Archive for the ‘Fascia’ Category

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Fascial Work and Pregnancy

Monday, October 24th, 2011

Are there contraindications with fascia work and pregnancy?

Of course, and very interesting ones. Briefly though and worst case first:

1) If there were a miscarriage in the first trimester (often happens around 10 weeks) or a premature delivery in the last trimester, and it was ascribed to the bodywork you did, you would feel badly even though it is highly unlikely your work would have had anything to do with it. Best to work on women who want and feel good about their pregnancy, and in the middle trimester by preference. If the pregnancy is not wanted or in any way physiologically difficult, I proceed much more cautiously.

2) In the final trimester, the hormone relaxin is beginning to loosen the connective tissue net in the body, so that the ligaments of the pelvis can relent to let the baby through – but it acts on tissues all over the body. This is a two-edged sword – it is a great time to get unusually good change because the fascia is pre-softened, but not a great time for heavy work as you can unbalance their system.

3) If you know what you are doing, you can help prepare the adductors, bottom of the pelvis, sacrum, diaphragm, and belly for the work of delivery. Those with visceral skills can help reduce any adhesions that would interfere with labor. Again: careful because of the softened tissue – do not put a lot of strain on the pubic symphysis or SI joint ligaments. The contraindication is against heavy-handed work that could put in imbalance; work slowly and always toward balance.

4) Myofascial work during pregnancy should be limited to preparation for birth or relief of pain. The mother’s body is already undergoing major structural change during the childbirthing year – now is not the time to try to impose a reconfigured posture or do a general course of myofascial work – save that for the post-partum months.

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Soft-Tissue Patterns

Tuesday, June 7th, 2011

An attendee at the Perform Better Summit writes:
“I wanted to thank you for revolutionizing the way I look at fascia. I just had a question that hit me on the way home. I use Neuromuscular Re-education a lot in practice and I continually get frustrated with inconsistent results. Could it be that because I am not addressing the fascial restriction that the muscle and soft tissue is just falling back into the “slot”? I am getting good temporary results, but unless I address the restriction I can re-ed all i want. If there is no room for the soft tissue am I beating my head against the wall?”

“I know its a bit of a long drawn out question but i was just wondering your opinion on it and if i am on the right track. Thank you again. I am going to bring your book and DVD to work tomorrow and read and watch during lunch. I intend on attending your Anatomy Trains course.”

Thanks for the kind words. Frustration with the tendency of soft-tissue patterns to reassert themselves is very common. These patterns are ruts carved into the soft-tissue roads – call them habits. Habits are very tricky to resolve, because they are reinforced on several levels. Re-education works at the level of neurology, or what we call ‘movement strategy’ – habit in the nervous system. Trigger points are a habit at the level of the muscle itself – an efficient choice the body makes for maintaining low grade constant tension, and they need rehydration, and the reason for the tension also needs to be removed.

But yes, to answer your question, it can be held at the level of the fascia as well. A muscle cannot develop or turn on inside an eccentrically loaded fascial sleeve, IMO. The longer the problem has been in place, the more likely it has a fascial component, even if that was not the original fault or injury. Just know that in your re-ed or rolling or bodywork, fascia responds more slowly then muscle, so one slow and firm application does more than three fast and superficial ones. This is especially truw around the fascial shortening in scar tissue, but applies generally to all adhesions.

The other aspect of adding fascial work is expressed in Ida Rolf’s adage: Where you think it is, it ain’t. The fascial shortness that is creating the trigger points or the eccentric loading may be some distance – like, on the other side of the body – from the site of pain you want to eliminate. You need to be able to see and reason out the patterns to make a permanent change.

So all the elements need to be addressed: skeletal misalignment, fascial shortness, movement strategy, and neuro-muscular dysfunction. Even then, if there is a psychological factor, the client can put it all back in place if their subconscious perceives that they ‘need’ it. Getting all these elements to coordinate can feel like juggling chain saws, putting up wallpaper one-handed, or at least like trying to pick up more laundry than you can carry – but persevere! Fascial workers are just as hamstrung if they don’t address the neurological issues. No one has the high ground here – it’s just a matter of getting cannier with practice.

