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Preface:
Welcome to an exciting new field in musculoskeletal therapy: the fascinating world
of fascia. Fascia forms a continuous tensional network throughout the human body,
covering and connecting every single organ, every muscle, and even every nerve or
tiny muscle fiber. After several decades of severe neglect, this ubiquitous tissue
has transformed from the “Cinderella of orthopaedic science” into an
almost super star position within medical research. Starting with the first few
years of this 21st century, the number of research papers on fascia in peer-reviewed
journals experienced an almost exponential increase. The 1st International Fascia
Research Congress, held at the Harvard Medical School in October 2007, was celebrated
with worldwide acknowledgement. Similar to the rapidly growing field of glia research
in neurology, there is now a global recognition that this underestimated contextual
tissue plays a much more important role in health and pathology than was estimated
during previous decades. As every medical student knows and every doctor still remembers,
up to now, fascia has been introduced in anatomy dissection courses as the white
packing stuff that one first needs to clean off, in order “to see something”.
Similarly, anatomy books have been competing with each other, in how clean and orderly
they present the locomotor system, by cutting away the whitish or semi-translucent
fascia as completely and skilfully as possible. While students appreciate these
appealing graphic simplifications, with shiny red muscles, each attaching to specific
skeletal points, frustration is certain when these simplified maps have almost nothing
to do with how the real body feels and behaves, be it in medical surgery or during
therapeutic palpation. To give an example: in real bodies, muscles hardly ever transmit
their full force directly via tendons into the skeleton, as is usually suggested
by our textbook drawings. They rather distribute a large portion of their contractile
or tensional forces onto fascial sheets. These sheets transmit these forces to synergistic
as well as antagonistic muscles. Thereby they stiffen not only the respective joint,
but may even affect regions several joints further away. If we look closely at the
two powerful muscles gluteus maximus and tensor fascia lata, both insert into the
dense fascial sheet along the lateral thigh, called the iliotibial tract. This tissue
is part of the fascial envelope of the thigh, called fascia lata, whose tension
influences not only the stiffness of the lateral hamstrings and quadriceps, but
also severely effects the behaviour of the knee joint and the whole lower leg. The
simple questions discussed in musculoskeletal textbooks “which muscles”
are participating in a particular movement thus become almost obsolete. Muscles
are not functional units, no matter how common this misconception may be. Rather,
most muscular movements are generated by many individual motor units, which are
distributed over some portions of one muscle, plus other portions of other muscles.
The tensional forces of these motor units are then transmitted to a complex network
of fascial sheets, bags, and strings that convert them into the final body movement.
Into how many ‘muscles’ each of them has been divided by our historical
textbook authorities, depended more or less on their manual skills with the dissection
knife. Their distinctions have little to do with the question about which movements
these structures can perform. Similarly, it has been shown that fascial stiffness
and elasticity play a significant role in many ballistic movements of the human
body. First discovered by studies of the calf tissues of kangaroos, antelopes, and
later by horses, modern ultrasound studies have revealed that fascial recoil plays
in fact a similarly impressive role in many of our human movements. How far you
can throw a stone, how high you can jump, how long you can run, depends not only
on the contraction of your muscle fibers; it also depends to a large degree on how
well the elastic recoil properties of your fascial network are supporting these
movements. If the architecture of our fascial network is indeed such an important
factor in musculoskeletal behaviour, one is prompted to ask why this tissue been
overlooked for such a long time has. There are several answers to this question.
One aspect has to do with the development of new imaging and research tools, which
now allow us to study this tissue in vivo. Another reason is the degree to which
this tissue resists the classical method of anatomical research: that of splitting
something into separate parts that can be counted and named. You can reasonably
estimate the number of bones or muscles; yet any attempt to count the number of
fasciae in the body will be futile. The fascial body is one large networking organ,
with many bags and hundreds of rope-like local densifications, and thousands of
pockets within pockets, all interconnected by sturdy septa as well as by looser
connective tissue layers. This ‘non graspability’ of fascia is also
reflected in the use of many different terminologies throughout literature, describing
which exact tissue types are included under the term “fascia”. Whether
the thin intramuscular endomysium or the superficial fascia can be regarded as fascia
(or rather as loose connective tissue), or whether only dense irregular connective
tissue sheets should be included, seems to depend on the individual perspective
of each author. Let me therefore introduce you to the newly proposed definition
of fascia proposed at the first Fascia Research Congress. The term ‘fascia’
here describes the soft tissue component of the connective tissue system that permeates
the human body. This includes not only dense planar tissue sheets (like septa, joint
capsules, aponeuroses, organ capsules, or retinacula), which may be also called
“proper fascia”, but it also encompasses local densifications of this
network in the form of ligaments and tendons. Additionally it includes softer collagenous
connective tissues like the superficial fascia or the innermost intramuscular layer
of the endomysium. While not everybody will be happy with this new terminology,
it offers many important advantages for the field. Rather than having to draw most
often arbitrary demarcation lines between joint capsules and their intimately involved
ligaments and tendons (as well as interconnected aponeuroses, retinacula and intramuscular
fasciae), fascial tissues are seen as one interconnected tensional network that
adapts its fiber arrangement and density according to local tensional demands. This
terminology fits nicely to the Latin root of the term ‘fascia’ (bundle,
bandage, strap, unification, binding together) and is synonymous with the non-professional’s
understanding of the term “connective tissue” (in contrast to medical
and biological scientists, which include cartilage, bone and even blood as connective
tissue). ROBERT SCHLEIP PhD Director, Fascia Research Project Ulm University, Germany
Contents:
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . .
V Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . .
VIII Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
IX Acknowledgements . . . . . . . . . . . . . . . . . . . .
XI Introduction . . . . . . . . . . . . . . . . . . . . . . . . . .
