User:Steccoluigi

FASCIAL MANIPULATION
Stecco Luigi, via Piacenza,3, Arzignano, Vicenza, Italy

From a histological point of view the fascia consists of a mixture of elastic fibres and ondulating collagen fibres. The ondulation of the collagen fibres allows the fascia to adapt to stretching within physiological limits whilst it returns to it’s resting position by means of the elastic fibres. Fascia is well innervated and the Free nerve endings found within the fascia are activated during it’s lengthening and shortening. Fascia is anchored onto bone and this allows it to be stretched without displacing it from it’s original position. In each body segment we find that there is a part of the fascia which slides freely over muscle and a part that is tensioned by tendonous expansions. These myofascial insertions maintain the fascia in a basal resting tension and they increase the pull on the fascia throughout movement. The subcutaneous loose connective tissue and the endomysial fascia allow for myo-fascial sliding. Through the study of the insertions of muscles on the fascia, using both mathematical and physical criterium, it is possible to understand the play of myofascial tensions. Whilst examining the angle of incidence of these muscular insertions on the fascia one can deduce a point of convergence of the specific myofascial tensions involved. These are called the Centres of Coordination (CC). As these CC are situated at topographic points of convergence of fascial tensions they are also more vulnerable. Following a muscoloskeletal trauma there is a loss of active and passive movements with diffuse pain around the joint. The site of this pain is called the centre of perception (CP). The fascia is a flexible tissue, however, when subjected to prolonged stretching or trauma that stresses the collagen fibres a sclerosis occurs at the CC. This densification or sclerosis of the CC does not allow the fascia to extend in it’s normal physiological way. These densifications thus cause a mechanical stress to the Free nerve endings embedded in the fascia which consequently transforms their function from proprioception to nociception. The myofascial unit is composed of the Centre of Coordination (CC) and the corresponding Centre of Perception (CP). There is a centre of coordination for each myofascial unit (mf). We have six mf units ( flexion-extension, abduction-adduction, intra-extrarotation) for each joint in the body (Luigi Stecco, Neuro-myo-fascial Unit, 1st International Symposium on Myofascail Pain and Fibromyalgia, Minneapolis, May 1989) From a clinical view point the most interesting aspects of the effectiveness of Fascial manipulation are: -	it can identify an imbalance in a myofascial unit as the cause of pain; -	it can modify the densification of a point of the fascia. The therapy leads to the origin of the imbalance focusing on the centre of coordination or densified area of the myofascial unit. Pain manifests itself where movement takes place, namely joints or the centre of perception (CP). The centre of perception is the sum of the articular afferents for a given direction of movement. In each myofascial unit the CC is found over the point where the muscle is innervated and the CP over the point of innervation of the joint. The static and dynamic receptors that are embedded in the capsules and the ligaments are organised in such a way that the innervation of the sensitive part of the joint capsule is provided by the same nerve trunk that innervates the muscles that protect it. When there is pain the treatment should not be aimed at the joint (CP) but at the cause of the imbalance focusing on the CC of the myofascial unit. The densification obstructing the CC forms a ruvid tissue within the fascia which on palpation is similar to granulation tissue. Fascial manipulation produces manual friction over the densified CC bringing about a local rise in temperature sufficient to modify the densification. Once the heat produced is sufficient to pass from the state of sol to gel, the pain ceases and the passive and active movement limitation disappears immediately. Palpation of the CC after treatment will ascertain that the ruvid densification has disappeared and that the fascia slides freely over the underlying structures. An inflammatory reaction sets in shortly after as the fibroblasts begin to form collagen fibres which are aligned along the lines of the direction of physiological forces.

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