Real estate

[noddy]

Alice.. Just so we are clear here: Fascia= connective tissue ... Connective tissue = bone. Yes, bone is a form of connective tissue.
In an inclusive discussion you post ALL the literature. Not just the literature that most makes you shine.. All of it.. Alice, It is up to the reader to pull from their own knowledge and then discuss their position. Not have someone else spoon feed them conclusions.
Admittedly yes, the piezoelectricity argument is questionable based on current studies but is this a reason to pan all research on the subject? As I stated, there is a respected Professor at UBC (Thomas Abraham) conducting studies presently. Should we mach into his lab and pan him as a heretic? No because that would be like going back to the dark ages (Burn the witch!!! Yes, I had to add one Monty Python quote http://www.youtube.com/watch?v=zrzMhU_4m-g ).
Yours,
Don Solomon

[Diane]

Don, connective tissue, bone, muscle = mesoderm.

[noddy]

"If you can bear to hear the truth you've spoken Twisted by knaves to make a trap for fools," (thanks Rudyard).
There seems this kind of myopic feel to this forum.. Everyone is bent o on pouncing on each others ideas. Rather than a easy exchange of ideas among respected peers.. Sad really !!! I'm sure there are members out there that would rather and open type of dialogue Rather than a bunch of brute like exchanges.. Hmm silent majority please speak up (not the usual bellicose suspects who think they speak for you). Now that said I should like to respond to Jasons, fair inquiry, Jason you asked " I finished the article. It seems consistent with previous work by Threlkeld (cited in the paper) and consistent with other literature I reviewed for my doctorate (Silvernail 2011 - shameless plug) on manual therapy and forces. While mature connective tissue requires forces outside the range of manual therapy to plastically deform, softer tissue or immature connective tissue (eg during a healing response) will deform to much smaller applied forces. Having read the article, I'm left wondering about its clinical relevance, other than to conclude ad the authors did that fascia is difficult to deform and that neurophysiologic mechanisms are more plausible. Don, what is your take on the relevance of this article? I don't see this changing anything I do in the clinic or the explanations I provide to my patients or other professionals." on Face Book then came over to this forum and donned a new hat! when you said (I edited down the repeated lines to the last sentence) "After I read that article, I can't think of one thing it changed for me: not in what I do, the mechanisms behind what I do, how I explain things to patients or colleagues, not in what I should be targeting with therapy.
Is there any clinical relevance here, and in your opinion what is that?"
Jason you raised some excellent points, and I must say I am not an expert in all things Fascial. I am a simple Manual Practitioner working in private practice. That said I have to say I am interested in any ideas that will give me a more complete idea of how to help my patients recover.
What I gained from that article was A deeper appreciation for the fact that the models we are using, today, to explain treatment are whole incorrect. I would like to read the work you cited from your dissertation as I am particularly interested in wound healing and the resultant tissue formation and deformation. You might find Willie Fourie's work interesting as his primary focus is in the area of post mastectomy tissue rehabilitation. Have a quick look on youtube Part 1: http://www.youtube.com/watch?v=2EgAc...eature=related Part 2:http://www.youtube.com/watch?v=ZNfiK...eature=related Part 3: http://www.youtube.com/watch?v=_twuA...eature=related
SO the overriding question is How do layers release, give the conclusions reached in the paper (Three-Dimensional Mathematical Model for Deformation
of Human Fasciae in Manual Therapy). I had suggested that (given Dr Helen Langevin's work in the areolar connective tissue http://www.fasciacongress.org/2009/a...remodeling.pdf ) perhaps some of the therapeutic changes we are observing in treatment may in fact be due to the changes in this layer of tissue. Dr Langevin's team has shown the fibroblasts within the Areolar Connectiver Tissue exhibit pronounced, dynamic cytoskeletal remodeling, spreading and lamallipodia formation within minutes in response to tissue stretch. One might reasonable hypothesize that this fibroblastic activity could serve as a form of sensory Proprioception that may activate the neural matrix triggering the observable clinical results we see.. The great joy of this, for me is in the question... Questions leading to questions...
Jason, I'm curious why you did not comment on any of Dr Va der Wal's research. Personally I think his paper is far more clinically relevant as his observations regarding muscular loading (series vs parallel) and the location on the GTO's and their relationship to co-activation of the Neural Matrix... Post is getting a bit long.. Will post more once I get my week end finished..
Yours,