1 Basic Principles . . . . . . . . . . . . . . . . . . . . . . .
3 Superficial fascia . . . . . . . . . . . . . . . . . . . .
5 Deep fascia . . . . . . . . . . . . . . . . . . . . . . . .
7 Epimysial fascia . . . . . . . . . . . . . . . . . . . .
12 Physiology of the fasciae.. . . . . . . . . . . . . .
13 Part I: The centres of coordination Chapter
1 – Fascial Manipulation . . . . . . . . .
19 A - Fascial control of segmental movement
19 The myofascial unit . . . . . . . . . . . . . . . . . .
19 B - Fascial control of posture . . . . . . . . . .
25 The myofascial sequence . . . . . . . . . . . . . .
25 Chapter
2 – Treatment of the CC. . . . . . . . . .
31 A - Compilation of an assessment chart for segmental treatments . . . . . . .
. . . . . . .
31 B - Compilation of an assessment chart for global treatments . . . . . . . .
. . . . . . . . . . . .
35 Fascial manipulation - Indications and Contraindications . . . . . . . . . .
. . . . . . . . . .
37 Chapter
3 – Mf Sequence of antemotion . . . .
39 Mf units of the trunk . . . . . . . . . . . . . . . . .
40 Mf units of the lower limb . . . . . . . . . . . . .
50 Mf units of the upper limb . . . . . . . . . . . . .
56 Example of treatment . . . . . . . . . . . . . . . .
64 Chapter
4 – Mf Sequence of retromotion . . . .
65 Mf units of the trunk . . . . . . . . . . . . . . . . .
66 Mf units of the lower limb . . . . . . . . . . . . .
76 Mf units of the upper limb . . . . . . . . . . . . .
82 Example of treatment . . . . . . . . . . . . . . . .
90 Chapter
5 – Mf Sequence of mediomotion . .
91 Mf units of the trunk . . . . . . . . . . . . . . . . .
92 Mf units of the lower limb . . . . . . . . . . . . .
102 Mf units of the upper limb . . . . . . . . . . . . .
109 Example of treatment . . . . . . . . . . . . . . . .
117 Chapter
6 – Mf Sequence of lateromotion . . .
119 Mf units of the trunk . . . . . . . . . . . . . . . . .
120 Mf units of the lower limb . . . . . . . . . . . . .
130 Mf units of the upper limb . . . . . . . . . . . .
137 Example of treatment . . . . . . . . . . . . . . . .
145 Chapter
7 – Mf Sequence of intrarotation . . .
147 Mf units of the trunk . . . . . . . . . . . . . . . . .
148 Mf units of the lower limb . . . . . . . . . . . . .
158 Mf units of the upper limb . . . . . . . . . . . . .
165 Example of treatment . . . . . . . . . . . . . . . .
173 Chapter
8 – Mf Sequence of extrarotation . . .
175 Mf units of the trunk . . . . . . . . . . . . . . . . .
176 Mf units of the lower limb . . . . . . . . . . . . .
186 Mf units of the upper limb . . . . . . . . . . . . .
193 Example of treatment . . . . . . . . . . . . . . . .
201 Parte II: The centres of fusion Chapter
9 – Fascial Mobilisation . . . . . . . . . .
205 A - Fascial control of segmental motor schemes . . . . . . . . . . . . . . .
. . . . . . . . . . . .
205 The centre of fusion . . . . . . . . . . . . . . . . . .
208 B - Fascial control of global complex movements . . . . . . . . . . . . . .
. . . . . . . . . . .
210 The myofascial diagonals . . . . . . . . . . . . .
211 The myofascial spirals . . . . . . . . . . . . . . . .
213 Chapter
10 – Treatment of the CF . . . . . . . . .
221 A - Assessment chart compilation for segmental treatments of CF . . . . . .
. . . . . .
221 B - Assessment chart compilation for global treatments of CF . . . . . . . .
. . . . . . .
223 Chapter
11 – Retro-latero centres of fusion . .
229 CF of the upper limb . . . . . . . . . . . . . . . . .
231 CF of the trunk . . . . . . . . . . . . . . . . . . . . .
238 CF of the lower limb . . . . . . . . . . . . . . . . .
245 Example of treatment . . . . . . . . . . . . . . . .
251 Chapter
12 – Retro-medio centres of fusion .
253 CF of the upper limb . . . . . . . . . . . . . . . . .
256 CF of the trunk . . . . . . . . . . . . . . . . . . . . .
262 CF of the lower limb . . . . . . . . . . . . . . . . .
269 Example of treatment . . . . . . . . . . . . . . . .
275 Chapter
13 – Ante-latero centres of fusion . .
227 CF of the upper limb . . . . . . . . . . . . . . . . .
279 CF of the trunk . . . . . . . . . . . . . . . . . . . . .
286 CF of the lower limb . . . . . . . . . . . . . . . . .
293 Example of treatment . . . . . . . . . . . . . . . .
299 Chapter
14 – Ante-medio centres of fusion . .
301 CF of the upper limb . . . . . . . . . . . . . . . . .
303 CF of the trunk . . . . . . . . . . . . . . . . . . . . .
310 CF of the lower limb . . . . . . . . . . . . . . . . .
317 Example of treatment . . . . . . . . . . . . . . . .
323 Chapter
15 - Synoptic tables . . . . . . . . . . . . .
325 CF and CC . . . . . . . . . . . . . . . . . . . . . . . . .
327 Comparative movement verifications . . . .
339 Parallelism with acupuncture . . . . . . . . . .
355 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . .
359 Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . .
361 Alphabetical index of centres of coordination and centres of fusion . . . .
. . . . . . . . . . . . . . .
363 Alphabetical index of anatomical photographs
365
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