Basic Science and Implications for Conventional and ...shop2.fascialnet.com/media/pdf/9a/61/c9/preview529758b3da27d.pdf · Thomas W. Findley, Robert Schleip (eds.) Fascia Research

Thomas W. Findley and Robert Schleip, Editors

Basic Science and Implications for Conventional andComplementary Health Care

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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 geneticand molecular aspects of the extracellular matrix. However, the study of fascia and its function as an organ of support has been largely neglectedand overlooked for several decades.

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 inthe 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 inducedhydration 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 ResearchBasic Science and Implications for Conventionaland Complementary Health Care

München ⋅Jena

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Welcome to the first scientific exploration of fascia froman interdisciplinary perspective. This book contains 16full-text articles from the leading scientists in fasciaresearch. These articles explore a diverse range of topics:the microdynamics and mechanotransduction, myofi-broblasts and fascial tonus regulation, fascial anatomyand biomechanics, the sensory innervation of fascia andrelated pain mechanisms, as well as explorations of clini-cal aspects, measurement technologies and new hypothe-ses. They are complemented by abstracts from the FirstInternational Fascia Research Congress, held at TheConference Center of Harvard Medical School, Boston,October 4-5 2007. This book pays equal attention to abasic science investigation of fascial anatomy and fascialdynamics, as well as to the exploration of clinical implica-tions for conventional medicine as well as complementa-ry health care. The full text articles reprinted here repre-sent the highest standards of scientific methodology,with thorough review of the entire text by standard jour-nal review procedures, and were selected by the editorsfrom over 1500 papers from the key presenters at thiscongress. The abstracts were selected by peer review by 3 members of the scientific review committee of theFascia Research Congress and those accepted are present-ed as submitted without editorial input from the review-ers. Some are clearly from experienced scientists, and oth-ers from less research experienced clinicians, which insome cases are based more on clinical observation thanon rigorous scientific experiments. Nonetheless, thereview committee members felt that they contained valu-able information based on clinical experience, which may– or may not – be validated by more substantial scientif-ic research studies.

This book will be an invaluable asset for those attendingthe congress, where the authors of the enclosed full-textarticles will be among the major keynote presenters. Itwill also be most useful for all other scientists and clini-cians interested in fascia research. All abstracts are also be posted at the congress website: www.fascia2007.com.Please refer to this website for viewing original color illus-trations of some of the enclosed illustrations, if their leg-end refers to specific color markings. The website alsocontains a glossary of terms used in this book in relationto fascia research.

This book is written for medical scientists interested infascia, as well as for clinicians who work with this inter-esting tissue. The latter category includes acupuncturists,physiotherapists, osteopaths, chiropractors, massagetherapists, practitioners of structural integration as wellas orthopedic and other medical clinicians, and also yogainstructors, sports coaches and other movement thera-pists. It is designed to give both a through overview of thefundamental of fascia research as well as a taste of mostrecent scientific and clinical explorations and hypotheses.

This book was supported by NIH grant 1 R13 AT004146-01 from National Center from Complementary andAlternative Medicine. Its contents are solely the responsi-bility of the authors and do not necessarily represent theofficial views of the NCCAM, NIAMS, or the NationalInstitutes of Health. Many people have generously donat-ed their time and expertise to the planning of the fasciaresearch congress and to the production of this book. Wewant to express our deepest appreciation for the devotedwork of Mr David Wronski, project coordinator, andediting assistance of Matthew Foy, without whom thisbook would not have been possible.

Foreword

Thomas Findley MD PhDAssociate Director, Center for Healthcare KnowledgeManagement, Veterans Administration New JerseyHealthcare System, East Orange NJ USAProfessor New Jersey Medical School, Newark NJ USAResearch Director, Rolf Institute, Boulder CO USA

Robert Schleip Dr. biol.hum. Dipl.Psych.Director, Fascia Research Project, Inst. of AppliedPhysiology, Ulm University, Germany Research Director, European Rolfing Association e.V.,Munich, Germany


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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IntroductionThomas Findley, Robert Schleip

Fascia is the soft tissue component of the connective tis-sue system that permeates the human body forming awhole-body continuous three-dimensional matrix ofstructural support. It interpenetrates and surrounds allorgans, muscles, bones and nerve fibers, creating a uniqueenvironment for body systems functioning. The scope ofour definition and interest in fascia extends to all fibrousconnective tissues, including aponeuroses, ligaments, ten-dons, retinaculae, joint capsules, organ and vessel tunics,the epineurium, the meninges, the periostea, and all theendomysial and intermuscular fibers of the myofasciae.There is a substantial body of research on connective tis-sue generally focused on specialized genetic and molecu-lar aspects of extracellular matrix. However, the study offascia and its function as an organ of support has beenlargely neglected and overlooked for several decades.Since fascia serves both global, generalized functions andlocal, specialized functions, it is a substrate that crossesseveral scientific, medical, and therapeutic disciplines,both in conventional and complementary/alternativemodalities.Thirty years ago the study of physical medicine and reha-bilitation included muscle strengthening, anatomy, exer-cise physiology, and other aspects of therapeutic modali-ties. What was notably less present in the scientific andmedical literature was how to understand and treat disor-ders of the fascia and connective tissues. Since then muchadditional information has been developed. The purposeof this book is to organize relevant information for scien-tists involved in the research of the body’s connective tis-sue matrix (fascia) as well as professionals involved in thetherapeutic manipulation of this bodywide structuralfabric. It is based on materials presented at the FirstInternational Fascia Research Congress: Basic Science and implications for conventional and complementaryhealth care (www.fascia2007.com). The Fascia ResearchCongress is the first international conference dedicated tofascia in all its forms and functions. The principal the-matic topics are: mechanical force transmission throughfascia and fascial anatomy; matrix and fibroblast biology;force adaptation and response to loading; fascial innerva-tion, nociception and proprioception; fascial research inspecial populations; a panel discussion of controversies infibroblast research; and a panel for scientist-clinicianinteraction and formulation of future research directions.Bringing together the most recent solid research on theproperties of the fascial fabric with those who observe itsworkings daily in the clinic will inform and energize both

groups toward further comprehensive developments andapplications in this growing field. It is hoped that thisendeavor will also serve to advance understanding ofstructure and function so as lead to answering ongoingquestions with scientific rigor.In the general population of industrialized countries,about two thirds are unable to work because of back painat least once in their life and musculoskeletal painaccounts for 17% of primary care office visits in the US(Lynch 2005). In 1997 in the United States there were 192million visits to chiropractors, 114 million to massagetherapists and 5 million to acupuncturists (Eisenberg1998). Ni (Ni 2002) found that in 1999, 15 million adultsused chiropractic therapy, 12.5 million used massage and3 million acupuncture. These numbers were confirmedagain in the US national health survey of 2002 (Barnes2004) (Tindle 2005); percentage use is 25% higher amongpersons with arthritis (Quandt 2005). The tendency forthis kind of ailment is rising in concordance with theincreased percentage of jobs which require extended stat-ic positioning of the worker in a fixed, usually seated,position. Fascia is an important factor in generation ofthe described ailments, and a more thorough under-standing of its function will allow better preventionmeasures and healing therapies to be developed, benefit-ing the American economy.Hypotheses which accord myofascia a central role in themechanisms of therapies have been advanced for sometime in the fields of acupuncture, massage, structuralintegration, chiropractic and osteopathy. Practitioners inthese disciplines, especially those which do not have thelongevity of osteopathy or chiropractic, are generallyunaware of the scientific basis for evaluating suchhypotheses. Many practitioners are unaware of thesophistication of current laboratory research equipmentand methods. Laboratory researchers, in turn, may beunaware of the clinical phenomena which suggestavenues of exploration.Among the different kind of tissues that are involved inmusculoskeletal dynamics, fascia has received compara-tively little scientific attention. Fascia, or dense fibrousconnective tissue, nevertheless potentially plays a majorand still poorly understood role in joint stability, in gen-eral movement coordination, as well as in back pain andmany other pathologies. One reason why fascia has notreceived adequate scientific attention in the past decadesis that this tissue is so pervasive and interconnected thatit easily frustrates the common ambition of researchers to divide it into a discrete number of subunits which canbe classified and separately described. In anatomic dis-plays the fascia is generally removed, so the viewer can seethe organs nerves and vessels but fails to appreciate the

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little formal statistical training, yet also contain moreadvanced statistical guidelines for the more experiencedresearcher, and are widely used for teaching research tomedical residents.