Don Solomon

[noddy]

Dr Chaitow posted this suggested reading list for clinically relevant studies on FB. I repose it here for your convenience.
Leon Chaitow These are examples of SOME of the evidence for the value of fascial consideration in manual treatment. They are not exhaustive, but representative, of how this direction of research is informing our understanding of how the body functions, and what we might be able to offer therapeutically, when we consider ALL body tissues. Some effects apear mechanical, others 'hydraulic' and of course many involve the nervoussystem Fascia glides and Fascia get’s stuck ......“Fascia forms a gliding interface with underlying muscle [allowing] free excursion of the muscle under the relatively immobile skin. A plane of potential movement exists in the form of the areolar tissue layer, [apparently] lined with a lubricant, hyaluronic acid.” McCombe D et al 2001 Jnl. Hand Surgery 26B:2: 89-97
Can Fascia be Manipulated?
• “This study explores the tissue deformation forces in human fascia during manual therapy. It also puts these forces into a relationship with their effect on viscoelastic tissue deformation.”
• “Fascia lata and plantar fascia require similar forces for the same amount of deformation.”
• “Perhaps not surprisingly: less dense fasciae, like the superficial nasal fascia, require lesser forces for plastic deformation than denser fasciae like the fascia lata.”
• “In order to achieve a viscoelastic deformation
during manual intervention, without causing tissue damage, it is suggested that there should be no slow increase in the applied force. Rather it is recommended that a fairly constant force be maintained, for up to 60 seconds, in order to allow for a plastic stress relaxation response of the tissue.
Chaudhry H et al 2007 Viscoelastic behavior of human fasciae under extension in manual therapy. Journal of Bodywork and Movement Therapies. 11:159–167

A formula for fascial manipulation
“Skin tension in vivo is not uniform in all directions, and these differences in direction (“Langers Lines”) are used by surgeons to plan surgical incisions. We have acquired information on fascial fiber direction in individual fascial layers.”
“This paper provides a means to model manual therapy interventions in longitudinal and transverse directions and may allow more precise specification of manual therapy techniques.”
Chaudhry H et al 2011 Mathematical Model of Fiber Orientation in Anisotropic Fascia Layers at Large Displacements. Journal of Bodywork and Movement Therapies. Article in Press

Neurophysiological Influences
Stecco et al. (2008) found that the outer layers of the deep fascia contained a rich vascular and nerve supply, with intrafascial nerve fibres seen throughout. ….[some were ] presumed to be stretch receptors.
Stecco et al 2008 Journal of Bodywork & Movement Therapies 12:225-230

Fascial Stiffness & Water
•Klingler & Schleip (2004) measured wet & dry fresh human fascia
•They found that during an isometric stretch, water is extruded, refilling afterwards.
•As water extrudes temporary relaxation occurs in the longitudinal arrangement of the collagen fibres.
•With moderate strain there are no micro-injuries, and water soaks back into the tissue until it swells, becoming stiffer than before.
Some tissue responses to manual therapy may relate to this sponge-like squeezing and refilling in the semi-liquid ground substance, with its water binding glycosaminoglycans and proteoglycans.
Klingler W Schleip R Zorn A 2004 European Fascia Research Project Report. 5th World Congress Low Back and Pelvic Pain, Melbourne, November 2004

Fascia and stretching
Loose connective tissue responds to light tissue stretch, which “may be key to the therapeutic mechanism of treatments using mechanical stimulation of connective tissue”
•Langevin H et al 2010 Histochem. Cell Biol. 133(4):405-15

