All, Exploratory, Informative

Why I’m Mad About Myofascia

Myofascia has been quite a buzz word for the past 10 years or so. It has completely revolutionized the fitness world and altered how people stretch. It has had an enormous impact on how we see form, biomechanics, range of motion and referral pain. It is singly responsible for the creation and sale of hundreds of different mobility tools and seeming torture devices for opening and stretching it. But what is it? Where had it been hiding before 10 years ago?And why am I such a huge fan?

Fascia

Hidden is an apt adjective for describing fascia. While it is literally everywhere in the body, it is easily overlooked. Scientists and medical professionals have long known of its existence, but they have never been able to assign it any significance. It is cut through surgically without a second thought, completely disregarded during dissections and poorly understood en vivo. 

There are various definitions of fascia, ranging from technical to philosophical. Any one person talking about fascia, may be talking about multiple things at once; the thick connective tissue structures (called aponeuroses) that help to stabilize the body, the slippery, fluid network that interconnects all the structures of the body or, for those who prefer more esoteric imagery, the material that houses human consciousness.

The truth is, collectively, therapists have a hard time agreeing on what fascia is, how it should be described and what its clinical applications might be.

Structure

Fascia is a predominantly fluid matrix, about 65-70% water, so the only way to really witness it, is in a live specimen.  One of the best examples of fascia as an interconnected network in living tissue, is seen in the video footage by French hand surgeon, Dr. Jean-Claude Guimberteau. If you go to YouTube, you can find countless clips of the fascia, as it appears under the skin. I think visuals like this: https://www.youtube.com/watch?v=G_Eu-FdKDs8 are imperative to understanding how structures connect throughout the body.

So what does the fascia do? One idea, is that it is present in order to compartmentalize structures; to keep them anchored, while allowing them to move around each other without friction. This slight separation also allows structures to perform their jobs independently, without losing interconnectedness.

Fascia is often defined by the quality of tensegrity, a word coined by Buckminster Fuller to describe the interrelationship between tension and compression. As with any other structure, the human body is constantly transmitting the tensional forces placed upon it.  As a consequence, it must shift and create compensations in order to direct that force along a path; one that hopefully incurs the least amount of damage.

Physiology

How about the idea of fascia as a storage container, similar to adipose tissue? I am not sure that there is any research on this idea, but clinically, any therapist who has been doing fascial work for a considerable amount of time will tell you that all manner of stuff gets stuck in the connective tissue. This includes alcohol, drugs, smoke and even emotions.

I, along with many other therapists, have experienced former smokers, alcoholics and addicts, coughing up smoke, releasing chemical odors and feeling inebriated during and/or immediately after sessions. This is known to occur even if a person has been sober for many years. It is fascinating to see how the body stores past habits.

Another thought as to the physiological functioning of the fascia, is as an expansive communication network, as critical to the body as the circulatory and nervous systems. Even if this network functioned purely through the compensations of tension and compression, as described above in the tensegrity model, it seems to make sense that a substance so all-encompassing would easily serve as an agent of communication.    

Philosophy

Yes, you read correctly before; I stated that there are some who would consider the fascia as the seat of human consciousness. I cannot give any evidence as to whether or not that is true, but I will say that the idea that human connective tissue can store “memories” of past trauma, whether physical or emotional, is well-founded. So in that sense, maybe the fascia does act as an instrument for telling each individual’s biography.

The growing prevalence of mind-body medicine in the modern medical arena indisputably tells us that the physical and emotional bodies are inextricably linked; that past traumatic events and their associated emotions very much get housed in our tissue and manifest themselves physically. These physical manifestations might be mild aches and pains, or could be much more severe conditions, such as cancers and auto-immune disorders.

Beyond that, our emotions literally shape us. There is a great book by Stanley Keleman called, “Emotional Anatomy”, filled with visceral imagery of how shock, fear, anger, grief, disappointment, regret and hatred contort our physical form. Imagine emotions similarly to a car accident; transmitting sometimes injurious forces through our bodies. As described above, our connective tissue (fascia) must absorb and/or disperse those forces. Over time, a human’s posture can truly give away the story of their emotional past.

