Does Fascia Matter?

A detailed critical analysis of the clinical relevance of fascia science and fascia properties
11,000 words, updated Feb 20th, 2013 Whats new? by Paul Ingraham, Vancouver, Canada

SHOW SUMMARY ZOOM

Sheets of fascia can contract a bit like muscle but how strongly? Enough to make a difference?

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? 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. But is fascia actually important in therapy? More than any other soft tissue? This article questions fascia excitement from a scientific perspective.1 Fascia enthusiasts are rarely specific aboutwhy fascia matters, or how exactly fascial work can help people with common pain problems. They speak mainly about the complexity and ubiquity of fascia, as if those alone are good enough reasons to focus on fascia. Attempts to get more specific are usually sloppy. Poor clinical reasoning about fascia seems to be common. This problem was captured perfectly for me by something a massage therapist said to me on my 40th birthday in 2011. I was getting a

massage (because I really do love massage). The therapist was doing fascial work, of course you cant get a massage in Vancouver these days without getting some. She was using some mildly uncomfortable pulling and twisting techniques, trying to manipulate my fascia, instead of using the more satisfying Swedish styles I was craving. She launched into an awkward explanation of her technique, but words failed her: Well, your problem2 is fascia. The fascia is the thing you have to do something with. If you fix the fascia, everything gets more well, the fascia will make everything better. Somehow.

Deja vu? Feel like youve seen this here before? You probably have. This is a like new compilation of most of the fascia writing Ive done over the last year about four old articles merged into one, with some re-writing

and new information. You can now buy a $5 lecture version from Movement Lectures.

TABLE OF CONTENTS
1.
2. 3.

Introduction
1.1Barely

known to science! 1.2En garde! The fascia science challenge

4.
5. 6. 7. 8.

Sloppy fascia reasoning

Rewritten Feb 20 '13
2.1Electrified

by piezoelectricity 2.2Fuzzy logic: Gil Hedleys fuzz speech

NEW Feb 19 '13

2.3Idas 2.4The

idea about thixotropy

9.

acupuncture connection: is fascia actually magic? 2.5Not so exotic after all

NEW Jul 31 '12

10. Real fascia science that supposedly matters

11. 3.1Fascia is 12. NEW Feb 15 '13

much too tough to release

may not even be real 13. 3.3Does stimulating fascia reduce post-exercise muscle soreness?

3.2Release

14. Minor update Aug 30 '12

3.4Does

it matter that fascia contains muscle cells?

15. Minor update Aug 30 '12

3.5Fascia

strong like bull! Or mouse? 16. 3.6Do weak fascial contractions matter? 17. 3.7No clinical relevance at all? Not even a teensy bit? 18. 3.8Is fascial contraction even interesting? 19. 3.9What does Dr. Schleip think?

20. Conclusions Results of the Fascia Science Challenge so far

21. 4.1To

be continued

22.
24. 25.

Appendices
Reading 5.2Whats new in this article? 5.3Notes

23. 5.1Further

Barely known to science!

There is a lot of fascia research going on these days. However, because none of that research is clearly clinically relevant some of it might be, but its all quite debatable theres 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 sinch 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! In the history of science and medicine, guesses tend to fill knowledge gaps and the guesses usually turn out to be wrong. Exotic and new biology is also not very usefulbiology. No one can get safe, effective, reliable treatment protocols out of poorly understood biology. If you could, the biology wouldnt be poorly understood anymore, and youd probably be famous for pushing back the frontiers of human

Exotic and new biology is not also not very useful biology.
knowledge. Some fascia research is truly intriguing, and

what many researchers are saying about fascia

is reasonable and not an awkward reach beyond where the data can take us. Unfortunately, far too many therapists fascinated by fascia are reaching beyond what the science can actually support today way beyond and it is doubtful that it ever will. In some cases, in fact, we already know enough to know that a property, even if it is confirmed, is not really all that useful. Please beware the implication of therapeutic significance from scraps of basic biology. It is easy to sound cool talking about new biology because biology is cool. It is quite hard to make biology useful. Few basic biology facts ever become the basis for any kind of treatment. Certainly a lot of fascia science is right, but I question whether or not itmatters that it is right. In fact, on one occasion, a rather pedantic experimental psychologist was telling him about a long, complicated experiment he had done, incorporating all the proper controls and using considerable technical virtuosity. When

he saw Cricks exasperated expression he said, but Dr. Crick, we have got it right we know its right, Cricks response was, The point is not whether its right. The point is: does it even matter whether its right or wrong?
V.S. Ramachandran, telling a story about Francis Crick

En garde! The fascia science challenge

Fascia is biologically interesting! All biology is. But clinical relevance is the central question of this article: if fascia science cannot actually inform treatment in some practical ways, then it makes no sense to be fascinated by it in a therapeutic context. You might as well get excited about the biology of the immune system, or olfaction, or epigenetics, for all they have to do with hands-on healing.
Reader suggestions and feedback are welcome, both critical and supportive. However, hate mail will be

ignored. I receive a quite a bit of hate mail on this topic.Please think twice before you hit send.

Fascia enthusiasts routinely denounce this article, accusing me of ignorance of the current Science of Fascia. Thats understandable. However, I am pretty up on massage-related research its my full-time job so I feel confident challenging critics to cite even one example of fascia researchwith clear, direct relevance to what happens in treatment. If such a thing exists, I will be happy to publicly discuss it, and acknowledge my oversight. I could be wrong about fascia. I even hope that I am. Maybe it is important to manipulate fascia specifically. This article covers three main examples of allegedly clinically relevant fascia research below. (That may not sound like much, but the article is already several thousand words long, so be careful what you wish for.) I will add more in time. All three are actually good

examples of fascia science with poor clinical relevance. We do not have a winner yet. Before we get to that, though, Id like to start with a couple stranger examples of sloppy fascia science piezoelectricity and fuzz! and some of the general issues with fascial therapy.

There is a crack in everything Thats how the light gets in.

Leonard Cohen, Anthem

PART 2

SLOPPY FASCIA REASONING

Electrified by piezoelectricity
A popular notion is that piezoelectric effect an electric charge generated by flexing crystals is at work in fascia, and an extrapolation

 that it is also the mechanism for fascial release. It is hardly clear that this is actually the case. It has never been more than speculation. The first part is possible but unproven. The second part goes much too far and is demonstrably false and clearly contradicted by modern researchers. Crystalline properties are a pre-requisite for peizoelectricity. To get a piezoelectric spark, you have to have crystals. In the famous 1987 book Jobs Body which I read three times, back in the day Juhan proposes that connective tissue may behave like a liquid crystal.3 A strong emphasis on may: this has never actually been shown to be the case. Juhan was speculating. This doesnt mean that there is no piezoelectric effect in fascia, and there are plenty of problems with the idea, but its not totally out to lunch. Wedo know that piezoelectricity sparks fly when bone is flexed and stressed, and this guides the slow

remodelling of bone,4 which is super cool. Its a terribly clever system! Its also a great example of a clinically irrelevant biological property. It has nothing to do with anything a manual therapist could ever do to a bone. It is beautifully evolved to change bone extremely slowly in response to extremely specific stimuli which, presumably, cannot remotely be simulated by manual therapy. Trying to affect that system with your hands is quite futile. Thats going to be the case for the great majority of physiological systems, known and unknown even if you understand them, it doesnt mean you can use them, or affect them with your hands. Maybe fascia does something similar to bone with piezeoelectric effect. It wouldnt shock me. But no one has ever demonstrated that it actually does. Indeed, no one has even tried to find that property of fascia, as far as I can tell.

