If We Cannot Stretch Fascia, What Are We Doing?

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 Science-minded manual therapists have learned to adapt to this information, dropping outdated hypotheses and unsupported claims.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, SaveYourself.ca

 

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!

Guest (not verified) says:

Clear picture. Agree. My only point to question involves the Thought Experiment. And these are just my thoughts. Correct me if needed. Static compression serves to inhibit nervous system input, yet prolonged (sitting) encourages ischemia and consequent trigger points, as would the edge of a chair pressing into the hamstrings for a prolonged period. If I were applying a fascial release technique on the gluteals I would incorporate varying mechanical forces, primarily that of tensile and shear, not simply compression.

Alice says:

I think the point that Schleip is trying to make with his "thought experiment" is that if prolonged pressure stretched fascia, we should all end up with droopy, wrinkled derrieres pretty quickly. However, we don't. Sitting erect may cause direct compression, but sitting slumped (as I am at this moment and is pretty common) creates a lateral stretch on the skin. In spite of spending endless hours over the course of many years imposing such mechanical pressures on our bodies, we don't find ourselves with floppy fascia in those places that are subject to such pressure. If we did, it's hard to imagine what we'd look like!

Thanks for stopping by and commenting!
 

Ruth Spaulding, NC LMBT (not verified) says:

More indication that massage is truly a holistic, mind-body connection.

Todd (not verified) says:

Great article Alice. I love the thought experiment!

Alice says:

Thanks, Todd!

Guest (not verified) says:

The pure mechanical model of Rolfing, has been called "mesodermic stretchy corpse" therapy, an allusion to the lack of awareness of the clients conciousness in creating change in the body tissues. Even the Ruffini corpuscles theory is along the same lines, that change is somehow created by external intervention. Schliep finishes his article with an image of bound or tight soft tissue being similar to an stubborn young child, who needs to be coaxed or teased into moving. Tissue will adapt in response to stimulus, intelligently, there is always an intelligent response to a given situation, and it is that which creates the change. In this sense, the more we involve the mind and ANS of the client the better, together with the realisation that human bodies are 70% water.

Anne (not verified) says:

Yes it does seem significant to bear in our awareness that we are working with a living human body. There is an innate intelligence in the tissues of the body, muscle, fascia, cerebrospinal fluid, dural mater, lymphatic fluid, glymphatic system, nerve tissue in its diversity, and so forth. The response of the body always involves the nervous system, in my experience. We therapists don't do something to the physical body rather we engage with the body in its entirety and it responds according to its capacity and awareness at that time.

Guest (not verified) says:

Excellent, Alice,

It's interesting that, in spite of the holistic orientation of most bodyworkers, that the mind-body dualism still prevailed for so long. That is, the notion that it was fascia that changed - without the necessary involvement of the nervous system (and thus the mind).

This is an important corrective which poses the further fascinating question of precisely how do we get our hands on the nervous system? And does nervous system really fully convey the nature of the bodymind changes that result from high-level bodywork?

As you know, I still find important the use of the term "energy" as a general term for what is changing in addition to "structure". Whatever we choose call it, this rediscovery of "nervous system", "energy", "psycho-social influence" and the questions of how best do we affect it through our touch and interactions is fascinating.

Thanks for the good work that raises as many questions as answers.

David Lauterstein

Alice says:

"It's interesting that, in spite of the holistic orientation of most bodyworkers, that the mind-body dualism still prevailed for so long. That is, the notion that it was fascia that changed - without the necessary involvement of the nervous system (and thus the mind)."

And I never quite thought of it that way. Interesting perspective, David.

"This is an important corrective which poses the further fascinating question of precisely how do we get our hands on the nervous system?"

I think the most obvious answer to that question is through the skin. I first read it in Deane Juhan's book Job's Body: "The skin is the surface of the brain." This is not just an interesting metaphor, it is fairly literal. Juhan describes very basic human embryology, how the brain, the nervous system, and the skin all evolve from the same embryonic cells. When we start out as a fertilized egg and the egg starts dividing, the earliest cells are all the same. At a point, they start to differentiate into three layers: the endoderm, which becomes the internal organs; the mesoderm, which becomes the musculoskeletal system; and the ectoderm, which becomes the brain, the spinal cord, the peripheral nerves, and the skin. The skin, the brain, the nervous system, are intimately linked from the beginning, rising from the same embryonic layer.

We have a brain, a spinal cord, and nerves that go out to the periphery - motor nerves to create action and sensory nerves that sense our internal and external environment. Many of the sensory nerves go to the skin. As manual therapists, we touch skin. In spite of the charts and drawings we study showing the body with the skin stripped off of it, what we touch with our hands is skin. We know that when we touch the skin, we stimulate mechanoreceptors which send impulses to the brain and the brain reacts. This is textbook science, there is nothing controversial about that. There are other avenues to the brain: sight, smell, sound, ingesting chemicals, but as manual therapists, our hands on the skin give us a direct path to the nervous system. When we touch the skin, we touch nerve endings that send impulses directly to the brain. Contemplating that gives one a different perspective.

My Russian massage teacher Zhenya Kurashova Wine first pointed this out when I first studied with her many years ago and I thought, yes, yes, and went on, like most manual therapists, to thinking about everything but the nervous system and the skin - muscles, tendons, ligaments, joints, circulation, etc. I didn't think much about exactly what brought about changes in pain levels, how the muscle went from being contracted to being relaxed, how the client moved from being agitated to being calm.