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Expansion and Contraction

Monday, June 6th, 2011

A student recently asked me to discuss prenatal and postpartum fascial changes in terms of “normal” tension, moving to expansion and contraction. So, I’d like to talk about this in three ways:

1) Movement function: You can see the body as seven hinged ‘masses’ (meaning heavy bits: the head, chest, pelvis, arms and legs) with six rotational ‘spaces’ or swivels in between (the neck, waist, shoulders, and hips). In pregnancy, you add a large incompressible mass into the waist section. In early pregnancy, this makes little difference, but by the last months, and the last two weeks in particular, the weight of the baby and the amniotic fluid tend to lock together the rib cage and the pelvis masses into on big mass. This puts special movement requirements on the woman in late pregnancy (not to mention difficulty breathing – ever tried running upstairs in the ninth month?).

Clinically, I find many women need restoration of the rotational aspect of the waist, and that exercises and awarenesses that go in this direction are very helpful.

2) Tissue stretching: Without doubt, the growth of a baby stretches tissue, a day at a time, and of course the pelvic floor tissues in a hell of a hurry. Linea alba diastasis, stretch marks in the dermal layer, and a less-than-adequate pelvic floor tone are all common sequelae from pregnancy and delivery. Inevitably, the uterus sits more forward than backward, because of the lumbar spine behind. All the abdominal muscles and fasciae are stretched, and despite the well-toned mother’s best efforts, the baby tends to stick out over the pubic bone in late pregnancy. This position puts great strain on many organ and ligament attachments – too many to predict, as it depends on the mother’s posture and the baby’s position.

Assisted restoration can use bodywork, exercise, and such devices as sacral belts when necessary. Natural restoration varies due to the mother’s inherent fascial elasticity, muscle tone, and nutrition – and whether they are nursing or not.

3) Birth hormones: A cousin of oxytocin called relaxin is secreted in the mother’s body starting a bit before birth (it varies) and some time after birth (longer with nursing), and this causes fascia all over the body to relent a little – making the mother a bit like someone with ligamentous laxity or hypermobility. It’s a good idea to release the ligaments around the pelvis to make the birth easier, but it makes restoration harder.

Oxytocin is also the love drug, and fixates the mother on the child, to the detriment, sometimes, of herself. Good bodywork soon after delivery can be vital in restoring proper span to the pelvic floor and proper joint relations, but often the mother is ignoring her own feelings in favor of the baby’s well-being. It is up to us, members of her community, to make sure she gets the proper post-natal care. I have a very baby-friendly practice – on the breast, on your stomach, beside you on the table, beside the table in a basket – whatever the mom wants. But get in here and get the pelvis re-aligned before the relaxin disappears (certainly by about 6 months in most) and restoration gets harder.

In general, fascial tissues restore slower than muscular ones, though muscular effort can aid the fascial restoration. Fascial tears or adhesions will slow or distort muscle action. Malalignment in the SI joints or pubic symphysis affects both. All these are most easily adjusted and combed out in the first couple of months after birth.

In a proper society, we will make sure that all mothers have sustained pre- and post-partum structural care that will ease the birth process and speed the restoration to full function afterward.

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An Ode to J.C. Guimberteau

Monday, February 7th, 2011

Dear Dr Guimberteau:

I am writing to express my profound appreciation of your work, which has been invaluable to so many of us who are traversing the edge of the medical field, seeking better models from and for the body in motion, and for a better use of the self.

Your unique images of ‘living matter’ – showing how the matrix accommodates so vitally and immediately to the shifting tension, compression and shear forces – create an instant shift in perception that can never be undone in anyone who views them. Your data flies in the face of ‘established’ truths, but the images call to mind so many diverse poetic images that they can only be true.

When someone makes such an earth-shattering discovery, which no practitioner can see and remain unchanged, it is tempting to see only the result, and say, ‘That was easy,” or “Wasn’t he lucky” – both reactions are versions of “Why didn’t I think of that?”

I was cleaning up my office (a perennial frustration) in preparation for tackling my own next book and came across the text on hand surgery you gave me last spring when I visited you and your clinic in Bordeaux with Mistral. Leafing through this book again, I was impressed with how your discoveries were no lucky find, but a painstaking exploration that had many avenues (some of them surely blind).

You obviously made many forays into new techniques based on novel concepts, with many attempts at photos and other examinations before you hit on the camera and technique that has so many implications for both the medical and the peri-medical world.

