Ann Sleeper Reports from the First International Fascia Research Congress 2007

Fascia’s time is coming. After years of gradual spread from osteopathy and structural integration (Rolfing, etc.) into other manual therapies, fascia’s tipping point is just about here.

The tipping point, according to Malcolm Gladwell, is when everything comes together and all of a sudden, a concept or a thing permeates the culture and everyone knows about it.

The First International Fascia Congress is both a sign of that progress and a big boost to help it along in the culture of manual therapy.

How it happened

What does it take to reach that tipping point? First, you need a few influential people to make the concept of fascia understandable and to spread it around to the rest of us. Well, those people are around now, and some of them were at this conference. Many of us have heard of Tom Myers, a leading teacher of Rolfing-style fascial release and of the Anatomy Trains concept of myofascial continuity. John Barnes and John Upledger are the best known proponents of the osteopathic style of fascial treatment. And in most massage therapy communities around North America, there are influential local fascial teachers and therapists busy spreading the word. In fact, in just the last few years, many new massage therapy schools have fascial work integrated into their curriculum from day one, not just tacked on as an afterthought.

Second, the message has to stick in our minds. To massage therapists, fascia used to seem like somebody else’s tissue to work with — now it’s starting to seem like ours, too. What has made fascia finally stick in our minds? Lots of things, but the tensegrity concept has something to do with it. (See below) Seeing the body clearly as a 3-dimensional interrelated structure changes our thinking, and suddenly, fascia seems essential.

And third, the environment must be right to allow the concept of fascia to tip. And it is right. In the last 15 years, massage therapy has changed tremendously. There’s a lot of interest in making long-lasting structural change in our patients, not just in pain relief. As it happens, fascial work is pretty good at that.

Another big environmental change is that we have discovered science, and science has discovered us. The need for evidence-based practice has brought us together, and our increased cultural acceptance has made that possible.

The Research Conference

The First International Fascia Research Congress was the brainchild of Robert Schleip, a Rolfer who became a scientist, and of Thomas Findlay, a scientist who became a Rolfer. Using their ties in both communities, they found fascia scientists and fascial practitioners from around the world and brought them together in Boston.

Research conferences don’t usually include people from such disparate backgrounds, but the communication between the two groups was exactly the point of this conference. We practitioners found the details of the science hard to follow at times — and sometimes the scientists did too — but we all got the gist of it. And the scientists got to hear more about what we’re doing and what we would like to learn from them. This article will discuss just part of the flood of information presented at the conference.

Science mind vs. therapist mind

Like many others, before the conference I had read Robert Schleip’s fascinating articles about recent scientific discoveries about fascia and what that might mean to practitioners.

Like many others, I suspect, I ignored Robert’s warnings that the science indicates, but doesn’t always fully prove, his exciting speculations about the nature of fascia. To my mind, it was a done deal. Fascia has smooth muscle fibres in it so it can contract and is an active, not a passive contributor to movement! Fascia is intimately connected to the autonomic nervous system via pressure receptors and so the pressure we apply in treatment causes a decrease in sympathetic tone! What could be better?

The scientists had to rein us in a bit. A good scientist must speculate, but never makes claims that aren’t backed by plenty of high-quality experimental evidence. We, on the other hand, like nothing better than to speculate based purely on our experience and palpation, because that is an important part of our hands-on learning process. So is fascia an active contractile tissue in the body? It looks like it might be, but we don’t know yet for sure.

What is tensegrity?

However, there is good evidence for the tensegrity structure of cells, showing that they all move together and change shape together because of their fascial interconnections. Fibres called microtubules form the cell’s skeleton and create a scaffolding for the internal parts of the cell to cling to. This skeleton, the cytoskeleton, emerges from the cell to form an external scaffolding that each cell can attach to via protein receptors called integrins. The scaffolding and the cells are intertwined so when one part moves or distorts, the others do too. That means that cells operate as tensegrity structures, and so tissues at higher levels, right up to the bones and the myofascia .

To illustrate this, I’ll expand on the old fascial metaphor of pulling on a sweater. If you pull on one corner of your sweater, the rest of the sweater distorts and moves toward the place you apply the pull. Now imagine that your sweater has chopsticks interlaced in the weave, and as you pull on your sweater, the chopsticks move too. This is a crude example of a tensegrity structure. The integrity of the structure is based on the tension between the hard parts (chopsticks, or skeleton) and the soft stretchy parts (sweater, cells, or myofascia). When you move one, you move them both, and furthermore, the whole structure moves as one. This is how symptoms can appear far from the site of the application of pull, or the force of injury.

If I yank on my sweater, it may not tear where I’m holding it, but it may tear at that weakened part that I never mended. In the same way, the force of both injury and therapy can have an effect far removed from the site of application. Now imagine that the sweater is not a flat thing, but a 3 dimensional structure like the body, and you’ll have the idea. And this means that when you move your arm, all the tissues move in tandem, right down to the cellular level.

What if I press on this cell?