Can the strain of a stretch be isolated?
A hamstring stretch produces 240% of the resulting strain in the Iliotibial tract - and 145% in the ipsilateral lumbar fascia - compared with the hamstrings.
Using the word ‘isolated’ - together with ‘stretching’ - is therefore difficult to justify.
Strain transmission, during stretching, affects many other tissues beyond the muscle that is being targeted, largely due to fascial connections
Franklyn-Miller A et al 2009 IN: Fascial Research II: Basic Science and Implications for Conventional and Complementary Health Care Munich: Elsevier GmbH

“Hypomobility results in time-dependent adhesion development within the Z joints. Such adhesion development may have relevance to spinal manipulation, which could theoretically break up Z joint
intra-articular adhesions”
Cramer G et al 2010 Zygapophyseal joint adhesions after induced hypomobility. Journal of Manipulative and Physiological Therapeutics 33:508-518

Load can be used therapeutically – e.g. Exercise & Manual methods, to stimulate tissue repair and remodelling in tendon, muscle, cartilage and bone
Mechanocoupling = Physical load (often
shear or compression) perturbs cells, transforming into various chemical signals - within and among cells
Cell–cell communication = Stimulus in one location leads to a distant cell registering a new signal, despite distant cell receiving no mechanical stimulus
Effector cell response = Mechanical loading stimulates protein synthesis at the cellular level, promoting tissue repair and remodelling
Khan K M Scott A 2009 Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British J Sports Medicine 43:247–251

•Active scars can restrict back flexion, which the patient feels as low back pain. This can be relieved by treatment of scars on the abdomen and/or below the symphysis (Kobesová, 2007)
•Kobesova A et al 2007 Jnl. Manipulative & Physiological Therapeutics 30(3):234-238.

“……strain direction, frequency and duration, impact important fibroblast physiological functions known to mediate pain, inflammation and ROM….”
Standley P Meltzer K 2008 Effects of Repetitive Motion Strain (RMS) & Counter-Strain (CS), on fibroblast morphology and actin stress fiber architecture Jnl.Bodywork & Movement Therapies, 12(3):201-203

[noddy]

When I was preparing to post the previous I read on in the thread, only to find that Dr Chaitow had posted a well written reply that encapsulates a lot of the ideas I was trying to communicate in my reply to Jason. Dr Chaitow wrote:
"Jamie, why some people repetitively refuse to objectively examine the evidence for including fascial considerations in their assessment, and/or treatment approaches, is extremely difficult to comprehend. The evidence - for example - of the biomechanically induced changes in treatment of post-surgical scar tissue is solid, and offers therapists of all denominations tools that can help people with pain and restricted function. The treatments are gentle, effective (as demonstrated clinically, as well as via real-time US imaging). Studies on animals and humans have started to explain the biochemistry as well as the physical nature of the changes that emerge - with the work of Fourie, Olanska, Lewit and Bove all informing us and enhancing the theoretical models that Chaudhry, Findley and others have proposed: e.g. that light, sustained stretching of adhesions is the most effective approach. see: Lewit K, Olsanska S. Clinical importance of active scars: abnormal scars as a cause of myofascial pain. J Manipulative Physiol Ther 2004;27:399-402 AND Fourie W J, Robb K. Physiotherapy management of axillary web syndrome following breast cancer treatment: Discussing the use of soft tissue techniques. Physiotherapy 2009;95:314–320 AND McCombe D, Brown T, Slavin J, Morrison W A. The histochemical structure of the deep fascia and its structural response to surgery. J Hand Surg 2001;26B(2):89-97 AND alim R, Kadan Y, Nachum Z, et al. Abdominal scar characteristics as a predictor of intra-abdominal adhesions at repeat caesarean delivery. Fert Steril 2008;90(6):2324-2327 AND Bove G Chapelle S IN PRESS Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model.Journal of Bodywork & Movement Therapies AND MORE AND MORE.....these studies are not theoretical models. Fourie has demonstrated the value of treating scars in post-mastectomy cases over and over again, and teaches practical, simple, effective methods, worldwide, in major hospitals in the UK, to nurses, as well as to massage therapists, PTs and others. The methods are effective for new scars and old scars... and remember that this is just one facet of fascia research where clinical as well as pure science studies inform each other - there are others. Diane may want to ignore such evidence, but I urge you (and her) to remove the blinkers, and add this dimension to whatever you do now, rather than pretending that because you get reasonable results, you don't need to know more. This is not a fundamentalist belief system "fascia is everything" but it is a strong assertion that without understanding fascia better your results will not be as effective as they can be."
Yours,
Don Solomnon

