If We Cannot Stretch Fascia, What Are We Doing?

Posted on: Thu, 12/06/2012 - 2:23am By: Alice

When Ida Rolf began putting her hands and elbows on people’s skin and applying pressure, creating a slow, sustained stretch, she imagined that she was stretching fascial sheets. Generations of manual therapists have followed her thinking, accepting this explanation to account for the changes felt in tissue tension beneath their hands and the sensations experienced by those who receive this type of therapy.

 

Ideas change over time

Much of manual therapy has grown largely out of anecdotal experience and tradition. Without the means to directly observe or measure what happened inside of the body, explanations for results had to be created from the “outside” and have largely been guesswork. As manual therapy has moved forward, an interest in understanding exactly how touch affects the body has led to a growing interest in research. With research has come the realization that many explanations of the past are not supported by evidence and are sometimes contradicted by evidence. Science-minded manual therapists have learned to adapt to this information, dropping outdated hypotheses and unsupported claims. While some have found it disconcerting to have cherished notions disproved, others have embraced knowledge and have adapted their conceptual models to fit what is known. They may continue to use modalities that have produced desired results but their understanding of how that comes about changes to fit the evidence.

Such a change is happening in the field of “fascial” therapy.

When Rolf began her groundbreaking work in manual therapy, she devised a hypothesis in an attempt to explain how changes created by her contact came about. However, in recent years, evidence has challenged those explanations. Robert Schleip, Ph.D., was one of the key organizers of the first Fascia Research Congress and is a highly respected researcher. He is credited with discovering minute contractile fibers in fascia, a discovery whose clinical relevance has not yet been demonstrated but still excited many in the world of fascial therapy just the same. In his two-part article, “Fascial Plasticity: a new neurobiological explanation,” published in 2003 in the Journal of Bodywork and Movement Therapies, Schleip points to studies which contradict the notion that we can change the shape of fascia with our hands. One study found that collagen fibers would only begin to stretch shortly before they reached the breaking point, something that would not be desirable in a living human being. In other studies, Schleip, Trager, and others have done Rolfing under anesthesia and found that it produced no results. If the application of manual pressure had the ability to stretch fascia, there should have been a change in spite of anesthesia blocking any neural response. Why, then, was there no change when anesthesia took the nervous system out of the picture?

 

A neurobiological explanation

If we aren’t stretching fascia, then how do we account for the “release” felt by both the practitioner and the subject? Schleip and others have suggested that the change in tonus is not achieved by an alteration in the shape of fascia but is instead controlled by the nervous system. Schleip suggests that one possible mechanism of change brought about by sustained manual pressure could be the Ruffini corpuscles.

Why Ruffini corpuscles? Clinically, we observe that applying a slow, extended stretch to the skin can create desirable changes both locally and centrally, decreasing tension in the area where the hands are applied as well as creating an overall sense of relaxation. Ruffini corpuscles respond to lateral skin stretch, that is, stretching the skin tangentially or along the same plane as the tissue below. They are slow-adapting, meaning that they continue firing for as long as the stretch is sustained, unlike some mechanoreceptors which respond briefly to new stimulation and then stop responding if it continues.

We know that when we apply our hands to the skin of the body, we stimulate mechanoreceptors. Impulses are sent through the sensory nerves to the brain. The brain evaluates and responds, sending out impulses of its own through nerves to various parts of the body, causing changes to occur in the diameter of blood vessels, breathing, muscle tonus. If it likes our touch, it can create the changes we associate with relaxation, release of tension, and can decrease the sensation of pain. If it feels threatened by our touch, it will do the opposite. As manual therapists, we are always trying to create changes that make the body feel at ease. We can achieve this through the nervous system.

The nervous system is constantly monitoring its environment, responding to a complex array of input. It would be naive and simplistic to think that response to our touch could be reduced to one set of mechanoreceptors or to ignore all the other countless factors. However, when examining the kind of manual therapy we have come to think of as "fascial," understanding the role of Ruffini corpuscles is a good place to start.

 

Why does it matter?

Does it matter whether we believe we are stretching fascia or not? It matters that we think accurate thoughts about how the body works and what effect our touch has on the body. Understanding how the body actually works will help us work more effectively.

We may still use our hands in ways that we have before. If those methods work to achieve the client's goal, there is no need to abandon them. However, we want to know that how we think about what we are doing is accurate and we want to be able to communicate honestly with our clients. If we discover that our conceptual model is contradicted by what is known about how the body works, then it is time to adapt our model so that our thinking is in agreement with evidence.

Manual therapists need not feel threatened by the news that we cannot stretch fascia. A growing number of Rolfers, practitioners of myofascial release, and related modalities are continuing to use their hands in the ways that have worked for them in the past while adapting their thinking to an updated neurobiological explanation. Many have found that this shift to thinking about the role of the nervous system in manual therapy has led to new, even more effective approaches.