Of course, how I communicate to my client, how I create an environment where they can feel relaxed - all those psycho/social factors - are important, too, and they, too, are having an impact on the brain. But for now, focusing on the corporal part of the equation, eventually I came to realize that it wasn't my mechanical pressure on fascia or muscle that made the change in tonus in a matter of a few minutes, but the nervous system which controlled that tonus in the first place.

I've been curious about the Rolfing under anesthesia references that Dr. Schleip had mentioned and wrote to ask him about it. He was kind enough to respond and sent me the following link with an apology for the crudeness of it. It occurred before he'd been trained how to do proper research but it's still fascinating.
http://www.somatics.de/Talking%20to%20Fascia.htm

David, I thank you for stopping by and for sharing such thoughtful comments. I agree that there are many questions for us to think about. Some have apparent answers, some do not. It is in asking the important questions, thinking about them carefully, and engaging in thoughtful discussion that we are able to continue to expand our understanding of how the body works and how we, as manual therapists, can help our clients live with less pain and more ease in their bodies. I appreciate your contribution to that process.

Guest (not verified) says:

The thought experiment doesn't provide a workable analogy. Sitting is compression, true. But sitting doesn't provide lateral stretch; therefore, it couldn't cause the stretched-out drooping Dr Schliep refers to.

Alice says:

I understand your point, but sitting slightly slumped (as I am doing right now and which many people do quite a bit) does put a lateral stretch on some tissues for an extended period of time. Most manual therapists' direct contact with any singular section of the body lasts for a few minutes, yet many of us can remain in a position that puts mechanical pressure on an area for hours on a daily basis without any apparent "stretching" of tissue. Schleip's point is that every day we are subject to mechanical pressures that exceed the pressures applied my  manual therapists and yet we don't find those areas "stretched."

Nicki Lee (not verified) says:

Thank you Alice, this has been very interesting and helpful. Like many manual therapists I've had to abandon most of my explanations to clients (and myself) about what is actually happening to them when I work. I have kept the techniques, of course, because there is certainly evidence reported and felt by both me and the clients that the tissues respond and the clients feel better, but it would be nice to have 'tidy' reasons to give them! I guess this will have to wait some time.

Alice says:

Nicki Lee, I'm glad you found it helpful. It can be uncomfortable for us to give up some cherished ideas. It can be even more uncomfortable learning to live with ambiguity, with not knowing. However, if we are committed to understanding things as they are, rather than as we hope them to be, to asking the difficult questions and looking at what evidence actually is telling us, it can be quite exciting and a whole new world opens to us.

I once worried that my clients would think I didn't know what I was doing if they asked a question and I admitted that I didn't know the answer and that, in fact, science did not yet have an answer. However, I've found that they appreciate my honesty, my commitment to reality, and to continued learning.

Thank you for stopping by and leaving a comment.

John C. Barnes, RMT (not verified) says:

Hi Alice, great to see your thoughtful comments re-posted on linkedin.
It has never been my understanding that we actually "stretch" the fascia in what is traditionally thought of as stretching, as you would stretch a piece gum. Fascia is collagen and elastin fibers suspended in a ground substance. Some of the bonds between the fibers are strong and some are weak.There are traditionally two ways to alter the fascia and several ways to impact the surrounding tissue and the body in general through fascial work.
How one might alter the fascia: think of fascia as a net. When secured at all four corners a net can have great tensile strength. When stressed from only one corner it deforms nicely, but does not really change its inherent structure or shape. this is how fascia stretches in normal everyday situations.
Now imagine that one third of the knots could untie and re-tie themselves. Under the right conditions you could alter the length or width of the net. The way that i have been taught and practice fascial work is similar to the structural integration approach; you apply pressure into the tissue and then glide along/with it to achieve a change. What is happening?
1) the pressure has an impact on the ground substance, changing it from a gel to a sol state. This facilitates the rearranging of fibers within the ground substance.
2) The sustained glide (or what is often referred to as a "stretch"), in the presence of the pressure and inherent piezoelectric effect, cause the weak bonds to temporarily release and reform in a new configuration. I am less clear on the mechanism of gentler direct/indirect techniques. I will admit to good success with them, but not as clear on why, perhaps it is a neurological response.
Next we come to restriction or adhesions between layers of fascia. This can be between myofascial layers, between the fascia around ligaments or the fascial envelope over the serous membranes around viscera. This is the "release" part which is not always an actual "release".; but again is not a stretch in the traditional sense of elongating a pliable substance.
Nowhere in any of this do we need to actually stretch a fascial sheet to achieve a therapeutic effect while working with fascia, but we can still have a profound impact on posture and function.

The first problem with your objections is in the narrow definitions imposed on the discussion and the use those definitions to justify the objection. The second problem is the imprecise language that we use as bodyworkers to explain what we think we are doing.

Alice says:

Hello, John! Nice to see you here!

I have just now embedded a link to a page where you can download Schleip's paper (I had difficulty before, so pardon the delay), so if you haven't read it, I recommend you read it. He addresses some of your points more articulately than I could, plus he provides some references.
http://www.somatics.de/FascialPlasticity/main.htm

Regarding Ida Rolf's hypothesis that mechanical pressure causes a change in colloidal ground substance, the change from gel to liquid persists only while heat or mechanical energy is being applied. As soon as they are removed, colloidal substance returns to its original state. So the thixotropic hypothesis has been rejected as an explanation since it would not last after the practitioner removes their hands.

