) is USUALLY LESS THAN ACCURATE, with the same being true of most visible disc herniations as well (HERE). Thirdly, when the authors say that over 100 conditions are related back pain, they are grossly UNDER-EMPHASIZING THIS ASPECT. And lastly, we've known for years that chronic low back pain is the single biggest cause of disability in the developed world (HERE).
The patient in this case study was a geriatric male (age 65), with a history of spinal fracture from a football injury over fifty years prior, which was followed a few years later by a rugby injury. He ended up in a rigid, full-torso brace for three months, eventually having his lower back FUSED several years later. This individual had all the usual signs and symptoms associated with his injury and subsequent treatment; severe degeneration, disc herniations, SCIATIC-LIKE SYMPTOMS, as well as a shuffling gait (see 'under-emphasizing' link above). He had tried therapy (THIS WAS HIS RESULT), TRIGGER POINT INJECTIONS (they did not work either), and was not interested in a life lived on "THE BIG FIVE". Eventually, a PRP INJECTION was tried.
Although I am certainly not against Platelet-Rich Plasma injections (they are unarguably much safer than CORTICOSTEROIDS), I'm biased because even though I have seen numerous patients get incredible results from stem cell injections, I have yet to see a patient who had good results from PRP. What I really want you to listen to, however, is the cherry-picked description of what PRP does, according to the study's author.
"Platelet-rich plasma is thought to work through the release of growth factors in areas of tissue damage. The alpha-granules in platelets contain many growth factors that are responsible for the initiation and maintenance of the healing response. The growth factors that are released include platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-beta), vascular endothelial growth factor (VEGF), and fibroblast growth factor (FGF). The fibrin matrix that forms also has an additional stimulatory effect on healing by trapping platelets and providing an initial matrix for fibroblast migration."
Forget PRP for a moment. What I want you to grasp here is that if you look at two of my past posts on what it takes to stimulate fibroblastic activity (HERE and HERE), you'll find each and every one of the features from the paragraph above, as well as many others. How is it being done without drugs, stem cells, or PRP? It's being done via intense body work (HERE & HERE).
And while it's true that "intense" means that my patients occasionally look like THIS (emphasis on "occasionally"), my goal is always to use the MINIMALLY EFFECTIVE DOSE when treating. What's kind of cool for my patients here in the OZARKS OF RURAL SOUTHERN MISSOURI is that I've been talking about this relationship --- the relationship between BRUISING and healing (fibroblastic activity) --- for the BETTER PART OF TWO DECADES! What's doubly cool is that we haven't even gotten to the best part of this case history yet --- CS. The authors went on to talk about CENTRAL SENSITIZATION, saying........
"Central sensitization is the amplification of neural signaling within the central nervous system that causes pain hypersensitivity not only at the site of pain but in the spinal cord and brain as well. It is thought to be the primary reason chronic back pain is virtually impossible to treat. It is possible that there is bi-directional neurological input that is responsible for the development and maintenance of central sensitization. In this case, it is possible that nociceptive input in the periphery resulted in the development of central sensitization. Once this nociceptive input was removed, the phenomenon of central sensitization also resolved. This suggests that the identification of the original pain generator remains important in patients with a long history of chronic low back pain and that additional attention should be focused towards the thoracolumbar fascia, as full resolution of their pain complaint may still be possible."
I must admit that when I read this, I almost fell out of my chair. Why? Because mainstream medicine's concept of Central Sensitization is that chronic nociceptive inputs (PAIN, INFLAMMATION, etc) in the periphery can create abnormal brain activity that can cause pain to play on a loop in the brain, even though the original injury is 'healed'. In regards to what THIS AUTHOR is saying, one of two things must be true. Either, contrary to popular belief, these abnormal brain loops can be broken (FUNCTIONAL NEUROLOGISTS know this is often possible), or, even though people are being told they are 'healed' (such as insurance companies do all the time with WHIPLASH PATIENTS), the reality is that they could very well be carrying the same CHRONIC INJURY they've carried for decades ---- the point of my post titled CENTRAL SENSITIZATION AND TISSUE REMODELING!
Not only have I shown my readers many studies related to the thoracolumbar fascia (HERE, HERE, and HERE are a few), but I've shown you what it takes to start addressing it in the earlier-mentioned manner (HERE). I've also shown you how thoracolumbar adhesions are responsible for sciatica (HERE) as well as the technology that this doctor used to image his patient's thoracolumbar fascia (HERE). I've even shown you how research continues to show how spinal surgery frequently fouls up the function of the thoracolumbar fascia (HERE). On top of it all, I'm constantly providing you ideas to help you start addressing your own back problems (HERE and HERE are two examples of many).
Although I would never for a moment try and convince you that fasical adhesions of the thoracolumbar spine are the only cause of back pain, they are a major reason for all the reasons I've listed HERE. What about CASE HISTORIES / TESTIMONIALS from patients with problems of the thoracolumbar fascia that were treated without PRP? Allow me to show you two unsolicited emails (HERE and HERE) as well as an amazing one-minute video of a patient from California who suffered with low back pain for over two decades before finding a solution in tiny Mountain View, Missouri (HERE). And because fascia is found all over the body (HERE ARE ALL MY POSTS ON FASCIA), the exact same concepts frequently work for people with chronic neck pain as well (HERE).
As an extra boon for many of you, remember that tissue remodeling is only a small part of my protocol for helping people start the process of taking their lives back, albeit an important one. While it certainly won't provide the solution for everyone; on this first day of 2019, my generic protocol is yours, completely free of charge (HERE). Just remember to like, share or follow on FACEBOOK since it's a good way to reach a lot of people, most particularly the people you love and care about most.
IS DR. STEPHEN LEVIN CORRECT?
IS BONE REALLY FASCIA?
"The definition of fascia keeps expanding and what is now considered fascia includes all the muscles except the cells encased within epimysium and perimysium, the nerve devoid of its neural component, the gut devoid of its digestive cells, and the organs (kidney, heart, liver, etc.) devoid of their specialized organ cells. In fact, anything that encapsulates or connects anything to anything else in the body with the exception of skin, bone, cartilage, the inside of cells, and anything that takes a compression load, is considered fascia. (It is obscure to me just what the basis is for excluding the body’s firmer structures). More simply defined, fascia seems to be that which is not parenchyma (the functional tissue of an organ as distinguished from the connective and supportive tissue)."
My first thought was hold on --- if everything is fascia, then nothing is fascia. However, after reading the article in its entirety and then watching his video explaining how "BONE IS A SPECIALIZED CONDENSATION OF CALCIUM SALTS WITHIN THE FASCIA," I was more convinced. Especially after he addressed this topic in the context of the 'continuum' (I'll get there in a moment). Levin went on to describe the entire thing as being like "a doorway connecting rooms in an apartment," showing how the PERIOSTEUM (the ultra-thin cellophane-like membrane that covers bones) is continuous with all of these tissues, fascia TENDONS, MUSCLES, and bones, although it may have different names according to where its found (EPIMYSIUM / PERIMYSIUM, etc). Dr. Levin went on to explain that when you add it all together, bone is not quite what we think it is.
"Bone is not a crystalline column of calcium, it is a stiffly starched shirt very much dependent on the structure of its fabric for both form and function. The underlying structure of the bone is the same soft collagenous connective tissue network that composes the rest of the fascial organ. The calcium crystals manufactured by the bone’s parenchyma do not become part of the bone’s parenchyma (its inner workings), or a product to be excreted or used elsewhere in the body; they become part of the fascia support system of the bone organ. However, the calcium crystals do not dictate the layout of the boney apartment, they are stiffeners that strengthen the collagenous weight-bearing walls."
Back to the continuum: Once we start to see how fascia penetrates virtually every tissue imaginable, as well as surrounding and invaginating most (many would argue all) organs, we get a better picture of why ultra-smart people have been calling fascia a SECOND NERVOUS SYSTEM for decades as well as intimately (and causally) linking it to all pain, sickness, and disease (HERE). Honestly, this paper is super cool and short enough to read in five minutes, which I suggest you do. Allow me to use this concept to show you a consequence of this aspect of fascia going haywire.
One of the things we know is that when fascia is injured or exposed to SYSTEMIC INFLAMMATION, it becomes fibrotic and THICKENS or DENSIFIES (Dr. Stecco's word). We see this not only in virtually all injuries, but we see it in numerous disease processes including cancer (HERE). In fact, it's an important enough phenomenon that fibrosis (the medical word for thickened scar-like tissue) is the #1 cause of death on the planet (HERE). The same thickening that's characteristic of fascia is likewise characteristic of bone.
Publishing in the August 2005 issue of Nature Materials (Sacrificial Bonds and Hidden Length Dissipate Energy as Mineralized Fibrils Separate During Bone Fracture), a team of 11 researchers from the physics department at University of California, Santa Barbara showed just how right Levin really is. A press release (Fundamental Discovery About the Fracture of Human Bone: It's All in the 'Glue) that was published in a university publication (The Current) revealed that unhealthy bone undergoes continual fractures at the molecular level, leading to a (you guessed it) thickening of the bone; even though said bone may be significantly weaker.
A certain amount of thickening (whether bone or soft tissue) can be a good thing. For instance, in response to the mechanical loads and forces of athletic endeavors or hard labor, the goal is to achieve muscle hypertrophy along with some connective tissue thickening. However, once we understand the work of the renowned German surgeon, who, in the mid 1800's, figured out that bone grows / thickens / becomes more dense in response to mechanical forces put on it (even if said forces are 'bad' such as what might be seen in altered biomechanics), we can begin to grasp how big this concept really is. His name was put on his theory, which eventually became known as WOLFF'S LAW. The work of Dr. Julian Wolff should help you understand why I'm a huge fan of WEIGHTLIFTING, explosive exercises such as SPRINTS, REBOUNDING / TRAMPOLINING, or stretching / exercising on a simple and inexpensive WBV MACHINE.
Here's what's doubly cool about all of this. If you will focus on reducing whole-body inflammation (I've left you a few pointers HERE), the end result is not only stronger bones and connective tissues, but better overall health as well as the likelihood of diminished pain ---- this is often times the case even for those struggling with CENTRAL SENSITIZATION. If you found today's post interesting or beneficial in any way, be sure and spread the wealth by liking, sharing, or following us on FACEBOOK.
AN EXPERT REVIEW AND SYNOPSIS OF MYOFASCIAL PAIN SYNDROMES
What's just as interesting as calling trigger points a source of pain is that he referred to them a "source of functional limitation". In other words, these creatures (TP's) are not only painful, they have the potential to alter the way you go about your normal day-to-day life. Bordoni went on to talk about the various theories on why people get Trigger Points. Here are some of the takeaways (trying to simplify some of this for my readers).
- Trigger points are more prone to be found in red muscle (aerobic, slow twitch, postural) that white muscle (anaerobic, fast twitch, explosive movements).
- Constant (repeated) microtrauma is a problem --- probably one of the reasons that the consensus is that REPETITIVE INJURIES are usually harder to deal with than acute trauma.
- This constant microtrauma to red fibers causes an increased need for cellular OXYGEN, which depletes cellular energy (ATP) and causes increased sensitivity to pain.
- In this environment, numerous chemicals, compounds, and elements (including the biomarkers we refer to collectively as "INFLAMMATION,") causes both tissue STIFFNESS AND DENSITY, as well as the heightened pain sensitivity and low threshold to meet said sensitivity we saw in the previous bullet. When this process happens in the central nervous system it's known as CENTRAL SENSITIZATION. As the famed neurologist and acupuncturist (he's considered the father of modern dry needling techniques) Chan Gunn said, this can make fibrotic tissue over 1,000 times more sensitive to pain than normal tissue (HERE).
- Thanks to the above-mentioned CS, as well as similar phenomenon occurring in the peripheral nervous system, areas of the nervous system begin firing on their own, sometimes almost perpetually, with an end result that there is "a constant local contraction of the muscle fibers". Mind you, I am not saying that the entire muscle is contracting, but instead, due to the fact that when an individual muscle fiber contracts it contracts at 100%, the individual fibers under the control of a specific nerve can be hyper-stimulated and contract until they finally run out of ATP. The end result is that once this occurs, many people will get a short period of TP relief until the body replenishes it's stores of cellular energy to start contracting again.
