Wednesday, March 13, 2019

Top 5 Takeaways from "Fascia as Sensory & Emotional Organ"

Presented by Robert Schleip, PhD (Ulm University, Germany) & Thomas Myers (Anatomy Trains)

Key takeaways from the recent Fascia Course that I attended in Boston, 2019   This course was presented by two of the biggest “gurus” in the world of Fascia, whom I have been following for quite a number of years.  I’ve heard them speak individually on separate occasions but what a huge treat it was for me and many others to hear both of them speak at this course.  
Dr Robert Schleip and Tom Myers
1. Fascia is a sensory organ. There are greater than 100 million sensory receptors in the body-wide fascial net. (Grunwald M, 2016). The fascial element of the muscle is innervated by approximately 6x as many sensory nerves as its red muscular counterpart. 
Clinical Implication:  Fascia can be a source of nociception.

2. Fascia contains 4 types of sensory nerve endings.  These are Golgi tendon organs, Ruffini receptors, Pacini corpuscles & interstitial receptors, collectively called fascial mechanoreceptors.  They can be found in the intramuscular, extra-muscular and fascial tissues.  This article by Dr. Robert Schleip  is found in and provides examples of how specific techniques could be utilized to optimize intended stimulation of specific mechanoreceptors in fascial tissues. 

3. Muscle vs Fascia as source of nociception:
Hypothesis Development:   
When patients describe the location of their symptoms, they describe muscle pain in a more focal/localized manner and in a smaller area. Location of fascial pain is larger and more diffuse and descriptors have an emotional quality. Suggested indicators of fascial pain include: diffuse in area, emotional quality, and sensitive to stretch. These features need to be differentiated from discogenic pain.

4. Healthy fascia requires a specific level of hyaluronan (formerly termed hyaluronic acid) to allow for optimal glide and normal functioning of deep fascia.
Hyaluronan (HA) is abundant in soft connective tissue.   Changes in the concentration, molecular weight, and binding with other macromolecules can have dramatic effects on the sliding movement of fascia.   
Too much hyaluronan causes tissues to get “sticky” (increased viscosity) and reduce lubrication and gliding of the connective tissues and muscle, and over time, will lead to alterations in muscle structure & function. 
Clinical Implication:  Immobility & Inflammation can increase the viscosity of HA-containing fluids. 

4. Feeling stiff is mostly related to the brain’s state of protection more than and accurate representation of the state of the tissues.
Clinical Implication: 
Modulate input into the nervous system to reduce threat, hence state of protection.  Integrate multimodal input (eg. tactile, movement, auditory, visual etc.) can alter perception in a chronic pain state. 

5.  Pandiculation:  Nature’s way of maintaining the functional integrity of the myofascial system.

Definition: A stretching and stiffening especially of the trunk and extremities (as when fatigued and drowsy or after waking from sleep) - Merriam-Webster.

Pandiculation as found in nature

Pandiculation involves an active contraction while gradually lengthening them, and then contracting again to a rest position.  Eg. yawn, involuntary stretching upon waking up.  These full body “active stretch” prepares your myofascial system and body for action and movement. 

  Does this cat-cow exercise look familiar? 

Clinical Implication:  Include PANDICULATIONS (active stretch) as part of your routine throughout the day. 

Clare Frank is the founder of Movement Links, Inc, a company borne out of a desire to enhance clinicians’ understanding of the movement system. She is the program director of Azusa Pacific University Advanced Fellowship in Movement & Performance and clinical faculty of Kaiser Permanente Spine Rehab Fellowship.  Clare is a lifelong learner, implementor and advocate for the movement system.


Key References
The Lumbodorsal Fascia as a Potential Source of Low Back Pain: A Narrative Review.
Wilke JSchleip RKlingler WStecco C.

Training principles for fascial connective tissues: scientific foundation and suggested practical applications.  Schleip RMüller DG.

Fascia as a Sensory Organ: Clinical Implications  Schleip R

A fascia and the fascial systemStecco CSchleip R

Feeling stiffness in the back: a protective perceptual inference in chronic back pain.

Viscoelastic Properties of Hyaluronan in Physiological Conditions.
Cowman MKSchmidt TARaghavan PStecco A.

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