Chapter 3Microdynamics: from mechanotransductionto cellular dynamics➜ 3.1.1: The first paper by Chen and Ingber describesdesign principles for the musculoskeletal system whichresult in special improvements in performance. They firstexplain engineering principles of tension and compres-sion, with emphasis on effects of architecture and pre-stress. Pre-stressing in biological systems serves to obtainstability with minimum mass, providing rapid mechani-cal responsiveness to added stress, and reducing loads onindividual structures thus reducing structural fatigue.There is a hierarchical organization of a few types ofmaterial in the musculoskeletal system which allows abroad spectrum of mechanical properties exhibited bybones, muscles, cartilage ligaments and tendons (andother forms of fascia). The remodeling of bone inresponse to local mechanical stress, know as “Wolffs Law”results in deposition of bone in specific patterns whichcorrespond to engineering lines of tension and compres-sion. This molecular organization results in increasedstrength for less mass in the bony system. The designprinciples carry through to the molecular level in otherbiological tissues, including cartilage tendons and liga-ments. In soft tissues composed primarily of collagen andelastin, the prestress is generated from from active con-traction of the myofibroblasts. Mechanical engineering atthe cellular level begins with the observation that all liv-ing cells are contractile; in muscle cells there is a highlyorganized contractile system and in other cells the con-tractile elements are organized into a loose network. Cellshave a structural framework which allows forces to betransmitted within the cell. The cytoplasm itself canlocally alter its stiffness by changes in cytoskeletal poly-merization. Living cells react to a mechanical stimulus onthe cell surface by immediate changes in the cytoplasmand nucleus.The basic design principles of the musculoskeletal systemresult in maximal use of tensile materials from the molec-ular to the whole body scale. How the different elementsare connected in a three dimensional network is moreimportant than material properties of the individualcomponents. Stability is achieved through prestress and geometric organization such as triangulation.Hierarchical organization of components structured on

smaller and smaller scales results in overall structural effi-ciency. Finally, dynamic remodeling results in ability tomodify stiffness and flexibility in response to loadingpatterns experienced over time. The design principles inliving systems can be described by the architectural sys-tem known as “tensegrity.” In this system, isolated com-pression elements are connected by continuous structureproviding tension. In contrast, most man-made struc-tures rely on continuous stacks of bricks or similar com-pression objects. Even when prestress is incorporated, asin prestressed concrete, the stiffness in such man madeobjects remains constant regardless of the imposed stress-es. In contrast, stiffness increases when stress loads areincreased in living tissues and also in man made 3Dtensegrity structures. The tensegrity model suggests waysin which living tissues can sense and respond to mechan-ical stresses.➜ 3.1.2: In the second paper Langevin and Sherman sug-gest a model for low back pain which incorporates con-nective tissue plasticity with pain psychology, posturalcontrol and neuroplasticity. They start by describing whatis known in persons with low back pain about tissuestructure abnormalities, psychological factors, changes inmovement patterns and increased peripheral pain sensi-tivity and brain cortical activation patterns. They suggestthat connective tissue remodeling in persons with chron-ic low back pain may result from either increased stress(“overuse injury”) or consistent absence of stress leadingto atrophy and fibrosis. The loose connective tissues sur-rounding and within the muscle fibers play importantroles in the response of muscle tissue to mechanical stressas well as in the sensory input from these tissues.They propose that connective tissue fibrosis occurs in thelow back due to decreased activity, muscle spasm co-con-traction or microtrauma, and neurally mediated inflam-mation. This model can be used to evaluate interventionswhich involve application of external forces (e.g. massage,manipulation and acupuncture), movement educationsuch as tai chi and yoga, and general increase in activitylevel and conditioning. They rightly point out that “thedevelopment, testing and implementation of effectivetreatment strategies are highly dependent on understand-ing the pathophysiological mechanisms of the conditionbeing treated.” After reviewing the basic science present-ed here, the clinician scientist may be eager to skip tochapter 9 on measurement and new hypotheses.However, perseverance in reviewing the full-text articlesand abstracts will be rewarded by yet more ideas for eval-uation.➜ 3.1.3: The third paper by Grinnel describes the abilityof fibroblasts to reorganize collagen matrix in cell cultureto a dense mass one tenth the original size; these mechan-

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ical forces are large enough to cause scarring and defor-mation in many body organs after injury. Applying amechanical load to the fibroblasts results in generation ofactin stress fibers within the cell and development ofthese cells into myofibroblasts while absence of amechanical load for as little as 24 hours cause the samecells to become quiescent through the extracellular signalregulated kinase pathway. Microscopic examination ofthe collagen matrix shows vast difference in structure andorganization of the fibroblasts depending on whethertension on the cells was released immediately or after fourhours during culture. Since the collage matrix contractsto the same degree in both cases, little attention has beenpaid to the structural differences and different cellularmechanisms which may signal contraction in the twomodels. Grinnel emphasizes that “cells use different sig-naling mechanisms for contraction according to whetherthey are mechanically loaded or unloaded at the timewhen contraction is initiated.”➜ 3.2: Paper abstracts explore the effects of tissue stretchon collagen fibers in skin (➜ 3.2.4 Hoffman), nuclearshape and smooth muscle actin redistribution (➜ 3.2.2Storch) and Procollagen-1 and TGF-β1 (➜ 3.2.1Bouffard). Micromanipulation of individual fibroblastsby Evanko (➜ 3.2.3) showed both changes in cellularshape and in hyaluran amount and organization. Finally,Corey (➜ 3.2.5) explored the innervation of deep fasciaby large numbers of sensory fibers, suggesting a mecha-nism for both generation of musculoskeletal pain as wellas more distant effects of tissue stretch.➜ 3.3: Poster abstracts suggest that tissue stiffnessincrease due to isometric stretch (“strain hardening”) isnot dependent on cellular viability (therefore not due tocellular contraction) but does correlate with enhancedtissue matrix hydration (➜ 3.3.3 Schleip). Tissue studiesin humans with particular clinical conditions were per-formed in women with stress urinary incontinence (➜3.3.5 Wen), Pelvic organ prolapse (➜ 3.3.1 Man), Lowback pain (➜ 3.3.2 Schleip), and sulcus vocalis or scarringof the vocal cords (➜ 3.3.4 Tsunoda). These studies sug-gest altered collagen and elastin metabolism, regions offascia with increased tissue repair activity, reduced num-bers of contractile cells, and regeneration of fascia fromtransplanted stem cell population in these different clini-cal conditions.

Chapter 4 Myofibroblasts and fascial tonus regulation

Myofibroblasts are connective tissue cells which containdense stress fiber bundles that are mostly composed of

alpha smooth muscle actin. First discovered by Majnoand Gabbiani in the early 1970’s, they have been shown toplay a major role in wound healing and to be alsoinvolved in many other normal as well as pathologicalcontractile tissue processes. Most of these cells developout of normal fibroblasts stimulated by the influence ofmechanical tension as well as specific cytokines. Theirsmooth muscle–like contractility enables these cells tomaintain a contractile force over long duration timeswith little energetic costs. An increased presence ofmyofibroblasts is a driving factor behind chronic fascialcontractures, such as in Morbus Dupuytren, in plantarfibromatosis, in excessive scar formation, or in frozenshoulder. Recently, the presence of myofibroblasts (ormyofibroblast-like contractile cells) has also beendemonstrated for normal dense connective tissues, suchas joint ligaments, menisci, tendons, organ capsules, andothers.The full-text articles in this section (➜ 4.1) start with areview of the biology of myofibroblasts by Gabbiani, co-discoverer of this cell type and prominent keynote pre-senter at this first fascia research congress (➜ 4.1.1). Hisbrief review emphasizes the heterogeneity of this cell typeand proposes 4 different phenotypes of this versatile cell.Since publication of this classic paper in 1992 manyimportant advances have been made in understandingthis new cell type. This is represented by two excellentarticles by Hinz (Gabbiani’s successor at the EPFLresearch laboratory in Lausanne, Switzerland) andGabbiani (➜ 4.1.2 and ➜ 4.1.3). They represent presentday understanding concerning myofibroblasts, particu-larly the transition from normal fibroblasts to myofibrob-lasts, as well as the role of force transmission between thiscell and the extracellular matrix via specially developedadhesion complexes at their cell membrane. Finally, mostrecent findings of the Fascia Research Project at UlmUniversity in Germany are reported regarding the pres-ence of myofibroblasts in normal fascia. These includethe unexpected finding of an increased density of thesecells in the human lumbar fascia and culminate in a forcecalculation for fascial contraction in vivo based onmechanographic tests with rat fascia in vitro (➜ 4.1.4).The following abstracts of further congress lectures relat-ed to this subject cover further details. Tomasek links tothe chapter on mechanotransduction (➜ chapter 3) withnew findings concerning the expression of differentsmooth muscle actins in response to mechanical stimula-tion (➜ 4.2.1). Spector emphasizes the contractile behav-ior of musculoskeletal connective tissue cells and theimportant roles he proposes for it in regenerative medi-cine (➜ 4.3.1). This is followed by Naylor’s description of past and current attempts in finding pharmacolo-

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gical agonists and antagonists for fascial contractility (➜ 4.3.2). His approach is taken into further detail by thein vitro contraction tests reported by the German fasciaresearch group, including their successful stimulation ofactive fascial contractions with thromboxane and of fas-cial relaxation with the gaseous smooth muscle relaxantnitric oxide (➜ 4.3.3). In conclusion Remvig gives anoverview on current knowledge of general hypermobilityand tissue stiffness (➜ 4.3.4). The following posterabstracts explore the subject of tissue stiffness regulationin further detail (➜ 4.4). Notably a relation of fascial stiff-ness and the enigmatic feature of resting muscle tone(passive muscle stiffness) is addressed by Masi (➜ 4.4.2)and by Klingler (➜ 4.4.3). Remvig (➜ 4.4.4) looked atmyofibroblast density in tendon and fascia biopsies frompersons with hypermobility and controls. LeMoon (➜4.4.1) suggests connective tissue contractility is the cen-tral mediating factor in myofascial pain.