- As the vicious cycle spins faster and faster, not only is there an increase in pain, but the FIBROBLASTS actually start converting to myofibroblasts, which dramatically changes the dynamics of the fascia. In fact, Bordoni theorizes that the fascia, which acts as A SECOND NERVOUS SYSTEM, has the potential to itself start sending "looped" messages that play over and over again, causing further "spontaneous presence of local muscle contraction."
- There is also an alteration of the hyaluronan or hyaluronic acid (HA) that, like most everything else seen in fascia, also thickens, becoming more viscous, creating a scenario where the various layers of fascia do not slide on each other (IT LOOKS LIKE THIS). This seems to cause stretching of the nerve tissue in the fascia, creating still another reason for it "becoming constantly activated".
- If you throw altered BLOOD PRESSURE into this whole mess, the smallest blood vessels (the capillaries) become ischemic, starving their corresponding muscles for O2. In a nation where we learned just last week that our COLLECTIVE BMI (body mass index) went up yet again, it's just another nail in the proverbial coffin.
- Because the internal environment of a trigger point is hypoxic (low oxygen), it's also acidic. For those of you who suffer from any sort of digestive issue, I suggest you read about the inverse relationship between the stomach and the body as far as acidity / alkalinity is concerned (HERE).
- The end result is that there are several positive feedback loops (viscous cycles) that set themselves up, causing a release of neurotransmitters that stimulate contraction, based largely on inflammation, hypoxia, acidity, and the muscle contraction itself, "surging the sending of painful information to the nervous system."
- Trigger points, if biopsied, contain cells, tissues, and biochemical markers that are different than normal surrounding tissues. Not surprisingly, the tissues are themselves thickened (sometimes researchers refer to this as "DENSIFICATION").
One of the theories that Bordoni specifically mentioned has to do with altered neurological function of the nervous system as it relates to the SKIN. "The concept of altered electrical activity of the skin and the afferents [sensory nerves] coming from the TPs could explain the altered emotional state in patients with the myofascial syndrome (anxiety and depression)." Interesting, considering ANXIETY and DEPRESSION are both considered to be "inflammatory" diseases (HERE).
Furthermore, we saw confirmation of previous studies that various parts of the brains of people in chronic pain, and especially chronic myofascial pain, actually shrink and atrophy. In fact, I've seen studies showing that this phenomenon can be so severe that over time, brain scans of those who have lived with chronic pain become almost indistinguishable from people with neurodegenerative diseases such as ALZHEIMER'S (HERE).
Although the books by TRAVELL & SIMONS were mentioned (Janet Travell was JFK'S PERSONAL PHYSICIAN), what I found most interesting was the lack of consensus as to what can be used to effectively image and / or destroy these creatures ("Currently, the causes of the presence of TPs are only speculative, as well as the correct evaluative and therapeutic approach."). As far as treatment, Bordoni mentioned every single one of my 'BIG FIVE,' as well as "lidocaine patches, BOTOX, POSTURE-CONTROL EXERCISES, NUTRITION, THERAPY, CHIROPRACTIC ADJUSTMENTS [actually, he mentioned "Osteopathic Manipulation"], ultrasound, STRETCHING, DRY NEEDLING, YOGA, ACUPUNCTURE" and a number of others. What wasn't mentioned was, at least in my mind, even more interesting than what was. Namely, any sort of bodywork, massage therapy, rolfing, TISSUE REMODELING, etc.
The paper's theme was that the drugs are not going to be very helpful and can actually cause a myriad of SIDE EFFECTS. It seems that Bordoni would agree that A SYSTEMIC APPROACH to trigger points has the potential to be much more effective than simply attacking these beasts in a purely local fashion. If you appreciated today's post, be sure to share it with others. FACEBOOK is still an effective way to reach the people you love and care about most!
AWARENESS OF THE FASCIAL SYSTEM
"It was as if some ghostly bridge across the city of Geneva, Switzerland, had permitted two photons of light nearly seven miles apart to respond simultaneously to a stimulus applied to just one of them. Since there was no way for the photons to communicate with each other, ''classical'' physics would predict that their independent choices would bear no relationship to each other. But when the paths of the two photons were properly adjusted and the results compared, the independent decisions by the paired photons always matched, even though there was no physical way for them to communicate with each other. Entangled particles are identical entities that share common origins and properties, and remain in instantaneous touch with each other, no matter how wide the gap between them [in this case 7 miles]. Albert Einstein sneered at the very possibility of such a thing, calling it ''spooky action at a distance.'' Scientists still (somewhat shamefacedly) speak of the ''magic'' of ''quantum weirdness.'' And yet all experiments in recent years have shown that Einstein was wrong and that action at a distance is real."
Italian researchers, DR. BRUNO BORDONI and Dr. Marta Simonelli, recently published a short but well-bibbed paper in the journal, Cureus, titled The Awareness of the Fascial System. The gist of the treatise was that "Each cell communicates with the other cells by sending and receiving signals; this concept is a part of quantum physics and it is known as quantum entanglement... A fascial cell has not only memory but also the awareness of the mechanometabolic information it feels, and it has the anticipatory predisposition in preparing itself for alteration of its natural environment." Why is this such a big deal? Because these authors state (and I would agree), "Cellular behaviour and the inclusion of quantum physics background are hardly being considered to find out what happens between the operator and the patient during a manual physical contact." This may account for fascia being described as the root of all sickness and disease (HERE).
One of the first things the authors did was to describe FASCIA in terms of "salutogenic homeostasis". HOMEOSTASIS describes your body in perfect metabolic balance. Salutogenic homeostasis is a term that instead depicts an approach focused on specific things that support health and well being as opposed to focusing on things that disrupt health and cause disease. The next factor mentioned was something called INTEROCEPTON. Related to PROPRIOCEPTION --- the body's ability to perceive it's spatial and positional relationship to the external world --- interoception refers to the body's ability to sense what's going on in its internal environment. Listen to how a team of Belgian, German, and Australian researchers described the phenomenon in 2016's On the Origin of Interoception (Frontiers in Psychology).
"Over the course of a century, the meaning of interoception has changed from the restrictive to the inclusive. In its inclusive sense, it bears relevance to every individual via its link to emotion, decision making, time-perception, health, pain, and various other areas of life. While the label for the perception of the body state changes over time, the need for an overarching concept remains. Many aspects can make any particular interoceptive sensation unique and distinct from any other interoceptive sensation. This can range from the sense of agency, to the physical cause of a sensation, the ontogenetic origin, the efferent [motor] innervation, and afferent [sensory] pathways of the tissue involved amongst others. In its overarching meaning, interoception primarily is a product of the central nervous system, a construct based on an integration of various sources, not per se including afferent information."
Just last year Bordoni wrote a paper on this specific topic in Complementary Medicine Research that was titled Emotions in Motion; Myofascial Interoception, which stated, "What is still missing [from most therapeutic approaches] is the awareness that the body is also emotion. The myofascial continuum is able to stimulate the areas of the brain that deal with the emotional state, and manual treatment activates the interoceptive system." In today's paper, Bordoni described how this occurs. "The [fascial] continuum constantly transmits and receives mechanometabolic information that can influence the shape and function of the entire body. These afferent [sensory] / efferent [motor] impulses come from the fascia and the tissues that are not considered as part of the fascia in a bi-univocal mode."
This is why, as I have shown my readers repeatedly, fascia has the ability to act as a SECOND NERVOUS SYSTEM. In fact, because of the massive volume and type of information that fascia conveys, I have heard some experts argue that MECHANOTRANSDUCTION could allow fascia to accurately be described the body's primary mode of communication, with the nervous system coming in second place (and the GUT'S ENTERIC SYSTEM likely coming in third). Much of this is due to something known as RAIN (Rapid Adaptability of the Internal Network) made possible by the fluid portion of fascia (HERE).
"The nervous system does not regulate the morphological features of the fascial system. The latter is a holobiont, an asymptotic behaviour between the mechanical environment inside and outside the cell and the modification of the environment itself. A non-movement syntropic is based on a heuristic basis: the maximum configuration of the order and at the same time maximum differentiation with the aim to have access to all information. Tissues use a stigmergic communication through a stochastic process to achieve optimal adaptation strategies; tissues change their characteristics and the means of transmission of external information inward. It is not only about a tissue, but it is, in fact, an awareness. The article discusses the fascial cellular response modality to mechanical stimuli and the possible influence on the fascial tissue by a manual palpation during a manual treatment, in terms of quantum physics and physiology."
In other words, the shape and configuration of fascia is something it does based on it's mechanical environment, for the express purpose of optimizing both it's physical properties and optimizing its ability to pass information throughout the body. One action, leads to another, which leads to another, resulting in a type of communication that innately creates amazingly complicated structures, and at least at times, does so seemingly spontaneously. Thus, the whole is far greater than the sum of its individual parts, and is at least part of what makes studying fascia in cadavers and in vitro (outside of the living organism in a petri dish or test tube) so difficult and inaccurate.
So; not only are tissues and cells are aware of other tissues and cells via traditional means such as that can be explained purely via mechanical, electrical or biomagnetic means, but Bordoni argues that they are likely aware of each other in a manner similar to the "entanglement" seen in Dr. Nicolas Gisin's twin-photon experiment at the University of Geneva. This is the astounding beauty and mystery of quantum mechanics, with the end result, as Bordoni states through the title of his paper, that fascia is "aware".
Despite a host of factors that Bordoni and Simonelli could not prove or were not certain of (mostly specific quantum mechanisms that physicists still do not understand even though they can observe them), they said, "What we know for sure is that manual approaches to tissues can alter the cellular behaviour of the fascial system." That, folks, is why bodyworkers do what they do, and why I feel I have a PRETTY GOOD HANDLE ON WHAT IT TAKES to help people living with chronic pain start the process of taking their life back. Just before invoking EPIGENETICS, Bordoni spoke of this awareness in terms of tissue memory.
"Mechanical events suffered by the fascial holobiont are actively maintained in its memory, with the aim of being already predisposed to a new action of the same stressors. A fascial cell has not only memory, but also has the awareness of the mechanometabolic information it feels, and it has the anticipatory predisposition in preparing itself for alteration of its natural intra- and extracellular milieu. A cellular genome can monitor itself in response to mechano-metabolic stimuli, obtaining information not only from the extracellular matrix (ECM) but also from other cells and tissues."
The paper that Bordoni cited for the first part of this paragraph was a 2014 paper (Does Fascia Hold Memories?) by a fellow Italian osteopath named Paolo Tozzi, that was published in the Journal of Bodywork and Movement Therapies. In this paper, Paolo made the case that what we essentially refer to as "memory" is based on quantum physics and contained in water, chemicals, the fascial structure (TENSEGRITY), the neurofascia, the ECM, microtubules, FIBROBLASTS, and others, even though we don't have a good grasp on how it actually works. Dr. Paolo ended with this fascinating "hypothesis" that is right in line with the quantum physics that Bordoni has been talking about.
"There is increasing evidence that organisms may communicate between cells and tissues by electromagnetic radiations, phonons and photons. Biophotons are believed to be emitted from a coherent photon field within the living system that may work as an energy (and possibly as a memory) storage field. It appears then that the body matrix, as a continuous physical and energetic system, is capable of conducting message units in the form of electrons, vibrations, protons, photons, phonons. It is therefore an informational network that distributes regulatory signals throughout the body, coordinating cellular and extracellular activities involved in growth, morphogenesis and regeneration. A yet more interesting possibility is that the liquid crystalline continuum may function as a quantum holographic medium, recording the interference patterns of local activities interacting with a globally coherent field. Holographic memory is distributed globally and yet can be accessed and recovered locally. Possibly during bodywork, the interaction of vibrational, biomagnetic and bioelectric fields between therapist and client may allow an exchange of information about the history and the present status of the living matrix. The information encoded in cell and tissue structure and activity may be read holographically, by tuning to the appropriate frequencies. This may even lead to a recall of past traumas and of an array of related sensations. The result may be the restoration, balancing, and tuning of resonant vibratory circuits."