Some people have run with the idea like its a proven fact, though. For instance, James Oschman states unequivocally and overconfidently that connective tissue is piezoelectric, a fact that can be used as a firm foundation for the further speculation that it accounts for the fascial releases.5
Is this a straw man? Nope. A straw man would be an idea that no one actually believes or takes seriously and therefore meaningless to criticize. Certainly not everyone interested in fascia thinks that fascial piezeoelectricity is real or important. However, enough do that its no straw man! It may not represent the best thinking in the field, but it is certainly out there.

And its simply inconsistent with the reality of fascial plasticity, which we do know quite a lot about. Theres no point in speculating abouthow fascia responds quickly to manipulation, because it cant and doesnt: its too tough and slow-changing.6 In contrast to the total absence of research into fascial piezeoelectricity, the properties of fascial plasticity are well studied, and there simply is no short term change in fascia to explain! It cant respond to the pressures of massage

therapy any more than bone can. In addition to the footnote, this will be substantiated in various ways throughout the rest of the article. Could piezoelectricity be at work in some other way in fascia? Anythings possible. But now were cruising into pure guess work. Do we know anything at all about it, let alone the physiological intricacies of such a phenomenon? Do we know why it evolved? What it does, how it does it? Can we affect it? And, if we dont know these things, how can we possibly use it to devise a reliable therapy? Obviously we cannot.

Fuzzy logic: Gil Hedleys fuzz speech

Another fine example of imprecise scientific enthusiasm is Gil Hedleys extremely popular fuzz speech. In this video with a bazillon views, Hedley plays fast and loose with a dissection observation: there are cobwebby layers of fine, loose connective tissue between thicker sheets of fascia. The anatomy is interesting anatomy is always interesting but Gil Hedleys interpretations are dubious. His leaps of logic are charismatic, but also large and precarious. That stiff feeling you have is the solidifying of the fuzz, Hedley confidently explains. He thoroughly makes the case that fuzz explains the sensation of stiffness.

At best, that is an unsafe assumption, and one that ignores many other highly relevant factors like neurology, say, or the fact that hes looking at a dead person. He does not know what happens to that tissue in a living body. In fact, that fuzzy texture only manifests post mortem according to biotensegrity expert, Dr. Steven Levin.7 This is a very interesting passage, worth reading carefully, but note the emphasized phrase particularly: In Guimberteaus video, Strolling Under The Skin, what you see there is that the fuzzy stuff is really dynamic tissue that is under constant change. Tissues dont slide, there is no shear, they reconfigure with each movement. The dynamics of a cell ceases with death. Ca++ [calcium ions] flood into the cell and it stiffens thats rigor mortis. It starts within minutes of death, as soon as the circulating ATP [energy molecule] runs out. The fuzz is connective tissue that is stiffened during rigor mortis, and it doesnt happen unless you die. It occurs within minutes of death, and you can almost watch it happen. It is like snot hardening. The mucus booger that comes out of your nose quickly hardens and

becomes quite stiff; at death, the mucus that connects all our tissues, does the same. All that melting the fuzz is conjecture based on misinterpreted observations on dead tissue. Even so called fresh cadavers are but poor players in the game of life. Almost any amount of normal movement is sufficient to sustain a normal range of motion. Fuzz solidification either isnt happening or doesnt matter, because its effortless to move through. Also, there are other explanations for the sensation of stiffness: better, evidencebased, and un-fuzzy explanations. I discuss them in some detail in Quite a Stretch.

Idas idea about thixotropy

A shabby, decades-old idea is still often seriously cited as the explanation for how fascial therapy works: because it softens fascia with thixotropic effect. The idea came from

Ida Rolf (founder of Rolfing). Fascia researcher Robert Schleip:8 Many of the current training schools which focus on myofascial treatment have been profoundly influenced by Rolf (1977). In her own work Rolf applied considerable manual or elbow pressure to fascial sheets in order to change their density and arrangement. Rolfs own explanation was that connective tissue is a colloidal substance in which the ground substance can be influenced by the application of energy (heat or mechanical pressure) to change its aggregate form from a more dense gel state to a more fluid sol state. A quick look at how thixotropy works in human physiology shows that this just doesnt add up. The thixotropic effect is nifty physiology, but its not a therapeutic effect in itself, nor is it the mechanism of one. Idas idea was wrong. Thixotropy is an obscure physical property of certain slimy body fluids that get thinner when agitated or stressed. You can easily observe thixotropic effect in beach sand, near the

waters edge: stamp your feet in the sand, and it starts to liquify.
What makes these substances gooey and slimy? Why, a family of carbohydrate molecules, of course: the glycosaminoglycans. Also known as the snot molecule. Think of any movie monster with tons of ropy saliva thats glycosaminoglycans!

Thixotropic fluids in the human body include synovial fluid in joints, mucus, semen, and the gelatinous and poorly-named goo called ground substance the stuff that gristly connective tissue fibres are embedded in like bits of coconut in Jello. Ground substance is the most plentiful thixotropic substance in the body. But thixotropy is minor, slow, and temporary, and fascia is too tough to change. Fascial sheets are incredibly tough, and you cant change their density and arrangement quickly or easily. And thixotropy just isnt fast enough to explain the relatively speedy, dramatic effects on tissues that

therapists claim to achieve. Dr. Schleip: either much longer amounts of time or significantly more force are required for permanent deformation of dense connective tissues.9 Thixotropy might slowly make fascia morepliable, but not stretchier. If thixotropy had the power to increase the extensibility of connective tissue, then we would become obviously more flexible just from sitting in a sauna Ive tested this repeatedly and never observed any increase in flexibility just from being hot.10 Even if it works in some small way, thixotropic effect is going to be temporary, fading within seconds or minutes after hands are removed.

When the stimulation stops, so does the thixotropy, and a therapy cant work if the affected tissue immediately reverts to its previous state.Thixotropy

will stop when the stimulation stops but a therapy cant work if the affected tissue immediately reverts to its previous state. Dr. Schleip calls this the reversibility problem and definitely not an attractive implication of this model for the practitioner. Last but not least, thixotropic effect is simply aminor effect. Its occurring a little bit all the time, with or without massage. Massage surely does induce it a little, but just as surely much less than ordinary physical activity like with circulation. Massage therapists are very fond of claiming that massage increases circulation, but if it does so at all, the effect is much smaller than what exercise does! Perspective matters. Another similar thought experiment: if sustained pressures or sheering could significantly change connective tissue, then working a chair all day long or any long-duration posture would also deform your fascia.

