Book_Printer_front 9/7/07 11:37 AM Page 1

Basic Science and Implications

for Conventional and
Complementary Health Care

Thomas W. Findley and Robert Schleip, Editors

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Fascia is the soft tissue component of the connective tissue system that permeates the human body. It forms a whole-body continuous three-
dimensional matrix of structural support. It interpenetrates and surrounds all organs, muscles, bones and nerve fibers, creating a unique
environment for body systems functioning. There is a substantial body of research on connective tissue generally focused on specialized genetic
and molecular aspects of the extracellular matrix. However, the study of fascia and its function as an organ of support has been largely neglected
and overlooked for several decades.
esquecido
The purpose of this book is to organize relevant information for scientists involved in the research of the body’s connective tissue matrix (fascia)
as well as professionals involved in the therapeutic manipulation of this body wide structural fabric. It is based on materials presented at the
First International Fascia Research Congress: Basic Science and Implications for Conventional and Complementary Healthcare, October 4-5,
The Conference Center, Harvard Medical School (www.fascia2007.com). It includes sections on...

• Microdynamics: From Mechanotransduction to Cellular Dynamics

• Myofibroblasts and Fascial Tonus Regulation
• Anatomy and Biomechanical Features of Fascia
• Fascia and Pain
• Clinical Considerations
• Muscle and Fascial Dynamics and Surgery
• Measurement of Fascial Change in Humans
• New Hypotheses, New Directions

Interest in fascia extends to new scientific findings in the following categories:

— The presence of contractile cells (myofibroblasts) within the fascial fabric. Clinicians are interested in their role in creating contractile tonus in
the fascial fabric, how they form, how they are activated, and their influence on passive muscle tonus.

— Biomechanical properties of fascial tissues: creep, relaxation, hysteresis, effect of sustained spinal flexion on lumbar tissues, strain induced
hydration changes, myofascial manipulation and fascial viscoelastic deformation.

— Mechanotransduction between the cytoskeletal structure within the cell and the extracellular matrix, and its implications for health and disease.

— Forms of mechanical signaling within the fascial matrix, such as the tugging in the collagen matrix created by twisting acupuncture needles

— How fascia is innervated, and how proprioception and pain are created, detected and modulated by the spinal cord and the rest of the
nervous system.

ISBN: 978-3-437-55009-6
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Thomas W. Findley, Robert Schleip (eds.)

Fascia Research
Basic Science and Implications for Conventional
and Complementary Health Care

München ⋅Jena
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Foreword

Welcome to the first scientific exploration of fascia from This book will be an invaluable asset for those attending
an interdisciplinary perspective. This book contains 16 the congress, where the authors of the enclosed full-text
full-text articles from the leading scientists in fascia articles will be among the major keynote presenters. It
research. These articles explore a diverse range of topics: will also be most useful for all other scientists and clini-
the microdynamics and mechanotransduction, myofi- cians interested in fascia research. All abstracts are also
broblasts and fascial tonus regulation, fascial anatomy be posted at the congress website: www.fascia2007.com.
and biomechanics, the sensory innervation of fascia and Please refer to this website for viewing original color illus-
related pain mechanisms, as well as explorations of clini- trations of some of the enclosed illustrations, if their leg-
cal aspects, measurement technologies and new hypothe- end refers to specific color markings. The website also
ses. They are complemented by abstracts from the First contains a glossary of terms used in this book in relation
International Fascia Research Congress, held at The to fascia research.
Conference Center of Harvard Medical School, Boston,
October 4-5 2007. This book pays equal attention to a This book is written for medical scientists interested in
basic science investigation of fascial anatomy and fascial fascia, as well as for clinicians who work with this inter-
dynamics, as well as to the exploration of clinical implica- esting tissue. The latter category includes acupuncturists,
tions for conventional medicine as well as complementa- physiotherapists, osteopaths, chiropractors, massage
ry health care. The full text articles reprinted here repre- therapists, practitioners of structural integration as well
sent the highest standards of scientific methodology, as orthopedic and other medical clinicians, and also yoga
with thorough review of the entire text by standard jour- instructors, sports coaches and other movement thera-
nal review procedures, and were selected by the editors pists. It is designed to give both a through overview of the
from over 1500 papers from the key presenters at this fundamental of fascia research as well as a taste of most
congress. The abstracts were selected by peer review by recent scientific and clinical explorations and hypotheses.
3 members of the scientific review committee of the
Fascia Research Congress and those accepted are present- This book was supported by NIH grant 1 R13 AT004146-
ed as submitted without editorial input from the review- 01 from National Center from Complementary and
ers. Some are clearly from experienced scientists, and oth- Alternative Medicine. Its contents are solely the responsi-
ers from less research experienced clinicians, which in bility of the authors and do not necessarily represent the
some cases are based more on clinical observation than official views of the NCCAM, NIAMS, or the National
on rigorous scientific experiments. Nonetheless, the Institutes of Health. Many people have generously donat-
review committee members felt that they contained valu- ed their time and expertise to the planning of the fascia
able information based on clinical experience, which may research congress and to the production of this book. We
– or may not – be validated by more substantial scientif- want to express our deepest appreciation for the devoted
ic research studies. work of Mr David Wronski, project coordinator, and
editing assistance of Matthew Foy, without whom this
book would not have been possible.

Thomas Findley MD PhD Robert Schleip Dr. biol.hum. Dipl.Psych.

Associate Director, Center for Healthcare Knowledge Director, Fascia Research Project, Inst. of Applied
Management, Veterans Administration New Jersey Physiology, Ulm University, Germany
Healthcare System, East Orange NJ USA Research Director, European Rolfing Association e.V.,
Professor New Jersey Medical School, Newark NJ USA Munich, Germany
Research Director, Rolf Institute, Boulder CO USA
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Table of Contents

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 The 2005 conference on the biology of manual therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

3 Microdynamics: from mechanotransduction to cellular dynamics . . . . . . . . . . . . . . . . . . . . . . . . . . 19

4 Myofibroblasts and fascial tonus regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

5 Anatomy and biomechanics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

6 Fascia and pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

7 Clinical considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

8 Muscle dynamics and surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

9 Measurement of fascial change in humans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

10 New hypotheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
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Introduction groups toward further comprehensive developments and