[Bas Asselbergs]

Don, the fascia is an interesting tissue, much like the earlobe cartilage, nails, hair, bloodvessels and others are.
To extrapolate any therapeutic benefit from the studies you quote to the majority of patients in pain, is a fanstastic stretch.

Then the diagnostics of "fascial restrictions".
Scar tissue may contribute to pain and restrictions. A major problem is to relate scar tissue to pain - the #1 reason patients show up at our door.

If fascia-fans do not know how little scar tissue has to do with pain, and how hard it is to reliably connect the two, that is their loss. The fact that there are still people in our professions talking about "I think there are scars or restrictions in your fascia" is shameful.

The title alone of one of these studies is risible: "Abnormal scars as a cause of myofascial pain" - have these people not read anything about the neurosciences of the past 15 years?

Then the nonsense to think that some research conclusions provide "proof":
in the Langevin study

Following this lead, the
hypothesis presented in this paper is that the ‘‘connectivity’’
provided by connective tissue is not only
be anatomical, but functional as well

(my bold - thanks Bernard)

What makes you think we have blinkers on? Many times over we have read and discussed papers relating to fascia research - yet the "fascia-fans" continue to roll them out without any significant value OVER the neurosciences as it pertains to treatment.

It is blatantly obvious that most fascia-fans have NOT read Butler, Mosely, Ramachandran, Shacklock, Gifford etc etc. Or if they did, they did not want understand it.
You see, neurosciences takes away the special and powerful "skill sets" of the specialized practitioner. It shows that the patient's nervous system decides what and when it will respond positively to an interaction - understanding THAT is the first step to respecting its power and approaching it with consideration of that power. Not with an intent to permanently deform any tissue's present state.

But I know I am probably wasting time. Most fascia-fans have invested much time and even more money in that very important tissue (ahem) - it is hard to admit to oneself it was an interesting but expensive detour in a fantastical land of fairy-tale. Disney is cheaper.

[Fletch]

Are we going to get any other response from Don, other than points of order?

Maybe another plug for the conference?

[Diane]

Maybe another plug for the conference?

:clap2:

Good one Fletch!

[John W]

There seems this kind of myopic feel to this forum.. Everyone is bent o on pouncing on each others ideas. Rather than a easy exchange of ideas among respected peers...

Don't confuse myopia with focus. Our focus here is on critical appraisal of research and theories related to conservative treatment for pain. This seems to be something the fascialists at the International Congress (how grand!) have little experience with or interest in.

[Diane]

There seems this kind of myopic feel to this forum.. Everyone is bent o on pouncing on each others ideas. Rather than a easy exchange of ideas among respected peers...

We are pretty picky about what ideas will/can take us forward out of the swamp of manual therapy and which ones will hold us back like quicksand. Once we have run an idea through Occam's Meat Grinder and seen what it looks like without meat attached, i.e., if it can stand up to scrutiny, looks like it could move manual therapy forward a notch, then there can be easy exchange and respect. :angel:

[Jason Silvernail]

We've been over this process before with these tissue-based models.

In the 1970s it was all about the spinal joints. Congresses, research, studies, interventions, etc, etc. You were a fool if you didn't think the joint was "where the real action is". Everybody who is anybody was talking about the joints, treating the joints, manipulating the joints. Does pain come from joints? No. That research was fine but showed most of the structure and degenerative changes of these joints to be not relevant to everyday clinical practice. We learned some interesting things about the joints, how they move, how they are innervated, and some treatments targeting them were tried. We did learn some things on the periphery of painful issues, but no huge breakthrough. So we looked elsewhere.