The idea of thixotropy is hardly state-of-the-art thinking about fascia, but it is certainly still prevalent among therapists practicing fasciallyfocussed therapy, and trying to explain what they do. Unfortunately, it was never even a good idea in the first place, even decades ago.

The acupuncture connection: is fascia actually magic?

Another disconcertingly popular notion about why fascia matters is that the meridians of Chinese medicine correspond directly to fascial anatomy and function. If you polled therapists doing fascial manipulation, I think you would find that a great many believe that they are doing the same thing that an acupuncturist is doing just in a different way. They believe that fascial therapy works for the same reasons acupuncture works.

Indeed, most fascial therapists probably believe that acupuncture works. And therein lies the problem. Unfortunately for fascial release therapy, acupuncture is not a good ally: it has been failing many fair, good quality scientific tests for years now, and is simply not what it seems to be. Acupuncture as we know it today is not so ancient after all: its current form is a modern invention of the pediatrician Cheng Danan ( , 1899-1957) in the early 1930s1112

For most of history, acupuncture existed primarily as a method of bloodletting exactly like the prescientific medieval European practice.Before that, for most of history, it
existed primarily as a method of bloodletting exactly like the prescientific medieval European practice. And then theres the myth

of acupunctures popularity.13 Even its alleged popularity and widespread use in China is quite trumped up it is, for instance, not actually used for anaesthesia.14These are rather embarrassing facts for acupuncture. Acupuncture is obsolete Eastern folk medicine propped up by Western hype and wishful thinking. The proposed association between fascial meridians and the chi meridians of traditional Chinese medicine is meaningless. Even if meridians and all the other rubric of acupuncture were real, though, acupuncturists are unable to demonstrate their power clearly: their needles are consistently no more helpful than placebos. Even pro-acupuncture researchers have repeatedly admitted that the effect of the needles is small at best. And if the acupuncturists cant manipulate these meridians effectively enough to achieve clearly measurable effects, why would pulling on fascia be able to do it?

Acupuncture lore has no business in a serious discussion about fascia and its possible importance in therapy.
SY Does Acupuncture Work for Pain? A

review of modern acupuncture evidence and myths, particularly with regards to treating low back pain and other common pain problems

Not so exotic after all

Piezoelectricity, fuzz, and fascial meridians are three good examples of popular but poor reasons why fascia supposedly matters. There are other reasons, both better and worse, and discussion of genuine fascia science is still coming. But first I want to make it clear that common fascia talk often fails to even reach the level of being science-y. Despite all the talk of exotic properties of fascia, fascias clinical importance is usually expressed only in terms of a couple extremely simplistic rationales, which dont seem exotic at all:

1. 2.

its everywhere and connects everything (well, yeah), and it gets tight (not clear, see below). A strong theme in fascial therapy is the emphasis on the interconnectedness of anatomy via fascia, always making the point that pulling on any one part of fascia affects the whole body, like pulling on the corner of a sweater affects all the threads. (That sweater analogy appears virtually everywhere online that fascia is mentioned. It gets really tiresome, actually. Didnt think it mattered much ten years ago. Still dont.) The main idea of fascial therapy is that the stuff can get tight and restrictive, like clothing a size too small, and needs to be released, and that therapists can achieve this by various methods of yanking on it. The yanking may be extremely intense, too some flavours of fascial therapy are among the most painful of all hands-on techniques.15

And thats what fascial therapy boils down to most of the time, in the wild. I have personally encountered lots of talking about fascia that is exactly this rudimentary and even worse, like the example I quoted in the introduction The fascia will make everything better! Many therapists are perfectly capable of discussing the topic more intelligently, of course, but low quality reasoning and communication about fascia is distressingly common (and my exposure is quite extensive, due to the large volume of email I receive). Consider this gem of simplistic rationalization, reported by Barrett Dorko, PT: Restricted fascia is full of pockets. When the tissue starts to release, these pockets are opened up. When these pockets open, the sensations that were trapped in them are released. Such overconfident, poor quality clinical reasoning isnt universal just excessively

common within the culture of fascia enthusiasts. Now, lets get to some real fascia science.

The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge.

Stephen Hawking

PART 3

REAL FASCIA SCIENCE THAT SUPPOSEDLY MATTERS

Fascia is much too tough to release

Manual therapists need not feel threatened by the news that we cannot stretch fascia.

If We Cannot Stretch Fascia, What Are We Doing? Alice Sanvito, Massage Therapist

My original challenge to readers (in the fall of 2011) to suggest fascia science that supports fascial therapy was kicked off with a fine example: one that is just about the exact opposite of what I asked for, underminding the clinical relevance of fascia rather than supporting it. Despite the extraordinary number of comments I received on early versions of this article, few readers answered my challenge directly. Of the handful of scientific papers that were suggested to me, this was the most interesting: Three-dimensional mathematical model for deformation of human fasciae in manual therapy
Chaudhry et al. Journal of the American Osteopathic Association. Volume 108, Number 8, p379-90. Aug 2008.

The Chaudhry et al article is indeed clinically relevant to fascial therapy but not in a

supportive way. This fascia science actually contradicts the big idea of fascial therapy. The main point of manipulating fascia16 is to physically change it in some way to achieve what is usually described as a release. Although the concept of release may correspond to some other physiological phenomenon another discussion it certainly cannot be explained in general by physically changing the fascia. What Chaudhry and colleagues showed is that fascia is much too tough to release" (mechanical deformation17) by stretching it. Although they oddly imply in their summary that it might be possible to do so with the superficial nasal fascia, the main textof the paper makes it clear that even that thin tissue is extremely tough, and would only mechanically deform if subjected to surprisingly intense forces. This is consistent with well-established properties of fascia,

namely that its extremely tough stuff. Collagen is like that. If I could write my own conclusion to this paper, it would go more like this: CONCLUSION: You cannot change the structure of fascia, because it is tougher than Kevlar. If the stuff were thicker, people would be bulletproof.18 CLINICAL IMPLICATIONS: If you want to physically change someone's fascia by force, you're going to have to get medieval. This directly contradicts a major popular rationale for fascial manipulation. This paper is only clinically relevant to fascial therapy insofar as it presents evidence that discourages and undermines existing common practices and beliefs. Therefore, perhaps it was a poor choice to cite it in this context. Its also just old news that fascia is too tough to change. For instance, Dr. Robert Schleip debunked the idea in his 2003 paper about fascial plasticity, and if you dont take his word

for it a well-respected fascia researcher then whose opinion would be credible enough? He dismisses the traditional explanations of thixotropy and peizoelectric-effect-mediated adaptation, and thoroughly describes fascial toughness. He concludes that plastic fascial change in response to moderate loading is impossible to conceive.19 As strongly stated as that may be, Ill go even further. Dr. Schleip (and virtually everyone else) assumes that release is a real thing that needs explaining. Im not so sure

Release may not even be real

In the context of fascial therapy, a release is:

a palpable, relatively quick change in tissue texture clinically meaningful (makes some kind of real difference to the patient)

somewhat lasting (if it didnt last, what would be the point?) somewhat predictable (that is, its happening because of treatment) And fascial therapists more or less unanimously assume that its fascia, specifically, that is doing the releasing. No doubt the first thing a quick change in texture happens in the course of manual therapy. It is not safe to assume the rest, though. And whats left of the concept of a release if you take away the clinically meaningful, lasting, and predictable parts? What if its just a change in texture, a bit of movement under the skin?
Yes, I do have experience. Many readers accuse me of having no practical experience with patients, when in many cases I clearly have more (and better) than they do. Not that its a contest, but its just so deeply ironic and amusing when people assume that the only possible explanation for my opinions is that I must not have any work experience as a massage therapist. I have a decade of it, and this fact is readibly available in my bio.