Piezoelectricity has also been rejected as a hypothesis. (And remember, these are hypothetical explanations only. They have never been confirmed by any evidence.) Schleip explains why: "The half-life span of non-traumatized collagen has been shown to be 300-500 day, and the half-life of ground substance 1.7-7 days (Cantu & Grodin 1992). While it is definitely conceivable that the production of both materials could be influenced by piezoelectricity, both life cycles appear too slow to account for immediate tissue changes that are significant enough to be palpated by the working practitioner." While piezoelectricity is an interesting phenomenon and its effect has been documented in bone, there is no evidence that anything a manual therapist can do with their hands has any effect on it or that it is clinically relevant.

Did you read the paper referenced above about the disappearance of "fascial restrictions" under anesthesia? Schleip had the opportunity to test three subjects before they were put under general anesthesia. In two of them, if their arms were raised above their head in a supine position, they would not extend far enough to rest upon the table. Schleip assumed this was due to fascial restriction. However, under general anesthesia, their arms moved easily all the way to the table. Loss of muscle tonus is universally observed in patients under general anesthesia and they have to be moved very carefully because of it. So, their restricted ROM before anesthesia could not possibly be due to fascial restrictions. It also further supports that the thixotropic and piezoelectrical explanations are not plausible.

If you haven't read the papers, I hope you'll take time to do so. They are not difficult and I think you'll find them fascinating.

Thanks for stopping by and leaving your comments!

 

 

 


 

Adele (not verified) says:

I am new to the Holistic Massage Practice, studied through Healing Hands International Massage Academy. I joined the Massage group to learn more, and I must say that I find it intellectually informative. This article of Fascia, muscle stretching has been very interesting. In my thinking at the end of the day, belief is the most important factor. The Brain is so complex and powerful, as we have seen in so many examples:
“The man that freezes to death in broken freezer” www.snopes.com/horrors/gruesome/freezer.asap
“We know that the brain does have the ability to change and reorganize itself in regard to the functions it performs. This process is called neuroplasticity, and it is a gift on par with neurogenesis, the brain’s ability to generate new cells throughout our lifetimes.”
http://www.healyourlife.com/author-david-perlmutter-md-facn/2011/07/wisd...
In a nutshell; I you and the client believe, then our touch can have the brain respond to relieve and just maybe heal.
Adele van Jaarsveld
South Africa

John C. Barnes, RMT (not verified) says:

I appreciate the insights and information. Some of the conclusions however do not necessarily follow as absolutes.
1) I don't suggest that a possible change in ground substance is anything but temporary, in fact to meet the theory it needs to be short lived.
2) I think it is interesting that more information about nuero-feed back from fascia is coming to light. It also communicates proprioceptive information from paripheral to core fascia (and presumably on to the brain, as the information is registered in our awareness). The fact that both decreased muscle tonus and decreased fascial inhibition are exhibited under anesthesia does prove that the fascia was not part of the cause of decreased ROM. The need to be careful moving limbs would apply to damage to fascia as well as muscle tissue.
3) your previous comments about collagen fibers not stretching until near breaking point is also a red herring, as I few would suggest that the individual fibers are changed in length. It is the tissue itself that needs alter its resting length or shape.
Just trying to keep the logic sound.

Alice says:

John, have you read Schleip's paper? He goes into detail on pages 2 & 3 regarding the experiments investigating plasticity of collagen fibers. Read his paper and get back to me.

Do you have any studies that do demonstrate that you can change the shape of fascia? Schleip is one of the top researchers in the field. He is the one who discovered the small contractile fibers in fascia. Go to his website and read his papers. He's very aware of the research out there. And he's pointing out that the evidence says that we can't stretch fascia. That being the case, there has to be another explanation.

Someone recently posted a very eloquent comment about this at the SomaSimple forum. PatrickL writes, in part:

"Science is more about what is most likely and what is less/least likely. I cant say with 100% certainty that you're not feeling fascia when you palpate a client. I can say with 100% certainty however, that you are not feeling the fascia in isolation . . . Science is a process we use to make collective sense of our unavoidably subjectively experienced lives. Science is about minimizing the number of assumptions we make in our efforts to explain the world around us.


The neuroscience literature does not lead us to a point of absolute certainty. I can not say with certainty that I am definitely 'right' to have a neurocentric explanatory model for my work as a manual therapist. But Neuroscience/pain science research and the palpation studies . . .  cast massive doubts over the reasonableness of other commonly practiced and widely/blindly accepted models that rely heavily on sensory perception as a means for assessing, explaining and treating a given clinical presentation."


Read the rest of his comment here.

Alice says:

My apologies for the odd change of typeface. Unfortunately, I have no idea how that happened, have no idea how to correct it, and my webmaster is rather busy right now. Please pardon the weird formatting.

Alice says:

I've just added a video of Schleip speaking about his research. Sorry I didn't think of this sooner.

Giles Hinchcliffe (not verified) says:

The content here is fascinating, thanks Alice. I work with a combination of sports massage and holistic work. I have no knowledge of much of the terminology you use. Nevertheless I have 10 years experience.

To me, most of the outcomes depend on my client's mind. If I provide the bodywork they want / expect, then they will get the outcome they want. Some clients believe in No Pain No Gain and others are quite the opposite. So I presume their brain has a mindset that is triggered by my touch. My job is to provide the correct linkage.