Bordoni went on to talk about parts of the cell that are responsible for carrying both electric and non-electric messaging; the CELL MEMBRANE, the cytoskeleton, and the microtubules. Cell membranes are polarized, meaning they conduct electric charges. When tissue undergoes deformation, whether the deformation is in the form of an injury, like say a WHIPLASH, or the subsequent treatment thereof (HERE) it is polarized / depolarized, creating a messaging system that can, in certain cases, travel at speeds of almost 400 feet per second --- just a bit longer than a football field with both endzones. Thanks to the liquid portion of fascia and the fact that fascia is literally what connects you to every other part of you, fascia-based messaging can travel at the speed of sound in water ---- over 5,000 feet per second or about 12 times faster than the very fastest electrical messages (something I talked about HERE). Dr. B talked about another type of messaging system that can take hours. Here is what he said about fascial messaging as it relates to tissue memory.
"Cell deformation by intrinsic forces could give rise to very fast or extremely slow messages. We can assume that palpation can create mechanical stresses that continue over time. Cells are deformed following vectors, as the shape of the man's footprinted in the sand. Cellular morphology affects the extracellular matrix shape, influencing how the mechanometabolic resulting message will be transported: slow, fast or conditioning its direction. Probably this kind of "mirror" behaviour would allow the cell to better respond to stress solicitation, improving its adaptation. The cytoskeleton plays an important role for cell conformational memory."
The end result of the tissue messaging and tissue memory is that, "the cell can change its morphology [shape, form, structure, pattern, size, etc] in real time. The DNA adapts itself to cellular morphological changes, increasing the transcription of genes activated by specific regions of DNA which are sensitive to the flow of electromagnetic energy: electromagnetic response elements or EMRE. The deformation of the cellular structures also activates the transcription of other genes, which are specific to a mechanical stimulus." What does this mean in English? It means that even though I don't really know jack about quantum physics or the biochemical minutiae of fascia, I can use general principles of TISSUE DEFORMATION to get THESE SORTS OF AMAZING RESULTS on a day-to-day basis. In fact, THIS METHOD USUALLY WORKS SO WELL that when it doesn't, it leaves me perplexed, wondering what I missed or failed to account for.
If you want to see what it may take to start the process of successfully addressing some of the most commonly-seen underlying causes of pain and disease (fortunately, they are usually the same), HERE is the post for you to browse. And if today's post resonated with you, be sure and make sure it makes the rounds on FACEBOOK, as it's still the easiest way I know to reach the people you love and care about most.
TORN OR ADHESED FASCIA
WHAT IN THE WORLD DOES IT LOOK LIKE?
Because fascia does not image with standard technology (HERE), struggling patients are frequently treated as though their problem / pain doesn't exist --- as if IT'S ALL IN THEIR HEAD. It's also common to be treated as a drug seeker, especially in the environment surrounding our ever-present OPIOID EPIDEMIC. The result is patients who live in despair, often times being told their pain is the result of DEPRESSION, when the opposite is far more likely to be true. What's exciting is that for many of you reading today's post, there is hope. There may actually be a way to start breaking out of the prison of HELPLESSNESS / HOPELESSNESS and STRESS your pain has confined you to.
Today I want to show you a picture of a FASCIAL ADHESION that's caused several years of CHRONIC PAIN (9 on a scale of 10) in a woman who had tried everything under the sun in an attempt to not only treat, but simply figure out what was wrong with her. The problem started several years ago as the result of OVER-VIGOROUS STRETCHING, which caused a "popping" sound, intense pain, and later, hardness in her lower abdomen (yes, soft tissues will often pop when they TEAR OR BREAK).
Although over the course of her ordeal she was given a myriad of ever-changing diagnosis (including CUTANEOUS NERVE ENTRAPMENT(S)), she was eventually told she had INTRA-ABDOMINAL ADHESIONS, ultimately ending up having them surgically removed (she'd had several past abdominal surgeries, including more than one vertical C-section, which were, excepting an appendicitis surgery, decades old), which helped a great deal with the feeling of hardness and internal abdominal pain. Unfortunately, the severe pain above her right lilac crest (the bone you put your hands on when you put your hands on your hips) was still there, only worse.
I tested and found areas of restriction, and in her case decided to work my way in towards the epicenter of her pain instead of working my way out (part of my reasoning was that she had extremely tight HIP FLEXORS and a great deal of pain in her upper buttock / hip / lower back --- I did not find much adhesion in her THORACOLUMBAR FASCIA). Since sitting was what reproduced the most pain (sitting was never pain-free for her), I would work on an area, then have her walk around a bit. I would then have her sit for a little while to see if her pain had changed (I call this BULLSEYING).
Before I ever got to the epicenter (the four arrows), her pain upon sitting had reduced substantially. As I worked my way in, I found two quarter-sized areas of ADHESED FASCIA which were obviously TETHERING HER substantially. Upon breaking them, her pain diminished even further. right next to these I found THE TEAR ITSELF (click for a pic of a different patient), which ran ran almost from her navel to her spine (you can visually see some of it in the picture above).
After working on this area, the patient could not reproduce pain. I gave her the proper stretching protocol and she and her husband started their journey home, with her riding in the back of a van so that she could stretch and pull the HAIRBALL-LIKE tissues apart before the broken adhesion could re-adhese. For the record, her husband was in the room with us for the entirety, the towel on her hind end was tucked into her underwear, and even though it's cut off in the pic, she was wearing a bra that had been pushed up, with a towel stuffed underneath.
I am not completely sure whether or not these results will hold up for her but SHE WILL KNOW AFTER THIS ONE TREATMENT whether or not that's the case. Not surprisingly, however, when a patient leaves my clinic unable to reproduce the pain that has been turning their life upside down, it's a hopeful sign. Will she have to return for more treatment? I have no idea. Regardless, we found her problem, allowed her to visualize it (important because IF IT BLEEDS, WE CAN KILL IT), and began the process of breaking down the SCAR TISSUE and FIBROSIS. If she does have to return, her next visit will be much shorter and easier (I spent an enjoyable hour and a half with she and her husband, learning the history of the area they hail from). And no; not everyone I treat has this kind of scar tissue, or for that matter, any significant scar tissue at all.
The scheduling slots for the OUT OF STATE & INTERNATIONAL PATIENTS I treat are, for the most part, reserved for Tuesday and Thursday mornings so that I can spend whatever time may be needed to address whatever we happen to find. While I cannot guarantee a "cure," browse through a few of the hundreds of PATIENT TESTIMONIALS on our site, some in the form of letters or emails, and others in the form of videos that we mainly do in-house (although on occasion someone sends me something they shot on their phone). Quite a few of these testimonials are from long-distance patients, but the majority are from the folks I treat right here locally (Springfield, Mountain Home, Rolla, and Poplar Bluff are all only an hour and a half away).
Also be aware that my average patient is not going to leave the office looking like this. Many patients simply need the right CHIROPRACTIC ADJUSTMENT to resolve their problem(s). However, if you are not holding your adjustments like you feel you should be (HERE), it's a common sign that there may be invisible scar tissue and adhesion present. For those who may be wondering, HERE is what a typical "First Visit" will look like for a local patient. It costs nothing to talk to me to see if I think I can help.
Because you must never forget how intimately inflammation is related to scar tissue (HERE), and that there are things you can be doing to address your level of systemic inflammation (HERE) ---- or that adhesed fascia is believed by a growing number of experts to be THE ROOT OF ALL PHYSICAL AILMENT --- it might behoove some of you to click the links in this paragraph. Finally, if you are one of the folks enjoying the mountains of free, relevant, and cutting-edge health-related information found on my site, be sure and spread the wealth. One of the best and easiest ways to reach those you love and care about most is by liking, sharing, or following on FACEBOOK.
FASCIA & SPORTS INJURIES
WHAT DOES THE LATEST RESEARCH HAVE TO SAY?
The paper starts with these words, "Molecular crosstalk between extracellular matrix (ECM) molecules and cellular components is an important determinant of fascial tissue physiology and pathophysiology." The ECM (extracellular matrix) is the liquid portion of fascia. What's interesting is that sound / vibration travels much faster in water than it does in air (3,300 mph -vs- 767 mph) making the fascial web an ideal "SECOND NERVOUS SYSTEM" due to the fact that fascia connects every part of you to every other part of you. Not to mention it's a prime example of a phenomenon known as MECHANOTRANSDUCTION --- the ability to convert mechanical stimulus to biochemical signals readily understood by the brain, nervous system, and receptors in various organs and tissues of the body.
"Strong alterations of the local ECM microenvironments are necessary to allow cellular adaptation and rebuilding of fascial tissues. All factors influencing cell or ECM behaviour can result in changes in the structure and homeostasis of tissues and organs."
HOMEOSTASIS is the state your body should be in, the state where everything works and flows in harmony. If you want to rebuild fascia, you will have to push your body's ability to adapt to the limit. Although there are many ways to push the body's tissues (KETTLEBELL SWINGS would be an example), when it comes to dealing with hardcore FASCIAL ADHESIONS it's critical to actually "BREAK" the adhesion. Although different practitioners go about this in different ways, in my clinic I incite fibroblastic activity via something I call Tissue Remodeling (HERE & HERE). "In fascial tissues such as tendons, acute and chronic loading stimulates collagen remodelling." What does it mean to "load" tissues?
In terms of physics, connective tissues are meant to resist shearing or pulling forces (these tissues must be elastic like fascia), or they must resist compressive forces (these must be more rigid like bone). "The mechanical properties of fascial tissues can be modified by several factors, including a change in... crosslinks and molecular organization... and the contractile activity of myofibroblast cells." In English this means that SCAR TISSUE can have issues with its organization. If the tissue is structurally random and heavily crosslinked, it begins to take on characteristics that are more bone-like, losing elasticity in the process (look for my upcoming article about bone as fascia). My goal is to find these areas and "UNTETHER" them (see 'break' link above). Beyond the obvious --- that fascial adhesions have the ability to cause pain --- why does it make sense to actually address mechanical problems mechanically as opposed to chemically (drugs)?
"Myofascial tissue that is stiffer or more compliant than normal has been shown to influence the magnitude of intermuscular force transmission and, arguably, may have a significant effect on muscle mechanics."
The authors went on to reveal why, helping explain why things like MUSCLE RELAXERS or other BIG-FIVE DRUGS are not helpful in the long run because they cannot successfully address biomechanical issues such as fibrosis and densification (I'll discuss it momentarily). "Physiological ageing is a highly individual process characterized by a progressive degeneration of tissues and organ systems. Age-related alterations in fascial tissues include densification (alterations of loose connective tissue) and fibrosis (alterations of collagen fibrous bundles). Functionally, these pathological changes can modify the mechanical properties of fascial tissues and skeletal muscle, thereby contributing to pain-related and age-related reductions in muscle force or range of motion."
Although I addressed AGE-RELATED CHANGES IN FASCIA yesterday, what's critical to remember is that this "aging" process (degenerative process) is not solely reliant on a person's chronological age. It has much to do --- maybe even arguably more to do --- with how well a person takes care of themselves, i.e. how much systemic inflammation they are generating or exposing themselves to. "Although early inflammation after tissue damage due to physical exercise or injury is crucial for tissue remodelling and adaptation.... limiting the magnitude of inflammation might be beneficial for tissue regeneration and gains in muscle mass and strength, depending on the nature of the injury and in elderly people." Here is where things really start to get interesting.
"Excessive or prolonged loading or direct trauma to fascial tissues initiates micro and macro changes necessary for tissue repair. These effects may also contribute to pathological changes that modify tissue function and mechanics, leading to compromised function of the healthy tissue. Effects may become systemic, and thus not limited to the injured/loaded tissues."
In other words, it essentially takes controlled trauma of varying degrees to both break down the old injury and create the local inflammation needed for the repair process. The train, however, starts going off the rails once the inflammatory process moves from local to systemic (more on that process can be found on my COLLAGEN SUPER PAGE). The authors go on to talk about the fact that this systemic inflammation has the ability to generate the scar tissue that the medical community refers to as "FIBROSIS". If you follow my site you are already aware that the endgame of inflammatory processes are fibrotic changes to tissues and organs.
