IMAGING THE BODY'S FASCIA
"Does fascia — sheets and webs of connective tissue — have any properties that are relevant to healing and therapy? Are there good reasons to do manual therapy (massage particularly) that is “aimed” at fascia specifically? Fascia gets discussed in therapy offices a lot these days. It is supposedly the key to many a therapeutic puzzle, and is now routinely targeted by therapists of all kinds. Fascia is fashionable. But is fascia actually important in therapy? More than any other soft tissue? There is a lot of fascia research going on these days. None of that research is clearly clinically relevant and significant — some of it might be, but it’s all quite debatable. There are no slam dunks. In the absence of hard data, there’s also a lot of speculating about why fascia is important, which leads to some claims that it has clinically relevant properties and functions that are still barely known to science. For instance, perhaps fascia can actively cinch up like a corset around muscles, or maybe it is the medium of a liquid crystal communication system, or even maybe it melts like butter when you move. Who knows!" Paul Ingraham from a 2013 article on his website (SaveYourself.ca) called Does Fascia Matter?
"And yet, fascia's "major functions" have yet to reveal themselves. To date, there have been no home runs establishing a clear, causal link between fascia's molecular, cellular, or biomechanical properties and the effective treatment of pain, injury, or disease – at least to the satisfaction of the broader scientific community." From Robbie Gonzalez's July 29, 2014 article for the Daily Explainer called How a Mysterious Body Part Called Fascia Is Challenging Medicine.
"Consider a membranous envelope that glistens with a slick lubricating fluid. A continuous envelope that extends from head to toe, front to back, surrounding every organ, every blood vessel, every nerve, every bone, every muscle. An envelope that changes thickness as it extends from region to region. Its purpose: to support and lubricate. An example of its function: to prevent a muscle from catching on its neighboring muscles as it contracts. Blood vessels and nerves travel within the fascia to arrive at their designated end organs. In turn, fascia itself receives a profound number of nerve endings. The fascia is a fundamental structure in which the circulatory system and nervous system converge. When the fascia becomes compressed or twisted, tensions are transmitted along the fascial planes. When an individual experiences hip pain, tissue restriction might be occurring in another location. An ankle, for example, may be restricted enough to be pulling superiorly... enough to influence the hip. This transmission of tension through the fascial planes is referred to as Fascial Drag." From Dr. Mark Rosen's website on Osteopathy. Remember that the "Father of Osteopathy" (ANDREW TAYLOR STILL) touted Fascia as the cause / cure of all disease back in the 1800s.
"Among the different kinds of tissues that are involved in the body’s 'elastic' framework (chiefly ligaments, tendons, muscles, etc); fascia has received the least scientific attention – probably because in most regions of the body it cannot be imaged with even the most technologically advanced imaging techniques such as MRI (hey, out of sight, out of mind). Nevertheless, fascia plays a major (albeit poorly understood) role in joint stability / instability, proprioception, coordination, strength, joint motion, as well as Pain Syndromes of all kinds. It can even be involved in various disease processes." Dr. Russell Schierling from Destroy Chronic Pain
When it comes to FASCIA, who's right? Is it Ingraham who's associated with DR. GORSKI'S vitriolic Science Based Medicine blog, which touts the beauty and benefits of "EVIDENCE-BASED MEDICINE" (he's the assistant editor)? Or is it Dr. Rosen, who believes that adhesed Fascia is at the forefront of a great deal of (maybe the majority of) sickness, pain, and disease (HERE)? While I think that everyone has something to add to the conversation, I tend to fall into the "Fascia is Amazing" camp (not difficult to tell, considering the final quote above is from my Destroy Chronic Pain site). Maybe it has to do with my skepticism of the skeptics (click on the EBM link above for some of the reasons why I have real doubts concerning the veracity of Evidence-Based Medicine). More likely it has to do with the AMAZING CLINICAL RESULTS I've gotten for making Fascia a huge part of my practice since Y2K.
Not that I think that Fascia has magical powers or anything like that (you'd have to read Ingraham's piece), but because of what I see in clinical practice on a daily basis (HERE for instance), I will continue to tout Fascia as a critically important piece of the puzzle until research convinces me that my model is faulty and needs to change. Even the hyper-animated Dr. Headley has to some degree changed his mind about the model he espoused in the video below (i.e. his comments about "melting like butter"). Just remember that changing the way one thinks about your model does not necessarily invalidate treatment based on said model.