applications in this growing field. It is hoped that this
Thomas Findley, Robert Schleip endeavor will also serve to advance understanding of
structure and function so as lead to answering ongoing
Fascia is the soft tissue component of the connective tis- questions with scientific rigor.
sue system that permeates the human body forming a In the general population of industrialized countries,
whole-body continuous three-dimensional matrix of about two thirds are unable to work because of back pain
structural support. It interpenetrates and surrounds all at least once in their life and musculoskeletal pain
organs, muscles, bones and nerve fibers, creating a unique accounts for 17% of primary care office visits in the US
environment for body systems functioning. The scope of (Lynch 2005). In 1997 in the United States there were 192
our definition and interest in fascia extends to all fibrous million visits to chiropractors, 114 million to massage
connective tissues, including aponeuroses, ligaments, ten- therapists and 5 million to acupuncturists (Eisenberg
1 dons, retinaculae, joint capsules, organ and vessel tunics,
the epineurium, the meninges, the periostea, and all the
1998). Ni (Ni 2002) found that in 1999, 15 million adults
used chiropractic therapy, 12.5 million used massage and
endomysial and intermuscular fibers of the myofasciae. 3 million acupuncture. These numbers were confirmed
There is a substantial body of research on connective tis- again in the US national health survey of 2002 (Barnes
sue generally focused on specialized genetic and molecu- 2004) (Tindle 2005); percentage use is 25% higher among
lar aspects of extracellular matrix. However, the study of persons with arthritis (Quandt 2005). The tendency for
fascia and its function as an organ of support has been this kind of ailment is rising in concordance with the
largely neglected and overlooked for several decades. increased percentage of jobs which require extended stat-
Since fascia serves both global, generalized functions and ic positioning of the worker in a fixed, usually seated,
local, specialized functions, it is a substrate that crosses position. Fascia is an important factor in generation of
several scientific, medical, and therapeutic disciplines, the described ailments, and a more thorough under-
both in conventional and complementary/alternative standing of its function will allow better prevention
modalities. measures and healing therapies to be developed, benefit-
Thirty years ago the study of physical medicine and reha- ing the American economy.
bilitation included muscle strengthening, anatomy, exer- Hypotheses which accord myofascia a central role in the
cise physiology, and other aspects of therapeutic modali- mechanisms of therapies have been advanced for some
ties. What was notably less present in the scientific and time in the fields of acupuncture, massage, structural
medical literature was how to understand and treat disor- integration, chiropractic and osteopathy. Practitioners in
ders of the fascia and connective tissues. Since then much these disciplines, especially those which do not have the
additional information has been developed. The purpose longevity of osteopathy or chiropractic, are generally
of this book is to organize relevant information for scien- unaware of the scientific basis for evaluating such
tists involved in the research of the body’s connective tis- hypotheses. Many practitioners are unaware of the
sue matrix (fascia) as well as professionals involved in the sophistication of current laboratory research equipment
therapeutic manipulation of this bodywide structural and methods. Laboratory researchers, in turn, may be
fabric. It is based on materials presented at the First unaware of the clinical phenomena which suggest
International Fascia Research Congress: Basic Science avenues of exploration.
and implications for conventional and complementary Among the different kind of tissues that are involved in
health care (www.fascia2007.com). The Fascia Research musculoskeletal dynamics, fascia has received compara-
Congress is the first international conference dedicated to tively little scientific attention. Fascia, or dense fibrous
fascia in all its forms and functions. The principal the- connective tissue, nevertheless potentially plays a major
matic topics are: mechanical force transmission through and still poorly understood role in joint stability, in gen-
fascia and fascial anatomy; matrix and fibroblast biology; eral movement coordination, as well as in back pain and
force adaptation and response to loading; fascial innerva- many other pathologies. One reason why fascia has not
tion, nociception and proprioception; fascial research in received adequate scientific attention in the past decades
special populations; a panel discussion of controversies in is that this tissue is so pervasive and interconnected that
fibroblast research; and a panel for scientist-clinician it easily frustrates the common ambition of researchers
interaction and formulation of future research directions. to divide it into a discrete number of subunits which can
Bringing together the most recent solid research on the be classified and separately described. In anatomic dis-
properties of the fascial fabric with those who observe its plays the fascia is generally removed, so the viewer can see
workings daily in the clinic will inform and energize both the organs nerves and vessels but fails to appreciate the
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little formal statistical training, yet also contain more smaller and smaller scales results in overall structural effi-
advanced statistical guidelines for the more experienced ciency. Finally, dynamic remodeling results in ability to
researcher, and are widely used for teaching research to modify stiffness and flexibility in response to loading
medical residents. patterns experienced over time. The design principles in
living systems can be described by the architectural sys-
tem known as “tensegrity.” In this system, isolated com-
Chapter 3 pression elements are connected by continuous structure
providing tension. In contrast, most man-made struc-
Microdynamics: from mechanotransduction
tures rely on continuous stacks of bricks or similar com-
to cellular dynamics pression objects. Even when prestress is incorporated, as
➜ 3.1.1: The first paper by Chen and Ingber describes in prestressed concrete, the stiffness in such man made
design principles for the musculoskeletal system which objects remains constant regardless of the imposed stress-
1 result in special improvements in performance. They first
explain engineering principles of tension and compres-
es. In contrast, stiffness increases when stress loads are
increased in living tissues and also in man made 3D
sion, with emphasis on effects of architecture and pre- tensegrity structures. The tensegrity model suggests ways
stress. Pre-stressing in biological systems serves to obtain in which living tissues can sense and respond to mechan-
stability with minimum mass, providing rapid mechani- ical stresses.
cal responsiveness to added stress, and reducing loads on ➜ 3.1.2: In the second paper Langevin and Sherman sug-
individual structures thus reducing structural fatigue. gest a model for low back pain which incorporates con-
There is a hierarchical organization of a few types of nective tissue plasticity with pain psychology, postural
material in the musculoskeletal system which allows a control and neuroplasticity. They start by describing what
broad spectrum of mechanical properties exhibited by is known in persons with low back pain about tissue
bones, muscles, cartilage ligaments and tendons (and structure abnormalities, psychological factors, changes in
other forms of fascia). The remodeling of bone in movement patterns and increased peripheral pain sensi-
response to local mechanical stress, know as “Wolffs Law” tivity and brain cortical activation patterns. They suggest
results in deposition of bone in specific patterns which that connective tissue remodeling in persons with chron-
correspond to engineering lines of tension and compres- ic low back pain may result from either increased stress
sion. This molecular organization results in increased (“overuse injury”) or consistent absence of stress leading
strength for less mass in the bony system. The design to atrophy and fibrosis. The loose connective tissues sur-
principles carry through to the molecular level in other rounding and within the muscle fibers play important
biological tissues, including cartilage tendons and liga- roles in the response of muscle tissue to mechanical stress
ments. In soft tissues composed primarily of collagen and as well as in the sensory input from these tissues.
elastin, the prestress is generated from from active con- They propose that connective tissue fibrosis occurs in the
traction of the myofibroblasts. Mechanical engineering at low back due to decreased activity, muscle spasm co-con-
the cellular level begins with the observation that all liv- traction or microtrauma, and neurally mediated inflam-
ing cells are contractile; in muscle cells there is a highly mation. This model can be used to evaluate interventions
organized contractile system and in other cells the con- which involve application of external forces (e.g. massage,
tractile elements are organized into a loose network. Cells manipulation and acupuncture), movement education
have a structural framework which allows forces to be such as tai chi and yoga, and general increase in activity
transmitted within the cell. The cytoplasm itself can level and conditioning. They rightly point out that “the
locally alter its stiffness by changes in cytoskeletal poly- development, testing and implementation of effective
merization. Living cells react to a mechanical stimulus on treatment strategies are highly dependent on understand-
the cell surface by immediate changes in the cytoplasm ing the pathophysiological mechanisms of the condition
and nucleus. being treated.” After reviewing the basic science present-
The basic design principles of the musculoskeletal system ed here, the clinician scientist may be eager to skip to
result in maximal use of tensile materials from the molec- chapter 9 on measurement and new hypotheses.
ular to the whole body scale. How the different elements However, perseverance in reviewing the full-text articles
are connected in a three dimensional network is more and abstracts will be rewarded by yet more ideas for eval-
important than material properties of the individual uation.
components. Stability is achieved through prestress ➜ 3.1.3: The third paper by Grinnel describes the ability
and geometric organization such as triangulation. of fibroblasts to reorganize collagen matrix in cell culture
Hierarchical organization of components structured on to a dense mass one tenth the original size; these mechan-
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ical forces are large enough to cause scarring and defor- alpha smooth muscle actin. First discovered by Majno
mation in many body organs after injury. Applying a and Gabbiani in the early 1970’s, they have been shown to
mechanical load to the fibroblasts results in generation of play a major role in wound healing and to be also
actin stress fibers within the cell and development of involved in many other normal as well as pathological
these cells into myofibroblasts while absence of a contractile tissue processes. Most of these cells develop
mechanical load for as little as 24 hours cause the same out of normal fibroblasts stimulated by the influence of
cells to become quiescent through the extracellular signal mechanical tension as well as specific cytokines. Their
regulated kinase pathway. Microscopic examination of smooth muscle–like contractility enables these cells to
the collagen matrix shows vast difference in structure and maintain a contractile force over long duration times
organization of the fibroblasts depending on whether with little energetic costs. An increased presence of
tension on the cells was released immediately or after four myofibroblasts is a driving factor behind chronic fascial
hours during culture. Since the collage matrix contracts contractures, such as in Morbus Dupuytren, in plantar
to the same degree in both cases, little attention has been
paid to the structural differences and different cellular
fibromatosis, in excessive scar formation, or in frozen
shoulder. Recently, the presence of myofibroblasts (or
1
mechanisms which may signal contraction in the two myofibroblast-like contractile cells) has also been
models. Grinnel emphasizes that “cells use different sig- demonstrated for normal dense connective tissues, such
naling mechanisms for contraction according to whether as joint ligaments, menisci, tendons, organ capsules, and
they are mechanically loaded or unloaded at the time others.
when contraction is initiated.” The full-text articles in this section (➜ 4.1) start with a
➜ 3.2: Paper abstracts explore the effects of tissue stretch review of the biology of myofibroblasts by Gabbiani, co-
on collagen fibers in skin (➜ 3.2.4 Hoffman), nuclear discoverer of this cell type and prominent keynote pre-
shape and smooth muscle actin redistribution (➜ 3.2.2 senter at this first fascia research congress (➜ 4.1.1). His
Storch) and Procollagen-1 and TGF-β1 (➜ 3.2.1 brief review emphasizes the heterogeneity of this cell type
Bouffard). Micromanipulation of individual fibroblasts and proposes 4 different phenotypes of this versatile cell.