Chapter 5 Anatomy and biomechanics

Three full-text articles emphasize the important role offascia in musculoskeletal force regulation. The first one isby Huijing, recipient of the prestigious Muybridge award2007 in the field of biomechanics for his recent insightsinto the role of epimuscular force transmission betweenantagonistic and synergistic muscles in normal muscle aswell as in patients with spastic paresis. This article reviewsavailable literature on myo-tendinous and myo-fascialforce transmission in general (➜ 5.1.1). Solomonow thenexamines the role of ligaments musculoskeletal disorderssuch as in work-related low back pain (➜ 5.1.2). Hestresses the important sensory function of these fascialstructures as well as their viscoelastic properties of creepand relaxation in response to extensive loading. Last butnot least the article by Olson et al. (➜ 5.1.3) explores the‘flexion-relaxation phenomenon’ in which trunk flexionfrom the standing position results in a myoelectric silentperiod of the lumbar posterior muscles, which is com-monly attributed to a taking over of spinal stabilizationby the passive stretch resistance of posterior lumbar con-nective tissues. Interestingly, this phenomenon is radical-ly altered when the trunk flexion is performed from asupine body position rather than from the classically usedstanding position. It is concluded that lumbar kinematicsor fixed sensory motor programs by themselves are notsufficient to explain the flexion relaxation phenomenon.Bodyworkers especially in structural integration(Rolfing) are accustomed to observing clinical differencesin muscle and fascial motion between supine and stand-

ing body positions, and this paper begins to establish sci-entific parameters of these observations.The abstracts from the plenary session on fascia anatomyand biomechanics consist of two important contribu-tions, both of which point at the important biomechani-cal function of the lumbodorsal fascia. The first one byVleeming (originator of the force/form closure conceptabout joint stability) cites evidence for the ability of thelumbar fascia to transmit tension between leg and trunkmuscles, such as from the latissimus dorsi on one side andthe gluteus maximus on the other side (➜ 5.2.1). The sec-ond abstract of this group is written by Gracovetsky, whois mostly known for his ‘spinal engine’ model concerningthe role of spinal rotation in human gait (➜ 5.2.2). It asksthe provocative question “Is the lumbodorsal fascia nec-essary?” and then proceeds to provide two positiveanswers: First, the essential role of visco-elastic behaviorof collagen for the stability of the spinal system; and sec-ondly, the role of fascia in providing necessary constraintsfor muscular movements.These important contributions from keynote presentersat this first congress are then complemented by addition-al abstracts. This includes three anatomical examinationsof particular fascial sheets in the human body: the deepfascia of the limbs (➜ 5.3.1 Stecco), the fascia lata (➜5.3.2 Fourie), and the superficial fascia (➜ 5.3.3 Headley);and is then followed by a mathematician’s proposedmodel of the relation between mechanical forces anddeformation of human fascia in manual therapy (➜ 5.3.4Chaudhry). The chapter is then completed by 7 posterpresentations (➜ 5.4). The first examines the use of theterm fascia in the literature (➜ 5.4.1 Mirkin), and is thenfollowed by two examinations of particular fasciae – pec-toral fascia (➜ 5.4.2 Stecco) abdominal fascia – as well asby different explorations concerning therapeutic fasciamanipulation. Burns (➜ 5.4.4) has developed a simulatorfor training fascial palpation. Remvig (➜ 5.4.5) exploresthe literature for scientific evidence of myofascial re-lease, and de Witt (➜ 5.4.6) describes a technique forassessment and treatment of lines of fascial motion inathletes.

Chapter 6 Fascia and pain

➜ 6.1.1: Simons and Mense review muscle tone as itrelates to clinical muscle pain. Muscle tone depends onthe physical properties of the soft tissues – viscoelasticproperties of the muscular and associated tissues, andanatomic limitations in motion- as well as degree of elec-trical activation of the contractile elements of the muscle,

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both voluntary and involuntary (muscle spasm). Theydefine viscoelastic tone as measured by resonant frequen-cy of the muscle, and elastic stiffness as measured by slowmovements. In both cases there may or may not be elec-trical activity of the muscle detected by electromyography(EMG), but this determination is critical to know justwhat is being measured. They cover clinical usage andmeasurement of muscle tone as well as definitions ofmechanical properties of muscles. Muscle is thixotropic,that is when first moved it resists motion but after the ini-tial motion the viscosity decreases up to ten fold.Similarly they cover clinical usage and measurement ofcontracture and muscle spasms, as well as several clinicalconditions such as tension headache, torticollis and nightcramps. The reader will gain insight into both clinicalpractice and definition of terms and measurement whichare essential to research in this area.➜ 6.1.2: Khalsa provides a review of the system used toperceive musculoskeletal pain. Both peripheral and cen-tral neurons in this system can adapt from millisecondsto weeks after noxious stimuli. Sensory stimuli is sentfrom muscles over nerves which conduct at a wide range of velocities, from over 100 meter/second to under 2 meter/second; half of such nerves are in the slowestcategory. Muscle nociceptors vary in mechanicalthresholds, and can be sensitized by a number of localchemicals. The response at the cellular level to localmechanical trauma in a muscle is described in detail.Different mechanisms may be involved for compressionthan for stretch.➜ 6.1.3: An experimental study in rats by Sauer, Bove etal. shows that primary nociceptors innervating nervesand their surrounding connective tissue release neu-ropeptides involved in inflammation, but this does nothappen when the nerve is isolated from its neighboringconnective tissue matrix; in contrast, capsaicin (hot pep-per) stimulates both isolated nerve axons and axons withintact connective tissue sheaths.➜ 6.2.1: Shah reports latest insights concerning thenature of myofascial trigger points. Using the newlyrefined method of microdialysis (using ultrafine needlebiopsies) he found that active trigger points in the uppertrapezius exhibit a unique biochemical milieu of sub-stances associated with pain and inflammation, such assubstance P, bradikinin, and others.➜ 6.2.2: The previous examination of Sauer, Bove et al. ofthe influence of perineurial connective tissue elementsand related nerve endings in the creation of pain sensa-tions (➜ 6.1.3) is updated in an abstract by Bove, whichproposes different mechanisms for distally perceived painas opposed to pain which is perceived as arising from thenerve trunk.

➜ 6.3: Further abstracts include the reported increase inestimated weight of their gun belts by police offers withchronic low back pain as opposed to matched healthycontrol subjects from the same group (➜ 6.3.1 Moga).Barker (➜ 6.3.2), recent recipient of the YoungInvestigator’s Award of the journal Spine for her relatedwork on the lumbar fascia, explores the influence oflumbar fascia tension on segmental sagittal spinal motionstability, using loading tests and rapid motion photo-graphy on 9 unembalmed cadavers. She concludes thattension on the lumbar fasciae simulating moderate contraction of transverse abdominal muscle alters segmental rotation and translation, reducing the insta-bility factor in both flexion and extension. Stevens-Tuttle(➜ 6.3.3, from Langevin’s group) shows that peri-muscular fascia remodeling occurs in a pigs whose move-ments are restricted with a harness, and that similarmovement restrictions can be observed in humans withlow back pain. This section is completed by two interest-ing computerized theoretical modeling contributions.Using MSM.Adam software, Trudeau and Rancourt(➜ 6.3.4) found that the thoracolumbar fascia has the potential to be the posterior structure that con-tributes the most to the stiffness of the spine in forwardflexion. They conclude that this fascia could therefore besubjected to trauma if the spine is displaced in a way thatexceeds its mechanical limits. Finally Zorn and hisGerman colleagues (➜ 6.3.5) explore the spring-likefunction of the lumbar fascia in human gait. Their calcu-lations reveal that – in contrast to the traditional gaitanalysis model – the pendulum action of the arms andthe spring-like action of the lumbar fascia can have thepotential to facilitate energetic efficiency in humanwalking.➜ 6.4: Posters from clinicians explore different aspectsrelated to therapeutic fascia manipulation, includinglumbar skin stretch measures in persons with hamstringtightness (➜ 6.4.1 Moga), postural changes after CoreIntegration (➜ 6.4.2 DellaGrotte), treatment of subacutelumbar compartment with Graston Technique, an instru-ment assisted soft tissue mobilization (➜ 6.4.3 Hammer),a randomized trial of Functional Fascial Taping for lowback pain (➜ 6.4.4 Chen), and identification and myo-fascial treatment of pelvic obliquity in athletes (➜ 6.4.5LeLean).

