Fascial Manipulation- An evidence based scientific manual therapy

Myofascial manipulation is a very specific treatment used to treat the fascia within the body. It is a specialised technique that only a few podiatrists are trained to perform.

What is fascia and muscle?

There are several types of fascia within the body and it is present throughout tissues in different forms. In its simplest form, it is connective tissue that wraps and supports all the organs, bones, muscles, nerves and blood vessels, and therefore, can influence the whole body and its function. Fascia forms an uninterrupted three-dimensional web of dense connective tissue and provides a complex neurological feedback system to the brain.

A muscle is made up from small units (myofibrils) that together form to make larger more complex structures (muscle). Each section being surrounded by specialized fascia. The combined smaller units when stimulated by the brain, via a motor nerve, will contract and in most cases will move a joint.

According to the “Stecco” method, a myofascial unit is:

1. A group of motor units that move a body segment in a specific direction by activating fibres (monoarticular and biarticular) in one or more muscles.
2. The joint that is moved
3. Nerve and vascular components
4. The fascia that connects these elements together

In the foot and leg, these myofascial units function as a coordinated group to provide a smooth, pain-free gait. The fascia around the muscles (epimysium) provides feedback to the brain and can co-ordinate the pull and function of the myofascial unit.

This is a due to a combination of vector forces that is located at its own CENTRE OF COORDINATION (CC). Therefore, CC are small areas on the deep fascia where the sum of tensional vectors coincides. The best analogy for this is to think of four horses in a line pulling a chariot. The reins from the four-horses coming together at a CC in the hand of the driver.

The CC’s are specifically located in myofascial units in each of the six body planes.

What will happen at the appointment?

At the first appointment a specific assessment process is followed (Stecco method) which involves a full history of the problem, some movement verification tests and some palpation tests of the identified segments. Treatment can then begin on the identified CC points.

What is a Myofascial Manipulation?

When the body is subject to trauma, injury or repetitive stress (abnormal gait) it creates and inflammatory reaction that causes areas in the myofascial planes to thicken (densification at the CC’s). This will cause the bodies natural lubricating substance (Hyaluronic acid, HA) to become more gel like and restrict the function of the fascia. This will alter the function of the myofascial unit and, in turn, will produce pain within an area known as the Centre of Pain or Perception.

Densification can also occur from altered biochemistry, adaption to stress / posture and dehydration. In some cases, the abnormal fascial function can cause entrapment of the free nerve endings and produce a neurological pain.

How does the treatment work?

Most of the treatment is undertaken with the elbow over the CC’s that have been identified from the assessment. The movement of the elbow causes friction which develops heat in the area and the breakdown of HA into smaller fragments. This will improve tissue gliding and restore the normal function which reduces the perception of pain in the area.

Generally, the treatment can be painful to perform and often the points are painful / sore for a few days after. This should resolve by the review appointment the following week.

Fascial Dysfunction:

What are the risks?
There are very few risks associated with the treatment but some possibilities are:

A headache after the treatment which will resolve and are due to an “unbalanced treatment”.

A fever if too many CC’s are treated in one session.

Essential information
You will need to bring some shorts as the assessment and treatment may involve the pelvis.

A chaperone can be provided but prior notification is required.

The treatment can be painful and some discomfort is expected after the treatment for a few days.

You should not take anti-inflammatory medication or use ice packs after the treatment unless advised to do so. A hot bath can help to reduce point soreness.

References
Stecco L., 2004. Fascial Manipulation for Musculoskeletal Pain. Piccin, Padova, Italy.
Stecco L, Stecco C.,2009. Fascial Manipulation Practical Part. Piccin, Padova, Italy.

Day JA, Stecco C, Stecco A. Application of fascial manipulation technique in chronic shoulder pain-anatomical basis and clinical implications J Bodywork & Movement Therapies 2009, 13:128-135.