by Evanko (➜ 3.2.3) showed both changes in cellular Since publication of this classic paper in 1992 many
shape and in hyaluran amount and organization. Finally, important advances have been made in understanding
Corey (➜ 3.2.5) explored the innervation of deep fascia this new cell type. This is represented by two excellent
by large numbers of sensory fibers, suggesting a mecha- articles by Hinz (Gabbiani’s successor at the EPFL
nism for both generation of musculoskeletal pain as well research laboratory in Lausanne, Switzerland) and
as more distant effects of tissue stretch. Gabbiani (➜ 4.1.2 and ➜ 4.1.3). They represent present
➜ 3.3: Poster abstracts suggest that tissue stiffness day understanding concerning myofibroblasts, particu-
increase due to isometric stretch (“strain hardening”) is larly the transition from normal fibroblasts to myofibrob-
not dependent on cellular viability (therefore not due to lasts, as well as the role of force transmission between this
cellular contraction) but does correlate with enhanced cell and the extracellular matrix via specially developed
tissue matrix hydration (➜ 3.3.3 Schleip). Tissue studies adhesion complexes at their cell membrane. Finally, most
in humans with particular clinical conditions were per- recent findings of the Fascia Research Project at Ulm
formed in women with stress urinary incontinence (➜ University in Germany are reported regarding the pres-
3.3.5 Wen), Pelvic organ prolapse (➜ 3.3.1 Man), Low ence of myofibroblasts in normal fascia. These include
back pain (➜ 3.3.2 Schleip), and sulcus vocalis or scarring the unexpected finding of an increased density of these
of the vocal cords (➜ 3.3.4 Tsunoda). These studies sug- cells in the human lumbar fascia and culminate in a force
gest altered collagen and elastin metabolism, regions of calculation for fascial contraction in vivo based on
fascia with increased tissue repair activity, reduced num- mechanographic tests with rat fascia in vitro (➜ 4.1.4).
bers of contractile cells, and regeneration of fascia from The following abstracts of further congress lectures relat-
transplanted stem cell population in these different clini- ed to this subject cover further details. Tomasek links to
cal conditions. the chapter on mechanotransduction (➜ chapter 3) with
new findings concerning the expression of different
smooth muscle actins in response to mechanical stimula-
Chapter 4 tion (➜ 4.2.1). Spector emphasizes the contractile behav-
ior of musculoskeletal connective tissue cells and the
Myofibroblasts and fascial tonus regulation
important roles he proposes for it in regenerative medi-
Myofibroblasts are connective tissue cells which contain cine (➜ 4.3.1). This is followed by Naylor’s description
dense stress fiber bundles that are mostly composed of of past and current attempts in finding pharmacolo-
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gical agonists and antagonists for fascial contractility ing body positions, and this paper begins to establish sci-
(➜ 4.3.2). His approach is taken into further detail by the entific parameters of these observations.
in vitro contraction tests reported by the German fascia The abstracts from the plenary session on fascia anatomy
research group, including their successful stimulation of and biomechanics consist of two important contribu-
active fascial contractions with thromboxane and of fas- tions, both of which point at the important biomechani-
cial relaxation with the gaseous smooth muscle relaxant cal function of the lumbodorsal fascia. The first one by
nitric oxide (➜ 4.3.3). In conclusion Remvig gives an Vleeming (originator of the force/form closure concept
overview on current knowledge of general hypermobility about joint stability) cites evidence for the ability of the
and tissue stiffness (➜ 4.3.4). The following poster lumbar fascia to transmit tension between leg and trunk
abstracts explore the subject of tissue stiffness regulation muscles, such as from the latissimus dorsi on one side and
in further detail (➜ 4.4). Notably a relation of fascial stiff- the gluteus maximus on the other side (➜ 5.2.1). The sec-
ness and the enigmatic feature of resting muscle tone ond abstract of this group is written by Gracovetsky, who
1 (passive muscle stiffness) is addressed by Masi (➜ 4.4.2)
and by Klingler (➜ 4.4.3). Remvig (➜ 4.4.4) looked at
is mostly known for his ‘spinal engine’ model concerning
the role of spinal rotation in human gait (➜ 5.2.2). It asks
myofibroblast density in tendon and fascia biopsies from the provocative question “Is the lumbodorsal fascia nec-
persons with hypermobility and controls. LeMoon (➜ essary?” and then proceeds to provide two positive
4.4.1) suggests connective tissue contractility is the cen- answers: First, the essential role of visco-elastic behavior
tral mediating factor in myofascial pain. of collagen for the stability of the spinal system; and sec-
ondly, the role of fascia in providing necessary constraints
for muscular movements.
Chapter 5 These important contributions from keynote presenters
at this first congress are then complemented by addition-
Anatomy and biomechanics
al abstracts. This includes three anatomical examinations
Three full-text articles emphasize the important role of of particular fascial sheets in the human body: the deep
fascia in musculoskeletal force regulation. The first one is fascia of the limbs (➜ 5.3.1 Stecco), the fascia lata (➜
by Huijing, recipient of the prestigious Muybridge award 5.3.2 Fourie), and the superficial fascia (➜ 5.3.3 Headley);
2007 in the field of biomechanics for his recent insights and is then followed by a mathematician’s proposed
into the role of epimuscular force transmission between model of the relation between mechanical forces and
antagonistic and synergistic muscles in normal muscle as deformation of human fascia in manual therapy (➜ 5.3.4
well as in patients with spastic paresis. This article reviews Chaudhry). The chapter is then completed by 7 poster
available literature on myo-tendinous and myo-fascial presentations (➜ 5.4). The first examines the use of the
force transmission in general (➜ 5.1.1). Solomonow then term fascia in the literature (➜ 5.4.1 Mirkin), and is then
examines the role of ligaments musculoskeletal disorders followed by two examinations of particular fasciae – pec-
such as in work-related low back pain (➜ 5.1.2). He toral fascia (➜ 5.4.2 Stecco) abdominal fascia – as well as
stresses the important sensory function of these fascial by different explorations concerning therapeutic fascia
structures as well as their viscoelastic properties of creep manipulation. Burns (➜ 5.4.4) has developed a simulator
and relaxation in response to extensive loading. Last but for training fascial palpation. Remvig (➜ 5.4.5) explores
not least the article by Olson et al. (➜ 5.1.3) explores the the literature for scientific evidence of myofascial re-
‘flexion-relaxation phenomenon’ in which trunk flexion lease, and de Witt (➜ 5.4.6) describes a technique for
from the standing position results in a myoelectric silent assessment and treatment of lines of fascial motion in
period of the lumbar posterior muscles, which is com- athletes.
monly attributed to a taking over of spinal stabilization
by the passive stretch resistance of posterior lumbar con-
nective tissues. Interestingly, this phenomenon is radical- Chapter 6
ly altered when the trunk flexion is performed from a
Fascia and pain
supine body position rather than from the classically used
standing position. It is concluded that lumbar kinematics ➜ 6.1.1: Simons and Mense review muscle tone as it
or fixed sensory motor programs by themselves are not relates to clinical muscle pain. Muscle tone depends on
sufficient to explain the flexion relaxation phenomenon. the physical properties of the soft tissues – viscoelastic
Bodyworkers especially in structural integration properties of the muscular and associated tissues, and
(Rolfing) are accustomed to observing clinical differences anatomic limitations in motion- as well as degree of elec-
in muscle and fascial motion between supine and stand- trical activation of the contractile elements of the muscle,
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both voluntary and involuntary (muscle spasm). They ➜ 6.3: Further abstracts include the reported increase in
define viscoelastic tone as measured by resonant frequen- estimated weight of their gun belts by police offers with
cy of the muscle, and elastic stiffness as measured by slow chronic low back pain as opposed to matched healthy
movements. In both cases there may or may not be elec- control subjects from the same group (➜ 6.3.1 Moga).
trical activity of the muscle detected by electromyography Barker (➜ 6.3.2), recent recipient of the Young
(EMG), but this determination is critical to know just Investigator’s Award of the journal Spine for her related
what is being measured. They cover clinical usage and work on the lumbar fascia, explores the influence of
measurement of muscle tone as well as definitions of lumbar fascia tension on segmental sagittal spinal motion
mechanical properties of muscles. Muscle is thixotropic, stability, using loading tests and rapid motion photo-
that is when first moved it resists motion but after the ini- graphy on 9 unembalmed cadavers. She concludes that
tial motion the viscosity decreases up to ten fold. tension on the lumbar fasciae simulating moderate
Similarly they cover clinical usage and measurement of contraction of transverse abdominal muscle alters
contracture and muscle spasms, as well as several clinical
conditions such as tension headache, torticollis and night
segmental rotation and translation, reducing the insta-
bility factor in both flexion and extension. Stevens-Tuttle
1
cramps. The reader will gain insight into both clinical (➜ 6.3.3, from Langevin’s group) shows that peri-
practice and definition of terms and measurement which muscular fascia remodeling occurs in a pigs whose move-
are essential to research in this area. ments are restricted with a harness, and that similar
➜ 6.1.2: Khalsa provides a review of the system used to movement restrictions can be observed in humans with
perceive musculoskeletal pain. Both peripheral and cen- low back pain. This section is completed by two interest-
tral neurons in this system can adapt from milliseconds ing computerized theoretical modeling contributions.
to weeks after noxious stimuli. Sensory stimuli is sent Using MSM.Adam software, Trudeau and Rancourt
from muscles over nerves which conduct at a wide range (➜ 6.3.4) found that the thoracolumbar fascia has
of velocities, from over 100 meter/second to under the potential to be the posterior structure that con-
2 meter/second; half of such nerves are in the slowest tributes the most to the stiffness of the spine in forward
category. Muscle nociceptors vary in mechanical flexion. They conclude that this fascia could therefore be
thresholds, and can be sensitized by a number of local subjected to trauma if the spine is displaced in a way that
chemicals. The response at the cellular level to local exceeds its mechanical limits. Finally Zorn and his
mechanical trauma in a muscle is described in detail. German colleagues (➜ 6.3.5) explore the spring-like
Different mechanisms may be involved for compression function of the lumbar fascia in human gait. Their calcu-
than for stretch. lations reveal that – in contrast to the traditional gait
➜ 6.1.3: An experimental study in rats by Sauer, Bove et analysis model – the pendulum action of the arms and
al. shows that primary nociceptors innervating nerves the spring-like action of the lumbar fascia can have the
and their surrounding connective tissue release neu- potential to facilitate energetic efficiency in human
ropeptides involved in inflammation, but this does not walking.
happen when the nerve is isolated from its neighboring ➜ 6.4: Posters from clinicians explore different aspects
connective tissue matrix; in contrast, capsaicin (hot pep- related to therapeutic fascia manipulation, including
per) stimulates both isolated nerve axons and axons with lumbar skin stretch measures in persons with hamstring
intact connective tissue sheaths. tightness (➜ 6.4.1 Moga), postural changes after Core
➜ 6.2.1: Shah reports latest insights concerning the Integration (➜ 6.4.2 DellaGrotte), treatment of subacute
nature of myofascial trigger points. Using the newly lumbar compartment with Graston Technique, an instru-
refined method of microdialysis (using ultrafine needle ment assisted soft tissue mobilization (➜ 6.4.3 Hammer),
biopsies) he found that active trigger points in the upper a randomized trial of Functional Fascial Taping for low
trapezius exhibit a unique biochemical milieu of sub- back pain (➜ 6.4.4 Chen), and identification and myo-
stances associated with pain and inflammation, such as fascial treatment of pelvic obliquity in athletes (➜ 6.4.5
substance P, bradikinin, and others. LeLean).
➜ 6.2.2: The previous examination of Sauer, Bove et al. of
the influence of perineurial connective tissue elements
and related nerve endings in the creation of pain sensa- Chapter 7
tions (➜ 6.1.3) is updated in an abstract by Bove, which
Clinical considerations
proposes different mechanisms for distally perceived pain
as opposed to pain which is perceived as arising from the ➜ 7.1: Five clinician/educators have prepared some ques-
nerve trunk. tions on a wide range of topics for the final Fascia
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Contributors