So allow me to take this opportunity to salute you and thank you – the groundbreaking work in Strolling, to which you have added the look upward into the basis of the skin in Excursion, and down into the muscles in Attitudes. Each has added to our understanding of the properties, architecture not just of the surface areas, but all areas where movement has to happen in the body.

The fact is, although I know you have been at it for many years, the implications from your insights are only beginning to trickle out , where they are having will have, I predict, a subtle but profound effect on everyone who considers the question of “How Life Moves”.

I am one of those people changed forever by seeing what you have documented. I know that this is but one step for you along an endless and circuitous path that leads wherever it leads. It takes a curious mind and a determined heart to follow a path so far and with such thoroughness and élan. Hail to thee!

Tom Myers

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Fascia

Monday, February 7th, 2011

Question: where in the human body there is no fascia? My friend recently asked me that question.do You know the answer??

Tom Myers replies…
Inside the gut, and inside the air passages are the only places. There is less (but still some) in the cheeks, breast, and pancreas. There is no fascial fiber in the blood, but fibrinogen dissolved in the blood will turn into fibrin when exposed to air (forming a scab) or turbulence (forming an arterial block).

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Fascia and Emotion

Monday, January 31st, 2011

A reader writes,

Dear Mr. Myers:

I have read and re-read your fascinating article on the sensory role of fascia that was published in Massage and Bodywork Nov/Dec 2010.

I have a question, with sort of a long build up, and I have posed this question to many people. Most of them say “I dunno.” With all your research and experience, you are no doubt in the best position to answer it, and I hope that you might think about actually answering me.

OK, first, my story. I am a fairly minted [therapist], who came into massage school as a middle aged woman…. and at one time was a ‘hard scientist’ (geologist). My family and my schooling all emphasized science and discounted intuition or any other “woo”-based fuzzy thinking. So I was very good at the A&P and Pathology, loved the nuts and bolts aspects of the work. To my incredible surprise, however, I discovered my real aptitude was for polarity and craniosacral work. I have furthered my studies in both fields, and have discovered just how important the intuitive part of the bodywork can be.

However, I still worship at the altar of the fascia. I can feel its motion, when it releases… and quite often, 1 will have these sort of intuitive flashes as the fascia changes. What I sense in my hands feels almost electric in nature, and it is at times accompanied by a sense of emotion, color, or a visual image of some kind. I have ended up doing very little ‘relaxing’ massage in my practice, but a lot of very gentle myofascial release, unwinding, or whatever you want to call it, and have found a huge effect in my clients’ outcomes.

When I read your article anbd realized the hufge amount of nerve endings that are involved in the fascia, not to mention the idea that emotions are stored everywhere in the body, a light went on for me. My scientific brain still wants to explain why I experience what I do as I lay my hands on a client.

So, my question for you is this:

Is it possible that what I sense in my hands, that “electric” feeling, is the electric discharge of the nerve endings in the fascia? For example, I usually get a feeling, almost like static electricity, from irritated muscles, then as the fascia/ muscle releases, I will get a feeling of opening and discharge of energy from the client.

Could that also be why I can get a feeling of emotion as my client releases it? In my limited experience, I have already seen some profound stuff coming out of people’s bodies, and I have participated in it with them in the sense that what I “see” or feel leads me to ask them questions which have aided in their letting go of memories or emotions in the course of their treatment.

I really just want to know if I am barking up the right tree or not. It has been a long and occasionally strange journey to accepting that I have some intuitive sense when I work with my clients, and the left brain is still struggling with the why aspect.

In any case, I am cutting out that article and will hang onto it for a long time. It really made me think for a long time about how anatomy is taught as well, and maybe that it ought to be reframed with the fascia taught first, then filling in the framework with the cellular stuff.

Thank you for taking the time to read this, even if you think it is all nonsense.

Best wishes

Ellen S.

Dear Ellen,

The dance between science (meaning hard science) and intuition is an old one. Intuition is a form of knowing (scientis) too, but a hard one on which to find agreement . ‘Trusting your intuition’ is good advice for your practice, but not very good advice for publishing, at least without a lot of caveats.

The extent of sensory endings in the fascia could be one form in which the electric forms of ‘release’ could be registered by your polarized hands. Remember, though, that there are no motor nerves in fascia to ‘relax’ the fascia – all the motor end plates are on muscles, not in the fascia itself, so releases you feel on the neurological level have to be happening in muscles.

