In September of 2015 I had the great pleasure to attend the Fourth International Fascia Research Congress (FRC 4) in Reston, VA. Partly to help me process information, and partly to invite those who could not attend to feel at least peripherally involved, I took notes and posted them on my FB profile page in real time, marked by #FRC4
Later I pulled them all together, cleaned up the type-os and blatant misspellings, and added some additional information about the speakers.
Here then are my FRC 4 field notes, with the disclaimer that I didn’t understand everything that I heard, and I may have gotten things wrong. (Hey, you get what you pay for.)
A complete copy of the congress proceedings can be found for sale here:
FRC 5 will be in 2018, probably in Europe. Time to start saving those pennies.
DAY 3
Observation, Assessment, and Evaluation of Fascial Dysfunction
Functional Assessment In Fascial Manipulation Methodology, A Specific Modality. Julie Ann Day, PT,
Based on biomechanical paradigm to analyze and treat fascial dysfunction.
In this system there are 14 myofascial units, each of which includes motor units, a joint or joints, nerves, and fascia. They are more or less in blocks. Each unit has a center of coordination (CC) where fiber contractions converge. Each unit also has a center of perception (CP), where movement of a joint is perceived. Changes in fascia sliding cause bad incoming information and poor efficiency in muscle contraction.
Links connect each segment– the art here is cool, would make a cool quilt. Centers of fusion are areas of deep fascia that connect thru the body.
They use specially designed charts to track dysfunction, along with subjective and objective findings.
Manual Assessment of Fascia, and Myofascial Release, C. Fernandez des las Penas.
Focus on lumbodorsal fascia (LDF). Refers to yesterday’s presentation on pain in LDF.
Question: can a clinician identify fascial restrictions?
When a person has lbp, the muscles and ldf do not move independently. I’m sorry, his accent is too intense for me to follow his conclusions.
He uses ultrasound to watch what happens at 3 layers during cross-handed mobilization. We see that skin, fascia and mm all move at different speeds. Conclusion, yes, it is possible to tell the difference.
Can we distinguish between fascia and skin-muscle movement? This seems like fighting words in here. He uses ultrasound to record movement when a hand moves skin on back, clearly all the layers are moving, skin, ldf, muscles.
So to engage the ldf, we need to move deeper than skin, not down to muscles. Now he’s doing something that got by me, isolating layers, but I missed how.
Physics of Myofascial Therapy, S. Gracovetsky.
Not a clinician, a physicist, here to point out some inconsistencies.
Question: if you have pain, what should you do? All reviews show that all types of manual therapies are about equally effective– which is not much.
Question: can we justify a lot of treatments? What is the common ground? Adaptive response to stressor.
Question: missed it.
Can anatomy be a guide for function? Points out disconnect between imaging and symptoms.
How can we assess the function of the fascia? What is the relationship between muscles and fascia?
Test: EMG in lordosis, trunk flexion. Normal lordosis corresponds to minimum EMG activity. This creates a surprisingly predictable chart.
When we add weight, the chart is the same but steeper curves. When energy is minimized this connects to minimum stress on skeleton, joints. This is a hint about “optimal weight-bearing”
All schools of thought need to go back to minimum stress rule.
Now added gravitational force. We have poor resistance to shear forces. Tensegrity may use shear to advantage, i.e., sheets on a boat.
We need to deflect gravitational force; we can see that in the protection of the facet joints. He says lordosis is protective, not a weakness.
Almost no shear force is transmitted across joints. When bones change shape, shear force leads to arthritis.
He suggests that fascia is a system to protect bones and joints from shear force as exerted by gravitational field. Fascia helps improve efficiency. That was cool.
Is it all about the interfaces? Geoff Bove, DC, PhD.
“I don’t think it’s all about the fascia.”
What’s an interface? Sliding surfaces. Interface problems could arise from fibrosed loose CT that becomes innervated (maybe).
Wow, great pic of mobilized v. non mobilized tendons. Furry v. Smooth.
Working in Barbe clinics with rats trained to reach thru a hole to grab a handle for food. They develop rep strain injuries like CTS.
On some of the rates they did rat massage: joint mobilizations, skin rolling, etc. nice film, good laughs.
They did 12 weeks of heavy training. Treated animals stayed healthier, didn’t show injury in reaching.
In histologic exam, treated animals looked like uninjured, demonstrating preventive potential of massage for people who do repetitive work.
Interface innervation… Are there nociceptors? Not clear.
At the Bove lab, they induced adhesions in rats abdomens. Treatment is general mobilization of the abdomen after surgery. Exams show this leads to less adhesions. Next issue is what nerves are growing in interfaces?
Adaptation Failure, Leon Chaitow, DO, PhD.
Symptoms are the sign of failing adaptation. Therapists must reduce the adaptive load, no matter what mechanism we choose.
SPECIFIC ADAPTATION TO IMPOSED DEMANDS
Transient mechanical stimulation to tissues produce changes.
Muscle Energy Technique: How does it work? First theories weren’t true.
Unsatisfactory explanations.
He’s giving some info on chronic pain… Some of it is dated.
Could fluid dynamics explain MET? It could reduce sensitization of peripheral nociceptors.
Could endocannabinoids explain it? Some manual therapies up-regulate endocanniboids, and have a biochemical effect.
Hydration and fascial stiffness variables, influences timing and speed of loading.
Takeaway: Figuring out mechanisms is freaking hard.
Imaging and Measuring Technologies, S. Sikdar, PhD, A. Stecco, MD
Loading and unloading fibroblasts changes the local chemical environment.
Nice pictures of fibroblasts, after overuse, then after myofascial release—pretty!
They wounded bioengineered tendons imbued with human fibroblasts. The best healing occurred when loaded at 3-12 % for 5 minutes.
Imaging of fascia in myofascial pain, Looking for objective imaging of whatever it is we call a myofascial trigger point, along with local tissues.
There were clear ultrasound and Doppler images of tissue nodules.
Bove and Sikdar are debating trigger points. It is professional and appropriate. Bove suggests what the tests showed was inflamed nerve endings. Sittka says he just found what he found, which was positive for signs of inflammation, and he is open-minded to whatever it turns out to be.
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If you enjoyed this series, I HIGHLY advise the purchase of the proceedings book and joining the Fascia Research Society.