Furthermore, pressure that causes cellular distortion changes not just the cell’s position and shape, but also its chemical processes and signals, function, growth, gene expression, and even whether it lives or dies. Researchers have been studying fibroblasts, the fascial cells that produce the fibres and ground substance of fascia.

These studies indicate that the fibroblast cells in fascia must also be responding somehow to the therapeutic distortion caused by manual therapy. Perhaps our work causes the fibroblasts to produce anti-inflammatory substances, growth factors and vasodilating substances to maintain local blood flow. Perhaps the strain of injury, on the other hand, might do the opposite, causing damaging effects and leaking of fluids in the tissue.

If that's true, then would one direction of therapeutic pressure be better than another to produce the best outcome for our patients? We don't know yet. But from studies like these, researchers are beginning to piece together cellular and molecular evidence for the effectiveness of myofascial release.

The final answers are not yet in. Researchers must painstakingly test one variable in this complex process at a time. And they must do it both with cells in the lab and in the body itself. Only then can these results be definitely related to our clinical practice.

High hopes for myofibroblasts

There was also a lot of discussion about myofibroblasts, which are fibroblasts with contractile smooth muscle cells in them. They help in wound healing to pull the tissues back together. They have also been found elsewhere in fascia, leading to the theory that they stiffen up the fascia to help it participate in movement. But although contraction has been produced in myofibroblasts in the lab, this very attractive theory requires more research to prove that they really are active in the fascial response to force and movement. Keep your eye on myofibroblasts, though. We’ll likely be hearing more about them.

Fascia at work

Fascial anatomy and biomechanics were more familiar territory for the practitioners in the room. Descriptions by several speakers of the astonishing range and complexity of this fascinating tissue elicited oohs and ahhs from the crowd. The lumbodorsal fascia has been getting attention lately, and a couple of researchers discussed its role as a sling during movement. First it stretches, then springs back, to help propel us forward in gait. So if it isn’t free to work well, then both posture and gait will be profoundly affected.

How tissue contraction and stretch produce pain was another topic of particular interest. The nerves are structures like any other, and they must be free to slip and slide as the tissues move. If they can’t, even the nerves themselves can produce pain — the nervi nervorum function as a pain receptors too.

Observation of fascia in motion in real human bodies is now possible thanks to MRI and ultrasound. More oohs and ahhs were produced by imaging of the tendons and myofascial layers of the wrist sliding during movement. But more warnings from the scientists were required. The motion in the imaging appeared greater than it really was — we were seeing more than one plane of motion at once. Oh, well.

Then it was our turn

Some practitioners were also invited to give presentations on their work with fascia, and naturally these were popular talks. A group of Canadian physiotherapists talked about low back stability, continence and the phenomenon of overbreathing (chronic hyperventilation).

Lauirie McLaughlin presented on overbreathing. This is a fascinating and clinically significant concept. You can hear her audio interview by clicking on her image in the right hand column of this article. No doubt we’ll be hearing more about that in the next few years.

A South African physiotherapist, Willem Fourie descirbed his work with scarring in the myofascia after breast surgery. You can watch an extensive interview with Willem by clicking on his images in the column beside this article.

Case studies by practitioners were displayed in poster form on the walls of the conference center, along with posters of still more research studies.

Fun hypotheses

A discussion of new hypotheses based on existing evidence gave some tantalizing glimpses of where fascia research is going. My favorite? The possibility that fascia isn’t just a support structure, it’s also a body-wide signaling network. It responds to pressure by producing electrical, cellular and tissue remodeling signals. The mechanical forces of movement and posture, both normal and due to injury, send these signals through the fascia to to affect not only fascia but all the other tissues as well. If this is true, the signals produced by pressure on the fascia could have a profound effect on health and disease. Now there’s the kind of hypothesis a fascial therapist likes to see. Let the experiments begin!

They’ll be back

Therapists are by necessity practical people. We wanted definite answers from the scientists that we could use to alter our practice. The scientists kept reminding us that their experiments are designed to show that certain mechanisms exist in the fascia. But in a living human body, things can behave differently than in experiments. For now, their answer to many of our questions has to be, “We don’t know yet.”

There’s enough information now for some very interesting theorizing to help us open our minds and senses to better perceive the fascia. Once the scientists learn more about what we do, they’ll have more new ideas for research. There will be a fascia conference in Amsterdam in 2009 and the Second Fascia Research Congress will be held in the United States in 2011. This could be the beginning of a beautiful relationship.

For more information about the First International Fascia Research Congress, go to their web site, fascia2007.com.

Abstracts of all the research papers presented can be downloaded free.

A DVD set of the conference plenary sessions can be bought for $200.

A Fascia Research book, including a summary of the conference and full text articles by leading scientists in fascia research, is available for $ 50 plus shipping and handling.

Click on this linkfor world wide DVD Screening Locations and Times!

Biography

Ann Sleeper is a massage therapist and educator living and practicing in British Columbia. She teaches Muscle Energy Technique and other courses based on osteopathic concepts.

Ann also provides courses and tutoring for massage therapists working toward licensure in British Columbia.

She can be reached by clicking on her icon at the right!