I have chosen to demonstrate below, a slightly more light-hearted version of this truth.

There are still countless aspects of the human experience yet to be understood, and I believe fascia falls into that category. When ones see the sheer ubiquity of this connective tissue matrix, it is hard to imagine it not serving a grander purpose than any we have yet conceived.

What Brought Me to this Work?

I became curious about myofascial work after being in practice for 6 years. I was getting good results as a massage therapist, but I often felt I was flying blind and knew there must be a more assessment-based approach that would also offer longer-standing results. After studying with a number of people, I realized the power of this work, on both a physical and emotional plane, and it quickly became my preferred technique.

The work that I do today is very much directed by postural evaluation and movement analysis, but also involves a level of conscious intention that was missing from my earlier work. Now, I find that I am able to assist with the healing of major injuries/limitations, sometimes with miraculous speed and efficacy. Learning this work has been a gift to me in my life; it has not only helped me to help my clients, but it has also been a great personal asset during my own times of injury. 

Misconceptions & Criticisms

One common misconception surrounding fascial therapy is that therapists are only working on the fascia. That is a preposterous assumption, considering everything I’ve just explained about the interconnectedness of fascia. This would be equivalent to thinking that a chiropractor only affects the bones, without having any impact on muscles or nerves. While manual therapists tend to specialize in a particular technique, it is important to remember that the body is a single entity and that you cannot touch one part without affecting every other part of that entity. A better way, then, to describe fascial therapists, is as having their intention on the fascia, even though they are undoubtedly affecting a number of other things as well.

There are those who question the clinical significance of fascial research. The aponeuroses that I described at the beginning of this blog, for example, are truly tough. When they constrict, they can apply thousands of pounds of pressure to the surrounding structures. There is even a condition, known as Compartment Syndrome, directly caused by fascial tightening. This is a medical emergency that can even result in amputation of a limb if not treated immediately in order to alleviate pressure and allow for unhindered circulation. The negative attitude towards fascial work then, comes from the idea that no therapist can possibly affect a substance so tough without having to utilize extreme force.

Response

While I find scientific evidence to be very powerful, massage therapy in particular, is an arena in which the gold standard of a randomized double blind placebo control study is, at best, challenging to conduct. This is one area where I find experiential knowledge and anecdotal evidence to reign supreme.

Massage is an experience, for both the practitioner and the client. If both people are perceiving improvement in the tissue and a reduction of adverse symptoms, isn’t that enough evidence of efficacy? Does the mode of transmission or the particular technique even matter at that point?

I love the work that I do, but I am also not so dogmatic to think that the techniques that I use are the only way to a desired result. When a therapist enjoys using a particular therapeutic technique, chances are she will get the best results utilizing that technique. And when a patient enjoys receiving a particular therapy, chances are she will receive the greatest amount of benefit from that thearpy. 

There is a great lesson to be learned here out of the field of interpersonal neurobiology: sometimes the therapist/patient connection is the healing (or the placebo, if you prefer) and the type of therapy becomes irrelevant.  Currently, myofascial release simply happens to be the way I most enjoy connecting with my clients in order to guide them through their healing process.

I became a therapist because I was primarily concerned with helping people transform their pain and consequently the quality of their lives. When scientific evidence defends the work that I do, I am doubly thrilled, but when science cannot comprehend what I am doing, the results of working with my clients are more than sufficient evidence for me to consider myself a successful therapist.

What Keeps Me in this Work?

While I call myself a myofascial therapist, and the techniques that I use myofascial-based, it is important to remember that any therapist trained in multiple techniques is never just doing one thing. In fact, healing is often intention-based work more than it is technique-based work. However, in studying myofascial techniques, I rediscovered something I had forgotten about manual therapy: how to truly connect to the person on the table. 

This work has reinforced my palpative skills and has given me access to a meeting ground between the physical and emotional bodies. It has allowed me to slow down, connect more profoundly, feel more deeply, elicit greater biofeedback from my clients and really create change. I learn something new with every person I touch, and for that I feel truly blessed.

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