"An acute inflammatory response is typically short-lived and reversible and involves the release of a range of molecules, including proinflammatory cytokines from injured cells and macrophages, along with other substances that sensitize nociceptive afferents and promote immune cell infiltration. If loading is prolonged or repetitive, persistent inflammation may develop leading to the prolonged presence of macrophages and cytotoxic levels of cytokines in and around tissues, ultimately resulting in ongoing tissue damage. Some tissue cytokines are fibrogenic and can promote fibrosis via excessive fibroblast proliferation and collagen matrix deposition."
Inflammation will cause sensory nerves (afferents) to become much more pain sensitive. How much more? When scar tissue itself becomes sensitized due to exposure to inflammatory mediators, the result is incredible pain sensitivity, which DR. CHAN GUNN describes as potentially being over 1,000 times more pain-sensitive than normal tissue. This is part of the scenario that sets up the unholy brain-based 'loop' of chronic pain known in the medical community as CENTRAL SENSITIZATION, where damaged tissue itself is no longer generating pain, but instead, the brain has become the pain generation. But it gets worse. Once tissues and organs start to experience the process of inflammation infiltration, they start to undergo fatty infiltration as well --- the process by which muscles and other connective tissues turn to fat (HERE). And if this weren't bad enough, the ECM-based fibrosis and "DENSIFICATION" that occurs right along with, is actually the world's #1 leading cause of death (HERE). Bottom line, if you have not been taking INFLAMMATION seriously, you must change your thought process if you hope to have any chance of reversing these physiological aberrations.
What did these authors say was good for reversing the processes above --- particularly in cases where it was not yet severe? How about some STRETCHING and RESISTANCE TRAINING; things I've dealt with on my site at length. I have always said that if you are unsure whether or not your pain is centralized, try a Tissue Remodeling treatment and see if it helps (HERE). Moving forward, the paper discussed what it takes to IMAGE FASCIA. While MRI can be used for certain tissues like the PF, the authors spoke at length about DIAGNOSTIC ULTRASOUND. From there they went on to the topic we are all waiting eagerly for --- treatment. In other words, are there other forms of treatment that may successfully help a person address adhesed fascia?
The authors stated that in all but rare cases, surgery for fascia is out, as are the medical community's number one treatment theme; NSAIDS and CORTICOSTEROIDS. Why? Because they "may impair regeneration and diminish tissue adaptation." There were warnings issued against FLUOROQUINOLONE ANTIBIOTICS as well, along with a limited endorsement of PRP INJECTIONS. FOAM ROLLING was mentioned as were several types of body work, including MYOFASCIAL TRIGGER POINT THERAPY. And while CHIROPRACTIC CARE was not mentioned, OSTEOPATHY was (not surprising considering the study was done in Europe). They also warned about the effects of certain drugs on fascia, speaking specifically about ESTROGEN / HRT. "While estrogen replacement in elderly, postmenopausal women impairs collagen synthesis in response to exercise.... Oral contraceptives have an overall depressing effect on collagen synthesis."
People are thinking and talking about fascia more than ever. While that's certainly cool, the fact that more people than ever are beginning to grasp the importance of lessening and controlling their inflammatory load is, at least in my mind, an even bigger deal. What I have done is put together a post (no charge to you) to help you in this endeavor. While I am not claiming to be a "cure all," I would suggest that for the vast majority of you it will provide a starting point or launching pad as far as addressing systemic inflammation; a first step in the process of taking your life back (HERE). If you appreciate this sort of work, be sure to like, share or follow on FACEBOOK as it's a great way to reach the people you love and care about most.
AGING, INFLAMMATION, FASCIAL THICKENING, AND DEGENERATIVE CHANGES SUCH AS OSTEOARTHRITIS AND LOSS OF FLEXIBILITYRead Now
THE RELATIONSHIP BETWEEN AGING, INFLAMMATION, LOSS OF FLEXIBILITY, DEGENERATION, AND FASCIA THICKENING
"The morphology of the connective tissue may play an important role in locomotor mechanics. Recent research has revealed an association between increased fascia thickness and reduced joint flexibility in patients with chronic pain. The present study aimed to examine the relationship of both factors in healthy individuals, additionally testing the hypothesis that older subjects display a higher fascia thickness. Young [average age 22] and old [average age 69] healthy females were recruited for a quasi-experimental, cross-sectional trial. All participants underwent standardized ultrasound-based thickness measurements of the deep fasciae of the trunk and lower limb. Flexibility was assessed using sit and reach testing (hamstring extensibility) and the Schober test (lumbar flexion and extension). Systematic between-group differences of fascia thickness and variable associations (i.e. fascia thickness and flexibility) were detected. Older participants showed higher thickness in the lumbar spine. Correlations of both body mass and fascia thickness, as well as flexibility and fascia thickness were found. Age-related changes in fascia thickness may be a contributing factor of restrictions in joint range of motion."
There are significant numbers of takeaways from this abstract.
- Firstly, we see that fascia can be imaged. Although I've shown you this in the past (HERE), it is neither widely known nor widely utilized here in America; probably because most physicians do not know what to make of the technology or how to interpret the tests yet (and also because it's not typically paid for by insurance companies in this capacity, unless maybe when trying to see TENDINOSIS).
- Secondly; although the changes in fascia thickness were "systematic," the brunt was found in the THORACOLUMBAR FASCIA (where the seven second videos in the first link from the previous bullet come from). Once you begin to understand what this MAGNIFICENT TISSUE really does and how it works to transfer forces from lower extremities to upper extremities and vise versa, you can start to see why when it becomes dysfunctional, the consequences can be numerous and potentially severe.
- Thirdly, when these authors speak of "age-related changes," one of the biggest we need to be aware of is that everything else being equal, older people have more inflammation than younger people. Makes sense once you realize that INFLAMMATION is the collective name of a group of immune system compounds released in response to damaged tissue. While small amounts of inflammation are needed for the normal healing process, too much of a good thing becomes a bad thing --- in this case a very bad thing. What do I mean? For starters, we know that inflammation itself causes a thickening of the fascia that the Steccos have referred to in previous research as "DENSIFICATION". We also know that the 'Cascade of Death' looks almost identical for virtually all disease processes; inflammation ------> fibrosis (scar tissue) ------> degeneration -------> premature death (HERE). Note that when I talk about degeneration in this context, I am not simply talking about musculoskeletal degeneration, but degeneration of organ systems as well.
- Fourthly, it shouldn't come as a surprise that in this study, thickening of the fascia was also related to "body mass". Think about what we already know. Although the numbers are somewhat less in Europe, 70% of the American population is either OVERWEIGHT OR OBESE, with another 7-10% appearing that way via their blood labs (MONW). Not shockingly, weighing too much is considered an "INFLAMMATORY DISEASE" along with a myriad of others from the same family (DIABETES or METABOLIC SYNDROME / PREDIABETES for example). Thus, between their age and weight, huge numbers of suffering geriatric patients already have two strikes against them --- most of the time before they ever realize the third strike is on the way to the plate and they haven't even stepped into the batter's box. Throw in the fact that the single most important factor in health (GUT HEALTH) is also known to decline during the aging process (HERE), creating even greater potential for suffering (or A REASON TO PARTY if you are a drug company).
- Fifthly; although it was not mentioned here, it's not news that "thickening" is seen in any number of other disease processes, CANCER INCLUDED. Also not mentioned here, once you grasp just how inflammatory junk carbs and sugar really are, it's not a shock that SUGAR WOULD BE CANCER'S PRIME FOOD CHOICE.
After putting it all together, the question then becomes; what are you going to do about it? Are you going to continue to live your life in the same old rut, putting on five pounds or so every year or two, while getting increasingly sedentary? Do you feel you may be TOO ADDICTED TO YOUR JUNK FOOD or SODA to take the plunge and actually do something about it? Are you scared of failing? Are you worried that you CAN'T AFFORD IT?
Fortunately, I address each and every one of these issues and many others in my post titled SOLUTIONS FOR CHRONIC PAIN AND CHRONIC ILLNESS: FORTUNATELY THEY ARE THE SAME. No matter what age you are, it's time to get down to the business of taking your life back, because as much as you wish it could be true; while your doctor can keep you loaded up on DANGEROUS DRUGS, he/she can't do this for you. If you are enjoying our site, be sure and spread the wealth by liking, sharing, or following on FACEBOOK. After all it's a great way to reach the people you love and care about most!
YOURS MAY NOT BE "CENTRAL SENSITIZATION" AFTER ALL
"Pain may be prevalent in 39 to 55% of post-stroke patients but not all cases involve central pain. The types of pain that may occur after a stroke include shoulder pain (the most common), headaches, spasticity, and lastly, central post-stroke pain (CPSP). CPSP represents about 25% of post-stroke pain cases."
After mentioning the usual array of drugs used to deal with CPSP (ANTIDEPRESSANTS, STEROIDS, OPIOIDS, anticonvulsants, and others), and likewise suggesting that none work well and all have problems associated with their use, Bottros made this statement. "CPSP is a result of misinterpretation of afferent sensory input by the sensitized neurons within the brain, rather than generated spontaneously by the damaged central nervous system (CNS) neurons." In other words, in at least some cases, sensory nerves are "misinterpeting" what they are sensing, not necessarily that CPSP is always generated by the brain itself.
In a study from the July issue of Pain (How Central is Central Poststroke Pain? The Role of Afferent Input in Poststroke Neuropathic Pain), Bottros' team found that by performing a nerve block in the affected extremity, they totally shut down the pain in 7 of 8 subjects within half an hour --- something that would be impossible if the pain were "autonomously generated within the CNS. Rather, this pain is dependent on afferent [sensory] input from the painful region in the periphery."
In English, this means that people's CHRONIC PAIN might not be, in many cases, as "centralized" as they've led to believe. And while I don't make any sort of claims about being able to help people with CPSP (that's a job for a qualified FUNCTIONAL NEUROLOGIST), I have been saying this very thing for a long time --- that a significant amount of pain that's been diagnosed as "centralized" is not. This is why I have suggested that people who are not really sure whether their pain is due to Central Sensitization or might be arising from FASCIAL ADHESIONS, should have A TREATMENT (yes, just one) and see. If they are in fact, "centralized," the only harm will be that they fired up their pain for a few days (HERE).
To carry the process one step further, in the PPM article, Dr. Bottros talked about "altering cytokines". Why is altering cytokines a big deal if you hope to improve your situation and your pain? Because CYTOKINES are the chemical messengers made by your immune system so that cells can signal and communicate with each other. And while integral for the healing process locally, when there are too many or too much of these chemicals coursing through your body systemically, bad things happen, including pain, fibrosis (SCAR TISSUE) and DISEASE. Listen to these cherry-picked findings from the journal International Anesthesiology Clinics (Cytokines, Inflammation and Pain).
"Cytokines are small secreted proteins released by cells have a specific effect on the interactions and communications between cells. Inflammatory responses in the peripheral and central nervous systems play key roles in the development and persistence of many pathological pain states. Certain inflammatory cytokines in spinal cord, dorsal root ganglion, injured nerve or skin [fascia] are known to be associated with pain behaviors and with the generation of abnormal spontaneous activity from injured nerve fibers. There is abundant evidence that certain pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α are involved in the process of pathological pain. In the CNS, there are two types of glial cells, microglia and astrocytes, which can be activated by excitatory neurotransmitters released from nearby neurons. It has been well demonstrated that spinal glial activation is necessary for induction of the neuropathic pain state. In summary, proinflammatory cytokines are involved in the development of inflammatory and neuropathic pain."
I've talked extensively on my site about TNF-ALPHA and INTERLEUKIN 6, showing that inflammation will always lead to FIBROSIS that in my clinic I refer to simply as scar tissue. Furthermore, we see that these cytokines have the propensity to activate Central Sensitization by hyper-activating microglia (HERE). This is why whether your pain is centralized or not, reducing the amount of systemic inflammation in your body is a good thing. And when you consider that virtually every disease process (including many that you've been led to believe are purely genetic --- HERE) is based on systemic inflammation, addressing said inflammation starts making even more sense. Sometimes, however, you will need treatments that actually create inflammation. Huh?