Fascia is an interesting tissue system because it is involved in so many different and diverse functions. It acts as an auxiliary nervous system (HERE). It has extreme toughness and elasticity -- two properties on opposite ends of the spectrum. And, along with your skeleton, it literally works against gravity to hold you up, which is due to one of it's unique properties called "TENSEGRETGY". However, Fascia presents practitioners with a unique set of dilemmas as well. Number one, it is known to be extremely pain sensitive (HERE). And number two --- they talk about this in the final video below --- FASCIA does not show up well with our current array of advanced diagnostic imaging. When you Google "Imaging Techniques Fascia" you will get a whole bunch of stuff on the Plantar Fascia, some information on Illiac Blocks, and an array of everything else --- most of it irrelevant to this conversation.
What I have known for awhile is that the only way you are really going to visualize Fascia --- particularly Fascia in motion --- is with Musculoskeletal Ultrasound Imaging (MSKUS). The best example of this technology in action is found in a post that I wrote on THORACOLUMBAR FASCIA (yes, there are extremely cool ten-second motion videos of healthy fascia compared to adhesed fascia). Unfortunately, this technology, while certainly not new, is not commonly used in a non-invasive manner. Allow me to explain. While the technology itself is non-invasive (no ionizing radiation such as that seen in CT), after helping make a diagnosis, I see it mostly being used to guide injections (PRP, CORTICOSTEROIDS, Sugar Water / Prolotherapy, HYALURONIC ACID, TRIGGER POINTS, etc, etc,). When you find someone using this technology, it will typically be in Sports Rehab Clinics or Regeneration (Anti-Aging Clinics) in larger metropolitan areas. Peter Gettings, writing for the British Medical Journal Blogs in December of 2014 confirmed that what I showed you earlier (it's almost impossible to correlate exam findings with patient symptoms) is true of Diagnostic Ultrasound as well.
"There is a steep learning curve to MSKUS. It takes a significant investment of time to improve once you have learned the basic skills of probe handling and image interpretation. It is so easy to see something abnormal on a scan and assume it’s the cause of the symptoms. One of the biggest lessons that I have learned from scanning is that there is often little correlation between the degree of abnormality seen on a scan and the severity of patients’ symptoms."
Be aware that after doing an extensive internet search for information, clinicians, studies, etc about using MSKUS specifically for imaging Fascia, I found the list to be quite short. While there are many probable reasons for this, it appears to me that aside from a few people (THE STECCOS, Leon Chaitow, and Randy Moore come immediately to mind), there are not many non-invasive practitioners who see Fascia as the major part of the "Big Picture" and using this technology to image it. Unfortunately, for the most part, the body continues to be imaged the same old way, which, when it comes to Fascia, is no more effective than if the imaging were being done by a monkey. It's why FASCIAL ADHESIONS often prove to be Chronic Pain's "PERFECT STORM". It's also why many of you have experienced the blank stares of physicians who have no earthly idea what's wrong with you and why you have so much pain (probably you as just another of the myriad of drug seekers they are constantly dealing with).
For the record, there is another device that I found, which, while not really "imaging" Fascia, can shed light about what's going on in the Fascia ----- THE MYOTON PRO. According to their website, "The Fascia Research Group from the Division of Neurophysiology of University of Ulm and the Center for Integrative Therapy from Stuttgart presented the study results of "Assessment of Myofascial Trigger Point Release with a Novel Myometer (MyotonPRO) in Addition to an Algometer" at the Third International Fascia Research Congress in Vancouver, March 2012. In the study the MyotonPRO was used as an objective diagnostic tool to assess efficiency of Myofascial Trigger Point Release technique. The conclusion of the study was that MyotonPRO could be used as an objective diagnostic tool to assess the efficiency of a treatment, the Myofascial Trigger Point Release technique. The study results were summarised both in a verbal as well as in a poster presentation. The results presented at the Congress generated significant interest from reputable opinion leaders, editors and expert researchers in the fascia world."
To me the question regarding any sort of MYOFASCIAL ISSUE is not whether one can create an electronic device to measure the quality / density / stiffness of the tissue, but whether or not these creatures can be successfully treated, and how long said treatment results last. My experience is that for people with hardcore chronic Trigger Points (particularly of the UPPER TRAPS & LEVATORS), you can do any number of treatments that will resolve them temporarily (SCAR TISSUE REMODELING, CHIROPRACTIC ADJUSTMENTS, Injections of all kinds, LOW LEVEL LASER THERAPY, hardcore MANUAL THERAPY, Theracane, MUSCLE RELAXERS, etc, etc) and provide great relief ---- temporarily. But they always seem to want to come back (HERE and HERE are what I have found that works best).
As is always the case, if you are struggling with any sort of musculoskeletal or neurological problem, there is great potential for you to help yourself by addressing inflammation. For starters, simply read THIS POST.
FASCIA VIDEOS FROM YOUTUBE
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).