But do not neglect the other possible avenues: The fascial net is itself a polarized, ionized, electric network, independent of the nerves within it. Fibrocytes, orteocytes, and chondrocytes are among the cells that have lots of integrin receptors into the body-wide tensional matrix – I refer you to the first chapter of my book, and the work of Donald Ingber among others who have done such great work to document this – that can have the effect of releasing the fascia independently, or co-dependently, with any stretching or visco-elastic change in the matrix itself. Understanding this tensional network is work that is proceeding apace in the hard science realm. Langevin’s work on cellular communication and distant effects of acupuncture within the fascial system is a prime example.

The connection to emotional reality is much harder to document – I personally dislike terms like ‘muscle memory’, and even ‘cellular memory’ has to be taken with some salt – but is a daily reality for those of us reaching into the human experience through reaching the actual physical tissues that make up that reality.

Of course, none of these systems – the nerves, the fascia, or the chemistry of the fluids, which is where I believe such emotional charges are stored, but it’s a hunch – are ever separate – they all grow and develop together, in full and unavoidable communication. So separating these systems and trying to parse them out for the ‘why’ question is an analytical task that may prove impossible without a holistic new paradigm, which is emerging day-by-day.

Absolutely, the fascial network should be taught first, and then the other bits filled in – or at least that’s how I do it in my classes. But the distance remains between the hard data and the practitioner’s felt sense, though the gap is closing fast. At the most global level, the WHY is in the patterning – neural patterning, fluid chemistry patterning, and fascial patterning – and the releases are shifts in the patterning – but the mechanisms remain to be explained.

The trouble with woo-woo fuzzy thinking is that it is not replicable or share-able in that special way that science has. The trouble with banishing fuzzy thinking is that no problem gets solved with the tools that created it – and fuzzy thinking is the only way to start getting beyond our current set of thinking tools. We could go into Bachelard’s epistemology here, but it would take a while to explain. In short, WHY, at the level of cause and effect, is a very good tool. At the level of relational thinking – relativity applied to life sciences – WHY is a dirty word.

As consciousness science gets more traction, intention and emotion should become more understandable in terms of their physical underpinning. in the meantime, follow your intuition, but maintain your skepticism as to the cause and means.

As the Islamic proverb has it: Trust in God and tie your camel.

Tom Myers

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SI: Formula or Process?

Monday, November 29th, 2010

An osteopath friend writes:

As a ten-fingered osteopathic physician and fasicanista who has also experienced SI and KMI from several master practitioners, I would suggest that there are times when skill overrides protocol. One of my training… mentors is Ilana Rubenfeld, Rolf’s contemporary in developing bodywork. She used to refer to Grandma Ida’s cookbook of ten recipes. Surely SI is more than formulaic!

As a DO, I have been instructed in figuring out how to use touch for diagnosis and treatment. Sadly, most DOs nowadays practice medicine as non-MDs with less overt usage of osteopathic manipulative medicine or treatment (OMM & OMT). Medical intentional therapeutic touch recommends reconsidering a finding if it reappears more than a few times– is something else needing attention or incompletely resolved? When receiving Rolfing by Tom Findley MD PhD SI and by Rosemary Feitas SI DO (alphabet soup after all our names), our work required several more sessions than ten to feel complete. Is this right or wrong?!? No!!! Yes!!!

Teachers are happiest when students take the work a step further. Let us commit to doctrine without dogma to better ourselves, further our work, and develop new models and methods as individual and our clients/patients are!

And my hot reply:

Without trying to usurp your work or your degree, I consider myself a ‘ten-fingered’ afascianado myself. One of the wonderful things about a kinesthetic conversation between two intelligent systems is that information can go both ways at once without loss of signal. (The same does not apply for spoken conversations – just tune into Fox News for proof of this assertion.) We can be feeling / assessing and treating at the same time – it’s a wonderful, protocol-free state that I imagine both you and I share in an thrive on.

Dismissing Grandma Ida’s cookbook and SI as formulaic is an easy path that many have taken before you. Not to be bellicose, but in California of the 70′s, I encountered many students of Ilana’s (not Ilana herself, I hasten to add) whose reflexive reversion to “And how’s that manifested in your life?” amounted to an unchanging protocol that soon grew tiresome.

