User:NatalieBrettler/Fascial manipulation

Fascial Manipulation Fascial Manipulation© is a manual therapy method developed over the last 40 years by Luigi Stecco, an Italian physiotherapist from the north of Italy, for the treatment of disturbances of the myo-fascial-skeletal-visceral system. It focuses on the fascia, in particular the deep muscular fascia, including the epimysium and the retinacula and considers that the myofascial system is a three-dimensional continuum. This technique presents a complete biomechanical model that assists in deciphering the role of fascia in musculoskeletal and visceral disorders. (1,2).

Definition: The term Fascial manipulation arises from the fact that the treatment is done by manually manipulating very specific points within the fascia where muscular forces converge to move body parts (and support internal organs). By seeking to restore balance within the fascial system, the body may then operate properly and heal itself efficiently, thus reducing pain and dysfunction. Background and methodology: In recent years, Dr. Carla Stecco  and Dr. Antonio Stecco have carried out extensive research into the anatomy and histology of the fascia via dissection of unembalmed cadavers in Italy and France(7,8). These dissections have new histological and anatomical data including the existence of myotendinous expansions between segments, the multi-layer structure of deep fascia and the abundant innervation of this tissue by mechanoreceptors and free nerve endings. The mainstay of the manual method developed by L. Stecco lies in the identification of a specific, localised area of the fascia in connection with a specific limited movement. Once a limited or painful movement is identified, then a specific point on the fascia is implicated and, through the appropriate manipulation of this precise part of the fascia, movement can be restored. Through analysing of musculoskeletal anatomy, Luigi Stecco realised that the body could be divided into 14 segments, with movement of each segment being governed by six myofascial units (mf units). A mf unit consists of monoarticular and biarticular unidirectional muscle fibres, their deep fascia and the joint they move in one direction on one plane. myofascial vectors within each mf unit converge at a specific point, named the Centre of Coordination or CC(9). adjacent unidirectional myofascial units are united via myotendinous expansions and biarticular fibres (7) to form myofascial sequences. 6 cc’s per segment coordinate movement on the three spatial planes, however, the complexity of physical activity in human beings requires coordination of an infinite variability. In order to synchronize complex movements other specific points of the fascia (often over retinacula) named Centres of Fusion(CF) have also been identified.

The fascia Fascia is formed by undulated collagen fibres and elastic fibres arranged in distinct layers, and within each layer the fibres are aligned in a different direction. Due to its undulated collagen fibres, fascia can be stretched and, thanks to its elastic fibres, it can then return to its original resting state. Given that fascia adapts to muscle stretch, it is unable to transmit force like a tendon or an aponeurosis. If these histological and functional distinctions are not taken into consideration, then one can confuse fascia with aponeuroses or, likewise, confuse the deep fascia with the subcutaneous connective tissue (superficial fascia). Subcutaneous connective tissue forms a very elastic, sliding membrane essential for thermal regulation, metabolic exchanges and the protection of vessels and nerves, whereas the deep fascia envelops the muscles, and surrounds the muscle’s aponeurosis up to where it inserts onto bone. Given its innervation and its multilayer structure, Deep fascia is effectively an ideal structure for perceiving and, therefore, assisting in organizing movements. Whenever a body part moves in any given direction in space there is a myofascial, tensional re-arrangement within the corresponding fascia. Afferents embedded within the fascia are stimulated, producing accurate directional or spatial information. Any impediment in the gliding of the fascia could alter afferent input resulting in incoherent movement. It is hypothesised that fascia is involved in proprioception and peripheral motor control in strict collaboration with the CNS.

Therapeutic implications The fascia is very extensive and so it would be difficult and inappropriate to work over the entire area. The localisation of precise points or key areas can render manipulation more effective. An accurate analysis of the myofascial connections based on an understanding of fascial anatomy can provide indications as to where it is best to intervene. Any non-physiological alteration of deep fascia could cause tensional changes along a related sequence resulting in incorrect activation of nerve receptors, uncoordinated movements, and consequent nociceptive afferents. Deep massage on these specific points (CC and CF) aims at restoring tensional balance. Compensatory tension may extend along a myofascial sequence so myofascial continuity could be involved in the referral of pain along a limb or at a distance, even in the absence of specific nerve root disturbance. In clinical practice, cases of sciatic-like pain and cervicobrachialgia without detectable nerve root irritation are common (8). This technique allows therapists to work at a distance from the actual site of pain, which is often inflamed due to non-physiological tension. For each mf unit, the area where pain is commonly felt has been mapped out and is known as the Centre of Perception (CP). In fact, it is important to place our attention on the cause of pain, tracing back to the origin of this anomalous tension, or more specifically to the CC and CF located within the deep fascia.