Certainly, most clients say they get little or no benefit from the beauty soft touch style bodywork, so depth does have an impact - perhaps on different levels of the nervous system. If only we could discover which nerve paths to work on for maximum effect. I have found myself recently massaging the clients neck whilst simultaneously massaging other areas - intuitively it feels effective and the feedback is positive.

Apologies for changing the tone to hands on, Alice, but it is what works in reality that interests me and my clients. Thanks again for the stimulating information.

Giles

Alice says:

Giles, no need to apologize. As for what "works:" many therapists are not so concerned about why something "works" or exactly how the body works. However, I think we should be committed to thinking accurate thoughts. If we understand how the body works and how our touch affects it, we have the potential to be more effective.

Most manual therapists have focused their attention on muscles, joints, ligaments, tendons, fascia, and have very little understanding of the nervous system. I know, because I'm one of them! It's only been during the last two years or so that I've taken the time to learn and there is still lots to know. However, as daunting as it may seem at first, it's no more difficult than the other things we have learned.

A person may believe "no pain, no gain" but that doesn't mean that it's true. Learning to work with the body, rather than trying to impose ourselves on it, takes attention. However, the brain is the master controller. What feels pain? What makes us feel less pain? What causes muscles to contract? What causes them to relax? The nervous system. How can we learn to work with the nervous system? By studying it and understanding how it works.

Anyway, Giles, thanks for stopping by and taking the time to share your thoughts!

Alfons (not verified) says:

They ARE all stretched out and droopy from daily sitting for extended periods of time.

But I guess that's not because of fascia seat-a-pulation, but because they sit on the anus and the pelvic floor muscles get weak (just like the feet when using high inlays inside shoes that fill up the 3 arches)

Alice says:

Perhaps this is where the fashion of "droopy drawers" came from, to cover up droopy butts.  ;-)

Thanks for stopping by and taking the time to share your thoughts.

David (Dahveed) Gross (not verified) says:

For me, it was brought home that there is a neural component to myofascial release when I was exploring the trigger point work of Bonnie Prudden. In her books, based on Janet Travell's work, Prudden offers trigger point routines for different ailments. In particular, I was exploring Prudden's routine of several trigger points for tennis elbow. I did a length test for biceps before and after the tennis elbow routine and found an increase in length for the biceps. Since I was not greatly deforming any tissue, I interpreted the change as being neurological in origin.
New topic: collagen only stretches before it breaks. My understanding is that this is based on experiments on strands of collagen teased out of rat tails that were put under tensile stress. I wonder if collagen might stretch, or change shape, differently in the living juices of the body.

Alice says:

"I wonder if collagen might stretch, or change shape, differently in the living juices of the body."

I don't know, all I know is the research the Schleip refers to in his article on plasticity. I figure since fascia research is his field, he would stay pretty informed on the research.

As you point out, brief periods of direct compression on a small area can sometimes create a change. It doesn't make sense that fascia would be changed in any significant way. If the change were occuring through the nervous system, then it starts to make sense.

Fascia is there to hold us together. I'm not sure that we want it to be released, even if we could.

Guest (not verified) says:

I am right on your page with this one!

As a structural integrator (KMI) I have found that by engaging the tissue can change the texture and the response. For instance, if you have one shoulder hanging and one hooked up you have one locked in eccentric contraction and one in concentric contraction. When you engage the fascia you are giving an opportunity for some fluid to get in to the dry parts. Information gets through water way faster than mud. Hydration can come from light or deep touch, but I have found that both are effective and the person you are dealing with dictates the approach. Altho there are times when memory, be it fear, trauma, sadness, abuse......has to be dug up in order for a lasting release. Of course, the emotional state is a part of the neurological response, which lives in the "physical" body. How can we separate the bodies? The whole point of connective tissue study is to NOT separate the bodies.

Alice says:

"When you engage the fascia you are giving an opportunity for some fluid to get in to the dry parts."

Can you provide some evidence that the tissue is "dry" and your pressure on it gets "fluid" into it? What fluid? Interstitial fluid? Blood? How exactly does this happen?

"Hydration can come from light or deep touch . . . "

How do you know the tissue is dehydrated? Can you provide some evidence to support your statement that your touch hydrates tissue? And if your touch is bringing fluid into tissue in one part of the body, isn't it taking it away from another part of the body? Are you saying that the discomfort some people may feel is a problem of fluid distribution?

"Altho there are times when memory, be it fear, trauma, sadness, abuse......has to be dug up in order for a lasting release."

Not sure what you mean by this. I am not a trained psychotherapist so I do not intentionally "dig up" fear, trauma, abuse, etc. That would be outside of my scope of practice.

"Of course, the emotional state is a part of the neurological response, which lives in the 'physical' body. How can we separate the bodies? The whole point of connective tissue study is to NOT separate the bodies."

David Lauterstein earlier pointed out that, in spite of a holistic approach, many manual therapists subscribe to dualistic thinking, believing that body and mind are separate. Mind is what the brain does and yes, our emotional state is one manifestation of the nervous system. When we affect the "physical" body, we affect the emotional state, and when we affect the emotional state, we effect the physical body. There is no separation, we cannot have one without the other.

Thanks for taking the time to share your thoughts!