Chapter 7 Clinical considerations

➜ 7.1: Five clinician/educators have prepared some ques-tions on a wide range of topics for the final Fascia

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Ron Alexander is the founder ofFunctional Fascial Taping® andrefined this technique over severalyears on the dancers of TheAustralian Ballet. During this periodhe was awarded the ‘Lady SoutheyScholarship for Excellence’. He deliv-ers FFT® workshops internationallyand has presented these real time

ultrasound investigations to the Royal College ofSurgeons, Edinburgh. ➜ 192, 203, 251

César F. Amorim was born in SãoPaulo, Brazil. Graduated inElectronics Engineering from Uni-versity of Vale do Paraíba-UNIVAPin 1992. He received his MS in Biomedical Engineering fromUniversity of Vale do Paraiba – SãoPaulo, Brazil in 2001, and iscurrently PhD Student. He is profes-

sor of Biomedical Engineering Department. His areas ofresearch interests are signal processing applied to bio-medical signals, detection, processing and interpretationof surface EMG. ➜ 219, 221

Julian Baker is the PrincipalInstructor of The Bowen Techniquein the UK and Europe. As Directorof The European College of BowenStudies, he has been responsible forits rapid growth since 1994, travel-ling extensively to teach, researchand has written many articles onThe Bowen Technique. ➜ 247

Priscilla Barker is Senior Tutor inAnatomy at the University ofMelbourne. She completed herBachelor of Physiotherapy in 1996and PhD in Anatomy in 2005. Herresearch is published in ‘Spine’,‘Grieve’s modern manual therapy’and ‘Movement, Stability & Lumbo-pelvic Pain’. She was awarded the2005 Spine Young Investigator of theYear. ➜ 185

Luiz Fernando Bertolucci, MD:physiatrist, biologist, Rolf Institutefaculty (anatomy and myofascialrelease), has been using Rolfing® inthe treatment of musculoskeletaldysfunctions. He is currently devel-oping a particular technique torelease fascia, which seems to bebased on neural reflexes. ➜ 221

Nicole Bouffard is from the Department of Neurology,University of Vermont, Burlington VT. ➜ 44, 45, 48, 186,224

Geoff Bove, DC PhD’s researchfocuses on mechanisms of pain dueto nerve injury, and how they relateto the musculoskeletal dysfunction.He is an authority on the mecha-nisms of pain, particularly thoseassociated with nerve injury andmusculoskeletal disorders, and neu-robiological mechanisms related to

manual therapy. He has published over 30 original arti-cles reviews, and chapters, including publications inJournal 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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Janet M. Burns, DO, an assistantprofessor of Osteopathic Manipu-lative Medicine (OMM) at OhioUniversity College of OsteopathicMedicine, is board certified inNeuromusculoskeletal Medicine/OMM, and Family Practice. Herresearch interests include the neuro-physiology of palpation and mecha-nisms of OMM. ➜ 139

Leon Chaitow, DO ND is editor ofJournal of Bodywork and Move-ment Therapies. He is author ofalmost 70 books relating to osteo-pathic and manual medicine and isvisiting lecturer at schools inAustralia, Denmark, Holland, Italy,Ireland, Switzerland, Spain, and theUnited States. ➜ 196

Hans Chaudhry, PhD is a ResearchProfessor in Biomedical EngineeringDepartment at New Jersey Instituteof Technology, Newark, New Jersey.U.S.A. His research publicationspertain to Mathematical Modelingin Postural Stability, Human Fascia,Cardiovascular System, OptimalPatterns of Wound Suturing. ➜ 135,242, 255

Shu-Mei Chen is a qualified physicaltherapist as well as a lecturer ofPhysical Therapy in Taiwan. Shereceived the B.Sc. in PhysicalTherapy and the M.Sc. in Medicinefrom Kaohsiung Medical Universityin Taiwan. She is currently studyingher PhD program at the School ofExercise and Nutrition Sciences atDeakin University, Australia. ➜ 192

Sarah Corey is from theDepartment of Neurology, Uni-versity of Vermont Burlington VT. ➜48

Patrizia D’Alessio, MD PhD is anItalian researcher with cell biologyexpertise, and lectures as Ass. Prof. atParis Universities. She has 3 patentson 4 anti-inflammatory anti-senes-cence molecules targeting endotheli-um and received the 2005 FrenchMinistry award for Innovative Re-search and foundation of the start-up company “AISA Therapeutics”. ➜244

Julie Ann Day completed a Diploma in Physiotherapy inAdelaide, Australia in 1977. Practitioner of FascialManipulation since 1999, and authorised teacher, shetranslated Luigi Stecco’s book “Fascial Manipulation forMusculoskeletal Pain” (Piccin 2004). Julie lives and worksin Padova, Italy. ➜ 257

Benita de Witt, B Sc Physio, has 25years of experience treating athletesand works in private practice inStellenbosch, South Africa. She hasdeveloped the Lyno Method, whichfocuses on the treatment of chronicinjuries; restoring body alignmentby means of fascia manipulation. ➜141

Josef DellaGrotte PhD CPF LMT isDirector of Core Integration Train-ing Institute Inc. ➜ 190


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Stephen Evanko received his PhDfrom the University of New Mexicoin 1993 where he studied the biolog-ical properties and biochemistry ofconnective tissues, with principleinterest in how tissues remodeled inresponse to different mechanicalstresses. He currently serves as aStaff Scientist at The Benaroya

Research Institute at Virginia Mason in Seattle where hestudies the biology of hyaluronic acid and proteoglycansin fibroblasts and smooth muscle cells. Stephen is also aCertified Advanced Rolfer® with a Structural Integrationpractice in Seattle. ➜ 46

Thomas W. Findley MD, PhDtrained in physical medicine andrehabilitation at the University ofMinnesota. Dr. Findley has exten-sive training in complementarymedicine, beginning with trainingin acupuncture while a medical stu-dent at Georgetown in 1975. Hemaintains an active clinical practice

as a Certified Advanced Practitioner of Rolfing StructuralIntegration in addition to his research activities asAssociate Director of the Center for HealthcareKnowledge Management, New Jersey VA HealthcareSystem. He is also Director of Research for the RolfInstitute of Structural Integration. ➜ 2, 135, 222, 242,254, 255

W. J. Fourie Nat. Dipl. P.T. Thirtyyears experience as musculoskeletalPhysical Therapist. Working in pri-vate practice in Johannesburg,Masters Student in the School ofAnatomical Sciences at theUniversity of the Witwatersrand andInternational presenter of courseson the role of Connective Tissue inMovement Dysfunction. ➜ 215

James R. Fox is from the Depart-ment of Neurology, University ofVermont, Burlington VT. ➜ 186,224, 252

Richard Allen Freiberg, OMD, DAP,Lac. began studying Acupunctureand Oriental Medicine in 1985 as anapprentice to Dr. Robert C. Sohn,AP, PhD. He received Diploma ofAcupuncture and Oriental Medicinefrom the Atlantic Institute ofOriental Medicine. He did advancedstudies as senior graduate-doctor

apprentice, for over six years, with world famousTraditional Chinese Medicine herbal expert Dr. Wu,Boping, OMD, MD, PhD (China). He practices inAcupuncture and Oriental Medicine as a primary careprovider diagnosing and treating illness and injury spe-cializing in soft tissue injury and pain syndromes.Received international Doctor of Oriental Medicinedegree in 1998 from Medicina Alternativa Institute inColombo, Sri Lanka from Prof. Dr. Anton Jayasuriya. Hehas created a synergistic method consisting of twoancient modalities: Gua Sha (frictional rubbing) and BaGuan (empty cupping), which Dr. Wu named as Ba GuaFa, and during the past thirteen years has successfully uti-lized Ba Gua Fa in over 20,000 patient treatment visits. ➜208

Guilio Gabbiani, MD PhD isProfessor of Pathology andImmunology and the University ofGeneva, Switzerland. His area ofresearch is smooth muscle andfibroblasts, and he has publishedmore than 300 scientific papers. Heis a member of the Editorial Boardof the American Journal of

Pathology, Arteriosclerosis Thrombosis and VascularBiology, Laboratory Investigation, Wound Repair andRegeneration, Differentiation, Cell Motility and theCytoskeleton, and Experimental Cell Research. ➜ 56, 67


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Serge Alain Gracovetsky, PhD,Professor Emeritus, ElectricalEngineering, Concordia University,Montreal, Canada, is the author ofnumerous research articles andrecipient of several awards related tohis work on the biomechanicsaround spinal dynamics and gait. Heis the originator of the ‘spinal

engine’ model, which emphasizes the important contri-bution of paraspinal connective tissues to human gait andis one of the first scientific authors exploring the biome-chanical function of the thoracolumbar fascia. ➜ 131

Peter Grigg, PhD is Professor andInterim Chair of Physiology, anddirector of the Biomedical Engineer-ing Program, at the University ofMassachusetts Medical School inWorcester MA. He is a neuroscien-tist with an interest in mechanore-ceptors. Studies of the mechanism ofmechanoreception led him into

investigations of the way soft tissues respond to mechan-ical loading, which led to the work described in thisabstract. ➜ 47, 236

Frederick Grinnell, PhD, is Pro-fessor of Cell Biology, University ofTexas Southwestern and has beenthe co-chair of the Gordon Con-ference on Science and TechnologyPolicy and chair of the GordonConference on Wound Repair. ➜ 39

Alan Grodzinsky, PhD, is professorof Electrical, Mechanical andBiological Engineering and Directorof the Center for BiomedicalEngineering at MIT. His researchlooks at how connective tissuemetabolism, growth, remodelling,pathology and repair is influenced

by mechanical, chemical and electrical stresses. ➜

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J. C. Guimberteau, MD, iscofounder and scientific director ofthe Aqui-taine Hand Institute(I.A.M), member of the FrenchHand Society (GEM) and of theFrench Plastic and ReconstructiveSociety (SF.C.P.R.E). He was trainedin the Hand and Plastic SurgeryDepartment of the Bordeaux

University (Dr. A.J.M. Goumain and Pr. J. Baudet) from1973 to 1980. During this surgical training, he was one ofthe pioneers in microsurgery and transplantations. ➜ 237

Warren Hammer, DC lectures at theNational Chirpractic College and isa renowned writer and lecturer ontreatment of soft tissue injuries. Heincorporates into daily practice theconstant flow of new scientific infor-mation that relates to the clinicalimprovement of the patient. Of crit-ical importance has been the incor-

poration of all valid methods and techniques of soft tis-sue evaluation and treatment. He believes that all jointmanipulations of the human body require evaluation ofthe soft tissue attachments to these joints. ➜ 191, 206