Ron Alexander is the founder of Priscilla Barker is Senior Tutor in

Functional Fascial Taping® and Anatomy at the University of
refined this technique over several Melbourne. She completed her
years on the dancers of The Bachelor of Physiotherapy in 1996
Australian Ballet. During this period and PhD in Anatomy in 2005. Her
he was awarded the ‘Lady Southey research is published in ‘Spine’,
Scholarship for Excellence’. He deliv- ‘Grieve’s modern manual therapy’
ers FFT® workshops internationally and ‘Movement, Stability & Lumbo-
and has presented these real time pelvic Pain’. She was awarded the
ultrasound investigations to the Royal College of 2005 Spine Young Investigator of the
Surgeons, Edinburgh. ➜ 192, 203, 251 Year. ➜ 185

César F. Amorim was born in São Luiz Fernando Bertolucci, MD:

Paulo, Brazil. Graduated in physiatrist, biologist, Rolf Institute
Electronics Engineering from Uni- faculty (anatomy and myofascial
versity of Vale do Paraíba-UNIVAP release), has been using Rolfing® in
in 1992. He received his MS the treatment of musculoskeletal
in Biomedical Engineering from dysfunctions. He is currently devel-
University of Vale do Paraiba – São oping a particular technique to
Paulo, Brazil in 2001, and is release fascia, which seems to be
currently PhD Student. He is profes- based on neural reflexes. ➜ 221
sor of Biomedical Engineering Department. His areas of
research interests are signal processing applied to bio-
medical signals, detection, processing and interpretation Nicole Bouffard is from the Department of Neurology,
of surface EMG. ➜ 219, 221 University of Vermont, Burlington VT. ➜ 44, 45, 48, 186,
224

Julian Baker is the Principal

Instructor of The Bowen Technique Geoff Bove, DC PhD’s research
in the UK and Europe. As Director focuses on mechanisms of pain due
of The European College of Bowen to nerve injury, and how they relate
Studies, he has been responsible for to the musculoskeletal dysfunction.
its rapid growth since 1994, travel- He is an authority on the mecha-
ling extensively to teach, research nisms of pain, particularly those
and has written many articles on associated with nerve injury and
The Bowen Technique. ➜ 247 musculoskeletal disorders, and neu-
robiological mechanisms related to
manual therapy. He has published over 30 original arti-
cles reviews, and chapters, including publications in
Journal of the American Medical Association (JAMA),
Journal of Neurophysiology, and The Lancet, and regu-
larly participates as a grant reviewer for NIH. ➜ 174, 183
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Contributors

Janet M. Burns, DO, an assistant Sarah Corey is from the

professor of Osteopathic Manipu- Department of Neurology, Uni-
lative Medicine (OMM) at Ohio versity of Vermont Burlington VT. ➜
University College of Osteopathic 48
Medicine, is board certified in
Neuromusculoskeletal Medicine/
OMM, and Family Practice. Her
research interests include the neuro-
physiology of palpation and mecha-
nisms of OMM. ➜ 139
Patrizia D’Alessio, MD PhD is an
Italian researcher with cell biology
Leon Chaitow, DO ND is editor of expertise, and lectures as Ass. Prof. at
Journal of Bodywork and Move- Paris Universities. She has 3 patents
ment Therapies. He is author of on 4 anti-inflammatory anti-senes-
almost 70 books relating to osteo- cence molecules targeting endotheli-
pathic and manual medicine and is um and received the 2005 French
visiting lecturer at schools in Ministry award for Innovative Re-
Australia, Denmark, Holland, Italy, search and foundation of the start-
Ireland, Switzerland, Spain, and the up company “AISA Therapeutics”. ➜
United States. ➜ 196 244

Hans Chaudhry, PhD is a Research Julie Ann Day completed a Diploma in Physiotherapy in
Professor in Biomedical Engineering Adelaide, Australia in 1977. Practitioner of Fascial
Department at New Jersey Institute Manipulation since 1999, and authorised teacher, she
of Technology, Newark, New Jersey. translated Luigi Stecco’s book “Fascial Manipulation for
U.S.A. His research publications Musculoskeletal Pain” (Piccin 2004). Julie lives and works
pertain to Mathematical Modeling in Padova, Italy. ➜ 257
in Postural Stability, Human Fascia,
Cardiovascular System, Optimal
Patterns of Wound Suturing. ➜ 135, Benita de Witt, B Sc Physio, has 25
242, 255 years of experience treating athletes
and works in private practice in
Stellenbosch, South Africa. She has
Shu-Mei Chen is a qualified physical developed the Lyno Method, which
therapist as well as a lecturer of focuses on the treatment of chronic
Physical Therapy in Taiwan. She injuries; restoring body alignment
received the B.Sc. in Physical by means of fascia manipulation. ➜
Therapy and the M.Sc. in Medicine 141
from Kaohsiung Medical University
in Taiwan. She is currently studying
her PhD program at the School of Josef DellaGrotte PhD CPF LMT is
Exercise and Nutrition Sciences at Director of Core Integration Train-
Deakin University, Australia. ➜ 192 ing Institute Inc. ➜ 190
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Contributors

Stephen Evanko received his PhD James R. Fox is from the Depart-
from the University of New Mexico ment of Neurology, University of
in 1993 where he studied the biolog- Vermont, Burlington VT. ➜ 186,
ical properties and biochemistry of 224, 252
connective tissues, with principle
interest in how tissues remodeled in
response to different mechanical
stresses. He currently serves as a
Staff Scientist at The Benaroya
Research Institute at Virginia Mason in Seattle where he
studies the biology of hyaluronic acid and proteoglycans
in fibroblasts and smooth muscle cells. Stephen is also a Richard Allen Freiberg, OMD, DAP,
Certified Advanced Rolfer® with a Structural Integration Lac. began studying Acupuncture
practice in Seattle. ➜ 46 and Oriental Medicine in 1985 as an
apprentice to Dr. Robert C. Sohn,
AP, PhD. He received Diploma of
Thomas W. Findley MD, PhD Acupuncture and Oriental Medicine
trained in physical medicine and from the Atlantic Institute of
rehabilitation at the University of Oriental Medicine. He did advanced
Minnesota. Dr. Findley has exten- studies as senior graduate-doctor
sive training in complementary apprentice, for over six years, with world famous
medicine, beginning with training Traditional Chinese Medicine herbal expert Dr. Wu,
in acupuncture while a medical stu- Boping, OMD, MD, PhD (China). He practices in
dent at Georgetown in 1975. He Acupuncture and Oriental Medicine as a primary care
maintains an active clinical practice provider diagnosing and treating illness and injury spe-
as a Certified Advanced Practitioner of Rolfing Structural cializing in soft tissue injury and pain syndromes.
Integration in addition to his research activities as Received international Doctor of Oriental Medicine
Associate Director of the Center for Healthcare degree in 1998 from Medicina Alternativa Institute in
Knowledge Management, New Jersey VA Healthcare Colombo, Sri Lanka from Prof. Dr. Anton Jayasuriya. He
System. He is also Director of Research for the Rolf has created a synergistic method consisting of two
Institute of Structural Integration. ➜ 2, 135, 222, 242, ancient modalities: Gua Sha (frictional rubbing) and Ba
254, 255 Guan (empty cupping), which Dr. Wu named as Ba Gua
Fa, and during the past thirteen years has successfully uti-
lized Ba Gua Fa in over 20,000 patient treatment visits. ➜
W. J. Fourie Nat. Dipl. P.T. Thirty 208
years experience as musculoskeletal
Physical Therapist. Working in pri-
vate practice in Johannesburg, Guilio Gabbiani, MD PhD is
Masters Student in the School of Professor of Pathology and
Anatomical Sciences at the Immunology and the University of
University of the Witwatersrand and Geneva, Switzerland. His area of
International presenter of courses research is smooth muscle and
on the role of Connective Tissue in fibroblasts, and he has published
Movement Dysfunction. ➜ 215 more than 300 scientific papers. He
is a member of the Editorial Board
of the American Journal of
Pathology, Arteriosclerosis Thrombosis and Vascular
Biology, Laboratory Investigation, Wound Repair and
Regeneration, Differentiation, Cell Motility and the
Cytoskeleton, and Experimental Cell Research. ➜ 56, 67
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Contributors

Serge Alain Gracovetsky, PhD, J. C. Guimberteau, MD, is

Professor Emeritus, Electrical cofounder and scientific director of
Engineering, Concordia University, the Aqui-taine Hand Institute
Montreal, Canada, is the author of (I.A.M), member of the French
numerous research articles and Hand Society (GEM) and of the
recipient of several awards related to French Plastic and Reconstructive
his work on the biomechanics Society (SF.C.P.R.E). He was trained
around spinal dynamics and gait. He in the Hand and Plastic Surgery
is the originator of the ‘spinal Department of the Bordeaux
engine’ model, which emphasizes the important contri- University (Dr. A.J.M. Goumain and Pr. J. Baudet) from
bution of paraspinal connective tissues to human gait and 1973 to 1980. During this surgical training, he was one of
is one of the first scientific authors exploring the biome- the pioneers in microsurgery and transplantations. ➜ 237
chanical function of the thoracolumbar fascia. ➜ 131

Warren Hammer, DC lectures at the

Peter Grigg, PhD is Professor and National Chirpractic College and is
Interim Chair of Physiology, and a renowned writer and lecturer on
director of the Biomedical Engineer- treatment of soft tissue injuries. He
ing Program, at the University of incorporates into daily practice the
Massachusetts Medical School in constant flow of new scientific infor-
Worcester MA. He is a neuroscien- mation that relates to the clinical
tist with an interest in mechanore- improvement of the patient. Of crit-
ceptors. Studies of the mechanism of ical importance has been the incor-
mechanoreception led him into poration of all valid methods and techniques of soft tis-
investigations of the way soft tissues respond to mechan- sue evaluation and treatment. He believes that all joint
ical loading, which led to the work described in this manipulations of the human body require evaluation of
abstract. ➜ 47, 236 the soft tissue attachments to these joints. ➜ 191, 206