Guest (not verified) says:

Hi Alice,

I think what I am getting from Schleip's research is:
1. fascia is contractile because it can have "tonus"
2. this fascial tonus occurs purely as a result of nervous stimulation
3. sustained stimulation of the ruffini corpuscles reduces the tonus of contracted fascia resulting in the tissue "release" felt by bodyworkers
4. fascia can be lengthened beyond its resting tone but only through a process of microfailure and recovery

Is that over simplistic?

Kind regards

Henry Johnson

Michael (not verified) says:

Very interesting info on stretching fascia for our massage clients here in Manhattan Beach. We specialize in trigger points, so it's good stuff to know. thanks!
Massage Manhattan Beach

Alice says:

Michael, thank you for stopping by. I apologize for the delay in putting up your comment.

I assisted at NMT seminars for 10 years and had the privilege with working with some astounding instructors. They encouraged critical thinking, did not mind being questioned, and in return would often challenge you. They helped me to learn to be more accurate about what I said, think about my sources, and required me to support my statements and ideas. They were some of the most science-minded people I knew in the profession and I still consider them models. To give an example: we had a dentist in the TMJ seminar and Judith Walker encouraged him, at the beginning of the seminar, to speak up if he thought anything she said was incorrect. She said they'd researched the material thoroughly, but if he questioned anything or had new information, she wanted him to tell her. She was committed to accuracy and did not want to lose credibility by teaching something that was incorrect. I really admired that!

As much as I appreciated what I learned in those seminars, even then I saw a few holes in what we were told. Travell & Simons changed their hypothesis in the second edition of Volume I and I thought there were some obvious flaws in it. However, it was the best we had at the time and I accepted it.

When I ran across this neurological hypothesis for trigger points proposed by Quinter & Cohen, I found answers to some questions that had not been satisfied by previous explanations. That was pretty exciting!

I'll have to write about that more in detail another time, but you might enjoy their paper. Every time I read it I learn something new and it's provided a little different way of thinking about trigger points. For a massage therapist, it's definitely not light reading! But it's also not that hard to understand if you're patient, take it a little at a time, and come back to it again a few times. I hope you enjoy it!


 

Dan Pope (not verified) says:

Great post. I'm presenting my doctoral research at CSM soon and our research was on how spinal manipulations work. it appears the old biomechanical theories are fading by the wayside and the nervous system is the new frontier when it comes to spinal manipulations as well. Great article!

Alice says:

Yes, the fall of the structural model is hitting the chiropractic profession, too, and many are adapting a more neurobiological approach. Good luck with your research!

John C. Barnes, RMT (not verified) says:

I must say that i have followed all 3 international fascia congresses with great interest. The empirical research is always interesting and can start to inform the way we work. Often it challenges what we think may be going on when we assess and work with tissue, especially fascia, and sometimes re-enforces it.
The main problem I have with transferring this to practical bodywork is the imprecision in terms around treatment - what they mean and the vast variation in application.
The language around what we do or think we are doing or feel we are doing when we work on someone is so imprecise that it also leads to a lot of misunderstanding. Two individuals can consider themselves MFR practitioners and have totally different approaches to treatment. The same individual may use very different approaches to treat different clients or even on different areas or structures on the same client. I rarely call what I do "myofascial release" anymore, but rather try to refer to it as "fascial work" partly because I work with visceral fascia, myofascia, periosteum, fascia around ligaments etc., but also because there may be no "release" involved.
To say that MFR does or doesn't have a specific effect is almost meaningless - what type of work are they doing? Who is doing it? What type of tissue are they treating? What is the nature of the "restriction" or injury that is being treated? What change are they trying to achieve? Do any two individuals use exactly the same technique? Do different bodies react differently, thereby changing the way one needs to work? It is almost impossible to quantify the interaction between therapist and client, between our hands/elbows/fingers etc. and the client's tissue because it is not static. It is an interaction that changes as we work and as the tissue changes and as that change is communicated to the client and then back to the tissue and finally back to us.
I remember being in massage school and thinking of ways to test some of the techniques I was learning, to see if they were really as effective as stated or if they achieved the results that my instructors said they did. It always came down to a mechanical model - constant and reproducible force/speed etc. I soon realized that good therapists don't work that way. We adapt pressure, speed, type of stroke, length of stroke etc. to the body and change it as the body changes.
It is extremely difficult to transfer empirical research on tissue to the live interaction between client and therapist.

Alice says:

I think it is possible for us to be able to communicate about what we do, how we do it, how the body works, what we think we are doing, what we know for sure, what is speculation. If we cannot, then might as well quit talking about it. Certainly won't be able to teach anyone anything.

Words have meaning. We have to agree on their meanings. Manual therapists are often not very good about this. "Myofascial release" can, as you point out, mean just about anything. People ask me all the time if I do "myofascial release" and I have no idea at all what they are asking me. My response is to ask them questions about what that means to them, what are they looking for, and if it sounds like something I do, I'll let them know. If not, I'll direct them towards someone more appropriate. 

One of the reasons I especially like the SomaSimple forum is the dedication to precision and clarity in language and thinking.

The therapeutic interaction is like a conversation. A good practitioner does not follow a script but, like real life conversations, every therapeutic encounter is unique and evolves. When we are inexperienced, we have to follow a script because we don't have enough experience to "speak" fluently. However, eventually we need to learn to have real conversations with our clients if we want to be real therapists.

As in real life with conversation, just because each conversation is unique does not mean we can't learn a language. This is why it is more important to learn principles rather than techniques. Techniques are fine as long as they are exactly what that client needs at the moment, but principles can be applied to any situation when they are understood.