Just remember that local inflammation is needed to heal injured tissues, whether the injury is acute or chronic. TISSUE DEFORMATION (breaking scar tissue and lengthening shortened, THICKENED or "TETHERED" connective tissues) requires activation of the local inflammatory response (HERE) as well as activation of the cells that make COLLAGEN (these are known as FIBROBLASTS). It's why the longer you study the simple protocol I created for helping people reduce systemic inflammation (HERE), hopefully reducing their pain levels in the process, the more sense it makes. If you like what you're seeing be sure and like, share, or follow on FACEBOOK as it's a great way to reach the people you love and care about most.
CAN FASCIAL ADHESIONS IN THE CHEST, ABDOMINAL AREA, AND HIP FLEXORS, CAUSE CHRONIC NECK AND UPPER BACK PAIN?Read Now
FASCIAL ADHESIONS OF ANTERIOR MUSCLES CAUSE PAIN IN THE UPPER BACK AND NECK
- ABDOMINALS: Not only are your abdominal muscles large, they are made up of numerous layers. Although I've talked about the problems associated with sit ups and crunches in the past (HERE), realize that they not only potentially lead to fascial adhesions of the abdominals, they can lead to disc herniations (trunk flexion opens the back part of the disc, while intense muscular contraction in this position pushes the disc's jelly center further back). Furthermore, FASCIAL ADHESIONS in the abdominals can lead to digestive and other organic issues (ENDOGUT) as well as being a contributing factor in HIATAL HERNIA.
- HIP FLEXORS: When you think about it, it's fairly easy to understand that tight or tethered HIP FLEXORS will, sooner or later, pull you into flexion. And as I've shown before (HERE), hip flexor tethering is also frequently related to abdominal tethering.
- PECTORALS: The chest muscles --- particularly where they meet the anterior deltoid or front shoulder muscles --- frequently becomes tethered. Again, several factors are at play, but sitting is a big one. However, when people go beyond sitting to hunched over a computer or factory line, the chest, front shoulder, and bicep, shorten even more. Also, in the gym, people have a tendency to overwork their chest and biceps, while under-working their back and triceps (people like to work the muscles they can easily see in a mirror). Once again, the result is being pulled into flexion by an overbalanced anterior musculature.
- SCM: The STERNOCLEIDOMASTOID MUSCLE (SCM) in the neck can create huge problems (neurological problems included) as far as flexion is concerned. When this muscle becomes tethered as is commonly seen with WHIPLASH INJURIES, it pulls the head downward into..... You guessed it, flexion. As I've told patients about 10,000 times, the number one most important range of motion in you body, let alone your neck, is your ability to get your neck into extension (the opposite of flexion). HERE, HERE, HERE, HERE, or even HERE are some good articles on this subject.
Why am I so down on trunk / neck flexion? It's the body's default state, and if you don't combat it, it's where you'll eventually end up. Only the flexion will become progressively worse, leading you into an increasingly "bent forward" posture. A simple way to think about this is that when you see people who are stooped, you intuitively realize they are not healthy (they are usually in a state of both UPPER CROSSED SYNDROME and LOWER CROSSED SYNDROME). This is because flexion is the posture of age, the posture of chronic pain, and the posture of chronic illness. You don't see truly healthy people who have a stooped posture. And because everything is connected (HERE), to the point where the fascia actually acts as its own nervous system (HERE), we can start to see how seemingly simple postural aberrations could lead to actual sickness and disease (HERE). What are you going to do about it?
Naturally, it's critical that you start bringing your body back into balance by bringing it out of flexion and back into extension. It's such a big deal that I've created a post on this very topic (HERE). Remember, however, that this is just one prong of a multi-pronged approach. In order to make a real difference with your stretching, you may have to have any anterior adhesions dealt with, otherwise stretching could prove unproductive, or worse yet, create more problems (HERE). And lastly, if you fail to deal with underlying inflammation, truly getting better is probably a pipe dream because inflammation causes fibrosis (HERE), whose hallmark is "THICKENED FASCIA". THIS POST should help you as far as addressing systemic inflammation is concerned. Liking what you're seeing? Be sure to spread the wealth by liking, sharing or following on FACEBOOK.
BRAND NEW STUDY SHOWS DIFFERENCES IN MRI IMAGES OF FASCIA IN AUTOIMMUNITY
"The fascial system is a complex network of connective tissue that interconnects all the components of the musculoskeletal system. The normal fascial system is relatively inconspicuous at MRI. MR patterns of fascial involvement in autoimmune diseases reflects the complex anatomy of the musculoskeletal fascial system. Autoimmune inflammatory disorders may involve the fasciae as well as the other components of the connective skeleton. There are however important variations among these conditions concerning the target tissue, intensity of the inflammation, type of cellular infiltrates, their natural history and, finally, their influence on the adjacent tissue such as the synovium, muscles or bones."
So; what I've been telling you all along is true; IMAGING FASCIA is difficult at best. However, if a radiologist is good, they can spot slight variations of normal (lots of side by side images of normal compared to pathological in this free study). Allow me to give you an example. The PERIOSTEUM is the fascial membrane that covers bone. As you notice what these authors say about the periosteum as related to AUTOIMMUNE DISEASES, pay attention to the word "THICKEN" and remember that one of the characteristics of messed up fascia is that it thickens when things go south. "MRI involvement of the periosteum in active autoimmune diseases consist of thickening.... Periosteum can be the main target as in hypertrophic [thickening] osteoarthropathy [bone arthritis] or accompany involvement of the deep fasciae or connective tissue of the muscles."
The authors talked about the epi and perimysium as well (the fascial layers that surround and permeate muscles), saying that "On MRI, it may be impossible to distinguish involvement of the connective tissue [fascia] from involvement of the muscle fibres. These changes may be focal or diffuse and may involve whole muscles or muscle groups. Chronic inflammatory involvement may induce fatty transformation of the muscles." This last sentence is important because it was just a couple of days ago I mentioned "fatty infiltration" in another post (HERE). For the record, "thickening" was discussed in other fascia-involved tissues as well: RETINACULA, APONEUROSES, MUSCLES themselves, as well as TENDONS. As far as the superficial and deep fasciae are concerned, the authors said this....
"MR involvement of the superficial fascia in active autoimmune diseases consists of thickening of the hypodermic reticular network of the superficial fascia.... Involvement of the superficial fascia can extend deeply and involve the deep peripheral fascia and the connective tissue of the muscles. MRI involvement of the deep fasciae in active autoimmune diseases consists of thickening of the deep peripheral fascia between hypodermis [skin] and muscles and/or the deep intermuscular fascia between muscles.... Deep fasciae are the main target of eosinophilic fasciitis and involvement can extend to the adjacent structures and involve superficial fascia, epi- and perimysium and/or periosteum. Chronic involvement of the deep fasciae may induce persistent thickening of the fasciae... suggesting fibrosis."
There it is again --- thickening. Only this time we see it linked to something I discuss at length on this site; FIBROSIS, which is essentially another name for scar tissue (HERE). All of this imaging stuff is great, but I'm not really sure that it's very helpful. As always, the bottom line is whether or not there is anything to be done about it.
Because autoimmune diseases are ultimately problems caused by a runaway immune system that's decided to attack self, it's important to understand that the drugs used to treat these various diseases SUPPRESS THE IMMUNE SYSTEM (don't even think about "BOOSTING" the immune system of a person with autoimmunity). Because it's all based on inflammation, if you can find what's driving said inflammation, while you may not be able to "cure" your problem, in many cases you can dramatically slow it's progression and improve your symptoms in the process. How? HERE. And since you probably know someone who is struggling with autoimmunity (HERE is a short list), be sure to share this post with them (FACEBOOK is a great way to do this).
BRITISH JOURNAL OF SPORTS MEDICINE TACKLES...
One of the first things discussed was the difference between structure (anatomy) and function (physiology). "The proposed terminology distinguishing the terms 'fascia' and 'fascial system' allows for the precise identification of individual structures as well as grouping them for functional purposes." Part of the problem with the anatomical study of fascia is that historically it's been considered an afterthought --- a tissue that always seems to be in the way of visualizing the more 'important' tissues such as muscles, joints, and organs. There are, however, several groups doing anatomy dissections for the express purpose of visualizing fascia (Gil Headley, Julian Baker, and the ANATOMY TRAINS group immediately come to mind, as well as the recent Human Fascial Net Dissection & Plastination Project). It's a start but the whole thing is still problematic.
While it's true that we are making incredible strides with our knowledge of fascia (HERE are my blog posts on the subject), the fact remains that it is at best, difficult to study in vivo (in living conditions). While imaging is slowly improving (HERE), neither imaging nor dissections on cadavers will ever tell the whole story as far as function in living humans is concerned. The authors continued by attempting to connect the information on fascial healing and repair on a cellular level to it's mechanical function as a unified tissue ultimately connecting all parts of the body together, making it in many ways, similar to a SECOND NERVOUS SYSTEM. Take a look at these cherry-pickings having to do with fascia "HOMEOSTASIS".
"Molecular adaptation of fascial tissues: effects of physical exercise, ageing, sex hormones and inflammation: Molecular crosstalk between extracellular matrix (ECM) molecules and cellular components is an important determinant of fascial tissue physiology and pathophysiology. Small functional and structural alterations in the ECM result in complex cellular adaptation processes and, vice versa, changes in cell function and structure leading to ECM adaptation. All factors influencing cell or ECM behaviour can result in changes in the structure and homeostasis of tissues and organs."
Frankly, this is one of the reasons that DR. DAVID SEAMANS, chiropractor, educator, functional neurologist, and expert on the effects of inflammation, recently wrote a piece for the American Chiropractor titled Is Mechanical Back Pain an Unscientific Myth that Should be Abandoned? Although I am going to respond to his article, I'll give you a preview by saying that while I don't think the concept should be totally abandoned, it certainly needs to be altered. Why? Chiefly because "mechanical back pain" underestimates the crazy effects of inflammation.
INFLAMMATION is the collective name for a cluster of chemicals made by your body in response to damaged tissue. While we usually think of tissue damage in mechanical terms (sprains, strains, bruises, broken bones, etc, etc, etc), the harsh reality is that it's easy to create massive amounts of tissue damage through totally controllable factors such as what we eat. And while diet is not the only reason for non-mechanical inflammation (HERE), it's not only by far the most common, it's also the easiest for you to take charge of, control, and manipulate. In other words, it's the lowest of the low-hanging fruit as far as solving inflammatory problems is concerned. And if you'd rather spend your days eating SUGAR and GRAINS? Inflammation is the cause of fibrosis (scar tissue), which just happens to be the cause of death for nearly half of all Americans (HERE). This is one of the reasons so many of today's elite fascial researchers are saying that problems with the fascia are related not simply to chronic pain, but to one's overall state of health (HERE or HERE).
Another topic of discussion in this paper was the importance of "mechanical stress" on fascia for an almost unlimited number of reasons. Firstly, when we talk about mechanical stress, this stress can be normal or abnormal. And just like Wolf's Law that deals with the remodeling of bones, mechanical stress will likewise "remodel" soft tissues along similar lines. This is known as DAVIS' LAW and can be better understood in my post on world record powerlifter, Donnie Thompson (see link). The authors go on to talk about the effects of aging on fascia, referring to it as "inflammaging". "The ECM is the main site of inflammatory responses taking place in tissues, it is not surprising that the ECM can interact with immune cells to change their function, which is important for growth and regeneration of tissues." Are you starting to see why it's difficult for any doctor to truly "fix" patients who are not serious about reducing their levels of SYSTEMIC INFLAMMATION? Oh; take a look at what was said about sex differences in fascial healing, regeneration, and repair.