In my many years working as a massage therapist, I felt various and sundry ripplings,

twitchings, and shifts under the skin. But in order to qualify as releases, those movements should have correlated strongly with my intentions and with the patients experience. Sometimes they did, but often they did not. So I always thought they were really quite random, occurring with great variety pretty much no matter what I did, or what patients reported.20 So while I certainly felt something change, I rarely thought of those changes as a meaningful release. Dr. Schleips 2003 paper about fascial plasticity basically just said that fascia is too tough to change, but muscle may react to touch and pressures, and that this is probably mediated by sensory nerve endings in all soft tissues. This is hardly surprising it basically just means that people react when poked and prodded and it doesnt really have anything to do with fascia in particular, except insofar as fascia has nerves in it, just like everything else. We have no idea whether or not any of that

actually constitutes a meaningful mechanism for a therapy. I can also make someone twitch their quadriceps by bonking their patellar tendon: does it matter, other than as a test of the reflex itself? Releases are probably mostly just trivial tissue noise in the hands-on experience, not a pivotal event in therapy. Or, if they are more meaningful, they are nearly impossible to interpret. Its not that nothings going on its that nothing in particular and knowable is going on. But we have trouble grappling with that, so we round it off to something more specific and definite and meaningful, an oversimplification that is more poetic than biologic. I have no objection to using release as a description of an experience, but I think it is quite misleading to pretend that it describes a particular biological event with clinical meaning and value which is exactly how most therapists imagine it, which is the only thing that really needs explaining. (And thats

not difficult: it boils down to a thick stew of good intentions, ego, and the human habit of imposing simplistic explanations on chaotic systems.)

Funny. Not actually possible. But funny! (Drawing by Claude Serre.)

Does stimulating fascia reduce post-exercise muscle soreness?

Perhaps but the clinical relevance of this data is tenuous at best so low that I would never normally be interested in this paper. In fact, I would never have chosen to read it myself, because I dont think its good

enough science. I spent some time on it only as an gesture of good faith to a critic, who supplied the paper as an example of basic fascia science that matters. It was probably not a good choice for that purpose. In vitro modeling of repetitive motion injury and myofascial release
Meltzer et al. Journal of Bodywork & Movement Therapies. Volume 14, Number 2, p162-71. Apr 2010.

This is a test tube study showing that naked cells handled stress better (fewer signs of harm) if they were treated with simulated myofascial release (MFR). A meaningful, accurate simulation of manual therapy on naked cells is an amusing notion, and its clear that what happened to those cells differs dramatically from what would happen in a real living body. Even if true and reproducible, this data would mainly support the rationale for MFR specifically for post-exercise soreness something of a dead end for clinical relevance,

because exercise-induced soreness has little to do with the main claims of fascial release therapy, which primarily concerns correcting postural asymmetries, eliminating alleged restrictions, and treating chronic pain. Post-exercise soreness is comparatively trivial, and patients usually dont seek therapy for it.21 Theres a lot of research showing that exercise-induced soreness is basically invincible anyway.22

A meaningful, accurate simulation of manual therapy on naked cells is an amusing notion.For

this property of fascia to be clinically relevant, it would have to imply that MFR might be able to treat chronic pain from other causes not the transient annoyance of soreness after a game of soccer. This isnt a rejection of all possible clinical relevance of the data. My point is that there

are so many problems that its relevance is watered down to quite a thin sauce way too thin. I do concede that the paper shows some evidence that fibroblasts have interesting and perhaps positive responses to mechanical forces. That is inherently interesting biology, and perhaps well worth investigating further but its a long reach to postulate any clinical relevance to what most therapists do, most of the time, with patients fascia. Reach is what the authors do, however. I suspect they are deeply interested in validating the notion that fascia is important, because they seem to be seeking evidence to support their pre-conceptions typical of The National Center for Complementary and Alternative Medicine-funded research, and a hallmark of low quality science. Its quite likely that if neutral researchers with no interest in

fascial therapy did this experiment they would not get or report the same results.

Does it matter that fascia contains muscle cells?

The next example of fascia science was suggested to me by Gil Hedley. Since he clearly believed me to be ignorant of fascia science and in dire need of educating, I asked him to recommend some reading to me a favourite paper showing something interesting and clinically relevant about fascia. As expected, he recommended a paper I was already familiar with, because it is something of a classic of fascia science: Robert Schleips 2006 dissertation on the contractile properties of fascia. Much more interesting stuff than the previous two examples. I will get into much more detail about this paper than the first two. Fascia is able to contract in a smooth musclelike manner and thereby influence

musculoskeletal mechanics
Schleip et al. Proceedings of the 5th World Congress of Biomechanics, Munich. Volume , Number , p5154. 2006.

Schleip and colleagues convincingly showed that fascia contains muscle cells and that they can contract slowly and weakly. That is undeniably interesting biology! But the point of this analysis is to ask: Does it even matter whether its right or wrong? Is it clinically relevant? Does it improve how we do therapy? Can we use the knowledge to affect the body with hands? That is the question. It is also a question that Dr. Schleip and his colleagues have addressed themelves on their website, FasciaResearch.de. What follows is my own analysis, which is generally consistent with theirs. However, interested readers should definitely have a look at theirarticle: it is readable and chock full of useful perspective, answering questions like Does fascia contract in response to emotional stress? and Can fascia contract on its own?

Fascia Contractility FAQ, a webpage on www.fasciaresearch.de. Important update: Dr. Schleip has read this article and corresponded with me about it amiably, and expressed clear agreement with my main point. Although he also had some thoughtful criticisms, we agree on what matters, and he shares my frustration with clinical overconfidence in fascia. I invited him to make a statement for my readers about this: look for it at the end of this part of the discussion.

Fascia strong like bull! Or mouse?

Before we get to clinical relevance, Ill quickly explain what Schleip et al. found: a kind of muscle cell in rat fascia, which they described as rather unexpected.23 They also tried out various methods of stimulating them in vitro (test tube) and found that, by golly, those

muscle cells did what muscle cells do: they contracted! Slow, weak contractions. But they contracted.