Frederick Grinnell, PhD, is Pro- Thomas Hausner, MD, Orthopedic

fessor of Cell Biology, University of Surgeon and General Surgeon, aged
Texas Southwestern and has been 42 years. He specialises in Hand-
the co-chair of the Gordon Con- and reconstructive Microsurgery in
ference on Science and Technology one of the largest Austrian hospital
Policy and chair of the Gordon for treatment of Trauma (“Lorenz
Conference on Wound Repair. ➜ 39 Böhler Trauma Hospital”), which
treats about 65000 trauma patients a
year. As a General Surgeon he is also
engaged in the treatment of multitraumatised patients,
especially with visceral trauma. ➜ 241
Alan Grodzinsky, PhD, is professor
of Electrical, Mechanical and
Biological Engineering and Director Gil Hedley, PhD, founder of So-
of the Center for Biomedical manautics Workshops, Inc. and
Engineering at MIT. His research Integral Anatomy Productions, LLC,
looks at how connective tissue teaches dissection workshops inter-
metabolism, growth, remodelling, nationally. He also produced The In-
pathology and repair is influenced tegral Anatomy Series, documenting
by mechanical, chemical and electrical stresses. ➜ on DVD his layer-by-layer, whole
Mechanotransduction panel chapter 3 body approach to human form and
fascial relationships. ➜ 134
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Ed Hemberger, structural Integ- Shabbir Indorewala, born: 1953,

ration Practitioner is a holistic prac- Nashik, India. Recipient of RAF
titioner involved in health and Cooper and AOI-E.Merck Awards.
bodywork for over 15 years, special- Has developed concept of: Endo-
izing in sports massage, neuromus- meatal Tympanoplasty, Anterior
cular and deep tissue. An avid cyclist Tympanotomy and Dimensional
and athlete himself, since 2001 Ed Stability of Free Fascia Grafts.
has been an assistant massage thera- Professor-consultant and MD of
pist for the Division II Professional Indorewala ENT Hospital, accredit-
Cycling Team, the Navigators. In 2002 he was selected to ed by National Board for ENT PG
be on the winter sports massage team for the U.S. training. ➜ 216
Paralympic ski team in Salt Lake City, Utah. In 2003 Ed
toured with Ofoto Lombardi, a Division III cycling team
from California. Ed is a certified holistic practitioner Donald Ingber, MD PhD is
through the Velazquez System of Training which is a syn- Director, Center for Integration in
thesis of principles and techniques of medical models, Medicine and Innovative
somatic techniques, sports psychology, psychotherapy Technology at Childrens Hospital
methods, organizational management and spiritual tradi- and is the Judah Folkman Professor
tions both ancient and contemporary. ➜ 207 of Vascular Biology at Harvard
Medical School. He has over 200
publications on cell structure and
Boris Hinz, PhD, did his postdoc- contractility. ➜ 20
toral training with Dr. Gabbiani and
is currently with the Cell Contract-
ility research group of the Laborato-
ry of Cell Biophyics, School of Basic Helen James, MPT, Adv.
Sciences, Swiss Federal Institute of Cert. Rolfer; the PI, has her
Technology in Lausanne. His re- graduate degree in Physical
search focuses on myofibroblast Therapy from Stanford Uni-
contraction, differentiation and versity. She is Professor
wound repair. ➜ 60, 67 Emeritus, Physical Therapy
Dept. California State Uni-
versity, Fresno. Ms. James
Allen H. Hoffman, PhD, PE is a owns a private practice in PT/Rolfing at Clovis, Ca. ➜ 256
Professor of Mechanical Engineer- Her Research Team includes:
ing at Worcester Polytechnic Insti- Mr Luis Castaneda, a graduate of Univ of Texas at El
tute. His research focuses on the Paso, and a graduate student in Physical Therapy at
mechanical behavior of soft tissues. California State University, Fresno, and M.E. Miller, PhD,
In 1988, he was a co-recipient of the PT, GCS; Assoc. Prof. in the Physical Therapist graduate
Elizabeth W. Lanir Kappa Delta program at California State Univ., Fresno.
Award from the American Academy
of Orthopaedic Surgeons. ➜ 47
Ricardas Kerpe MD, PhD is a lectur-
er at the Rehabilitation department,
Peter Huijing, PhD, Human Movement Sciences, Vrije Kaunas University of Medicine,
Universiteit, Amsterdam, The Netherlands, has received Lithuania. In 2006 accomplished the
international honors for his research in mechanisms of doctoral dissertation “Foot muscu-
extra-muscular myofascial force transmission and how lar tone in type 1 diabetes mellitus
this relates to properties of spastic muscles. ➜ 90, 212 patients and its correction using
functional electrical stimulation”.
Research interest area: muscles and
connective tissue properties. ➜ 220
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Contributors

Partap S. Khalsa, D.C., Ph.D., Werner Klingler, MD works as clin-

F.A.C.O. is Program Officer for the ical anesthesiologist and specialist
National Center for Complementary for human physiology at Ulm uni-
and Alternative Medicine of the versity, Germany. His research
NIH and was recently an Associate focuses on the pathology of contrac-
Professor of Biomedical Engineer- tile tissue. He is member of scientif-
ing, Orthopaedics, and Neurobiolo- ic organizations and has contributed
gy at the State University of New several publications in high-rank
York(SUNY) at Stony Brook, and journals. ➜ 50, 51, 76, 81, 82, 86, 188
currently serves as the Graduate Program Director for the
Department of Biomedical Engineering. Dr Khalsa has an
active research laboratory investigating neurophysiologi- Aleksandras Krisciunas, M.D.,D.Sc.
cal mechanisms of mechanosensory neurons, soft tissue habil is the Head of the Department
biomechanics, spine biomechanics, and mechanisms of of Rehabilitation Kaunas University
muscle and low back pain. He maintained, for 17 years, a of Medicine, Lithuania. The main
private practice of chiropractic in Massachusetts, is research area is rehabilitation of
board-certified in chiropractic orthopaedics, and served patients with cardiac and cardiovas-
terms as the President and Vice-President of his local cular diseases and evaluation of its
chapter of the Massachusetts Chiropractic Society. ➜ 12, efficiency. He has participated in
162, 196 developing an effective rehabilita-
tion system for patients and disabled people, consulting
work at rehabilitation centres and boards of medical-
Hollis H. King, DO, PHD, FAAO. social expertise. ➜ 220
Dr. King is the Associate Executive
Director of the Osteopathic Re-
search Center and Associate Nicky Lambon, MA MCSP DipTP
Professor of Osteopathic Manipula- Cert Ed FE PGCE CCIM. Nicky
tive Medicine at the Texas College of became a physiotherapist in 1980.
Osteopathic Medicine. He is a co- She has an MA in Law & Medical
author of the chapter on Osteopathy Ethics and is Principal Lecturer and
in the Cranial Field in Foundations Programme Manager for physio-
for Osteopathic Medicine, second edition. He has pub- therapy at Coventry University.
lished research on the effects of prenatal OMT on obstet- Nicky is also an external examiner at
rical outcomes, and has submitted grants to NIH for fur- Liverpool, Edinburgh & St George’s
ther research in this and other areas OMT. Dr. King is a Universities. ➜ 247
Past President and Fellow of the American Academy of
Osteopathy. ➜ 264
Helene M. Langevin MD is Research
Associate Professor and the Depart-
Miglena Kirilova, Institute of ment of Neurology, University of
Mechanics, Bulgarian Academy of Vermont Burlington VT. A licensed
Sciences. Research Associate at acupuncturist for ten years, she and
Institute of Mechanics, Bulgarian her team are studying tissue dis-
Academy of Sciences, Sofia, Depart- placement and remodelling due to
ment Biomechanics of Tissues and acupuncture needling. ➜ 33, 44, 45,
Systems. Member of Bulgarian 48, 186, 224, 252, 260
Society of Biomechanics, Union of
Bulgarian Mathematicians and the
Executive Body of the Bulgarian Society of Biorheology.
Research activity and interests mostly in the biomechan-
ics of soft tissues, cardiovascular biomechanics, tissue
engineered vascular grafts, biomaterials. ➜ 138
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Contributors