"As the exercise-induced increase in collagen synthesis is lower in women than in men, and as injury frequency and the expression of oestrogen receptors in human fascial tissue are sex-dependent, oestrogens may play an important regulatory role in ECM remodelling. The effects of oestrogens on collagen synthesis appear to differ between rest and response to exercise. While oestrogen replacement in elderly, postmenopausal women impairs collagen synthesis in response to exercise, oestrogen has a stimulating effect on collagen synthesis at rest. Oral contraceptives, on the other hand, have an overall depressing effect on collagen synthesis."
Two things here ladies. The first is that before you start any sort of HORMONE REPLACEMENT THERAPY, you need to study this issue yourself since the average family physician or OB is going to give you a less-than-accurate picture of what it's really doing to you. Secondly, while oral contraception is certainly the easiest and most convenient form of contraception, there are hundreds of studies showing how bad it is on so many levels. For more information on this topic, head over to DR. CHANDLER MARRS site, Hormones Matter. And not to leave the men out of this equation; if you are struggling with low T for any reason (HERE, HERE, or HERE), you are going to adversely affect your fascial system's ability to heal as well.
The authors went on to discuss via a very cool little diagram, at least a dozen factors that influence fascia stiffness. Why are these so critical to know whether you are an athlete or not? For instance, we know that fascial adhesions are associated with tissue thickening (HERE), and that furthermore, following the earlier theme of fascia being related not just to pain but to health, we know that numerous disease processes, including cancer, live, thrive, and grow in stiff, dense, environments (HERE). Basically, the circle diagram was made of of fascia-affecting entities that I've mentioned numerous times on my site. SURGERY, CORTICOSTEROIDS, TRAUMATIC & REPETITIVE INJURIES, TISSUE HYDRATION, and cross-linking (I refer to this as "TETHERING" with patients) are some of the things they discussed. Listen to how it was put together to give you a glimpse into the bigger picture.
"Fibrosis (eg, collagen deposition) around the tendon, nerve and myofascial tissues influences dynamic biomechanical properties secondary to tissue adherence and can tether structures to each other or induce chronic compression. Increased collagenous tissues surrounding the nerves can tether the nerves and also enhance pain behaviours. Furthermore, inflammatory cytokines can ‘spill over’ into the bloodstream, leading to widespread secondary tissue damage and central nociceptor wind-up. Circulating TNF is elevated in chronic lower back pain, and recent data highlight a relationship between elevated TNF and greater risk for progression to chronic pain in some individuals."
Because this paragraph describes the crux of the injury process, allow me to break it down a bit. Bathe normal tissues in inflammation (cytokines and tumor necrosis factor), and you end up with fibrosis. Bathe fibrotic tissues in chronic inflammation, and you are far more likely to end up with TYPE III PAIN. Inflammation creates microscopic tissue adhesions that cause various tissues (and even organs) to "tether" themselves to each other, leading to RESTRICTION, ABNORMAL BIOMECHANICS, and CHRONIC PAIN.
What's interesting about this situation is that in most cases, I tell my patients they will know in a single treatment whether or not I can help them (HERE is an example of this claim in action). The problem is that it can be difficult to tell whether a person is truly dealing with Type III pain or rather a severe and ongoing case of Type II. Depending on the circumstances, I frequently suggest one treatment to see if there is improvement (HERE), because while worst case scenario, treatment may fire the situation up temporarily, it will not make you worse. For most people in chronic pain, the risk of a temporary flare-up is worth the potential reward of long term pain solutions.
These authors also discussed something I've discussed on my site when talking about LOW BACK PAIN and the THORACOLUMBAR FASCIA --- the fact that abnormally moving tissues will turn to fat (ADIPOSE TISSUE) via a process known as "fatty infiltration" that will actually self-generate more inflammation. That's right folks; without some sort of intervention, body fat begats more of the same via inflammatory pathways. "Adipose tissue is a potential source of proinflammatory cytokines and has been implicated in a range of musculoskeletal conditions, including osteoarthritis. Regardless of the underlying mechanism, fibrotic changes in the muscle have a substantial potential impact on tissue dynamics and force generation capacity." Are you starting to get the picture that whether you call it SCAR TISSUE, FIBROSIS, or FASCIAL ADHESIONS, this stuff is bad and will have effects that reach far beyond the original area of pain or dysfunction?
As far as solutions are concerned, not only did the authors mention various "MODALITIES," EXERCISES, and STRETCHING for inducing tissue repair and healing, they mentioned NSAIDS as well. I would largely disagree with this, as this class of drug is not only heavily prone to overuse and abuse (KENNY EASLEY for example), but carries a wide range of nasty and UNDER-REPORTED side effects as well (HERE), including the fact that soft tissues tend to heal weaker and with less elasticity when under the effects of NSAIDS. "Anti-inflammatory drugs are used for sports-related overuse pathologies; however, they may impair regeneration and diminish tissue adaptation." In other words, they make you feel better while weakening the tissue. This is why I would argue that in most cases NSAIDS are palliative and not therapeutic.
The paper summed things up by talking about IMAGING FASCIA, which as I stated at the beginning of the paper, is difficult in the best of circumstances. As far as treatment, beside what's already been mentioned, they touched on PRP, Extracorporeal Shockwave Therapy, FOAM ROLLING, massage, MANIPULATION, and various sorts of bodywork. Interestingly, the authors admitted that the evidence for any of these as far as fascia is concerned is scant, but promising ("evidence suggests increases in arterial perfusion, enhanced fascial layer sliding and modified corticospinal excitability following treatment"). I would suggest that this is probably due to limitations in the research, but then again I'm a "homer" who has proven over and over that Tissue Remodeling as a form of treatment is not only beneficial, but potentially life changing (HERE).
Because few of us know a professional athlete, let alone plan on being one, my takeaway for the average recreational athlete is that you need to address more than fascia in order to best-address your fascia. How do I suggest you do this? Easy --- start by diminishing your inflammatory load. Although some of you reading this have SYSTEMIC ISSUES that will require the services of a functional doctor of some sort, how cool is it that a huge amount of the recovery process can be done on your own?
In fact, along with my FASCIA SUPER POST that gives you all 180+ articles I've written on the subject, nicely categorized in one spot, I've also provided you a generic protocol completely free of charge (HERE), so that you can start the process of change that will hopefully lead you to start taking charge of your life and your health. And if you appreciate what you find on our site, be sure and like, share, or follow on FACEBOOK, as it's a great way to reach those you love and care about most.
THE THORACOLUMBAR / ABDOMINAL CONNECTION
HOW IMPORTANT IS IT FOR CORE STABILITY?
The abdominal muscles are important for the stability of the lumbar region through the thoracolumbar fascia (TLF). CT images from 10 cadavers and 27 subjects were used to evaluate the continuity of the TLF with the abdominal muscles. The epimysial fascia of the EO was in direct continuity with the posterior layer of the TLF in eight cadavers and 23 CT images, whereas in two cadavers and four CT images the epimysial fascia of the EO first fused with the fascia covering the latissimus dorsi, and then both fasciae were in continuity with the posterior layer of the TLF. Therefore, the fascial continuity of the EO could explain the transmission of tension from the EO to the posterior layer of the TLF and its importance in maintaining the stability of the lumbar spine through a hydraulic effect. through the aponeurosis and fascia, which ensures synchronization between the erector spinae and the rectus abdominis.
What's the point? There are several. For starters, understanding the way the the three layers of the TLF move by gliding on each other (HERE), helps you realize why low back surgery can be so problematic (HERE) and why articles geared at helping you avoid said surgeries can be potential life savers. You've always heard that strong abdominal muscles help stabilize the spine? It's true and the opening sentence above helps explain why. It's because the abdominal muscles work through the Thoracolumbar Fascia. The EPIMYSIUM --- the outermost layer of fascia that surrounds individual muscles --- of the external obliques are, in the vast majority of cases, continuous with the outermost layer of the Thoracolumbar Fascia. And in those where it's not, it's continuous with the lats, which can be seen in the above left picture from Gray's Anatomy (Anatomy of the Human Body --- 1918) attached to the TLF. In other words, in one way or another, it's all one big continuous tissue.
Although they do not deal with it in the abstract, the external obliques are continuous with the rectus abdominus (above right). Not sure what an APONEUROSIS is? Just click the link. Bottom line, we have a built-in "belt" of muscles and very tough connective tissues (FASCIA) that surround our midsection, stabilizing us and protecting us as we lift, bend, twist, sit, etc. "Regarding fascial continuity in the trunk, and taking the EO into consideration, the TLF is formed by the fascia of all the abdominal muscles as the rectus sheath. In this manner, myofascial continuity between the TLF and the abdominal muscles is achieved." This is why you can no longer think of muscles as we used to think of muscles; strictly in terms of O, I and A.
Individual muscles have historically been viewed according to their origin (their chief attachment point that acts as an anchor), their insertion (the secondary attachment point that generally moves when the muscle contracts), and their action (the direction or plane that the muscles and attached bodyparts move in upon muscle contraction). I couldn't find the exact quote, but fascia researcher and author of ANATOMY TRAINS, Tom Meyers, said it something like this. We can no longer think of the body as 700 individual muscles, but as one muscle in 700 continuous pockets of fascia. What does this mean for you besides helping you better understand concepts like UPPER CROSSED SYNDROME and LOWER CROSSED SYNDROME?
For one, it means that you probably need to train your fascia differently than you have been. Are you engaged in some sort of STRETCHING or YOGA, while avoiding CRUNCHES? Are you doing some strength training from a ball (HERE)? Are you doing some functional training on a ball (HERE)? There are a nearly infinite number of YouTube videos showing variations of these sorts of exercises. Something that I personally enjoy is getting in plank position like the picture in the middle, with my legs / feet on my ball and my hands on a VIBRATION PLATE. From that position I can build core strength by manipulating the ball with my legs in an endless number of ways (rolling back and forth, side to side, obliquely, piking my butt in the air to pull the ball up to my hands, etc). I can also do many of the same exercises the opposite way, belly up, with my calves on the ball and my hands on the vibration plate.
The bottom line, taking care of your back is a multifaceted endeavor, which I have talked about at length HERE. And it's not just about doing a bunch of exercises. If you want to avoid a buildup of fibrosis (SCAR TISSUE) in your low back and elsewhere, you'll have to deal with your systemic inflammatory load (HERE), which will affect your back for the better in multiple ways. For those of you looking to put it all together into a comprehensive and unified package, I've created a completely free post for you as well (HERE). It's certainly not a "cure all," but out of the one hundred million Americans coping with some degree of chronic pain, it's going to help point the vast majority of you in the right direction. If there is someone you know or love who needs to see today's post, just remember that liking, sharing, or following on FACEBOOK is typically a great way to reach them.
FASCIA, TENSEGRITY AND FLUID DYNAMICS
A NEW MODEL FOR THE WAY FASCIA FUNCTIONS
Researchers do not agree on one, comprehensive "fascia" definition. Despite the scientific uncertainty, there is agreement with medical text that the fascia covers every structure of the body, creating a structural continuity that gives form and function to every tissue and organ. The fascial tissue has a ubiquitous distribution in the body system; it is able to wrap, interpenetrate, support, and form the bloodstream, bone tissue, meningeal tissue, organs, and skeletal muscles. The fascia creates different interdependent layers with several depths, from the skin to the periosteum, forming a three-dimensional mechano-metabolic structure.
This is a fairly common definition of FASCIA, which I have always thought of as the tough, cellophane-like membrane that makes up the covering or sheath that surrounds bones, nerves, blood vessels, organs, and as we mostly think of, muscles. However, pay close attention as Dr. Bordoni hits us with a new concept, a concept so revolutionary that he is creating an entire new model for thinking about both the anatomy (structure) and physiology (function) of fascia.
The fascia includes everything that presumes the presence of collagen/connective tissue or from which it is derived. All the tissue considered as "specialized connective tissue" of mesodermal derivation are inserted into the fascial system. These include blood, bone, cartilage, adipose tissue, hematopoietic tissue, and lymphatic tissue. The fascial system has no discontinuity in its path, with layers of different characteristics and properties overlapping
Re-read this short paragraph and grasp the immenseness what Bordoni is saying. He believes that fascia includes both blood and lymph. A paper he co-authored for the Journal of Evidence-Based Integrative Medicine (A New Concept of Biotensegrity Incorporating Liquid Tissues: Blood and Lymph) goes much deeper into the explanation of this concept.