A thought experiment

Schleip proposes an interesting thought experiment. During the time it took to read this article, one’s bottom, if seated, is subjected to more pressure over a longer period of time than most therapists will apply to the hips of a client. Yet most of us are not all stretched out and droopy from daily sitting for extended periods of time. Think about it.

You can hear Dr. Schleip speak about his research.

 

Further reading:

Fascia Science, Stretching the Power of Manual Therapy by Greg Lehman, The Body Mechanic

Fascial Neurobiology: An explanation for possible manual therapy treatment effects by Greg Lehman, featuring guest post by Chris Beardsley

Does Fascia Matter? By Paul Ingraham, PainScience.com

 

Note: I welcome your comments. And since the comment section has grown quite lengthy, I have, for the most part, stopped publishing additional comments since most of the comments submitted do not contribute anything new to the discussion. Thanks to everyone who has participated. I appreciate you stopping by!

I am a Structural Integration practitioner (practicing 7 years). I have always been taught and operated with the assumption that this process is not merely mechanical and not just about hands, pressure and tissue. That is such a compartmentalized faulty way of thinking about the body. Hands, pressure and tissue are factors but there's so much more. Of course all touch, sensation, change is happening via the nervous system. Ida Rolf knew and taught that. We can definitely affect fascial change. It happens via the nervous system. We can contact the nervous system through touch. I agree with the person who said that explaining our work is problematic because words mean different things to different people. Of course a simply mechanical approach is useless and of course bodywork under anesthesia is useless-- the conscious person needs to be there (whether moving or not). So much of this is obvious to me and my colleagues. In the right conditions, with the presence of practitioner and client and the opportunity to work together in the layers of the subtle body, muscle, connective tissue, and more, body tissues can change, adjust, shift, move positions, soften, lengthen, change texture. I do not care in the slightest what "research" shows. If "research" shows that no practitioners ever affect change on bodies, then that research simply sucks and better research needs to be conducted. The right questions weren't being asked. I agree that the change is happening BECAUSE of the presence and ubiquitousness and critical role of the nervous system. But it is faulty to say that "we can't affect fascia through touch."

Does this also include myofascial release with respect to John Barnes and his courses. does this also effect the way we look at doing craniosacral therapy. Are we looking at the difference between direct and indirect myofascial release?

Christopher, I think you're confusing "fascia" with "plantar fasciitis." Fascia is connective tissue and is found throughout the body. It surrounds the muscles and surrounds individual muscle fibers. When you cut up raw chicken, that thin but strong membrane you find beneath the skin is fascia. Some manual therapists believe that it is responsible for us feeling tight and that they can stretch it. However, the evidence suggests this is probably not true. Fascia can be very thin or rather thick in some places. 

Plantar fasciitis is a painful condition of the foot. The plantar fascia is a thick, tendonous structure that runs along the bottom of the foot. It attaches along the ball of the foot and then at the heel. It can become inflamed or irritated and cause pain at the heel or in the arch of the foot. The condition is common in runners but also among dancers or people who spend a lot of time on their feet, especially as they age. There is some disagreement about the nature of plantar fasciitis. By definition, an "-itis" is an inflammation. However, surgeons have found that in cases of chronic plantar fasciitis, there is no inflammation but, instead, a degradation of the tissue. There is also some possibility that some foot pain that is diagnosed as plantar fasciitis may actually be tarsal tunnel syndrome, which is actually a compression of a nearby nerve. 

So, while both share the word "fascia," plantar fascia is a specific structure in the body while fascia is connective tissue that is throughout the body.

Plantar fasciitis can be difficult to treat. My friend Paul Ingraham at SaveYourself.ca wrote an excellent tutorial on treating plantar fasciitis. I recommend it to anyone who suffers with this painful condition.

Thanks for stopping by and taking the time to comment! 

Hi Alice,

Just wondering if you know whether or not the research you present tests the length of time manipulation is applied and whether that has any effect? At page 2 of this article http://www.somatics.de/schleip2003.pdf
it only talks about manipulation applied for 2 min or less, and that any deformation of tissue CAN happen with longer time periods. I know the John Barnes method holds anywhere from 3-10 min on an area of "restriction" This might have been answered in the rest of the article so I am sry if I missed that. Just wondering if you knew anything about whether length of time was tested or not? Thanks!

 In practice, most Rolfers and other structural integrationists rarely apply pressure for over two minutes. However, in this paper by Threlkeld where they tested the properties of fascia, they applied tension to fascia for six hours, during which time a bit of "creep" occurred. However, when the tension was released, the fascia returned to its original shape. I am not aware of anyone who has yet come up with research to contradict that finding.