Aaron LeBauer, LMBT is the owner R.P. Lee received his DO degree
of LeBauer Structural Bodywork in from the University of Kansas City
Greensboro, NC. He has a B.A. from of Medicine and Biosciences in
Duke University, a certificate in 1976, and a residency in Osteopathic
Massage Therapy and Health Edu- Manipulative Medicine at the
cation from the National Holistic A.T.Still University College of
Institute, and is currently working Osteopathic Medicine in Kirksville,
toward his Doctor of Physical MO. He also trained with the
Therapy at Elon University. ➜ 204. American Academy of Medical
Acupuncture in 1986. In 1991, he moved to his present
location in Durango, Colorado to open a private practice
Linda-Joy Lee, a University of in osteopathic manipulative medicine, nutritional coun-
British Columbia graduate and fel- seling, homotoxicology, and medical acupuncture while
low of the Canadian Academy of using a system he developed to read the body for diagnos-
Manipulative Therapy, Linda-Joy tic and treatment strategies.
Lee is known internationally for her He has served on the board of Governors of the American
skills in movement and performance Academy of Osteopathy, chair of the Louisa Burns
analysis to restore optimum func- Osteopathic Research Committee of the AAO and has
tion. She has created novel approa- served on the Board of Directors of the Cranial Academy
ches to train thoracic stability, and is and the Cranial Academy Foundation. His 2005 book,
investigating these ideas in a PhD at the University of Interface: Mechanisms of Spirit in Osteopathy is about the
Queensland. LJ consults at her clinic, Synergy spiritual basis of osteopathic philosophy and a theoretical
Physiotherapy in North Vancouver BC, and teaches clini- physiological model of the primary respiratory mecha-
cians world-wide how to integrate multiple paradigms, nism. ➜ 265
new ideas and science for effective outcomes in clinical
practice in a series of courses in affiliation with Diane
Lee. ➜ 201 Peter Lelean is a remedial masseur
and structural integrator with 15
years experience. He has taught
Diane Lee is a University of British advanced therapeutic techniques
Columbia graduate (BSR), a fellow around Australia and specializes in
of the Canadian Academy of idiopathic scoliosis. Peter has identi-
Manipulative Therapy (FCAMT) fied fascial anomalies common to a
and a certified Gunn IMS practi- number of musculoskeletal condi-
tioner. She is well known interna- tions. ➜ 193
tionally for her clinical work and
case studies in which she integrates
scientific research with clinical Kim LeMoon is the originator of Fascial Facilitation, a
expertise into a practical evidence-based model. This soft tissue therapy for myofascial pain. Clinical success
model is taught world-wide in a series of courses in affil- with this method led to an exploration of the relationship
iation with Linda-Joy Lee. Diane’s passion is in helping between fascial contractility and myofascial pain syn-
women restore their form and function after pregnancy drome. Since 1997, she has maintained a massage therapy
and she works as a physiotherapy consultant at Diane Lee practice in New Jersey. ➜ 84
& Associates in White Rock, BC. ➜ 201
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Huub Maas is a research associate in Johannes Mayer Dr. med. 1981 –

the Department of Physiology, 1987: Family medicine; 1984 –
Feinberg School of Medicine at 1987: Manual medicine; 1996 –
Northwestern University. His re- 2000: Osteopathic medicine; since
search interests are muscular force 2001: teacher in Osteopathic medi-
transmission and the role of cine; 2000: member of AAO
mechanical skeletal muscle proper- (American Academy of osteopathy).
ties as well as proprioceptive feed- 2000: Vice president DGOM
back in neural control of locomo- (German Society of Ost. Med.).
tion. ➜ 213 2003: President EROP (European Register for Osteo-
pathic Physicians). 2006: educational committee of
WOHO. ➜ 258
Weng Chi Man did her graduate
work with Dr. James Ntambi at the
University of Wisconsin-Madison Laurie McLaughlin graduated from
and obtained her PhD in biochem- McMaster University (BHScPT), is a
istry in 2005. She is currently work- fellow of the Canadian Academy of
ing with Dr. Bertha Chen in the Manipulative Therapy (FCAMT)
OB/GYN department at Stanford and is certified in Contemporary
University for her postdoctoral Acupuncture (CMAG). Laurie
training. ➜ 49 teaches nationally and internation-
ally on the topics of fascia, breathing
and spinal manipulation. She is a
Michelle Marr, MSc BScHons senior consultant with LifeMark Health and is currently
PgCertHE MCSP. Michelle became a pursuing a Doctor of Science degree in Physical Therapy
physiotherapist in 1995 and is a spe- at Andrews University. ➜ 201
cialist in neurological rehab. She has
worked in the UK, USA and Zambia.
Following her Masters in 2005 she John M. McPartland first studied
became Senior Lecturer at Coventry medicinal plants with Euell Gibbons
University and runs a private prac- in 1969, and began cannabinoid
tice called Therapy Fusion Ltd. ➜ 49, research in 1981 (Mycopathologia
247 87:149-153). Dr. McPartland earned
degrees, residencies, and fellowships
at Penn State, University of Illinois,
Marilene Martin is in the School for Chicago College of Osteopathy,
Physiotherapy at São Marcos Uni- University of Pittsburgh, and
versity - São Paulo, Brazil. ➜ 205 Michigan State University. He has composed and deliv-
ered osteopathic curriculum at Michigan State University
(as Assistant Professor) and Unitec New Zealand (as
Associate Professor). ➜ New Directions panel chapter 10

Siegfried Mense Dr. med., is

Alfonse Masi, MD, DrPH, is at the University Professor at the Depart-
University of Illinois College of ment of Anatomy and Cell Biology,
Medicine at Peoria Il. ➜ 85 Heidelberg University, Germany. His
research looks at neurological path-
ways for pain stimuli and muscle
pain. ➜ 144
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Hanno Millesi Dr. med., is the Arya Nielsen is an adjunct faculty

Medical director of Wiener Privat- and practices East Asian medicine at
klinik and full professor at the Beth Israel Medical Center’s Conti-
Department of Plastic Surgery of the nuum Center for Health and
Medical Faculty of the University of Healing in NY. She teaches interna-
Vienna. He has received the Mille- tionally and has completed a doctor-
nium Award of the International ate in Interdisciplinary Studies with
Society for Reconstructive Micro- focus on integrative clinical science
surgery in 1999 and in 2001 the and health care. ➜ 249
Paracelsus Ring Award, Villach. ➜
241
James L. Oschman, PhD has pub-
lished 30 research papers in leading
Sue Mirkin is a physiotherapist with scientific journals, and an equal
a passionate interest in integrative number in journals of complemen-
anatomy and bodywork therapies. tary medicine. His work focuses on
She is currently engaged in short the connective tissues and myofas-
term contract work while deciding cial systems and their connections
how best to apply talents in clinical, with the cytoskeleton and nuclear
educational and/or research prac- matrix, a system he has termed the
tice. ➜ 136 living matrix. Jim has written two books on energy med-
icine, both published by Elsevier, in 2000 and 2003. He
lectures and gives workshops internationally on the bio-
P. Moga, DO is boarded through the medical significance of the living matrix. ➜ New
American Osteopathic Board of Directions panel chapter 10
Family Practice His clinical interests
have evolved towards musculoskele-
tal medicine, including manual-, Tim Paine, MA, is Senior Lecturer
occupational-, and sports medicine. and Award Leader, Department of
His research interests focus largely Sports & Exercise Sciences, Univer-
on spine loading, spine injury, and sity of Bedfordshire. He formed the
manual medicine outcomes. ➜ 184, Academy of Sports Therapy UK in
189 1994 and Sports Therapy UK in
2001 offering specialist training
courses in sports therapy . He is now compiling his sec-
I. L. Naylor: PhD is Senior lecturer, ond book on advanced soft tissue techniques. ➜ 218
School of Pharmacy, University of
Bradford, UK. His research interests
are study of myofibroblast behav- Alessandro Pedrelli: graduated as a
iour in wound repair and healing. ➜ Physiotherapist in 2003, at the
81 University of Bologna, with a thesis
titled: “Modular prothesis with elec-
tric knee (C-LEG): personal experi-
ence in walk re-education of trans-
femoral amputated patients”. Since
October 2003 he has been working
as a professional at his own consult-
ing room in Cesena, Italy. He attend-
ed three courses on Fascial Manipulation as a student
(2003, 2005, 2006), and in 2007 as a teaching assistant. In
October 2007, will run his first course on Fascial
Manipulation as a Teacher. ➜ 250
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Contributors

Helga Pohl, founder of Sensory- Robert Schleip, PhD, is a certified

Motor Body Therapy and the Centre Rolfing and Feldenkrais Teacher, is
for Body Therapy, worked as a clini- Research Director of the European
cal psychologist at the Max-Planck- Rolfing Association and Director of
Institute and at German universities, the Fascia Research Project, Ulm
and as a psychotherapist in private University, Germany. He holds a
practice. Her own experiences with PhD in human biology and an MA
chronic back pain lead her to a new in psychology and has been awarded
path as a body worker. ➜ 245 with the Vladimir Janda Award for
Musculoskeletal Medicine 2006. ➜ 2, 50, 51, 76, 81, 82, 86,
87, 135, 188
Denis Rancourt, PhD, is associate
professor in Mechanical Engineer-
ing at Université de Sherbrooke. He Jay P. Shah is a physiatrist/researcher
is a member of the PERSEUS at the NIH studying the pathophysi-
research group interested in human ology of myofascial pain, chronic
performance and safety. His research pain mechanisms and promising
interests include human motor con- physical medicine treatments. His
trol and system modelling and design. He holds a PhD team is utilizing novel microanalyti-
degree from MIT in ME. ➜ 187 cal techniques to uncover the unique
biochemical milieu of myofascial
trigger points and acupuncture
Lars Remvig, MD and DMSc, points. He teaches acupuncture at Harvard Medical
rheumatologist, senior consultant at School and New York Medical College. Dr. Shah has given
the Clinic for Orthopaedic Medi- many invited lectures and workshops at various national
cine, Rigshopitalet, Copenhagen. He and international meetings. ➜ 214
is past president of DSMM and past
member of FIMM Academy, Science
Board and has published articles, Charles Shang, MD, is from the
reviews and textbooks in manual/ Cambridge Health Alliance, Harvard
musculoskeletal medicine. His main Medical School. ➜ 209
interest now is Hypermobility. ➜ 83,
87, 140

Thomas Sandercock is a Research

Associate Professor in the Depart-
ment of Physiology, Feinberg School
of Medicine at Northwestern Uni-
versity. His research interests are the
mechanical properties of motor
units, muscle, and their interaction
to produce whole muscle force and
stiffness. ➜ 213
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Contributors