If SI was so fixed, I doubt it would have fascinated Ida or even the likes of me for a professional lifetime. The idea of a multi-session map to the territory of the body with a beginning, a middle, and an end built into it – whether that is ten, twelve or forty steps in the process – is an idea which DO’s, DC’s, LMT’s, psychotherapists and a host of other workers could usefully incorporate.

In practice, so many of these folks go on and on treating week after week, month after month without end – and I have many personal examples of OMM DO’s in this Maine area who do this with clients I refer to them – until the client either runs out of money, or comes to their own conclusion that the treatment has lost effectiveness.

While understandable from an economic or inertia standpoint, I feel strongly that this is a bad model to work under, and hope that osteopathic schools will come to see the value in designing a treatment plan that includes a ‘recipe’ for integration, completion, and letting go.

Too few of us, in performing the neighborly function of treatment, understand the value of an endgame to complete the process, or at the very least the value of fallow periods where the body integrates without further treatment. Ida and SI understand and incorporate this value into the schooling and the ‘formula’.

If SI were actually a fixed protocol, I could sit still for the ‘Ida’s cookbook’ remark. But it is not – her recipe is defined as a series of territories, goals, considerations, all dependent for actual treatment on the wonderfully complex findings within the client.

Of course, the best meals come from using a recipe as a guide, and either adding your own spice, or even throw out the recipe altogether because it inspired you to something more interesting, or because you had other ingredients on hand. All this metaphor applies to well-done SI.

Sorry for the diatribe, my dear, you just hammered an oft-pounded thumb.

And David Lauterstein adds:

“Lovely, Tom. The first part of what you’ve written recalls a beautiful passage from “Body, Memory, and Architecture” by Charles Moore (RIP) a brilliant and kind man: “The haptic sense is the sense of touch reconsidered to include the entire body rather than merely the instruments of touch, such as the hands. To sense haptically is to experience objects in the environment by actually touching them (by climbing a mountain rather than staring at it). Treated as a perceptual system the haptic incorporates all those sensations (pressure, warmth, cold, pain and kinesthetics) which previously divided up the sense of touch, and thus it includes all those aspects of sensual detection which involve physical contact both inside and outside the body. For example, if you accidentally swallow a marble you may haptically sense it as it moves through your body, thus experiencing part of the environment within your body. Similarly, you may sense body motion haptically by detecting movement of joints and muscle through your entire bodyscape. No other sense deals as directly with the three-dimensional world or similarly carries with it the possibility of altering the environment in the process of perceiving it; that is to say, no other sense engages in feeling and doing simultaneously. This action/reaction characteristic of haptic perception separates it from all other forms of sensing which, in comparison, come to seem rather abstract.” And, as far as forms go, though I don’t practice the SI protocol (just never learned it that way), I do the ZB protocol and of course, the twelve bar blues. :) ”

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7th Interdisciplinary World Congress on Low Back and Pelvic Pain

Friday, October 15th, 2010

Tom is not able to make this conference because of previous commitments, but the line-up is incredible, and he hopes you will attend if you can to see these great and significant presenters:

The organizers of the Fascia Research Congress would like our newsletter subscribers to know that registration is still open for the 7th Interdisciplinary World Congress on Low Back and Pelvic Pain

Balanced Solutions: Effective Implementation of Evidence Based Research

More information
November 9 – 12, 2010
Hyatt Regency Century Plaza
Los Angeles, CA, USA

Join an exciting list of international speakers and professionals. This Congress will feature diverse and exciting research delivered by highly recognized professionals from around the world, including the following speakers from past International Fascia Research Congresses:

Frank Willard: Anatomy of the trunk’s connective tissue structures and the lumbar fascia in particular.