In the 1980s it was all about the intervertebral disks.Congresses, research, studies, interventions, etc, etc. You were a fool if you didn't think the disk was "where the real action is". Everybody who is anybody was talking about the disks, treating the disks, manipulating the disks. Does pain come from disks? No. That research was fine but showed most of the structure and degenerative changes of these diskss to be not relevant to everyday clinical practice. We learned some interesting things about the disks, how they move, how they are innervated, and some treatments targeting them were tried. We did learn some things on the periphery of painful issues, but no huge breakthrough. So we looked elsewhere.

In the 1990s it was the core muscles. Congresses, research, studies, interventions, etc, etc. You were a fool if you didn't think the core muscles were "where the real action is". Everybody who is anybody was talking about the muscles, treating the muscles, manipulating the muscles. Does pain come from muscles? No. That research was fine but showed most of the structure and degenerative changes of these muscles to be not relevant to everyday clinical practice. We learned some interesting things about the muscles, how they move, which exercises activate which ones, how they contribute to spinal stability, how they are innervated, and some treatments targeting them were tried. We did learn some things on the periphery of painful issues, but no huge breakthrough. So we looked elsewhere.

Now those boosting the fascia want me to ignore all this history, and pretend that now, just now, we have key important information that will change things - and it's in the fascia. This time it's for real. Sounds like a familiar story to me.

I'm willing to bet there's some interesting information in these Congresses. I'd like to think that this sort of basic science can change practice in some way. I think there may be good material I'm overlooking because I haven't investigated the fascia research in more detail. But why can no one point out even one study that has even one clinically relevant pearl of information that changes anything we are doing in the clinic?

When asked, they respond with accusations of personal attack (none have been made), refusal to look at evidence (silly seeing as how we are asking for it), bias against fascia (there may be some truth to this but its not without reason), and vague accusations of "tone."
When they do respond, only one person (to his credit, Don Solomon) has so far provided one article (Chaudhry et al J Am Osteopath Assoc. 2008;108:379-390) that actually seemed to contradict most of the major claims of fascial importance. Subsequent responses have been "orgies of evidence" with multiple YouTube clips, and random citations with author opinion statements taken from the article without clear evidentiary support. This is a very familiar pattern with purveyors of pseudoscience, and it does not help the community of practitioners who think fascia is important to approach the issue in this way.

I'm still listening. If someone who thinks fascial knowledge really changes something in the clinic, really has a clinically relevant piece of information, I'm open to hearing it. Provide the citation and let's discuss it. I don't expect it to be perfect - the studies I base my practice on (available on request) aren't perfect either. I'm not looking for perfection but for information that a reasonable clinician would judge to be relevant to their practice in some important way. I don't think that's too much to ask, and alternatively silence and then a barrage of citations and opinion statements from respondents is no way to have a clinical conversation. And no way to convince people, either.

[zimney3pt]

Jason, very well stated...:clap2::clap2::clap2:

It's kinda like a dog chasing his tail around and around in a circle. Even if he catches it he doesn't know what to do with it and lets it go, only to try again at a later time. It's interesting that we laugh at how silly the dog acts when he does this. Yet we can be so serious about our own similar behavior.

[Diane]

Jason, very well stated...:clap2::clap2::clap2:

It's kinda like a dog chasing his tail around and around in a circle. Even if he catches it he doesn't know what to do with it and lets it go, only to try again at a later time. It's interesting that we laugh at how silly the dog acts when he does this. Yet we can be so serious about our own similar behavior.

:clap2::clap2::clap2:

[amacs]

Jason, can you post the study in SOS. As from the abstract is seems strange to choose this study to validate MFR. I've purposely never entered into the MFR debates as I find it pointless. I've attended a MFR course and the course leader didn't answer my questions or really give me any explanation about the technique apart form "this really works, its soooo cool".

please p.m. me who that was Dave

regards

ANdy

[John W]

Jason,
:thumbs_up