Perspective By any measure, fascial contractions are dramatically less powerful than muscular contractions. If anything, this diagram gives far too much credit to the power of fascia, which would barely register at all if depicted more accurately.

Its certainly not difficult research to understand.

Some important context that fascia fans will appreciate: for a long time, fascia was and often still is incorrectlythought of as a fairly lifeless, inert substance, the Saran Wrap of biology. I still hear various educated people referring to it in this way. However, massage therapists and chiropractors (in particular) are prone to swinging to the opposite extreme and talking about fascia as though it is more interesting than a lifetime subscription to National Geographic. The truth is somewhere in the middle.24 Dr. Schleips research demonstrates this. Fascia is not inert. But neither is it all that lively at least not in terms of contractility. We are not talking about a lot of muscle cells here. If you had blueberries with your cereal in the same proportion, youd be disappointed not enough blueberries! Its just a few muscle cells scattered throughout the fascia. Theres so few that they are visible only when you look very closely and in just the right way.

Nor are we talking about particularly strong contractions. Fascia isnt going to be ripping apart any chains with its bare hands. The maximum force generated by a small bundle of contractile rat fascia was around 35mN.25 In plain English thats not very dang much or the somewhat more precise about what it takes to set an AA battery rolling on a nice smooth surface. (It took me a long time to work that out. I have a weird job.) Thats not bad for a bundle of rat fascia, perhaps, but it doesnt really hold a candle to middle-of-thenight charlie horses either. Compared to the power of muscle contraction, fascia power barely even registers. The bull versus mouse comparison is a little unfair though, because its not just a matter of strong versus weak. Although fascial contractions may be weak compared to muscles, they could nevertheless be powerful in another way their effects

might, for instance, accumulate over time to produce contractures (permanent seizing up of tissues). So its still worth considering how these contractions might be clinically relevant.

Do weak fascial contractions matter?

Schleip et al.s basic finding seems sound enough, and I see no reason at this time to dispute the observation that fascia can contract. If theres anything wrong with their research methods, I dont know what it is. But for the property they described to matter to therapists who are choosing to focus their therapeutic attention on fascia for anybiological property to be clinically relevant it must be significant enough to have an effect on health. (It then must also be something that we can do something about, but lets start with it mattering in the first place.)

Schleip et al. characterized the raw power of fascial contraction quite differently than I just did. I deliberately made it sound trivial, within the bounds of their numbers.26 In their words, however, in the large sheets of fascia in the low back, the contraction could be strong enough to influence low back stability and other aspects of human biomechanics. Stability? Even if you exaggerate their numbers, they would still only account for a small fraction of the postural muscle power involved in dynamic spinal stabilization, never mind the generally mind-blowing structural toughness and resilience of the human spine. The idea that low back stability could be affected in any way by such a small, slowmotion force is a bit much for me to swallow.2728 And thats based on an estimate of the theoretical maximum force generated by the biggest, thickest blankets of fascia in

human anatomy. In most places in the body, fascia is much less substantial tough for its weight, but mostly quite thin and wispy, and a lot of it even microscopic.29 The forces generated must be dwarfed by that of muscle itself in rough proportion to the number and size of contractile cells involved. That fascial contractions might influence other aspects of human biomechanics is a bit vague. A general example of such aspects might be that contracting fascia could be involved in biomechanical asymmetries tighter on one side than the other. The validity of such a concern depends on just how sensitive you think human biomechanics are to forces so subtle that no one really had any idea that fascia contraction was even happening before this study. As regular readers here will know, I think biomechanics are over-rated as a factor in all kinds of pain problems, and theres extensive evidence that human beings are wonderfully adaptable and cope surprisingly

well even with gross deformities, never mind subtle assymetries and imbalances. I make that case in great detail in another article.30 The wording of the conclusions of Schleip et al.s paper is synonymous with saying that fascial contraction is relevant only if structuralism is a useful mode for doing and thinking about therapy. Also, their phrasing shows a strong bias in favour of the importance of fascia. And the study was funded by the International Society of Biomechanics, the Rolf Institute of Structural Integration, and the European Rolfing Association.31 Weak, slow fascial contractions strike me as being scientifically valid and interesting, but clinically minor. Once again, far from making me interested in fascia as a target for therapy, fascia science is convincing me of just the opposite.

No clinical relevance at all? Not even a teensy bit?

If it makes anyone feel better about all this, Im happy to concede that fascial contractility might be a little bit clinically relevant. Other evidence might even reveal something important although that would surprise me. It doesnt hurt my main point to make these concessions. To make my point, all I have to establish is that the clinical relevance is debatable and probably minor at best, rather than the slam dunk it would have to be to support even half of the excitement about fascia you see in the therapy industry today.32
What about fascia and trigger points?Schleip et al. dont bring trigger points (muscle knots) into this discussion, but a lot of other people certainly have. The notion is that a trigger point is being squeezed and sustained by clenching fascia, but this clinical concept suffers even more than other examples from the relative weakness of fascial contractions. I explore this specific claim of clinical relevance in detail in my trigger points tutorial.

In his original dissertation, Schleip limited his speculation about clinical implications to the

broad generalization that it can influence musculoskeletal mechanics, such as spinal stability. In a follow-up paper for Medical Hypotheses,33 he and several colleagues generally suggest that fascial contractility is a factor in muscle stiffness. The high water mark for potential clinical relevance is spelled out in this passage: This offers the possibility of a new understanding for many pathologies that involve a chronically increased myofascial tonus. Examples include conditions such as torticollis, low back pain associated with paraspinal compartment syndrome, tension headaches, and others. Similarly a decreased fascial tone could be a contributing factor in conditions that are often associated with decreased myofascial tension, such as in back pain due to segmental spinal instability, peripartum pelvic pain, or fibromyalgia. While usually other factors play a major role as well in these pathologies, it is possible that their progress could be influenced additionally by the regulation of fascial tissue tone

The emphasized phrase is key its an understatement. For instance, other factors dont usually play a major role in those conditions, they always do. And the role of those factors isnt just major, but probably nearly total relative to the presumably minor(and still unconfirmed) contribution of a little fascial tension. Some of the items listed are particularly implausible to me. Ive already mentioned how hyperbolic it is to suggest that fascia could have any serious impact on spinal stability. Another peculiar item here is fibromyalgia, a fascinating condition that might conceivably be affected in some small way by fascial contraction, but which is overwhelmingly a nasty disease of the nervous system. Suggesting it as a main example34 of how fascial contraction might matter makes about as much sense to me as saying that people with cancer might have some contracted fascia would it matter if they did?