Moshe Solomonow: Biomechanics, electromyography, stability and tissue biology of cumulative low back disorder

Andry Vleeming: Dynamic stability of the pelvis and spine: New insights in force closure and the consequences for rehabilitation
Siegfried Mense: The thoracolumbar fascia as a source of low back pain

Robert Schleip: Tearing and micro injuries of lumbar fasciae as potential pain generators

Helene Langevin: Ultrasound imaging of connective tissue pathology associated with chronic low back pain

Jean Claude Guimberteau: Journey under the skin to the muscles, lumbar fasciae and structural architectures

Jay Shah: Ultrasound techniques reveal objective abnormalities of myofascial trigger points and surrounding connective tissue

Leon Chaitow: Fascia directed therapies for the treatment of low back pain: review and new directions

Paolo Tozzi: Evidence-based correlation between low back pain and reduction of renal mobility, assessed by Dynamic Ultrasound Topographic Anatomy Evaluation (D.U.S.T.A.-E.): local kidney manipulation improves kidney mobility and decreases pain perception

Adjo Zorn: Walking with elastic fascia: saving energy by maintaining balance

Paul Hodges: Strategies for motor control of the spine and changes in pain: the deep vs. superficial muscle debate

The program will be presented in the format of three main sessions led by moderators and keynote speakers who are known for their expertise in selected areas. This will be followed by five parallel sessions that highlight topic specific research. Seven primary subject areas will address the dominant theme which includes movement stability in lumbopelvic pain, pelvic girdle pain (diagnostics, risk factors and motor control), cognitive aspects of treatment, evidence based practice for low back pain along with diagnosis and treatment, connective tissue and the role of fascia, surgical management and sports medicine and exercise.

Weekend workshops will share clinician experience in the management of lumbopelvic pain. Open poster presentation will illustrate the worldwide research of new and innovative ideas in the field.

More information

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Breathing

Wednesday, October 6th, 2010

In response to a request, let’s think for a minute about ‘stuck on the exhale’ vs ‘stuck on the inhale’: (I have great sympathy for the following, being somewhat bipolar and thus familiar with both extremes)

Of course both such people are continuing to breathe, but what the term means is that someone’s postural pattern tends toward either end of the bell curve where, in one instance, they cycle mostly around a position where the ribs are up, the diaphragm down, and the lungs are full. While these ‘stuck on the inhale’ people are circulating air enough to continue metabolism, they never really breathe out to where the lungs are empty, the diaphragm relaxes up, and the ribs fall.

At the other extreme lie those who hover around the exhaled position: ribs down, slumped, diaphragm unvibrant, lungs compressed. Again, they respire enough to live, but not through the full excursion of the ribs and lungs. Blood chemistry can change, and these folks tend to the depressed side. It’s hard to get your energy up when your breathing is down. This positional tendency tends to cast your eyes and attention down and inward as well – at the extremes these folks cannot get out of their own way.

Those stuck on the inhale are likewise manifesting a shaped pattern that has a meaning – we just haven’t developed a ‘Prozac’ for this disease. The inability to collapse breeds an (exclusively) outward looking manner that defies introspection and relies instead on others’ opinions to form one’s self-image. Hence we often see these barrel-chested in-breathers in positions like politicians, talk show hosts, and car salesmen, where the feedback is direct and self-worth in others’ eyes can be easily measured.

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Fascial Release

Friday, July 9th, 2010

With so much going on about fascia in general, Anatomy Trains in particular, and this site in the middle, I though I would share a clarifying piece of an email I just received from James Earls, the head of Kinesis in UK. He and I are coming out with a book soon on Fascial Release. So, are we doing fascial release, Anatomy Trains, of KMI? (KMI is our flagship training in a Rolf-evolved integrative bodywork).

Fascial Release is a technique, a way of getting malleable but tough tissue – the sinews that hold us together – to relent long enough for the movement pattern to change. There are lots of people using such techniques, and other techniques that can be incorporated into the fascial release domain. It’s this simple: some massage techniques done deeper, slower, and with an awareness of the ‘wave’ in the fascia become Fascial Release Technique – by definition, but not necessarily in origin. ‘There is nothing new under the sun of manipulation’, said Ida Rolf, and I still find this true 30 years and many brand names after her death.

Anatomy Trains is a model – a map of how the myofascia connects in longitudinal slings around the body. As a map, it is neither definitive nor exhaustive, and it certainly is not the territory of the lived, whole body. But it is a useful map with explanatory power, especially in long-term problems where postural compensation has set in.

KMI – SI is a process whereby we gently and progressively unfold the client’s pattern toward something more complete, more open, more aligned, and juicier. We use the Fascial Release techniques as a modus operandi, and we use the Anatomy Trains as an organizing map, but KMI is a modus vivendi – a way of bringing all this to bear on the art of life and living in a structured, moving body.

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