Thomas Hausner, MD, OrthopedicSurgeon and General Surgeon, aged42 years. He specialises in Hand-and reconstructive Microsurgery inone of the largest Austrian hospitalfor treatment of Trauma (“LorenzBöhler Trauma Hospital”), whichtreats about 65000 trauma patients ayear. As a General Surgeon he is also

engaged in the treatment of multitraumatised patients,especially with visceral trauma. ➜ 241

Gil Hedley, PhD, founder of So-manautics Workshops, Inc. andIntegral Anatomy Productions, LLC,teaches dissection workshops inter-nationally. He also produced The In-tegral Anatomy Series, documentingon DVD his layer-by-layer, wholebody approach to human form andfascial relationships. ➜ 134


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Ed Hemberger, structural Integ-ration Practitioner is a holistic prac-titioner involved in health andbodywork for over 15 years, special-izing in sports massage, neuromus-cular and deep tissue. An avid cyclistand athlete himself, since 2001 Edhas been an assistant massage thera-pist for the Division II Professional

Cycling Team, the Navigators. In 2002 he was selected tobe on the winter sports massage team for the U.S.Paralympic ski team in Salt Lake City, Utah. In 2003 Edtoured with Ofoto Lombardi, a Division III cycling teamfrom California. Ed is a certified holistic practitionerthrough the Velazquez System of Training which is a syn-thesis of principles and techniques of medical models,somatic techniques, sports psychology, psychotherapymethods, organizational management and spiritual tradi-tions both ancient and contemporary. ➜ 207

Boris Hinz, PhD, did his postdoc-toral training with Dr. Gabbiani andis currently with the Cell Contract-ility research group of the Laborato-ry of Cell Biophyics, School of BasicSciences, Swiss Federal Institute ofTechnology in Lausanne. His re-search focuses on myofibroblastcontraction, differentiation andwound repair. ➜ 60, 67

Allen H. Hoffman, PhD, PE is aProfessor of Mechanical Engineer-ing at Worcester Polytechnic Insti-tute. His research focuses on themechanical behavior of soft tissues.In 1988, he was a co-recipient of theElizabeth W. Lanir Kappa DeltaAward from the American Academyof Orthopaedic Surgeons. ➜ 47

Peter Huijing, PhD, Human Movement Sciences, VrijeUniversiteit, Amsterdam, The Netherlands, has receivedinternational honors for his research in mechanisms ofextra-muscular myofascial force transmission and howthis relates to properties of spastic muscles. ➜ 90, 212

Shabbir Indorewala, born: 1953,Nashik, India. Recipient of RAFCooper and AOI-E.Merck Awards.Has developed concept of: Endo-meatal Tympanoplasty, AnteriorTympanotomy and DimensionalStability of Free Fascia Grafts.Professor-consultant and MD ofIndorewala ENT Hospital, accredit-ed by National Board for ENT PGtraining. ➜ 216

Donald Ingber, MD PhD isDirector, Center for Integration inMedicine and InnovativeTechnology at Childrens Hospitaland is the Judah Folkman Professorof Vascular Biology at HarvardMedical School. He has over 200publications on cell structure andcontractility. ➜ 20

Helen James, MPT, Adv.Cert. Rolfer; the PI, has hergraduate degree in PhysicalTherapy from Stanford Uni-versity. She is ProfessorEmeritus, Physical TherapyDept. California State Uni-versity, Fresno. Ms. James

owns a private practice in PT/Rolfing at Clovis, Ca. ➜ 256Her Research Team includes:Mr Luis Castaneda, a graduate of Univ of Texas at ElPaso, and a graduate student in Physical Therapy atCalifornia State University, Fresno, and M.E. Miller, PhD,PT, GCS; Assoc. Prof. in the Physical Therapist graduateprogram at California State Univ., Fresno.

Ricardas Kerpe MD, PhD is a lectur-er at the Rehabilitation department,Kaunas University of Medicine,Lithuania. In 2006 accomplished thedoctoral dissertation “Foot muscu-lar tone in type 1 diabetes mellituspatients and its correction usingfunctional electrical stimulation”.Research interest area: muscles andconnective tissue properties. ➜ 220


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Partap S. Khalsa, D.C., Ph.D.,F.A.C.O. is Program Officer for theNational Center for Complementaryand Alternative Medicine of theNIH and was recently an AssociateProfessor of Biomedical Engineer-ing, Orthopaedics, and Neurobiolo-gy at the State University of NewYork(SUNY) at Stony Brook, and

currently serves as the Graduate Program Director for theDepartment of Biomedical Engineering. Dr Khalsa has anactive research laboratory investigating neurophysiologi-cal mechanisms of mechanosensory neurons, soft tissuebiomechanics, spine biomechanics, and mechanisms ofmuscle and low back pain. He maintained, for 17 years, aprivate practice of chiropractic in Massachusetts, isboard-certified in chiropractic orthopaedics, and servedterms as the President and Vice-President of his localchapter of the Massachusetts Chiropractic Society. ➜ 12,162, 196

Hollis H. King, DO, PHD, FAAO.Dr. King is the Associate ExecutiveDirector of the Osteopathic Re-search Center and AssociateProfessor of Osteopathic Manipula-tive Medicine at the Texas College ofOsteopathic Medicine. He is a co-author of the chapter on Osteopathyin the Cranial Field in Foundations

for Osteopathic Medicine, second edition. He has pub-lished research on the effects of prenatal OMT on obstet-rical outcomes, and has submitted grants to NIH for fur-ther research in this and other areas OMT. Dr. King is aPast President and Fellow of the American Academy ofOsteopathy. ➜ 264

Miglena Kirilova, Institute ofMechanics, Bulgarian Academy ofSciences. Research Associate atInstitute of Mechanics, BulgarianAcademy of Sciences, Sofia, Depart-ment Biomechanics of Tissues andSystems. Member of BulgarianSociety of Biomechanics, Union ofBulgarian 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, tissueengineered vascular grafts, biomaterials. ➜ 138

Werner Klingler, MD works as clin-ical anesthesiologist and specialistfor human physiology at Ulm uni-versity, Germany. His researchfocuses on the pathology of contrac-tile tissue. He is member of scientif-ic organizations and has contributedseveral publications in high-rankjournals. ➜ 50, 51, 76, 81, 82, 86, 188

Aleksandras Krisciunas, M.D.,D.Sc.habil is the Head of the Departmentof Rehabilitation Kaunas Universityof Medicine, Lithuania. The mainresearch area is rehabilitation ofpatients with cardiac and cardiovas-cular diseases and evaluation of itsefficiency. He has participated indeveloping an effective rehabilita-

tion system for patients and disabled people, consultingwork at rehabilitation centres and boards of medical-social expertise. ➜ 220

Nicky Lambon, MA MCSP DipTPCert Ed FE PGCE CCIM. Nickybecame a physiotherapist in 1980.She has an MA in Law & MedicalEthics and is Principal Lecturer andProgramme Manager for physio-therapy at Coventry University.Nicky is also an external examiner atLiverpool, Edinburgh & St George’sUniversities. ➜ 247

Helene M. Langevin MD is ResearchAssociate Professor and the Depart-ment of Neurology, University ofVermont Burlington VT. A licensedacupuncturist for ten years, she andher team are studying tissue dis-placement and remodelling due toacupuncture needling. ➜ 33, 44, 45,48, 186, 224, 252, 260


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Aaron LeBauer, LMBT is the ownerof LeBauer Structural Bodywork inGreensboro, NC. He has a B.A. fromDuke University, a certificate inMassage Therapy and Health Edu-cation from the National HolisticInstitute, and is currently workingtoward his Doctor of PhysicalTherapy at Elon University. ➜ 204.

Linda-Joy Lee, a University ofBritish Columbia graduate and fel-low of the Canadian Academy ofManipulative Therapy, Linda-JoyLee is known internationally for herskills in movement and performanceanalysis to restore optimum func-tion. She has created novel approa-ches to train thoracic stability, and is

investigating these ideas in a PhD at the University ofQueensland. LJ consults at her clinic, SynergyPhysiotherapy in North Vancouver BC, and teaches clini-cians world-wide how to integrate multiple paradigms,new ideas and science for effective outcomes in clinicalpractice in a series of courses in affiliation with DianeLee. ➜ 201

Diane Lee is a University of BritishColumbia graduate (BSR), a fellowof the Canadian Academy ofManipulative Therapy (FCAMT)and a certified Gunn IMS practi-tioner. She is well known interna-tionally for her clinical work andcase studies in which she integratesscientific research with clinical

expertise into a practical evidence-based model. Thismodel is taught world-wide in a series of courses in affil-iation with Linda-Joy Lee. Diane’s passion is in helpingwomen restore their form and function after pregnancyand she works as a physiotherapy consultant at Diane Lee& Associates in White Rock, BC. ➜ 201

R.P. Lee received his DO degreefrom the University of Kansas Cityof Medicine and Biosciences in1976, and a residency in OsteopathicManipulative Medicine at theA.T.Still University College ofOsteopathic Medicine in Kirksville,MO. He also trained with theAmerican Academy of Medical