The most interesting item listed is compartment syndrome, which is decidedly not a common complication or cause of back pain, but certainly is a problem (especially in the shins).35 Compartment syndrome is excessive pressure in a fascial compartment, like a sausage swollen in its wrapping. If fascia were to start squeezing a compartment for some reason, it might be a problem. It is the one item listed where there is a clear, direct and logical connection between fascia can contract and a way that it could contribute significantly to a health problem. That is clinical relevance. And yet there is still a clear problem with the scale of the forces here. Compartment syndrome is by definition only a problem when the pressure is significant, probably dramatically exceeding the maximum force with which fascia could squeeze the compartment. Visualize a hot water heater that isnt venting pressure the valve is busted, and its in danger of blowing.

The pressure inside is immense, and it would make no practical difference if the hot water heater itself was a little larger or smaller. Again, fascial contraction is probably not nearly strong enough to matter. Still, at least its easy to see how it could matter in principle, and the numbers might favour fascial contraction as factor. So you see how this goes: for one candidate example after another, the clinical relevance of fascial contraction is dubious or minor.

Is fascial contraction even interesting?

One of the lower moments in biology history was the labelling of non-coding DNA as junk DNA in 1972. The first time anyone with a scrap of imagination heard that, they thought, Yeah, right. As biologists slowly figured out what all that junk is for,36 there was a lot of

Well, yeah, okay, thats more like it. Of course. Its interesting science, but in some ways those discoveries are still overshadowed by the way were all not so very surprised. Similarly, the presence of muscle cells in fascia is no shocker. I never believed fascia was entirely inert any more than I believed in the junkiness of any DNA. If you spend much time studying biology, it quickly becomes apparent that there are no sharp lines or divisions, and that we consist of an incomprehensibly diverse and interconnected community of cells.

That connective tissue has a small population of muscle cells strikes me as blindinglyunsurprising.Muscle
blends exquisitely into tendon, with no clear demarcation at the cellular level: at the microscopic level, its like walking through the overlapping zone of two heavily integrated adjacent neighbourhoods, and the further you

go away from the muscle, the fewer muscle cells you see, and the more fibroblasts and their fibres. That connective tissue has a small population of muscle cells strikes me as blindingly unsurprising. Fascia surrounds and fractally wraps every muscle inside and out, for crying out loud how could it not have a few muscle cells and overlapping properties? I didnt know that before it was confirmed, but I certainly dont find it particularly surprising. I suspect that the slightly contractile properties of fascia are simply at one end of a continuum of motor function. Our muscular system is overwhelmingly our primary means of reacting to stimuli the major output of our nervous systems and in general terms the slight contractility of fascia is probably just the fringes of that functionality, a little bit more of the same. There are probably some subtle differences, but they are subtle and arcane and ultimately just a slight variation on the biological theme of muscularity. Im not saying

its completely uninteresting, but its overshadowed by the much more interesting muscular system as a whole, about which fascia is simply a mildly intriguing subtopic. And, in terms of clinical relevance, the muscular system itself is in turnovershadowed by neurology.

What does Dr. Schleip think?

Recently Dr. Schleip read my article and wrote to express his basic agreement with my key point about his research: Your comments on the small size of fascial contractions are right on, at least when viewing these within the periods of seconds to minutes, as is usually applicable for bodywork techniques. He also wanted me to know that he shares my annoyance with the over-zealous claims and projections of therapists doing fascial work. He is not thrilled with the way his research is

being used to justify premature overconfidence in fascial therapy. He also offered some thoughtful criticism on some specific points (and I made some changes, and will probably make more). Nevertheless, he had no major objections, and was generally pleased with what he read here: You have my respect for your detailed and critical analysis of the present work on fascia. Most of the people who criticize you have not done a portion of your reading work and could certainly learn a lot from the debate you started. I invited him to make a statement for my readers about this. Here is it in full, with some emphasized highlights: I share your emotional frustration with the current trend among bodyworkers of attributing anything wonderful or astonishing to the properties of fascia. In fact, our Fascia Research Group at Ulm University has been receiving an almost exponentially increasing number of inquiries

from enthusiastic healers (and martial art teachers) worldwide who wish that we would sanctify their claims that fascial contraction provides the explanation for their observed miracle powers. While I do tend to believe that the fascial net plays much larger roles in human functioning than previously assumed in orthopedic medicine, I am afraid that such over-zealous claims and projections are undermining the seriousness of the investigationand academic rigor that characterizes the work of the current leaders in fascia research, such as P. Huijing, H. Langevin, T. Findley, P. Standley and A. Vleeming. As a bodywork clinician myself, I have learned that there is hardly a more dangerous attitude among therapists than the hero healer/manipulator who is damn sure about his diagnosis and supposed treatment effects . This of course applies as much to fascia-oriented therapists as it does to those who base their work on supposed neuromuscular or other physiological effects,

There is hardly a more dangerous attitude among therapists than the hero healer who is
most of which are still unproven.

damn sure about his diagnosis & supposed treatment effects.While scientists
can learn a whole lot from the intuitive and experiential wisdom of complementary therapists, particularly about the nonfragmented and connecting properties of the fascial net, we bodyworkers can learn at least as much from the careful, questioning approach of good scientists, who are willing to doubt their own assumptions and to refrain from premature confidence and over interpretation of their findings. It is this mutual learning and interdisciplinary enrichment which in my opinion characterizes the best qualities of the current fascia research field, as expressed in the international Fascia Congress series and associated activities. Again, Dr. Schleip and I do not agree about everything but that is unimportant compared to our shared values and commitment to cautiously reserving judgement. We have each placed our bets on this topic, but not closed our minds. I fully support and endorse his enthusiasm to explore

the biology and he supports and endorses the value of my critical analysis.
PART 4

CONCLUSIONS
Results of the Fascia Science Challenge so far

Piezeoelectricity may occur in fascia, but its clinical relevance is nil not enough is known about it to even speculate about how it could be exploited in manual therapy. Gil Hedleys theory that congealing fascial fuzz causes stiffness is simplistic and wrong. It is not a plausible explanation for the sensation of stiffness, or a mechanism of action for fascial therapy or stretching. Fascial meridians relate fascial therapy to the meridians of acupuncture, which dont exist or even if they do cant actually be exploited for any therapeutic effect even by acupuncturists. Chaudhry et al showed that fascia is too tough to release. Indeed, even thin fascia is so tough that it is basically

inconceivable that it could be physically changed (stretched, loosened) without vice grips. This directly contradicts a major popular rationale for fascial manipulation, and is only clinically relevant to fascial therapy insofar as it presents evidence that discourages and undermines existing common practices and beliefs.

Meltzer et al concluded that stimulated fibroblasts might be happier fibroblasts specifically, they might be more resistant to post-exercise soreness. The results of this test tube study are questionable, but even if you take the data and interpretation at face value, it is a long reach from a test tube study to clinical reality. Treating post-exercise muscle soreness is not even a common goal for manual therapy. Schleip et al established that fascia is contractile to a trivial degree, but not that it matters. It is somehat unsurprising biologically, and clinically trivial. It is not a factor in any of the common problems most manual therapists work with maybe none at all and even if it was it is somewhat unlikely that hands-on therapy could relax it.