 

John C. Barnes, RMT (not verified) says:

I agree that words have meaning; unfortunately not always the same meaning to different people in different situations. There is no one common agreed upon definition of MFR, and within those numerous definitions there is often a great deal of variation, depending upon the structure, the type of injury or "restriction" (also imprecise) or the desired effect.
We do need a common language to communicate effectively and accurately; unfortunately, with much of bodywork, we are trying to construct a tower of Babel.
Massage/bodywork is both an ancient and new tradition. There is really no common syllabus in schools or common minimum standard for education. Basic minimum training varies from 150 hrs. to a three year undergraduate degree and that's just in North America. People invent new terms faster then the tech world. I invented my own term - Integrated Fascial Therapy - to describe what I think I am doing and what I teach. Did I have to run that past anyone or register an official definition with a governing body anywhere? No, I just made it up and started using it.
There are indeed basic principles of treatment in what I do and they can be taught and described. The problem arises when someone with a different set of principles or definitions tries to interpret what I am saying in light of their understanding. There is just so much nuance imbued in what we are trying to communicate that we often fall back in imprecise terms because the right word does not seem to be available. There is a saying that the Inuit have 50 words for snow; perhaps we need to agree upon some new words.

Mark Glesener D.C. (not verified) says:

Thank you for starting such a vigorous conversation. I found your blog through mikerenolds.com. I have found the fascial research and the technique of Fascial Manipulation, taught through the Fascial Manipulation Association, to be most enlightening and beneficial. The Stecco family and their compatriots have researched and explained the anatomy and physiology of the fascial system to my satisfaction. I am merely a clinician attempting to resolve pain in my patients. The Fascial Manipulation technique has given me new insites into radiating pain syndromes and long term recovery in chronic conditions. This has allowed me to address chronic conditions which have been recalcitrant to traditional therapies.

Alice says:

I'm glad you enjoyed it.

I don't know enough about Stecco to comment. So far, no one has demonstrated that you can stretch fascia and there is evidence to the contrary, as Schleip points out in his paper. Even though his paper is several years old, Schleip recently made a statement to Paul Ingraham of SaveYourself.ca supporting the articles that Paul has written on fascia, so if there were any recent research that demonstrated that it is possible to deform fascia, I'm sure he would have pointed that out.

Ingraham's detailed analysis of the research on fascia is a must-read for anyone who believes they are manipulating fascia.

The real question is this: what does the research show us? Our opinion doesn't matter. If we make a claim, exactly what evidence do we have to support it? What we observe from the outside is one thing. The story we make up about what might be happening on the inside is quite another. Do we want our stories to be more accurate? Or do we want to hold on to them in spite of evidence to the contrary?

We may still do the same thing with our hands. If it works well for our clients, there's no reason to change that. But our explanations need to change to fit the science.

Guest (not verified) says:

Send me a scientific study that suggest this because I cant use it in my article if I don't. Thanks

Alice says:

 I'm not sure what you are asking for. If you click on the link to the article on Fascial Plasticity, highlighted in blue, that will take you to the paper and all of the citations are there. 

Guest (not verified) says:

Gotcha. Thanks.

El (not verified) says:

One thing, it is impossible to do Rolfing or any structural integration under anesthesia because it requires movement as part of the hands on experience. It is not just about fascia, it is about whole body anatomy. Of course it involves neurobiology, you cannot achieve true integration without. This is hardly an aha moment.

Alice says:

 My understanding is that what was done, by Milton Trager and others, was that they applied their hands to the skin of the person under general anesthesia and applied a slow, sustained stretch to the skin, as is done in Rolfing, myofascial release, and other "fascial" therapies that claim to stretch fascia. If, in fact, they could mechanically stretch the tissue, as they claim they can, there should have been a difference in the subject's range of motion, for example, after they came out of anesthesia. There was not. This is not the only evidence that we cannot stretch fascia, just one piece of evidence.

"Of course it involves neurobiology . . . " This may be obvious to you, and this may be obvious to me, but the vast majority of manual therapists will insist that they are deforming fascia with mechanical pressure. This is what is still being taught and what most still believe in spite of the evidence to the contrary. Fortunately, a small but growing minority are recognizing this and are adapting their thinking to the evidence.

El (not verified) says:

You have to have the client move as you apply pressure, Ida always called for movement. I took KMI a few years ago Tom never says that you are just altering fascia. He has been promoting whole body anatomy for quite some time. He explains that you reeducate the body and mind. By the way Schleip has a program called fascial fitness and I do not think he completely agrees with your article. Check it out.

Alice says:

The issue under discussion is not whether structural integration requires movement, the issue under discussion is specifically whether one can deform fascia with manual therapy, a claim made by almost all manual therapists and instructors who teach fascial manipulation. Milton Trager is dead so we cannot discuss the matter with him, but Robert Schleip is not and you can ask him yourself why he chose to mention the anesthesia experiments in both his paper and in an interview. Apparently he, Trager, and others thought it relevant. It demonstrated that change in the tissue did not occur when the nervous system was taken out of the picture. This is contrary to what most fascia enthusiasts believe: that you can deform fascia with manual therapy. 