Acupuncture in 1986. In 1991, he moved to his presentlocation in Durango, Colorado to open a private practicein osteopathic manipulative medicine, nutritional coun-seling, homotoxicology, and medical acupuncture whileusing a system he developed to read the body for diagnos-tic and treatment strategies.He has served on the board of Governors of the AmericanAcademy of Osteopathy, chair of the Louisa BurnsOsteopathic Research Committee of the AAO and hasserved on the Board of Directors of the Cranial Academyand the Cranial Academy Foundation. His 2005 book,Interface: Mechanisms of Spirit in Osteopathy is about thespiritual basis of osteopathic philosophy and a theoreticalphysiological model of the primary respiratory mecha-nism. ➜ 265

Peter Lelean is a remedial masseurand structural integrator with 15years experience. He has taughtadvanced therapeutic techniquesaround Australia and specializes inidiopathic scoliosis. Peter has identi-fied fascial anomalies common to anumber of musculoskeletal condi-tions. ➜ 193

Kim LeMoon is the originator of Fascial Facilitation, asoft tissue therapy for myofascial pain. Clinical successwith this method led to an exploration of the relationshipbetween fascial contractility and myofascial pain syn-drome. Since 1997, she has maintained a massage therapypractice in New Jersey. ➜ 84


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Huub Maas is a research associate inthe Department of Physiology,Feinberg School of Medicine atNorthwestern University. His re-search interests are muscular forcetransmission and the role ofmechanical skeletal muscle proper-ties as well as proprioceptive feed-back in neural control of locomo-tion. ➜ 213

Weng Chi Man did her graduatework with Dr. James Ntambi at theUniversity of Wisconsin-Madisonand obtained her PhD in biochem-istry in 2005. She is currently work-ing with Dr. Bertha Chen in theOB/GYN department at StanfordUniversity for her postdoctoraltraining. ➜ 49

Michelle Marr, MSc BScHonsPgCertHE MCSP. Michelle became aphysiotherapist in 1995 and is a spe-cialist in neurological rehab. She hasworked in the UK, USA and Zambia.Following her Masters in 2005 shebecame Senior Lecturer at CoventryUniversity and runs a private prac-tice called Therapy Fusion Ltd. ➜ 49,247

Marilene Martin is in the School forPhysiotherapy at São Marcos Uni-versity - São Paulo, Brazil. ➜ 205

Alfonse Masi, MD, DrPH, is at theUniversity of Illinois College ofMedicine at Peoria Il. ➜ 85

Johannes Mayer Dr. med. 1981 –1987: Family medicine; 1984 –1987: Manual medicine; 1996 –2000: Osteopathic medicine; since2001: teacher in Osteopathic medi-cine; 2000: member of AAO(American Academy of osteopathy).2000: Vice president DGOM(German Society of Ost. Med.).

2003: President EROP (European Register for Osteo-pathic Physicians). 2006: educational committee ofWOHO. ➜ 258

Laurie McLaughlin graduated fromMcMaster University (BHScPT), is afellow of the Canadian Academy ofManipulative Therapy (FCAMT)and is certified in ContemporaryAcupuncture (CMAG). Laurieteaches nationally and internation-ally on the topics of fascia, breathingand spinal manipulation. She is a

senior consultant with LifeMark Health and is currentlypursuing a Doctor of Science degree in Physical Therapyat Andrews University. ➜ 201

John M. McPartland first studiedmedicinal plants with Euell Gibbonsin 1969, and began cannabinoidresearch in 1981 (Mycopathologia87:149-153). Dr. McPartland earneddegrees, residencies, and fellowshipsat Penn State, University of Illinois,Chicago College of Osteopathy,University of Pittsburgh, and

Michigan State University. He has composed and deliv-ered osteopathic curriculum at Michigan State University(as Assistant Professor) and Unitec New Zealand (asAssociate Professor). ➜ New Directions panel chapter 10

Siegfried Mense Dr. med., isUniversity Professor at the Depart-ment of Anatomy and Cell Biology,Heidelberg University, Germany. Hisresearch looks at neurological path-ways for pain stimuli and musclepain. ➜ 144


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Hanno Millesi Dr. med., is theMedical director of Wiener Privat-klinik and full professor at theDepartment of Plastic Surgery of theMedical Faculty of the University ofVienna. He has received the Mille-nium Award of the InternationalSociety for Reconstructive Micro-surgery in 1999 and in 2001 theParacelsus Ring Award, Villach. ➜

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Sue Mirkin is a physiotherapist witha passionate interest in integrativeanatomy and bodywork therapies.She is currently engaged in shortterm contract work while decidinghow best to apply talents in clinical,educational and/or research prac-tice. ➜ 136

P. Moga, DO is boarded through theAmerican Osteopathic Board ofFamily Practice His clinical interestshave evolved towards musculoskele-tal medicine, including manual-,occupational-, and sports medicine.His research interests focus largelyon spine loading, spine injury, andmanual medicine outcomes. ➜ 184,189

I. L. Naylor: PhD is Senior lecturer,School of Pharmacy, University ofBradford, UK. His research interestsare study of myofibroblast behav-iour in wound repair and healing. ➜81

Arya Nielsen is an adjunct facultyand practices East Asian medicine atBeth Israel Medical Center’s Conti-nuum Center for Health andHealing in NY. She teaches interna-tionally and has completed a doctor-ate in Interdisciplinary Studies withfocus on integrative clinical scienceand health care. ➜ 249

James L. Oschman, PhD has pub-lished 30 research papers in leadingscientific journals, and an equalnumber in journals of complemen-tary medicine. His work focuses onthe connective tissues and myofas-cial systems and their connectionswith the cytoskeleton and nuclearmatrix, a system he has termed the

living matrix. Jim has written two books on energy med-icine, both published by Elsevier, in 2000 and 2003. Helectures and gives workshops internationally on the bio-medical significance of the living matrix. ➜ NewDirections panel chapter 10

Tim Paine, MA, is Senior Lecturerand Award Leader, Department ofSports & Exercise Sciences, Univer-sity of Bedfordshire. He formed theAcademy of Sports Therapy UK in1994 and Sports Therapy UK in2001 offering specialist training

courses in sports therapy . He is now compiling his sec-ond book on advanced soft tissue techniques. ➜ 218

Alessandro Pedrelli: graduated as aPhysiotherapist in 2003, at theUniversity of Bologna, with a thesistitled: “Modular prothesis with elec-tric knee (C-LEG): personal experi-ence in walk re-education of trans-femoral amputated patients”. SinceOctober 2003 he has been workingas 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. InOctober 2007, will run his first course on FascialManipulation as a Teacher. ➜ 250


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Helga Pohl, founder of Sensory-Motor Body Therapy and the Centrefor Body Therapy, worked as a clini-cal psychologist at the Max-Planck-Institute and at German universities,and as a psychotherapist in privatepractice. Her own experiences withchronic back pain lead her to a newpath as a body worker. ➜ 245

Denis Rancourt, PhD, is associateprofessor in Mechanical Engineer-ing at Université de Sherbrooke. Heis a member of the PERSEUSresearch group interested in humanperformance and safety. His researchinterests include human motor con-

trol and system modelling and design. He holds a PhDdegree from MIT in ME. ➜ 187

Lars Remvig, MD and DMSc,rheumatologist, senior consultant atthe Clinic for Orthopaedic Medi-cine, Rigshopitalet, Copenhagen. Heis past president of DSMM and pastmember of FIMM Academy, ScienceBoard and has published articles,reviews and textbooks in manual/musculoskeletal medicine. His maininterest now is Hypermobility. ➜ 83,87, 140

Thomas Sandercock is a ResearchAssociate Professor in the Depart-ment of Physiology, Feinberg Schoolof Medicine at Northwestern Uni-versity. His research interests are themechanical properties of motorunits, muscle, and their interactionto produce whole muscle force andstiffness. ➜ 213

Robert Schleip, PhD, is a certifiedRolfing and Feldenkrais Teacher, isResearch Director of the EuropeanRolfing Association and Director ofthe Fascia Research Project, UlmUniversity, Germany. He holds aPhD in human biology and an MAin psychology and has been awardedwith the Vladimir Janda Award for

Musculoskeletal Medicine 2006. ➜ 2, 50, 51, 76, 81, 82, 86,87, 135, 188

Jay P. Shah is a physiatrist/researcherat the NIH studying the pathophysi-ology of myofascial pain, chronicpain mechanisms and promisingphysical medicine treatments. Histeam is utilizing novel microanalyti-cal techniques to uncover the uniquebiochemical milieu of myofascialtrigger points and acupuncture

points. He teaches acupuncture at Harvard MedicalSchool and New York Medical College. Dr. Shah has givenmany invited lectures and workshops at various nationaland international meetings. ➜ 214

Charles Shang, MD, is from theCambridge Health Alliance, HarvardMedical School. ➜ 209


Contributors

276▼

▼ ▼ ▼

Moshe Solomonow, PhD, MD(Hon) is the Founding Editor of TheJournal of Electromyography andKinesiology, and serves on theEditorial Board of several bioengi-neering and medical journals. Hewas a council member of theInternational Society of Electro-physiological Kinesiology, the

International Society of Functional Electrical Stimu-lation, and the IEEE-Biomedical Engineering Society. Hepublished over 120 refereed journal papers on motorcontrol, electromyography, muscle, ligament and jointbiomechanics, electrical muscle stimulation, prostheticsand orthotic systems for paraplegic locomotion.Dr. Solomonow organized the EMG Tutorial Workshopin the ISB Congress, the Canadian Society ofBiomechanics, The Human Factors and ErgonomicsSociety, and The Society for Clinical Movement Analysis,He received the Crump Award For Excellence inBioengineering Research (UCLA), the DistinctiveContribution Award. ➜ 108, 119

M. Spector is Professor of Ortho-paedic Surgery (Biomaterials),Harvard Medical School. SeniorLecturer, Mechanical Engineeringand Lecture, Health Sciences andTechnology, Massachusetts Instituteof Technology: Director of TissueEngineering, Veterans Administra-tion Boston Healthcare System.