To be continued
There is more fascia science, and I will extend this article with more analysis in the future. I honestly hope that there is clinically relevant fascia science that would be terrific. So far, however, I see no good reason for therapists to be fascinated by fascia and to make it a target tissue. Other alleged fascial properties and clinical relevance issues I intend to address eventually (definitely not a complete list):

The claim that connective tissue is a colloidal substance in which the ground substance can be melted by heat or mechanical deformation (thixotropy), and that this is the basis of a therapeutic release. Done February 2013. The claim that fascia is a liquid crystal. While it certainly has some elements of truth in it, the relevance to therapy is extremely dubious. This is closely related to the piezeoelectricity claim already covered by the article, but there is more to say about

the liquid crystal idea specifically. Done February 2013.

The claim that fascia contains memories in some sense. I will likely dispute both the property and its relevance. The claim that fascia is structurally important and tensegrity is interesting (agree), and that this is clinically relevant (disagree). Much of my rebuttal on this score already exists in my article about structuralism.

PART 5

APPENDICES
Further Reading

Length is Fine The story of the obsession with crookedness in physical therapy and treatment for chronic pain.

SY Your Back Is Not Out and Your Leg

SY Pain is an Opinion What recent

pain science can do for your chronic pain right now. The role of the nervous system in chronic pain is the major alternative to focussing on fascia. It has much clearer clinical relevance.

SY Does Massage Therapy Work? A

review of the science of massage therapy such as it is.

Syndrome A guide to the science of muscle pain, with reviews of every possible self-treatment and therapy option, even for the most difficult cases. Includes a section on the relationship between fascia and trigger points (e-book customers only).

SY Trigger Points & Myofascial Pain

Greg Lehman, a chiropractor and physiotherapist has a thoughtful new fascia article, Fascia Science: Stretching the power of manual therapy. Todd Hargrove, a Rolfer and writer (BetterMovement.org), has a good post onfascia and foam rolling and fascia under the microscope. If We Cannot Stretch Fascia, What Are We Doing?, a webpage on www.massagestlouis.com. Massage therapist Alice

Sanvitos clear summary of Dr. Robert Schleips theory that fascial release may be attributable to changes in muscle tone stimulated by mechanoreceptors in fascia and other soft tissues, and not by plastic deformation of fascia.

Whats new in this article?

Rewritten (Feb 20 '13, section #2.1) A major editing job, particularly to include the much more specific idea that piezoelectricity accounts for releases. See section #2.1,Electrified by piezoelectricity. New section (Feb 19 '13, section #2.3) No notes. Just a new section. See section #2.3,Idas idea about thixotropy. New section (Feb 15 '13, section #3.2) No notes. Just a new section. See section #3.2,Release may not even be real. Minor update (Jan 31 '13) Several minor additions and edits.

Minor update (Aug 30 '12, section #3.5) Added some acknowledgement that fascia contractility may still have some slowmotion power even if it is quite weak. Ill probably expand on this soon. See section #3.5, Fascia strong like bull! Or mouse? Minor update (Aug 30 '12, section #3.4) Added a very useful link to FasciaResearch.de. See section #3.4, Does it matter that fascia contains muscle cells? New section (Jul 31 '12, section #2.4) No notes. Just a new section. See section #2.4,The acupuncture connection: is fascia actually magic? Major update (Jul 25 '12) Article launched as a compilation of about four previous articles on this topic, with revisions and some new information.

Notes

1.

It is quite negative. I have fun taking therapy seriously. Criticism and deconstruction of ideas is normal and healthy and necessary for therapy professions to grow and change.BACK TO TEXT

2.

I didnt actually have any problem. It was supposed to be a relaxation massage, in a spa. Yes, she was a Registered Massage Therapist a well-trained and fully certified massage therapist. And thats probably exactly why she felt compelled to strut her stuff and troubleshoot my case and talk about fascia.BACK TO TEXT

3.

Juhan. Jobs Body. 1998. amazon.com Jobs Body is essentially a physiology textbook with imagination and a soul. Its a hard read, but equally rewarding. On the other hand, Juhan probably takes some his speculation too far too be useful or accurate.BACK TO TEXT

4.

The full details of how bone responds to stress are spelled out in Dr. Harold FrostsMechanostat model. For more information, see Tissue Provocation Therapies.BACK TO TEXT

5.

This kind of (wild) speculation is hardly unusual for Oschman: his writings are laced with much stranger ideas.BACK TO TEXT

6.

Dr. Robert Schleip, from his 2003 article, Fascial plasticity: a new neurobiological explanation:

The half-life span of non-traumatized collagen has been shown to be 300500 days, and the half-life of ground substance 1.77 days (Cantu & Grodin 1992). While it is definitely conceivable that the production of both materials could be influenced by piezoelectricity, both life cycles appear too slow to account for immediate tissue changes that are significant enough to be palpated by the working practitioner.
BACK TO TEXT

7.

The quoted passage is from my personal correspondence with Dr. Levin, and is used with his permission. For information about Dr. Levins work, see Biotensegrity: A new way of modeling biologic forms.BACK TO TEXT

8.

Schleip. Fascial plasticity: a new neurobiological explanation. Journal of Bodywork & Movement Therapies. 2003.BACK TO TEXT

9.

Heres Dr. Schleips full reasoning from his article, Fascial plasticity: a new neurobiological explanation: In most systems of myofascial manipulation, the duration of an individual stroke or technique on a

particular spot of tissue is between a few seconds and 1 minute. Rarely is a practitioner seen or is it taught to apply uninterrupted manual pressure for more than 2 minutes. Yet often the practitioners report feeling a palpable tissue release within a particular stroke. Such rapid i.e. below 2 minutes tissue transformation appears to be more difficult to explain with the thixotropy model. As will be shown later, studies on the subject of time and force dependency of connective tissue plasticity (in terms of creep and stress relaxation) have shown that either much longer amounts of time or significantly more force are required for permanent deformation of dense connective tissues (Currier & Nelson 1992).
BACK TO TEXT

10.

Some people will undoubtedly protest this, claiming that they certainly get more flexible in a sauna. Heat alone, without stretching, will definitely make us feel less stiff(a change in sensation), but does not actually increase flexibility. Ive tested this very carefully myself: see A Stretching Experiment.BACK TO TEXT

11.

The Acupuncture and Fasciae Fallacy. Kavoussi. www.sciencebasedmedicine.org . 2011.BACK TO TEXT

12.

Ramey. Acupuncture and history: The ancient therapy thats been around for several decades. ScienceBasedMedicine.org. 2010.BACK TO
TEXT

13.

How popular is acupuncture? McKenzie. www.sciencebasedmedic ine.org. 2011.)BACK TO TEXT

14.

Acupuncture Anesthesia: A proclamation from Chairman Mao. Atwood.ScienceBasedMedicine.org. 2009.BACK

TO TEXT

15.

Some fascial therapy is gentle, but I have personally encountered intense fascial therapy in the wild on numerous occasions. I prefer gentler therapy and usually request it. Despite being a confident and assertive communicator about my preferences, I have still had many unpleasantly intense fascial therapy experiences.BACK TO TEXT

16.