In order to understand what he's talking about, it's important that you first understand the concept of TENSEGRITY; the current model for the way that fascia both moves and acts as a mechanical support. In other words, tensegrity is what's thought to give fascia biomechanical properties that are in direct opposition to each other. On one hand fascia is elastic, allowing it to resist the forces constantly trying to pull it apart. On the other hand it's rigid, allowing it to combat the forces trying to compress it and squash it all together. Take a look at the abstract of this study.
The definition of fascia includes tissues of mesodermal derivation, considered as specialized connective tissue: blood and lymph. As water shapes rocks, bodily fluids modify shapes and functions of bodily structures. Bodily fluids are silent witnesses of the mechanotransductive information, allowing adaptation and life, transporting biochemical and hormonal signals. While the solid fascial tissue divides, supports, and connects the different parts of the body system, the liquid fascial tissue feeds and transports messages for the solid fascia. The focus of this article is to reconsider the model of biotensegrity because it does not take into account the liquid fascia, and to try to integrate the fascial continuum with the lymph and the blood in a new model. The name given to this new model is RAIN --- Rapid Adaptability of Internal Network.
What should you grasp from this paragraph? First, realize that MECHANOTRANSDUCTION is the process of turning mechanical stimulus into the electrical impulses that our nervous system and brain recognize best. This is part of what makes FASCIA AS A PROPRIOCEPTIVE ORGAN so critically important, and also provides at least a portion of the mechanism that allows FASCIA TO ACT AS A SECOND NERVOUS SYSTEM. Secondly, these processes require a fluid medium. And thirdly, blood and lymph are actually part of this "continuum" that we call fascia. Listen to what Rutgers University says in their online article, Connective Tissues: Blood & Blood-Forming Tissues. "Blood is considered a connective tissue for two basic reasons: (1) embryologically, it has the same origin (mesodermal) as do the other connective tissue types and (2) blood connects the body systems together bringing the needed oxygen, nutrients, hormones and other signaling molecules, and removing the wastes."
After describing the differences in the model of fascia put forth by three groups of academics, Bordoni says something interesting. He makes the point that these current definitions and descriptions of fascia --- definitions which always make a big deal out of differentiating superficial fascia from deep --- are erroneous. Why so? Because it's a delineation that we can only see in cadavers; it's not something that happens in real life --- a fact mentioned by John Barnes in my post from earlier this week (HERE). Bordoni's point is that without including these fluids as part of what we call fascia (particularly when they meet all the criteria), the model breaks down.
The fascial continuum allows the correct distribution of the tensional information produced by different tissues enveloped and supported by the fascia, so that the whole body system can interact in real time. One of the fundamental characteristics of the fascia is the ability to adapt to mechanic stress, remodeling the cellular/tissue structure, and mirroring the functional necessity of the environment where the tissue lays.
After letting us know that "collagen makes up more than the 30% of the protein mass of the human bod," Bordoni's team discussed FIBROBLASTS, providing a definition. Take a look at how important these cells really are.
Fibroblasts are the main cellular component of connective tissue and secrete components of extracellular matrix (ECM) such as collagen and matrix, glycosaminoglycan, elastic and reticular fibers, and glycoproteins. Fibroblasts communicate among each other and are fundamental for managing perceived and produced tension. They play a fundamental role in conveying tension and can dynamically affect mechanical tension, rapidly remodeling their cytoskeletons; the fibroblast’s cytoskeleton is made of microtubules, namely, actin filaments and intermediate filaments; specifically, the flexibility of actin enables a more rapid adaptation of the fibroblasts in the presence of compressive forces, due to the lengthening of the fascia. If the mechanical information is present for only a short period of time, any morphological variation is reversible, and the cytoskeleton of the fibroblast can be restored to its original state. The fibroblasts play a significant active role in stimulating inflammatory processes, because they are responsible for a suitable cleaning, repair, and replacement of the elements of the fascial continuum that have been and are affected by traumas resulting from daily use.
I have lots of information on my site about the ECM, but suffice it to say that the extracellular matrix is one of the most important parts of fascia that most people are completely unaware of. The ECM is a group of compounds and molecules secreted by supporting cells in order to provide structural and biochemical integrity to the tissue itself. Among other characteristics, the ECM is what allows cells to bind to one another when needed, communicate with each other (remember that "second nervous system" link from earlier?), and actually differentiate in to other tissues if required. The ECM also compromises a mixture of gels and fibrous tissues that fill the cell's empty space, mechanically dissipating forces that are constantly bombarding the tissue.
We've been talking about blood, but we need to get around to discussing lymph. Lymph is the fluid that circulates through a network of vessels known as the lymphatic system, and is made up of the interstitial fluid --- the fluid found outside of the cell that essentially bathes said cells in liquid. It is almost identical to blood plasma, which is the fluid part of blood. As an important part of your immune system, the lymphatic system collects junk (bacteria, viruses, CANCER CELLS, and other things that should not be there --- a problem made much worse if you have "THE LEAKIES"), and transports it to the lymph nodes, where the body can get down to the business of destroying it.
How does this all fit together to create a model of fascia different than our current model of fascia --- "tensegrity" --- the model that architect, Buckminster Fuller developed in 1961 (Fuller invented the GEODESIC SPHERE / DOME, which is the foundation for TENSEGRITY)? Follow along.
WHAT DOES ALL THIS HAVE TO DO WITH THE OLD MODEL OF FASCIA TENSEGRITY AND A SUBSEQUENT NEW MODEL?
Once again we see the concept not only of fascia as it's own nervous system, but as a system that is constantly changing in order to create the perfect amount of flexibility or stiffness, which ever is needed, in order to effectively cope with the perpetual barrage of internal and external forces being placed on the body. Also, for the record, Dr. Ingber, who is mentioned above, is the Harvard professor (MD / Ph.D), who along with DR. LANGEVIN and others, have shown how fascia is involved in all disease process (HERE). Here is an example of how / why this is true. For the record, I have already shown you that CANCER THRIVES IN STIFF TISSUES and that "THICKENING" is a hallmark of fascial adhesions.
The continuum of the liquid fascia is mirrored by the continuum of the solid fascia from transport system: vessels. To give some examples, if a lymph node is negatively affected by pathology and therapy, like in the case of cancers and radiotherapy, the whole lymphatic system is involved, implying the worsening of the transport of lymphatic material. With aging, the whole vascular tree suffers from thickening of the vessels with an increasing of stiffness (in particular with the thickening of the intimal and adventitious layer), even in absence of a manifest pathology like atherosclerosis. The venous system suffers a delay of its flow with aging, both in limbs and in the cerebral vascular system, with a high probability of developing different central and peripheral pathologies. Not only the tensegretive ability disappears, but when a local tensegretive discontinuity develops, the event will involve the whole blood and lymph net over time. If the solid fascia (vessels) is functional, the liquid fascia will be as well; if the liquid fascia does not encounter any obstacle on its path, the solid fascia (vessels and body structures) will be able to carry out its functions.
Bordoni and his team went on to show how the same thing is likewise true in joints, muscles, and tendons. When the tension and compression in a joint are at the right ratio, there is balance. Imbalance in the musculoskeletal system (CHIROS CALL THIS SUBLUXATION) creates a whole host of downstream sequelae that leads to problems that in many cases, don't seem even remotely related to the original problem. However, a quick peek of the earlier work mentioned shows that indeed they can be, and often times are. Listen to this extremely cherry-picked finale.
These variations and liquid movements improve the biotensegretive and myofascial functions, protect the organs, and allow a better immune defense. There is a direct relation between the strength expressed by muscles and the quantity/speed of arterial blood used. An artificially induced reduction of the quantity of blood that reaches the musculature during sports training makes protein synthesis easier, with increase of muscle hypertrophy. The lymphatic movement toward a specific district or tissue can not only mean a postural change but also an immunological necessity. Lymphatic structures react to the inflammatory stimulus by increasing the drainage and the quantity of lymph, probably to make up for a bigger liquid loss from the blood vessels. The liquid fascia has a high variability in changing the pressures at which it flows, both at rest and during postural changes, in order to improve the continuum of the solid fascia, concerning the movement, the function, and the shape.
What does all of this mean for the average practitioner? Although I doubt this information dramatically changes the way we treat our patients, there are two things that I took away from this study. Firstly, hydration is of critical importance. I realize we all understand this, but this study reinforces the consequences of failing to keep your cells and tissues bathed in fluid. Not enough fluid, and fascia is affected. And when fascia is affected, your health is affected (HERE). Secondly, we know that AGES (Advance Glycation Endproducts) affect fascia as well (HERE), thereby affecting the blood vessels themselves. This means that it's more important than ever to break your SUGAR ADDICTION today, which is interestingly part of THE PROTOCOL I've been providing my patients and readers for years. If you want to see all of my posts on fascia, HERE is the link. If you appreciate these posts, be sure and share them on FACEBOOK.
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.
FASCIA CONGRESS 2018
WHAT TO EXPECT REGARDING THE LATEST ON FASCIA?
Some of the topics specifically mentioned included fascia research as related to quantum physics and BIOMECHANICS. I saw a speaker whose area of expertise was fascia and the lymphatics / immune system (HERE), which will always include various sorts of FASCIA-RELATED AUTOIMMUNITY. There was mention of the THORACOLUMBAR FASCIA as it pertains to CHRONIC LOW BACK PAIN. Fascia's relationship to FIBROSIS (the "THICKENED" SCAR TISSUE that is sometimes referred to as "DENSIFICATION") was discussed as well. Also mentioned was fascia as related to BREATHING, PROPRIOCEPTION, and ENDOCRINE FUNCTION. There was some discussion about TENSEGRITY and the fact that most physiological functions of fascia, including HOMEOSTAISIS and NEUROLOGICAL FUNCTION, are intertwined to the point that increasing numbers of academics are saying that all disease processes have their roots there (HERE). It looks like there will even be a talk given on FASCIA AS RELATED TO CANCER. And this is just the tip of the iceberg.
I hope you are looking forward to the results of the Fifth Fascia Congress as much as I am, but in the meantime be sure to check out my fascia overview (HERE) as well as my FASCIA SUPER PAGE --- the post that contains all of the nearly 180 articles I've written on the subject. If you know people who need to be made aware of this event or of the importance of fascia in general, be sure to show us some love on FACEBOOK as it's a simple way to reach those you love and care about most with valuable information that just happens to be totally free (just like, share, follow or tag).
SYSTEMICALLY ADHESED FASCIA AND CHRONIC NAUSEA
And while he had made some headway, physical traumas he had had endured in his childhood left him not so much with chronic pain but with chronic nausea that he felt was the result of severe all-over FASCIAL ADHESIONS (never discount fascia as a potential cause or contributing factor of almost any physical issue you care to name --- HERE). When it comes to people with SYSTEMIC FASCIAL ADHESIONS I'm very choosy about whom I treat. Why? For the simple reason that most of these cases have underlying causes, many being based in underlying AUTOIMMUNITY or other CHRONIC INFLAMMATORY DEGENERATIVE PROCESSES. Gus convinced me that this was not the case with him and came out and spent a couple of weeks with us from San Fran. The improvements he made were astounding.
Rather than letting me tell you about it, I'll let Gus tell you. BTW, if you know people in similar situations, be sure and get this information in front of them. Besides forwarding them the link, one of the best ways to reach the folks you love and care most about is by liking, sharing, or following on FACEBOOK. I enjoyed our time together Gus and wish you the best! Oh; if your reading this and want to see more of these sorts of videos, be sure and take a look at some of the HUNDREDS OF OTHERS I have on my site.
SYSTEMICALLY TETHERED FASCIA
A CASE HISTORY
As far as my LONG-DISTANCE PATIENTS are concerned (HERE is another example of an LDP), I'm amazed at how many of them have been intensely working on their overall health in trying to battle whatever problem they are battling. Although I have shown you any number of CASE STUDIES in the past, this one is a bit different because it's S's journey to find a solution. By the way, thanks for letting me publish this S; I promise that someone somewhere will be helped.