Moshe Solomonow, PhD, MD Paul Standley, PhD, is a vascular

(Hon) is the Founding Editor of The physiologist and professor in the
Journal of Electromyography and Department of Basic Medical
Kinesiology, and serves on the Sciences at the University of Arizona
Editorial Board of several bioengi- College of Medicine. His research
neering and medical journals. He program investigates how vascular
was a council member of the smooth muscle and fascial fibrob-
International Society of Electro- lasts demonstrate regulation of
physiological Kinesiology, the cytokine and growth gene expres-
International Society of Functional Electrical Stimu- sion in response to biophysical stimuli. ➜ Mechano-
lation, and the IEEE-Biomedical Engineering Society. He transduction panel chapter 3
published over 120 refereed journal papers on motor
control, electromyography, muscle, ligament and joint
biomechanics, electrical muscle stimulation, prosthetics Antonio Stecco, MD, Padua Uni-
and orthotic systems for paraplegic locomotion. versity, 2007. Collaborator with the
Dr. Solomonow organized the EMG Tutorial Workshop University Paris Descartes to study
in the ISB Congress, the Canadian Society of the anatomy of fascia. Collaborator
Biomechanics, The Human Factors and Ergonomics with the Physical Medicine and
Society, and The Society for Clinical Movement Analysis, Rehabilitation Clinic of Padua
He received the Crump Award For Excellence in University to analyse the myofascial
Bioengineering Research (UCLA), the Distinctive pains and the clinical applications of
Contribution Award. ➜ 108, 119 the Fascial Manipulation method.
➜ 132, 137, 257

M. Spector is Professor of Ortho-

paedic Surgery (Biomaterials), Carla Stecco, MD, Padua University,
Harvard Medical School. Senior 2002. Specialisation in Ortho-
Lecturer, Mechanical Engineering paedist, 2007. Collaborator with
and Lecture, Health Sciences and Paris Descartes University to study
Technology, Massachusetts Institute the anatomy of the fascia with dis-
of Technology: Director of Tissue sections. Membership of Italian
Engineering, Veterans Administra- Society of Anatomy and Histology.
tion Boston Healthcare System. Author of 18 scientific papers and of
Director of Orthopaedic Research, Brigham and a book about Fascial Manipulation.
Women’s Hospital. ➜ 80 ➜ 132, 250, 257

Victoria A. Stahl received her B.S. Debbie Stevens-Tuttle is from the

degree in Computer Science from Department of Neurology, Uni-
the Georgia Institute of Technology, versity of Vermont, Burlington VT.
Atlanta, USA in 2001 and is current- ➜ 44, 186, 224, 252
ly pursing a PhD in Biomedical
Engineering from the Georgia
Institute of Technology and Emory
University, Atlanta, USA. ➜ 214
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Contributors

Kirsten N. Storch earned her Petra Valouchová, PT, PhD, spe-

Bachelors of Arts in Environmental cialised in Biomechanics, Master’s
Studies at the University of Oregon Degree in Physiotherapy. She has
in 2000 and went on to receive a been a physical therapist at Rehab-
Masters of Education at Plymouth ilitation department of University
State University in Plymouth, New Hospital in Prague and a university
Hampshire in 2003. She has worked teacher of physical therapy and gen-
at the University of Vermont in the eral medicine students at Charles
Department of Neurology with University Medical school. She has
Helene Langevin’s group since 2004 as a Laboratory certificates in Vojta´s method, Bobath concept, Mobiliza-
Research Technician. She published “Fibroblast spreading tion and soft tissue techniques. ➜ 217
induced by connective tissue stretch involves intracellular
redistribution of alpha and beta actin” in 2006, “Alpha
smooth muscle actin distribution in cytoplasm and Andry Vleeming, clinical anatomist,
nuclear invaginations of connective tissue fibroblasts” in worked for 17 years in the Erasmus
2007, and is currently completing a follow up paper. ➜ 45 University in Rotterdam. His PhD
was on the clinical anatomy, biome-
chanics and radiology of the pelvis.
James J. Tomasek is David Ross In 1996 he founded the Spine and
Boyd Professor in the Department joint center in Rotterdam the
of Cell Biology at the University of Netherlands. He is visiting professor
Oklahoma Health Sciences Center in clinical anatomy in several
and is also Dean of the Graduate Universities around the world. He is program chairman
College at the University of for the Office of continuing education of the University
Oklahoma Health Sciences Center. of San Diego for the World congress on lumbopelvic pain
➜ 78 (and chairman). ➜ 130

Matthieu Trudeau is a Master’s stu- H. Vránová is from the Department

dent in ME at Université de of Anatomy and Biomechanics,
Sherbrooke, Québec, Canada. He Faculty of Physical Education and
has a Bachelor’s degree in ME from Sport
Dalhousie University, Halifax, Nova Charles University in Prague, Czech
Scotia. Trudeau is a member of the Republic. ➜ 248
PERSEUS research group, which
conducts research projects in the
field of biomechanics. ➜ 187

Scott C. Wearing, PhD, is an RCUK

Koichi Tsunoda, MD, PhD is Academic Fellow within the
Assistant Professor, Faculty of Bioengineering Unit, University of
Medicine, University of Tokyo and Strathclyde. His research has
Chairman, Department of Artificial focused on the application of med-
Organs, National Institute of Sens- ical imaging techniques to investi-
ory Organs, Japan. His Specialties gate the effect of limb biomechanics
are Laryngology, Phonosurgery, and loading on musculoskeletal
Artificial Organs, Neuroscience. ➜ morphology, adaptation and injury.
52 ➜ 243
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Contributors

Yan Wen, MD, is currently a re- Can Yücesoy has BSc and MSc
searcher in the OB/GYN depart- degrees in Mechanical Engineering.
ment at Stanford University, study- He received a PhD on Biomechani-
ing the mechanism involved in the cal Engineering from University of
development of female pelvic floor Twente. He is a fulltime faculty
prolapse. ➜ 49, 53 member at Biomedical Engineering
Institute in Boǧaziçi University. His
research is in biomechanics with a
focus on myofascial force transmis-
sion. ➜ 212

Frank Willard, PhD, is located at the University of New

England. His human dissection projects in the low back Adjo Zorn, PhD, has been working
demonstrate the functional organization and innervation for many years as a physicist for
patterns of muscles and ligaments, in order to understand German car manufacturing compa-
pain generating mechanisms and their role in spinal cord nies for more than 20 years, and is
facilitation. ➜ Fascia anatomy and biomechanics panel also an Advanced practioner of
chapter 5 Rolfing Structural Integration with
his own practice for 13 years.
He is a member of the Fascia
Research Project of the University of
Ulm, Germany. His research work focuses on the biome-
chanical function of connective tissue. ➜ 81, 82, 188
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Index

Index

A Bowen technique 247 contractile proteins, in non-muscle

abdominal fascia, viscoelastic prop- brachial plexus, passive motion 241 cells 56
erties 138 breast cancer treatment, managing contractility, fascial 82
achilles tendons under tensile load, painful dysfunction 215 contraction mechanisms 40
measured with MRI 236 Brighton test 83 contracture 145, 150
actin organization 40 bruxism, electromyography 219 cramp 152
acupuncture 209 Bunkie method 141 cranial fascia 264
acupuncture needle rotation, – role of 214
changes in connective tissue C cytosceletal mechanics 25
structure 227 calcitonin gene-related peptide, cytoskeleton, shape stability 25
acupuncture sites, issue winding and nervi nervorum 178
needle forces 253 caldesmon 57 D
alpha-1-antitrypsin 49 capsicain 176 deep fascia
alpha-SM actin 57, 61, 89 carpal tunnel syndrome, ba gua fa – histological study 132
– expression, biomechanical stress 208 – innervation 48
70 cell migration 46 diabetes mellitus, foot muscular tone
anatomy and biomechanics 89 cellular adhesion 46 220
angiotensin II 57 cellular fascia studies 44 differentiated myofibroblast 64
ankylosing spondylitis 85 cellular network 209 doctors of osteopathy, chiropractic
anti-contractile drugs 81 chakra system, adult germ cells 210 13
antistress effects 14 chiropractic use 13 dynamic remodelling 27
aponeurotomy, acute effects 101 chronic fatigue syndrome, balance
apoptosis 25 improvement with Rolfing 242 E
axes of stress in bone 24 clinical questions 196 ECM adhesions, stress transduction
Axons, CGRP release 179 collagen distribution, manual tech- 71
nique 245 Ehlers Danlos Syndrome 83, 87
B collagen fiber reorganisation 47 elastic stiffness 145
ba gua fa, carpal tunnel syndrome collagen metabolism, pelvic support- elasticity 145
208 ing tissue 53 elastin metabolism, pelvic support-
back pain, active scars 217 compliance of muscle 147 ing tissue 53
balance improvement, with structur- connective tissue electrogeneic spasm 145
al integration 242 – body-wide network 260 endomysium 93
barrier-dam theory 84 – contracting cells 80 endothelium, fasciatherapy and pul-
basal lamina 91, 92 – intramuscular 93 sology 244
benign Joint Hypermobility – mechanical stress 35 engeneering of the musculosceletal
Syndrome 83 – mechanotransduction 15 system 21
biology of manual therapies, 2005 – muscle interaction 35 epimuscular myofascial force trans-
conference 12, 17 – muscular 103 mission 212
biomechanics and imaging 15 – musculoskeletal 80 epimysium 93
blepharospasm, structural integra- – structure 67 epi-perineurial anatomy, innervation
tion 222 connective tissue remodelling 44 and nociceceptive mechanisms
bone, axes of stress 24 – low back pain 34 183
bone growth and development 23 contractile activity 145 ergonomics, manual therapies 15
bone structure 23 contractile microfilaments 24 extracellular matrix 91
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Index