There are many instructors teaching "fascial" manipulation and it is beyond the scope of this article to address the specifics of each and every one. Besides, some are known to be litigious and do not tolerate public questioning of their ideas. However, if one examines their public writings, there is an overwhelming focus on connective tissue and a glaring absence of the role of the nervous system. What they teach is stretching fascia, plain and simple. I have been through classes of some, I have listened to DVDs of others, I have read the written material of many, including recent online discussions by prominent fascia instructors. I have spent many hours in discussion with their instructors and students and have been worked on by their instructors and students. I have been the recipient of over 20 Rolfing sessions myself and an uncounted number of sessions involving myofascial release and other fascial work. Hardly a day goes by that I am not in conversation with a manual therapist who believes that they can manipulate fascia. Outside of a very, very small minority who have adopted a neurocentric approach to their work, every one of them has indicated that they believe that they are changing the shape of connective tissue by applying pressure with their hands. I cannot recall a single manual therapist who pointed to the nervous system as the agent of change. Almost unanimously, they indicate that they believe that they are stretching fascia. When the idea that "fascial plasticity" is actually neurobiological is introduced to any group of fascia enthusiasts, you will get an immediate protest and they become irate very quickly. When asked to provide evidence that they can stretch fascia, they will present studies that are either irrelevant or actually contradict their own statements. The belief that you can stretch fascia is almost universal among massage therapists, physical therapists, and personal trainers. If you doubt this, google "stretch fascia" on the internet and read the various websites. It's all about stretching fascia, not about the nervous system. 

The science has shown that we cannot stretch fascia in spite of this being commonly assumed among manual therapists. Schleip is the only fascia researcher that I'm aware of who has admitted this clearly and publicly. Science-based manual therapists outside of the fascia community have been pointing to a neurobiogical explanation for years and have suffered vicious attacks because of it, including threats of law suits by a well known fascia guru who does not tolerate public criticism of his ideas. So much for free intellectual inquiry. I myself have been the target of disrespectful behavior by fascial proponents who have tried to discredit me personally but still failed to point out exactly where my information was wrong or produce one shred of evidence that one can deform fascia. 

There is tremendous resistance against accepting that evidence indicates that we cannot stretch fascia. Many, many instructors have built lucrative careers and modality empires on teaching fascia through workshops, books, and DVDs. For them, the fall of fascia is threatening economically and professionally. Many manual therapists have built their practices on the idea that they are stretching fascia after spending many years and paying thousands of dollars training to learn how to stretch fascia. It is hard, after that sort of investment, to face the possibility that what you were taught was wrong.

However, it does not have to mean that all is lost.

Looking at the evidence and accepting that it suggests that we cannot stretch fascia does not have to be threatening. What they actually do with their hands may be perfectly fine. They don't necessarily need to change what they are doing with their hands; they need to change their thinking about what they are doing. Those who have built empires, though, on the idea that one can and must stretch fascia have a lot to lose. It is no wonder that they hold on to the idea so doggedly in spite of evidence to the contrary. This is an example of why we need to recognize that any model we have is just that, a model, and not the thing itself. If we are committed to understanding how the body actually works, rather than our ideas about how it works, we are then free to change our thinking when the evidence indicates that we need to do that. However, if we are committed to a particular modality or dogma, when we are confronted with evidence that contradicts it we have a very, very difficult choice. If we are honest, we have to go with the evidence, no matter what discomfort or cost that may bring. 

The level of intense emotion that is aroused in many fascial practitioners when they are presented with evidence that contradicts their beliefs about fascia indicates that they suffer great mental pain as a result of being confronted with the idea that one cannot stretch fascia. This idea is central to what they believe they do. Were the concept that change is neurobiologically mediated commonly accepted in the fascial community, such an assertion would hardly lift an eyebrow. Instead, there is resistance at every turn. I am not concerned. Little by little, manual therapists are beginning to become aware of the role of the nervous system in our experience of pain, in ease of movement and lack of it. It will take awhile but it takes about 20 years for the research to filter out to the practitioners. It is happening. I'm happy to be a small part of getting the information out there.

John C. Barnes, RMT (not verified) says:

it is interesting that Robert Schleip constantly refers to the plasticity of fascia. I do hope you realize that plasticity implies the ability to deform and retain the the new deformed shape/form/length. If it is the word "stretch" that has you you hung up, perhaps a new description or new word for the altering of the the length or shape of fascial tissue is what you are seeking. Fascia is not collegen; fascia is not ground substance, fascia is not elastin fibres, it is an irregular connective tissue composed primarily of these components. Also included in fascia are neuroreceptors and other structures.
It is argumentative and possibly counterproductive to deny the ability of fascia to respond to manual intervention by altering its shape and length, simply on the basis of the word "stretch". If you accept that it does deform and retain its altered shape/length, but don't like the word stretch, perhaps you should propose a new word to describe the phenomenon.
Theories are just that, theories. They are not facts and we should not get caught up in defending a particular possible explanation around why something happens. At the same time we can not deny the result simply because the prevailing theory is found wanting.
Fascia does alter in shape and length in response to manual intervention. The term "stretch" may or may not be the best word to describe this phenomenon, but it is what has been the common accepted term and the definition of words changes as new usages are added to the common vernacular. That is a fact of language.
Please feel free to invent a new term and see if gets into common parlance.

I really think the significant discussion is around the mechanism of the altering of the shape of fascia - how does it adapt to manual intervention? - not what you call the process.

Alice says:

"It is interesting that Robert Schleip constantly refers to the plasticity of fascia. I do hope you realize that plasticity implies the ability to deform and retain the the new deformed shape/form/length."