Hello Dr. Schierling,
I wanted to share my story with you because I know you will find it intriguing. I found your website shortly after I cracked my own mystery and was seeking help to untwist me. Twenty six years of issues. Symptoms piling up and becoming difficult to live with. I managed to work, then have 4 children and work more, but energy is low, autoimmune issues and vertigo so it's a little more interesting. I had a strong feeling that it was all physical, but couldn't put my finger on it.
4.5 years ago I started a physical treatment that shed a big light on what was going on. But it had no source or reason behind it. Treatment focused on my upper back, right shoulder and hand that had muscle atrophy (top part, I was compensating with the bottom. In fact I was compensating throughout my whole body, with different directions...). It included deep, extra deep tissue massage, to break the inflammation out of the sleeping muscles. (maybe a coma would be a better word), electric pulses to restart muscle movement and laser to wake up the nerves. 3 months into a 3 times a week very painful treatment, I started feeling the pain. Pain I didn't have for years in some parts of my body. It was mostly discomfort and tightness everywhere.
This treatment made me make a list of all my issues. I created a table, chronologically sorted, of everything I remember about my body. 3.5 pages of them [She attached this record which included things like AUTOIMMUNITY, MIGRAINE HEADACHES, A MOTORCYCLE CRASH (WHIPLASH) EAR INFECTIONS, SEVERAL SURGERIES (including the appendectomy, which caused an ABDOMINAL WALL ISSUE), several SHOULDER INJURIES, LOW BACK PAIN, VERTIGO, CHRONIC NECK PAIN, FIBROMYALGIA, numerous FOOD INTOLERANCES ---- and this is just hitting some of the high points].
I also saw a Visceral Osteopath that mentioned the word fascia as related to internal organs being pulled. Nice ah? I was thinking about my appendectomy scar (1992) as a possible source for my issues, and there it was - I googled "fascia appendix scar" and wow.... It explained how my chronic neck pain and pulling sensation I was having are related to that painful scar. Yes after all these years it still hurts sometimes.
Since the article I found was related to craniosacral , I tried that. It made a minor change but nothing major. I went to a functional medicine doctor, she helped me find I have a slight leg length discrepancy (6mm). Wearing my orthotics for 3 months made my BPPV [vertigo] go away since my head wasn't constantly trying to sync with my hips. I was able to lie down without the spinning room... But my left ear balance nerve has 54% damage, so I still get dizzy and ears popping.
October 2017 I saw a physiotherapist in Israel during a family visit, who specializes in fascia - he does fascial manipulation. He recommended this treatment for me. During the treatment I found that not only the appendectomy scar is pulling my right side, but the bunion surgery I had on my left foot (8 months after appendix, at the age of 17!) is pulling down on my left. Did I say twisted? The treatment is slowly helping me gain more movement range, I stretch a lot and hope to have a straight back and normal metabolism, normal gut, normal skin... maybe just normal.
I would love to get your feedback and to send your my famous list...which my practitioner was very impressed with. So I'm pretty proud I was able to find the cause and treatment. I'm hoping it's the right one. It feels like it.
What do I have to offer you S? Other than the information in the links I provided, it's important to remember that breaking adhesed fascia is similar to playing a certain old-fashioned carnival game (HERE). There is a threshold that must be reached to break SCAR TISSUE. Fail to reach this threshold and you have done nothing to truly help the patient beyond making them feel good for the brief time they were on your table.
One of the major difference I noticed in what you've been doing and what I do in my clinic is the length of treatment time. Don't get me wrong, I have had people that I have done significant work on. However, not only is that not the norm, but people know within a treatment or two whether or not what I do is going to work (HERE). By the way, don't be afraid to like, share, or follow on FACEBOOK as it's a fantastic way to reach those you love and care about most with information that could potentially be transformational for them.
WHY SHOULD YOU WORK TO AVOID BACK SURGERY / BACK INJURY?
THE THORACOLUMBAR FASCIA
The TLF is a girdling structure consisting of several aponeurotic and fascial layers that separates the paraspinal muscles from the muscles of the posterior abdominal wall. The superficial lamina of the posterior layer of the TLF (PLF) is dominated by the aponeuroses of the latissimus dorsi and the serratus posterior inferior. The deeper lamina of the PLF forms an encapsulating retinacular sheath around the paraspinal muscles. The middle layer of the TLF (MLF) appears to derive from an intermuscular septum that developmentally separates the epaxial from the hypaxial musculature. This septum forms during the fifth and sixth weeks of gestation. The paraspinal retinacular sheath (PRS) is in a key position to act as a ‘hydraulic amplifier’, assisting the paraspinal muscles in supporting the lumbosacral spine. This sheath forms a lumbar interfascial triangle (LIFT) with the MLF and PLF. Along the lateral border of the PRS, a raphe forms where the sheath meets the aponeurosis of the transversus abdominis. This lateral raphe is a thickened complex of dense connective tissue marked by the presence of the LIFT, and represents the junction of the hypaxial myofascial compartment (the abdominal muscles) with the paraspinal sheath of the epaxial muscles. The lateral raphe is in a position to distribute tension from the surrounding hypaxial and extremity muscles into the layers of the TLF. This complex composite of fascia and aponeurotic tissue is continuous with paraspinal fascia in the thoracic and cervical regions, eventually fusing to the cranial base. Numerous trunk and extremity muscles with a wide range of thicknesses and geometries insert into the connective tissue planes of the TLF, and can play a role in modulating the tension and stiffness of this structure
Although this is a lot to digest, I want you to take away three main concepts: firstly, that the Thoracolumbar Fascia is intimately related to structures as distant as the CERVICAL FASCIA. Secondly, "what is traditionally labeled as TLF is in reality a complex arrangement of multilayered fascial planes and aponeurotic sheets". In other words, the Thoracolumbar Fascia is made up of at least three large layers of fascia and "APONEUROSES" that are not strictly attached together, but actually glide on each other. Or at least they should glide on each other in people not struggling with chronic low back pain (take 10 seconds to play THESE VIDEOS side by side in order to see the difference in the TLF of those with low back pain -vs- those without). And thirdly, fascia is used as a leverage tool to gain mechanical advantage for both movement and structural support (FASCIA IN BIOMECHANICS).
Thanks to our national OBESITY EPIDEMIC, the fact that we are the INFLAMMATION NATION (which always ends up causing scar tissue and fibrosis --- HERE), too much sitting and staring at screens, sedentary lifestyles, spending way to much time on CONCRETE or other hard surfaces, etc, etc; not only are back problems common, but back surgeries are common as well. This most recent study (Acute Surgical Injury Alters the Tensile Properties of Thoracolumbar Fascia in a Porcine Model), published in the October 2018 issue of Journal of Biomechanical Engineering, came to some conclusions which, if you've been following research on the TL spine, will not surprise you.
In this study, pigs were used because their Thoracolumbar Fascia has been shown to "produce similar results to those observed in humans". It's now common knowledge that injured fascia (it doesn't matter how the fascia is injured --- acute, chronic, surgical, etc) becomes thickened and dense (HERE and HERE). Controls were compared to pigs with "microsurgically induced local injury," with only one side of the TLF of the experimental group of pigs being 'injured'. After a healing process, tissue was harvested from the "noninjured side of vertebral level L3-4 in pigs randomized into either control or injured groups." What did the team discover?
After putting the harvested tissues through a wide range of intricate tests to check the biomechanical integrity of the TLF, it was determined that the uninjured side of the experimental group's thoracolumbar fascia had "more tissue stiffness, less energy dissipation, and less stress decay [it took longer for the injured TLF to dissipate the energy it could dissipate]." Bottom line, the authors stated that "These findings suggest that a focal thoracolumbar injury can produce impairments in tissue mechanical properties away from the injured area itself. This could contribute to some of the functional abnormalities observed in human LBP." Bear in mind that while the "injuries" for this study were created surgically, the gist of the study was not necessarily surgery but back injuries in general.
I realize that in some cases surgery is inevitable --- I get it. However, studies like this show that disruption of the fascia can screw people up in ways that no one (particularly those in the surgical field) was thinking about just one short decade ago. And here's the kicker --- creating problems in the Thoracolumbar Fascia can mimic signs of disc problems (chronic severe pain and SCIATICA), the very reason people tend to have surgery in the first place. Listen to this piece taken from the 2015 book, Nerves and Nerve Injuries: Pain, Treatment, Injury, Disease and Future Directions (Vol 2).....
"The superior cluneal nerves arise from the dorsal rami of the first three levels of the lumbar spine. There are typically three superior cluneal nerves.... The medial superior cluneal nerve arises from the L1. The intermediate superior cluneal nerve arises from the L2 and the lateral superior cluneal nerve arises from the L3. Each of these pass through the psoas major muscle and then the paraspinal muscles to run in the plane between the quadratus lumborum muscle and the anterior layer of the thoracolumbar fascia. They then pierce the inferior aspect of the latissimus dorsi muscle and travel through the thoracolumbar fascia before crossing the posterior iliac crest."
I show you this because PIRIFORMIS SYNDROME is frequently mistaken for disc herniations (MOST OF WHICH ARE HARMLESS ANYWAY). Furthermore, PS is frequently not recognized for what it really is, CLUNEAL NERVE ENTRAPMENT. Where could the three cluneal nerve branches become entrapped? As you saw in the quote above, the TLF would be the most likely culprit (see link). There are two ideas I want you to take away from this study.
The first is that as you learn more and more about FASCIA, you start to see why years ago Dr. Langevin (a Harvard-trained neurologist and renowned acupuncturist) was already saying that problems in the fascia are at the very root not only of pain, but of sickness and disease as well (HERE). Secondly, there are action steps you can be taking to either avoid ending up with serious back issues, or just as importantly, taking control of your life if you've already had a back surgery.
Although I would strongly suggest you talk to your physician before reading any further, THIS POST ON THE THORACOLUMBAR FASCIA happens to have a list that could help you in this endeavor --- a list that is actually a specialized portion of THIS LIST. If you like what you are seeing on our site, be sure to spread the wealth by showing us some love on FACEBOOK. And for those of you who consider yourself "fascia hounds," you might want to take a look at our FASCIA SUPER-POST --- it contains all 175+ posts I've written on the subject neatly categorized for easy access.
ADHESED FASCIA CAN ENTRAP NERVES IN THE
THUMB AREA LEADING TO PAIN IN OTHER PLACES
It is not only the Source Point for the large intestine meridian, it's the Command Point for the head and face --- important if you deal with GUT HEALTH ISSUES or with SKULL OR FACE PAIN. In fact, most of you have heard that if you rub this point it can help relieve a HEADACHE. Not only is this true for many people (try it), but it's a point that can be used for pain anywhere in the body (WARNING: Do Not Stimulate This Point if You are Pregnant as it's used in Chinese acupuncture to induce labor).
A brand new study published yesterday by German and Canadian researchers in the Scandinavian Journal of Pain (Pain in the Hand Caused by a Previously Undescribed Mechanism with Possible Relevance for Understanding Regional Pain) shows yet again how related FASCIA is to any number of anatomical or physiological subjects. In this observational study, a group of people with pain on the ulnar side of their hand (the karate chop or pinky side) were found to have increased sensitivity in the area of LI4 --- the opposite side of the hand.
When the doctors injected LI4 they noted that all the patients got better, indicating a "possible entrapment of a terminal branch of ulnar nerve piercing the fascia in the first interphalangeal webspace". In other words, these people had restricted fascia in the tissue between their thumb and pointer finger that the authors found to be irritating the other side of the hand via a process of NERVE ENTRAPMENT.
This is not only part of the reason that acupuncture has proved effective for any number of problems over the course of thousands of years, it also helps explain why DRY NEEDLING (needling without injecting anything) has proved helpful for various sorts of MYOFASCIAL PROBLEMS AND TRIGGER POINTS as well. If you read any of DR. LANGEVIN'S WORK (she is a neurologist and researcher at Harvard), you have at least some degree of understanding of why this might be the case. And if you are appreciating the free information on our site, be sure to take a look at our FACEBOOK PAGE and show us some love while you're there.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
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