I have been a sports medicine chiropractic physician for the last eight years with a diverse background. A portion of my practice has been integrating soft tissue therapies such as, myofascial release, Graston, gua sha, trigger point therapy and more. The results from treating soft tissue injuries varied among patients, some had immediate improvement while others were less responsive in what seemed to be the same problem. Inconsistencies emerged and I started to believe that there was a missing piece. I looked hard for many years and finally came across a technique called Fascial Manipulation which was developed from a physiotherapist from Italy, Luigi Stecco. Fascial Manipulation integrates many soft tissue therapies and puts them all together into one system. Now we can more effectively treat unresolved pain and chronic pain.
Fascial Manipulation is next big thing in physical medicine which helps practitioners tell the difference between disorders of the muscle and skeletal systems versus the fascial system. The fascial system has recently been getting more attention by researchers and the physical medicine community based on its role in normal muscle function and movement patterns. The fascia, as a structure, contains layers of fibrous tissue that completely surrounds our body and makes a 3D model of our actual physical self. The layers of the fascia surround muscles, groups of muscles, blood vessels, and nerves while actually holding some together and allowing others to glide past each other with body movement.
It appears that the fascial system which surrounds our entire body actually acts as a sensory organ. The deeper layers of fascia have sensory receptors called the mechanoreceptors and proprioceptors. The mechanoreceptors are receiving data that relates to physical pressure or touch while proprioceptors perceive movement and position. These receptors help shorten single muscles and coordinate the movement with larger muscle groups. Research demonstrates that forces up to 30% generated by a muscle, when it is contracted or shortened, does not actually occur from where the muscle starts and ends, but rather it is dispersed throughout the connective tissue within the muscle, the fascia.
The deep fascia is the most significant when discussing, evaluating and treating this system. To simplify, we will talk about the deep layer of fascia in the arms and legs. We can break down the deep layer into two smaller layers; the bottom layer, which goes around each individual muscle by itself, and the top layer, which bundles these muscles together in groups. The top layer has the task of creating continuation between the tissues and coordinates the forces transmitted by each muscle together. The information from the receptors helps create normal movement and communication between each muscle and between the muscles and the brain.
This system works well and is balanced as long as the two deeper layers glide over each other normally. Dysfunction, pain, inflammation and lack of motion start when the thickness of the loose connective tissue, mostly hyaluronic acid, increases between the layers, decreasing tissue glide. People that have experienced sports injuries, falls, or car accidents in the past or have had overuse injuries are on the top of the list for presenting with decreased normal tissue glide. This disruption can explain the phenomenon known as “myofascial pain”, which can be hard to diagnose, evaluate and treat. In such a state, it could actually be harmful to stretch your muscles passively. When your fascia is stressed and thickened, pain can result from faulty compensation patterns. For example, I have treated many hip pain patients that actually had fascial problems in ankles or knees from a previous injury. The hard part can be finding the root cause of the problem. Once I found the real problem, I was able to treat them with Fascial Manipulation and patients that had tried everything else saw results and got better. This is not to say that all pain results from the fascial system, but when it does this is a great method to resolve it.
The treatment process of Fascial Manipulation focuses on restoring the natural glide between the layers of the deep fascia. There are specific fascial points in the body that reflect each joint, muscles and connective tissue that move it in a specific direction. Some of these points even overlap with acupuncture points and meridians treated with traditional Chinese medicine. There are approximately six points per joint segment that need to be evaluated. Once the most thick or dense point has been identified, then the sequence of points up or down the body must be evaluated and treated. Five to six points are typically addressed at one time, spending two to four minutes per point, and about thirty minutes overall. There are many factors that determine how many treatments you need, but four to six treatments is typical. The treatment of these points is very specific and requires about 80% pressure and 20% friction. This produces heat between the fascial layers and changes the thickness of the hyaluronic acid; therefore, restoring the natural glide. The therapeutic goal is to permanently restore gliding to an area that was altered and eliminate recurrent and chronic pain.
I am a certified Fascial Manipulation practitioner and have utilized it in my personal practice at Chiropractic Therapeutics in Coeur d’Alene, Idaho for the past year. I have seen some amazing results with Fascial Manipulation in conjunction with spinal manipulation, manipulation of the extremities, kinesiotaping and functional rehabilitation. Patients often come into our clinic with an obvious source of pain, but not always with an obvious cause. Now we have an extra tool to truly find the cause and not follow the pain.
I am proud to be the first one in Idaho to receive this certification and I will share, educate and support others to learn about this new technique from the manual therapy world. If you have any questions about this technique or treatment please contact my office at (208) 292-4873 or email at Lmartinchiro@gmail.com.
Written by Logan Martin DC | Owner of Chiropractic Therapeutics
Stecco, L Fascial Manipulation for Musculoskeletal Pain, Piccin, 2004.
Stecco, L & C Fascial Manipulation Practical Part, Piccin, 2009.
Hammer, Warren DC. “The Fascial system is a sensory organ.” ACA News. April 2014: 15-19.