I understand that. I am using the terms "deform" and "stretch" interchangeably in this case. Many massage therapists do not understand the term "deform" and that is why I use the word "stretch." They believe that they can put their hands on the skin, press into it with a firm, sustained stretch on the skin, and that this will stretch the fascia below. They believe the fascia is "tight," that their mechanical pressure will stretch it out, and that it will remain stretched after they remove their hand. This is the explanation, first offered by Ida Rolf, for the difference felt before and after treatment. This is the central tenet of Rolfing, myofascial release, etc., and it has been demonstrated to be wrong. However, manual therapists continue to hold onto this idea very tightly. They produce no evidence to support their assertion that they can deform fascia.



"It is argumentative and possibly counterproductive to deny the ability of fascia to respond to manual intervention by altering its shape and length, simply on the basis of the word 'stretch'."

This has been the central tenet of fascial therapy, manual therapists believe it and defend it, and it is a claim that is no longer defensible and should be replaced with something that is defensible. That is the point I and others are trying to make. There is a huge amount of resistance to it. Claiming to mechanically stretch fascia with manual therapys is contrary to what is known about how the body works. Promoting accurate information and accurate thinking is good and productive. Those who have come to understand the role of the nervous system in manual therapy find it useful and find that a better understanding of how the body works leads to better outcomes with their clients. It makes a lot more sense than belief that the tissue itself is undergoing a compositional a change.



"If you accept that it does deform and retain its altered shape/length, but don't like the word stretch, perhaps you should propose a new word to describe the phenomenon."

The tissue is not deformed. That is the point. 

 

"Theories are just that, theories. They are not facts and we should not get caught up in defending a particular possible explanation around why something happens. At the same time we can not deny the result simply because the prevailing theory is found wanting."

Yes, our models are there to describe that which we observe but are not the thing itself. We should examine whether our models are plausible or not. We cannot ever be completely right, but we can get less wrong over time and that is the point of learning how the body works so that we can think more accurately about it. If our model is indefensible or cannot explain what we observe, it is time to change it or give it up.

For instance, Melzack and Wall originated the Gate Theory of pain which examined the experience of pain, which did a very good job of describing some things we knew about pain. However, that model left a lot of questions unanswered, did not account for many common observations. Later, they went on to develop the Neuromatrix Theory of pain. This model model goes beyond Gate Theory and explains many aspects of pain that were confusing before. This can help lead to better treatment of pain. The accuracy and plausibility of our models does matter. 

 

"Please feel free to invent a new term and see if gets into common parlance."

There's no need to invent a new term in this case. What is needed is a change in the way manual therapists think about what they are doing. 

John C. Barnes, RMT (not verified) says:

Alice I hate to seem picky and argumentative but your response is both confusing and contradictory. You say that you are using the term deform and stretch interchangeably and then you state that "The tissue is not deformed". Although this is consistent, it flies in the face of the plasticity of fascial tissue. It can't be both plastic and unable to be deformed.

Alice says:

 Don't be confused, John.

"Fascial plasticity" is a misnomer. That's the point. There is no fascial plasticity. We cannot stretch/deform/change the shape of fascia.

If anyone wants to challenge that statement, I will only entertain it if they produce actual evidence. Since Schleip himself, who is very, very familiar with the research out there, admits we cannot stretch/deform/change fascia with manual therapy, I doubt anyone else is going to come up with any convincing evidence.

Meanwhile, we have a perfectly good existing explanation for how the change in tonus/range of motion/sense of release comes about that is supported by science: the nervous system.

The term "fascial plasticity" should be dropped. Like the term "muscle memory," it is misleading and encourages manual therapists to hold onto the idea that the problem is in the tissue and that they can change the tissue with their hands.

I've heard all the arguments. People put up dozens of links to studies they clearly either have not read or else have not understood because so far, none of the studies anyone has put forth as evidence supports the assertion that we can stretch/deform/change the shape of fascia. Schleip admits this. If they think they have something new that Schleip doesn't know about, fine, bring it forth, but so far no one has provided evidence to support this idea. They invoke personal experience and outcomes, but outcome is not evidence that their hypothesis is correct. And yes, our explanation does matter, I've already explained why. Some people, when they realize they don't have facts, just hurl insults. There has been enough of that, one can find it in any forum where the subject is brought up. I will not have more of that here, we've had enough of it, it just wastes time and distracts from the real issue at hand. Honest inquiry, yes. But anyone who disputes the statement that we cannot deform/stretch/change the shape of fascia, must provide solid evidence to support that statement. 

If you read Schleip's papers, he continually refers to the nervous system, to mechanoreceptors. Why he feels the need to keep his focus on fascia in spite of that, I can only guess. You'll have to ask him that yourself.

Meanwhile, I will continue to point out that we can only touch skin, which is highly innervated, and that change in tonus is brought about by the nervous system. It's a revolutionary idea for manual therapists and it is not my idea. I am merely the messenger. It is in line with what we know in pain science and about the science of our perceptual experience of the body. Many different branches of research point in this direction. Manual therapy has been slow in catching up with the science but it's happening. There's a neurobiological revolution going on and my goal is to bring information about it to my colleagues who have not yet gotten the word. 

Rachel (not verified) says:

The problem with taking a stand---'fascia cannot be stretched (or deformed )' is that, when a person is touched, we see and feel that it is being changed, in shape and not just position. It depends on how large of a piece of fascia you are talking about, no?

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