Director of Orthopaedic Research, Brigham andWomen’s Hospital. ➜ 80

Victoria A. Stahl received her B.S.degree in Computer Science fromthe Georgia Institute of Technology,Atlanta, USA in 2001 and is current-ly pursing a PhD in BiomedicalEngineering from the GeorgiaInstitute of Technology and EmoryUniversity, Atlanta, USA. ➜ 214

Paul Standley, PhD, is a vascularphysiologist and professor in theDepartment of Basic MedicalSciences at the University of ArizonaCollege of Medicine. His researchprogram investigates how vascularsmooth muscle and fascial fibrob-lasts demonstrate regulation ofcytokine and growth gene expres-

sion in response to biophysical stimuli. ➜ Mechano-transduction panel chapter 3

Antonio Stecco, MD, Padua Uni-versity, 2007. Collaborator with theUniversity Paris Descartes to studythe anatomy of fascia. Collaboratorwith the Physical Medicine andRehabilitation Clinic of PaduaUniversity to analyse the myofascialpains and the clinical applications ofthe Fascial Manipulation method.➜ 132, 137, 257

Carla Stecco, MD, Padua University,2002. Specialisation in Ortho-paedist, 2007. Collaborator withParis Descartes University to studythe anatomy of the fascia with dis-sections. Membership of ItalianSociety of Anatomy and Histology.Author of 18 scientific papers and ofa book about Fascial Manipulation.➜ 132, 250, 257

Debbie Stevens-Tuttle is from theDepartment of Neurology, Uni-versity of Vermont, Burlington VT.➜ 44, 186, 224, 252


Contributors

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277

▼▼ ▼

Kirsten N. Storch earned herBachelors of Arts in EnvironmentalStudies at the University of Oregonin 2000 and went on to receive aMasters of Education at PlymouthState University in Plymouth, NewHampshire in 2003. She has workedat the University of Vermont in theDepartment of Neurology with

Helene Langevin’s group since 2004 as a LaboratoryResearch Technician. She published “Fibroblast spreadinginduced by connective tissue stretch involves intracellularredistribution of alpha and beta actin” in 2006, “Alphasmooth muscle actin distribution in cytoplasm andnuclear invaginations of connective tissue fibroblasts” in2007, and is currently completing a follow up paper. ➜ 45

James J. Tomasek is David RossBoyd Professor in the Departmentof Cell Biology at the University ofOklahoma Health Sciences Centerand is also Dean of the GraduateCollege at the University ofOklahoma Health Sciences Center.➜ 78

Matthieu Trudeau is a Master’s stu-dent in ME at Université deSherbrooke, Québec, Canada. Hehas a Bachelor’s degree in ME fromDalhousie University, Halifax, NovaScotia. Trudeau is a member of thePERSEUS research group, whichconducts research projects in thefield of biomechanics. ➜ 187

Koichi Tsunoda, MD, PhD isAssistant Professor, Faculty ofMedicine, University of Tokyo andChairman, Department of ArtificialOrgans, National Institute of Sens-ory Organs, Japan. His Specialtiesare Laryngology, Phonosurgery,Artificial Organs, Neuroscience. ➜

52

Petra Valouchová, PT, PhD, spe-cialised in Biomechanics, Master’sDegree in Physiotherapy. She hasbeen a physical therapist at Rehab-ilitation department of UniversityHospital in Prague and a universityteacher of physical therapy and gen-eral medicine students at CharlesUniversity Medical school. She has

certificates in Vojta´s method, Bobath concept, Mobiliza-tion and soft tissue techniques. ➜ 217

Andry Vleeming, clinical anatomist,worked for 17 years in the ErasmusUniversity in Rotterdam. His PhDwas on the clinical anatomy, biome-chanics and radiology of the pelvis.In 1996 he founded the Spine andjoint center in Rotterdam theNetherlands. He is visiting professorin clinical anatomy in several

Universities around the world. He is program chairmanfor the Office of continuing education of the Universityof San Diego for the World congress on lumbopelvic pain(and chairman). ➜ 130

H. Vránová is from the Departmentof Anatomy and Biomechanics,Faculty of Physical Education andSportCharles University in Prague, CzechRepublic. ➜ 248

Scott C. Wearing, PhD, is an RCUKAcademic Fellow within theBioengineering Unit, University ofStrathclyde. His research hasfocused on the application of med-ical imaging techniques to investi-gate the effect of limb biomechanicsand loading on musculoskeletalmorphology, adaptation and injury.➜ 243


Contributors

278▼

▼ ▼ ▼

Yan Wen, MD, is currently a re-searcher in the OB/GYN depart-ment at Stanford University, study-ing the mechanism involved in thedevelopment of female pelvic floorprolapse. ➜ 49, 53

Frank Willard, PhD, is located at the University of NewEngland. His human dissection projects in the low backdemonstrate the functional organization and innervationpatterns of muscles and ligaments, in order to understandpain generating mechanisms and their role in spinal cordfacilitation. ➜ Fascia anatomy and biomechanics panelchapter 5

Can Yücesoy has BSc and MScdegrees in Mechanical Engineering.He received a PhD on Biomechani-cal Engineering from University ofTwente. He is a fulltime facultymember at Biomedical EngineeringInstitute in Bogaziçi University. Hisresearch is in biomechanics with afocus on myofascial force transmis-sion. ➜ 212

Adjo Zorn, PhD, has been workingfor many years as a physicist forGerman car manufacturing compa-nies for more than 20 years, and isalso an Advanced practioner ofRolfing Structural Integration withhis own practice for 13 years.He is a member of the FasciaResearch Project of the University of

Ulm, Germany. His research work focuses on the biome-chanical function of connective tissue. ➜ 81, 82, 188


Index

▼

279

▼▼ ▼

Aabdominal fascia, viscoelastic prop-

erties 138achilles tendons under tensile load,

measured with MRI 236actin organization 40acupuncture 209acupuncture needle rotation,

changes in connective tissuestructure 227

acupuncture sites, issue winding andneedle forces 253

alpha-1-antitrypsin 49alpha-SM actin 57, 61, 89– expression, biomechanical stress

70anatomy and biomechanics 89angiotensin II 57ankylosing spondylitis 85anti-contractile drugs 81antistress effects 14aponeurotomy, acute effects 101apoptosis 25axes of stress in bone 24Axons, CGRP release 179

Bba gua fa, carpal tunnel syndrome

208back pain, active scars 217balance improvement, with structur-

al integration 242barrier-dam theory 84basal lamina 91, 92benign Joint Hypermobility

Syndrome 83biology of manual therapies, 2005

conference 12, 17biomechanics and imaging 15blepharospasm, structural integra-

tion 222bone, axes of stress 24bone growth and development 23bone structure 23

Bowen technique 247brachial plexus, passive motion 241breast cancer treatment, managing

painful dysfunction 215Brighton test 83bruxism, electromyography 219Bunkie method 141

Ccalcitonin gene-related peptide,

nervi nervorum 178caldesmon 57capsicain 176carpal tunnel syndrome, ba gua fa

208cell migration 46cellular adhesion 46cellular fascia studies 44cellular network 209chakra system, adult germ cells 210chiropractic use 13chronic fatigue syndrome, balance

improvement with Rolfing 242clinical questions 196collagen distribution, manual tech-

nique 245collagen fiber reorganisation 47collagen metabolism, pelvic support-

ing tissue 53compliance of muscle 147connective tissue– body-wide network 260– contracting cells 80– intramuscular 93– mechanical stress 35– mechanotransduction 15– muscle interaction 35– muscular 103– musculoskeletal 80– structure 67connective tissue remodelling 44– low back pain 34contractile activity 145contractile microfilaments 24

contractile proteins, in non-musclecells 56

contractility, fascial 82contraction mechanisms 40contracture 145, 150cramp 152cranial fascia 264– role of 214cytosceletal mechanics 25cytoskeleton, shape stability 25

Ddeep fascia– histological study 132– innervation 48diabetes mellitus, foot muscular tone

220differentiated myofibroblast 64doctors of osteopathy, chiropractic

13dynamic remodelling 27

EECM adhesions, stress transduction

71Ehlers Danlos Syndrome 83, 87elastic stiffness 145elasticity 145elastin metabolism, pelvic support-

ing tissue 53electrogeneic spasm 145endomysium 93endothelium, fasciatherapy and pul-

sology 244engeneering of the musculosceletal

system 21epimuscular myofascial force trans-

mission 212epimysium 93epi-perineurial anatomy, innervation

and nociceceptive mechanisms183

ergonomics, manual therapies 15extracellular matrix 91

Index


Index

280▼

▼ ▼ ▼

FFA 62Fascia– contractility 82– contraction 76– deformation 135– histological study 132– innervation 48– lumbodorsal 131– in literature 136– meridians 209– myofibroblast 76– superficial 134– thoracolumbar 130– and pain 143fascia deformation, three dimen-

sional mathematical models135

fascia lata, anatomy 133fascia remodelling, low back pain

186fascia strain hardening 51fasciagenic pain model 84fascial change, measurement 223fascial drag, virtual reality simula-

tion 139fascial manipulation, tissue changes

46fascial manipulation©

– anatomical basis 257– patellar tendinopathy 250– prorioception 207fascial plasticity, Bowen technique