According to a great many therapists. Not all, but probably most. Its spelled out clearly by a prominent fascial therapy pioneer, Luigi Inventor of Fascial Manipulation Stecco. This is someone who has the respect of large numbers of fascial therapists; his thinking about how fascial therapy works can be considered strongly representative not only of common thinking about fascial therapy, but also of its bleeding edge. In a review of the rationale for a workshop, he repeats the basic idea of tissue stuckness in need of releasing in an impressive array of fancier terms. This is just a small sample:

Once a limited or painful movement is identified, then a specific point on the fascia is implicated and, through the appropriate manipulation movement can be restored.
BACK TO TEXT

17.

Mechanical deformation is lasting change in the shape of the tissue, like working clay. This is in contrast to elastic deformation, where the tissue snaps back to its pre-manipulation state. To deform in this context is not a bad thing (as in deformity), but a change in form the goal that therapists generally have, in fact.BACK TO TEXT

18.

People are not bullet proof thanks to their fascia, alas wouldnt that be handy! And yet the hyperbole is definitely true in a sense. Fascia is mostly much too thin to actually be bulletproof. If fascia was just as thick as a Kevlar vest, it might well be just as bulletproof (or a little more, or a little less). This is just like how spider silk is stronger than steel cable pound for pound, it is. The catch in the comparison is that fascia most likely doesnt have the same puncture resistance property that Kevlar does. There are many kinds of toughness (i.e. bones resist compression exceedingly well, but are quite vulnerable to torsion). The point was simply that the research showed quite clearly that the forces required for plastic deformation of fascia significantly exceed what can be applied to it with hands. Whatever therapists are feeling when they claim to detect a release, its not that.BACK TO TEXT

19.

Schleip. Fascial plasticity: a new neurobiological explanation. Journal of Bodywork & Movement Therapies. 2003.

While high-velocity thrust techniques might create forces within that range, it seems clear that the slower soft tissue manipulation techniques are hardly strong enough to create the described tissue response [plastic deformation of fascia]. This research leads to a simple thought experiment. In everyday life the body is often exposed to pressure similar to the application of manual pressure in a myofascial treatment session. While the body naturally adapts structurally to long-term furniture use, it is impossible to conceive that adaptations could occur so rapidly that any uneven load distribution in sitting (e.g. while reading this article) would permanently alter the shape of your pelvis within a minute.
BACK TO TEXT

20.

Sometimes I felt things that seemed big that the patient seemed not to notice at all. Sometimes the patient had a profound sensory experience when I had noticed no change in the tissue whatsoever. I could not consistently elicit anything clearly. I am not a dumb guy, but I found it all quite uninterpretable and mostly unpredictable. I got tired of trying to find meaning in my sensations, and by my last three years in practice I abandoned all conceit that I could induce specific changes in tissue, and focussed

pretty much exclusively on my patients sensations not mine.BACK TO TEXT

21.

If its bad enough to think that you need help, youre also too sore to want anyone to touch you (let alone push on you). In any case, post-exercise muscle sorness is usually all wrapped up before patients can get to an appointment.BACK TO TEXT

22.

SY Ingraham. Delayed Onset Muscle Soreness

(DOMS): The mysteries of muscle fever, natures little tax on exercise. SaveYourself.ca. 5662 words.BACK TO TEXT

23.

Is it really surprising? Ill return to that question below. That phrasing doesnt actually come from the paper, so you wont find it there, but from a poster they made to summarize the paper.BACK TO TEXT

24.

Or perhaps somewhat to one side of the middleBACK TO TEXT

25.

A millinewton is 1000th of Newton, which is a measurement of force. A full Newton is not a lot: enough to accelerate a mass of one kilogram at a rate of one meter per second squared, without friction. Imagine what it would take to get a small

weight moving a little bit in space. Now divide by a thousand.BACK TO TEXT

26.

Id like to think I made it sound accurate, and the result just happens to be trivial.BACK TO TEXT

27.

A little personal perspective: my lovely wife has titanium in her back, installed to stabilize a massive fracture of her T12 vertebra in 2010. Such is the toughness of spines that the titanium fixations installed to protect her actually broke on both sides came loose from the brackets screwed into her bones. Similarly, severe scoliosis can twist titanium fixations like pretzels as it advances. Those are the kinds of forces involved in the back. Fascial contractions are a miniscule part of such impressive equations.BACK TO TEXT

28.

It is also noteworthy that the contractions they described were slow motion contractions, taking many seconds to develop at their fastest.BACK TO TEXT

29.

Analogy: in the circulatory system, there are only a few gigantic blood vessels, but countless fine and microscopic ones. The fascial system is similar: a few large, obvious sheets of fascia, a bunch of more modest and delicate structures, and then a nearly infinite network of extremely

thin and microscopic structures. This is why I say that we are wrapped in fascia fractally.BACK TO TEXT

30.

Leg Length is Fine: The story of the obsession with crookedness in physical therapy and treatment for chronic pain. SaveYourself.ca. 10040 words.BACK TO
TEXT

SY Ingraham. Your Back Is Not Out and Your

31.

Despite what it seems like, I am not actually accusing Schleip et al. of having any overt or serious conflicts of interest. In general, COIs are more common and less of a big deal in science than people think: where there is science there is funding, such is life, and funding sources affect science in muddy, complicated degrees ranging fromnot really at all to truly, madly, deeply. This seems like a borderline case to me, somewhere on the edge of being a problem. Its safe to say that these organizations probably would not fund or continue to fund research that came to the oppositeconclusion, i.e. not strong enough to influence low back stability and other aspects of human biomechanics.BACK TO TEXT

32.

This is another form of what I call failing the impress me test. Usually I bring that up to make the point that there needs to be strong evidence that treatments works before they can be considered proven small and temporary treatment effects should not impress anyone. In

this case, though, its the clinical relevance of fascial contractility that is failing to impress.BACK TO
TEXT

33.

Schleip et al. Passive muscle stiffness may be influenced by active contractility of intramuscular connective tissue. Medical Hypotheses. 2006. PubMed #16209907. BACK TO TEXT

34.

If youre not going to list really good, relevant examples here, where are you going to do it?BACK TO
TEXT

35.

I have written quite a lot about compartment syndrome with regards to their role in shin splints (see Save Yourself from Shin Splints!). The lower leg is by far the most common place in the body for compartment syndromes, both in the shins and the calf. They are more or less unheard of elsewhere in the body rare and generally minor and self-limiting. If fascial compartments were prone to problematic contraction, wed constantly be getting compartment syndromes all over the body.BACK TO TEXT

36. Basically, only a fraction of the genome is for coding proteins, but that important minority is regulated and tweaked by the rest of the noncoding DNA. So a (very rough) analogy is that the coding DNA is like software that makes you who

you are, but the junk DNA is the operating system that it needs to run on. Not so junky.