F foot muscular tone, diabetes mellitus knee extension moment 105

FA 62 220
Fascia force transmission 94 L
– contractility 82 – in limbs 103 laminin 92
– contraction 76 – in muscle and whole limb 90 lateral force transmission 94, 95
– deformation 135 – intramuscular 102 ligament 108
– histological study 132 frozen shoulder, contractile cells in – as sensory organ 114
– innervation 48 fascia 87 – ECM 24
– lumbodorsal 131 functional neuroimaging, manual – hypertrophy 115
– in literature 136 therapies 15 – increased physical activity 113
– meridians 209 – inflammation 113
– myofibroblast 76 G – mechanical properties 109
– superficial 134 gamma-interferion, scars 57 – structure 108
– thoracolumbar 130 germ cells, chakra system 210 ligamento-muscular reflex 114
– and pain 143 giant myofibroblast 62 liver fibrosis 57
fascia deformation, three dimen- granulation tissue, stimulus respon- lockjaw 156
sional mathematical models dence 56 low back pain
135 Graston technique 191, 206 – connective tissue remodelling 35
fascia lata, anatomy 133 Gravity, influence upon trund 120 – estimate of loads 184
fascia remodelling, low back pain growth control system 209 – fascial taping 192
186 growth factor beta 1 44 – functional taping 203
fascia strain hardening 51 gua sha, microcirculation 249 – in police officers 184
fasciagenic pain model 84 – injuries in lumbar fasciae 50
fascial change, measurement 223 H – pathophysiological model 33
fascial drag, virtual reality simula- Headache – perimuscular fascia remodelling
tion 139 – tension-type 153 186
fascial manipulation, tissue changes – trigger points 154 lumbar compartment syndrome,
46 hoarseness 52 subacute 191
fascial manipulation© hyaluronan 46 lumbar fascia
– anatomical basis 257 hypermobile joints 83 – function in human walking 188
– patellar tendinopathy 250 hypermobility syndrome, contractile – injuries 50
– prorioception 207 cells in fascia 87 – tension 185
fascial plasticity, Bowen technique hypertonia 146 lumbodorsal fascia 131
247 lumbopelvic stability 201
fascial taping I lysyl oxidase-like protein 1 49
– low back pain 192, 203 immune and endocrine systems 14
– ultrasound investigation 251 immune system, stress 15 M
fasciatherapy and pulsolgy, vascular impendance, mechanical 147 macrovacuolar concept 237
endothelium 244 inflammation, trauma 15 manual techniques, collagen distri-
fasciotomy, acute effects 99 integrins 24 bution 245
fiber-reinforced composites 91 intramuscular connective tissue 93 manual therapies
fibroblast-collagen-matrix contrac- – effects 12
tion 39 J – nervous system 14
fibroblasts 261 joint architecture 22 – techniques 13
fibromyalgia, neuroendocrine factors joint hypermobility, tissue stiffness manual therapists 13
14 83 Marfan Syndrome 83
fibronexus 61 joint stability, ligamento-muscular massage therapists 13
fibrosis 44, 57 reflex 21, 114 Massage Therapy Consortium 13
flexion-relaxation response to gravi- mastectomy, limb dysfunction 215
ty 119 K matrix extracellular 91
floppy infants 146 Kettner, Norman 15 matrix 265
focal adhesions 61 key notes, 2005 conference 14 matrix adhesions myofibroblasts 60
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Index

matrix contraction 41 myofascial pain nociceptor response to stimuli 167

matrix stiffness, myofibroblast dif- – fascial plasticity 84 nociceptors 164, 174
ferentiation 64 – connective tissue contractility 84 nocturnal leg cramps 158
matrx hydration changes, fascial myofascial pathways, role of 213 nonnoxious mechnical stimuli 14
strain hardening 51 myofascial relacatioin, heat induced nuclear shape, tissue stretch 45
maximizing strength per mass 21 86
Maxwell’s lemma 21 myofascial release 140 O
mechanical impendance 147 – scoliosis 204, 205 organism, construction 21
mechanical stress, myofibroblast dif- myofascial therapy, objective diag- osteoarthrosis, prevalence 87
ferentiation 69 nostic and therapeutic criteria osteopathy, chiropractic 13
mechanotransduction 20 221 ostogenesis imperfecta 83
meridians 260 myofascial transmission 94 oxytocin 14
– fascia 209 myofascial trigger points 154
merosin 92 – biochemical milieu 181 P
microcirculation, gua sha 249 myofiber cytoskeleton, connections pain modulation 14
microdynamics 19 to the basal lamina 96 pain perception 162
microinjury model 44 myofibered muscle, spanning/non- pain syndromes, sex hormones 14
microvacuola 238 spanning 96, 97, 102 pain transmission, Descartes 165
migratory fascia syndrome 193 myofibroblast painful muscle spasm 154
movement pattern abnormalities – activity 58 pain-spasm-pain misperception 154
low back pain 34 – contractility 81 palmar fibromatosis, contractile cells
muscle, interrelationships 104 – contraction 68 in fascia 87
muscle activity, unintentional 157 – differentiation 64 patellar tendinopathy, Fascial
muscle cramp 152, 168 – evolution 57 Manipulation© 250
muscle dynamics and surgery 211 – evolution 72 pectoralis fascia 137
muscle hardness, increased 85 – matrix adhesions 60 pelvic obliquity 193
muscle nociceptors, primary 164 – mechanical stress 69 pelvic organ prolapse 49
muscle nociceptors, anatomy and – superaturation 62 pelvic supporting tissue,
physiology 165 – tissue reconstruction 67 collagen/elastin metabolism 53
muscle overload 157 myofibroblast concept 56 pendulum test 147
muscle pain, delayed onset 168 myofibroblast formation, perimysium 93, 104
muscle rigidity 152 mechanoregulation 78 plantar fascial thickness 243
muscle spasm 144, 151, 154 myofibroblasts and fascial tonus reg- plantar fibromatosis, contractile cells
muscle spasticity 152 ulation 55 in fascia 87
muscle stiffness 158 myotendinous force transmission 93 PNF 218
muscle tension 144, 157 posture fascia 190
muscle thixotropy 144 N pregnancy
muscle tone 145 neck ROM and pain, structural inte- – fascia function 201
– definition 146 gration 256 – urinary incontinence 53
– measurement 147 nerve anatomy 183 prestress 26
– muscle pain 144 nerve sheaths, PGE2 release 179 procollagen-1 44
– resting 85, 86 nervi nervorum 174 progressive fasciotomy, acute effects
muscular connective tissue, blood nervous system, manual therapies 99
vessels and nerves 103 14 proto-myofibroblast 64
muscular force transmission 93 neuromatrix 162 psychological factors, low back pain
musculosceletal system neuromuscular disorders 115 34
– hierarchical organization 22 neuronal synapses, plasticity 14
– design principles 26 neuropathy, sensory radicular 163 R
musculoskeletal mechanics, fascia neuroplasticity, low back pain 34 recommendations, 2005 conference
76 neuroscience research 14 16
musculoskeletal pain, biomechanics neutrophil elastase 49 reflex, ligamento-muscular 114
162 nociceptive nerve ending 166 relaxation, heat induced 86
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Index

resonance 148 stress urinary incontinence 53 – isometric stretch 51

rigidity 152 structural hierarchy 27 – joint hypermobility 83
robotics, manual therapies 15 structural integration tissue stretch 44
Rolfing – blepharospasm 222 tissue structural abnormalities, low
– balance improvement 242 – neck ROM and pain 256 back pain 33
– blepharospasm 222 – sensory improvement 255 tone 146
– neck ROM and pain 256 – spinal cord injury 254 torticollis, spasmodic 155
– sensory improvement 255 subcutaneous sliding system 237 Traditional Chinese Medicine 260
– spinal cord injury 254 suFA 62 trans-sarcolemm, connections to the
sulcus vocalis 52 basal lamina 96
S trauma, inflammation 15
scar retraction 56 T triangulation 27
scarring 44 taxonomy of Therapeutic Massage trigger point hypothesis 84
scars, biomechanical impact 248 and Bodywork 13 triggerpoints, biochemical milieu
scars, osteopathic approach 258 tendinopathy, Graston technique 181
sclerosis, myofascial release 205 206 trismus 156
scoliosis, myofascial release 204 tenotomy, acute effects 99 tropomyosin 57
sensory improvement, structural tensegrity and mechanoregulation tympanoplasty, fascia shrinking 216
integration 255 20
shoulder movement after breast can- tensegrity architecture 27 U
cer treatment 215 tensegrity model of the spine 15 ultrasound for characterization of
signal categories 261 tension and compression 21 local connective tissue network
skin, collagen fibers 47 tension-relaxation phenomenom, in structure 224
skin distraction over the spine’s mid- ligament 110 urinary incontinence 53
line 189 tension-type headache 153
SM 22 57 TGF-β1 44, 53 V
Spasm, measurement 152 thixotopy 150 vacuoles 239
spasmodic torticollis 155 thixotropic behaviour 144 vaginal fibroblasts 53
spasticity 152 thixotropy 148, 149 vibration, low back problems 15
specific tone 145 thoracolumbar fascia 130 vinculin 67
spinal cord injury, structural integra- thoracolumbar fascia viscoelastic parameter, scar 248
tion 254 – spine stiffness 187 viscoelastic stiffness 145
spinal manipulation, effects 12 three-dimensional tensegrity model viscoelastic tone 144, 145
spine stiffness, thoracolumbar fascia 29 viscosity 148
187 tissue changes, fascial manipulation
stability with minimum mass 22 46 W
stiff-man syndrome 158 tissue displacement, acupuncture walking function of lumbar fascia
stiffness 145 sites 253 188
– measurement 148 tissue morphogenesis, cellular Wartenberg test 147
stress, immune systems 15 mechanotransduction 23 Wolff ’s law 23
stress fibers 24 tissue reconstruction, myofibroblast wound contraction 39, 56
stress transduction, ECM adhesions 67 wound healing, myofibroblast evolu-
71 tissue stiffness tion 72
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