247fascial taping– low back pain 192, 203– ultrasound investigation 251fasciatherapy and pulsolgy, vascular

endothelium 244fasciotomy, acute effects 99fiber-reinforced composites 91fibroblast-collagen-matrix contrac-

tion 39fibroblasts 261fibromyalgia, neuroendocrine factors

14fibronexus 61fibrosis 44, 57flexion-relaxation response to gravi-

ty 119floppy infants 146focal adhesions 61

foot muscular tone, diabetes mellitus220

force transmission 94– in limbs 103– in muscle and whole limb 90– intramuscular 102frozen shoulder, contractile cells in

fascia 87functional neuroimaging, manual

therapies 15

Ggamma-interferion, scars 57germ cells, chakra system 210giant myofibroblast 62granulation tissue, stimulus respon-

dence 56Graston technique 191, 206Gravity, influence upon trund 120growth control system 209growth factor beta 1 44gua sha, microcirculation 249

HHeadache– tension-type 153– trigger points 154hoarseness 52hyaluronan 46hypermobile joints 83hypermobility syndrome, contractile

cells in fascia 87hypertonia 146

Iimmune and endocrine systems 14immune system, stress 15impendance, mechanical 147inflammation, trauma 15integrins 24intramuscular connective tissue 93

Jjoint architecture 22joint hypermobility, tissue stiffness

83joint stability, ligamento-muscular

reflex 21, 114

KKettner, Norman 15key notes, 2005 conference 14

knee extension moment 105

Llaminin 92lateral force transmission 94, 95ligament 108– as sensory organ 114– ECM 24– hypertrophy 115– increased physical activity 113– inflammation 113– mechanical properties 109– structure 108ligamento-muscular reflex 114liver fibrosis 57lockjaw 156low back pain– connective tissue remodelling 35– estimate of loads 184– fascial taping 192– functional taping 203– in police officers 184– injuries in lumbar fasciae 50– pathophysiological model 33– perimuscular fascia remodelling

186lumbar compartment syndrome,

subacute 191lumbar fascia– function in human walking 188– injuries 50– tension 185lumbodorsal fascia 131lumbopelvic stability 201lysyl oxidase-like protein 1 49

Mmacrovacuolar concept 237manual techniques, collagen distri-

bution 245manual therapies– effects 12– nervous system 14– techniques 13manual therapists 13Marfan Syndrome 83massage therapists 13Massage Therapy Consortium 13mastectomy, limb dysfunction 215matrix extracellular 91matrix 265matrix adhesions myofibroblasts 60


Index

▼

281

▼▼ ▼

matrix contraction 41matrix stiffness, myofibroblast dif-

ferentiation 64matrx hydration changes, fascial

strain hardening 51maximizing strength per mass 21Maxwell’s lemma 21mechanical impendance 147mechanical stress, myofibroblast dif-

ferentiation 69mechanotransduction 20meridians 260– fascia 209merosin 92microcirculation, gua sha 249microdynamics 19microinjury model 44microvacuola 238migratory fascia syndrome 193movement pattern abnormalities

low back pain 34muscle, interrelationships 104muscle activity, unintentional 157muscle cramp 152, 168muscle dynamics and surgery 211muscle hardness, increased 85muscle nociceptors, primary 164muscle nociceptors, anatomy and

physiology 165muscle overload 157muscle pain, delayed onset 168muscle rigidity 152muscle spasm 144, 151, 154muscle spasticity 152muscle stiffness 158muscle tension 144, 157muscle thixotropy 144muscle tone 145– definition 146– measurement 147– muscle pain 144– resting 85, 86muscular connective tissue, blood

vessels and nerves 103muscular force transmission 93musculosceletal system– hierarchical organization 22– design principles 26musculoskeletal mechanics, fascia

76musculoskeletal pain, biomechanics

162

myofascial pain– fascial plasticity 84– connective tissue contractility 84myofascial pathways, role of 213myofascial relacatioin, heat induced

86myofascial release 140– scoliosis 204, 205myofascial therapy, objective diag-

nostic and therapeutic criteria221

myofascial transmission 94myofascial trigger points 154– biochemical milieu 181myofiber cytoskeleton, connections

to the basal lamina 96myofibered muscle, spanning/non-

spanning 96, 97, 102myofibroblast– activity 58– contractility 81– contraction 68– differentiation 64– evolution 57– evolution 72– matrix adhesions 60– mechanical stress 69– superaturation 62– tissue reconstruction 67myofibroblast concept 56myofibroblast formation,

mechanoregulation 78myofibroblasts and fascial tonus reg-

ulation 55myotendinous force transmission 93

Nneck ROM and pain, structural inte-

gration 256nerve anatomy 183nerve sheaths, PGE2 release 179nervi nervorum 174nervous system, manual therapies

14neuromatrix 162neuromuscular disorders 115neuronal synapses, plasticity 14neuropathy, sensory radicular 163neuroplasticity, low back pain 34neuroscience research 14neutrophil elastase 49nociceptive nerve ending 166

nociceptor response to stimuli 167nociceptors 164, 174nocturnal leg cramps 158nonnoxious mechnical stimuli 14nuclear shape, tissue stretch 45

Oorganism, construction 21osteoarthrosis, prevalence 87osteopathy, chiropractic 13ostogenesis imperfecta 83oxytocin 14

Ppain modulation 14pain perception 162pain syndromes, sex hormones 14pain transmission, Descartes 165painful muscle spasm 154pain-spasm-pain misperception 154palmar fibromatosis, contractile cells

in fascia 87patellar tendinopathy, Fascial

Manipulation© 250pectoralis fascia 137pelvic obliquity 193pelvic organ prolapse 49pelvic supporting tissue,

collagen/elastin metabolism 53pendulum test 147perimysium 93, 104plantar fascial thickness 243plantar fibromatosis, contractile cells

in fascia 87PNF 218posture fascia 190pregnancy– fascia function 201– urinary incontinence 53prestress 26procollagen-1 44progressive fasciotomy, acute effects

99proto-myofibroblast 64psychological factors, low back pain

34

Rrecommendations, 2005 conference

16reflex, ligamento-muscular 114relaxation, heat induced 86


Index

282▼

▼ ▼ ▼

resonance 148rigidity 152robotics, manual therapies 15Rolfing– balance improvement 242– blepharospasm 222– neck ROM and pain 256– sensory improvement 255– spinal cord injury 254

Sscar retraction 56scarring 44scars, biomechanical impact 248scars, osteopathic approach 258sclerosis, myofascial release 205scoliosis, myofascial release 204sensory improvement, structural

integration 255shoulder movement after breast can-

cer treatment 215signal categories 261skin, collagen fibers 47skin distraction over the spine’s mid-

line 189SM 22 57Spasm, measurement 152spasmodic torticollis 155spasticity 152specific tone 145spinal cord injury, structural integra-

tion 254spinal manipulation, effects 12spine stiffness, thoracolumbar fascia

187stability with minimum mass 22stiff-man syndrome 158stiffness 145– measurement 148stress, immune systems 15stress fibers 24stress transduction, ECM adhesions

71

stress urinary incontinence 53structural hierarchy 27structural integration– blepharospasm 222– neck ROM and pain 256– sensory improvement 255– spinal cord injury 254subcutaneous sliding system 237suFA 62sulcus vocalis 52

Ttaxonomy of Therapeutic Massage

and Bodywork 13tendinopathy, Graston technique

206tenotomy, acute effects 99tensegrity and mechanoregulation

20tensegrity architecture 27tensegrity model of the spine 15tension and compression 21tension-relaxation phenomenom, in

ligament 110tension-type headache 153TGF-β1 44, 53thixotopy 150thixotropic behaviour 144thixotropy 148, 149thoracolumbar fascia 130thoracolumbar fascia– spine stiffness 187three-dimensional tensegrity model

29tissue changes, fascial manipulation

46tissue displacement, acupuncture

sites 253tissue morphogenesis, cellular

mechanotransduction 23tissue reconstruction, myofibroblast

67tissue stiffness

– isometric stretch 51– joint hypermobility 83tissue stretch 44tissue structural abnormalities, low

back pain 33tone 146torticollis, spasmodic 155Traditional Chinese Medicine 260trans-sarcolemm, connections to the

basal lamina 96trauma, inflammation 15triangulation 27trigger point hypothesis 84triggerpoints, biochemical milieu

181trismus 156tropomyosin 57tympanoplasty, fascia shrinking 216

Uultrasound for characterization of

local connective tissue networkstructure 224

urinary incontinence 53

Vvacuoles 239vaginal fibroblasts 53vibration, low back problems 15vinculin 67viscoelastic parameter, scar 248viscoelastic stiffness 145viscoelastic tone 144, 145viscosity 148

Wwalking function of lumbar fascia

188Wartenberg test 147Wolff ’s law 23wound contraction 39, 56wound healing, myofibroblast evolu-

tion 72


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