Fascia! Fascia! Fascia!
In late March I attended a workshop on fascial work lead by Tracie Skolny RMT, founder of On Point Seminars. For the last few weeks I have been trying to process and integrate the things I learned, the things I unlearned, and the connections formed between things I had already known but did not know they were related. I’ve been chattering about it with my patients, colleagues, and my partner who does his best to follow along (lol). This blog is my attempt to pull it all together and make what previously seemed in opposition, work together harmoniously.
First, Fascia…
Many of you have probably encountered this word and understand it to be the saran wrap that encases all the things inside your body. You can unfold this concept like a fractal. Say you have a plastic wrapped skid of packages of spaghetti noodles. The plastic around the skid is one type of fascia encasing a whole muscle. When that layer is peeled back we find boxes analogous to another layer of fascia separating a segment of muscle from the other, and the package holding the spaghetti is analogous to the fascia around a bundle of muscle fibers. There are many different types of fascia in the body with their own jobs and textures. It is like saran wrap in some instances and also like a web that your innards are suspended in.
Layers upon layers…
The job of fascia is multifold; it provides structure to the soft tissue through “tensegrity.” Tensegrity is the concept of using tension to maintain integrity. You can kind of picture this like pitching a tent. The tent poles on their own do not stay upright nor do they form the shape of the tent. Likewise, the tent body just lays there limp on the ground without the poles. When the two are put together, the rigidity of the tent poles facilitates tension through the tent body, and the tent body distributes that tension across the poles evenly which creates the cavities of the tent in which you sleep and store your belongings. If the tent body is warped somehow the tensegrity is lost and the tent can collapse. If a tent pole is broken or comes apart from the anchor points, the tent can collapse. Our bodies are similar – the skeleton is analogous to the poles, our fascia (and many of the other soft tissues of our bodies) is the tent body. One without the other is just a pile of stuff. Brought together we have a thing.
Sensory organ?
Within the fascial tissue are many types of proprioceptors responsible for monitoring tension, contraction, and compression. It is arguable that fascia itself is neither an organ nor a sensory structure (and I personally lean in this direction) but carries within it sensory parts (nerves) and, through the fascial web, those nerves can monitor not just tension in their immediate areas, but tension in neighbouring parts. This is part of the 6th sense called proprioception, the sense of knowing where your body is in space and what position it is in. It can also participate in a 7th sense called interoception, the ability to feel the goings on of your internal parts and accurately interpret them. Similar to vibrations in a spiders web, tension occurring in one part of your body is communicated to neighbouring parts via the fascial system. Its this sensory aspect of the fascial system that RMTs and other body workers are connecting with in their work.
This is the part that had me most excited. Truthfully, the hands on part of the workshop was not new for me. Under a different name I have been using the technique for a few years and almost exclusively use it in the neck and shoulders, and layer it in a lot when working with the muscles of the back. What I found so pleasing about it was the meditative mindful quality of the work, and the opportunity to resource my patient's own attention and sense of what's happening inside themselves to inform me. To employ these techniques effectively one has to really focus ones attention on the sensations being perceived by the hands. Flutters, pulses, and softenings occur under the recipients skin when we touch them and when the RMT is paying attention we can feel the moment when the tissue “releases” or “let’s go” or otherwise moves from tense and turgid, to soft and loosy goosey. For the patient, while working with the therapist an opportunity to attune to the body's own sensations and interpret them with real time feedback from the therapist. This can provide a supported chance to settle the mind into the body, a big challenge for folks living with depression, anxiety and trauma as well as chronic pain and health problems, while (ideally) experiencing something pleasant and beneficial.
What’s in a release?
This is where things get a bit tricky and hotly debated in manual therapy professions. You have the people who say that fascia is just an inert and uninteresting tissue encasing the good stuff. Like Amazon packaging, it serves a singular purpose – packaging – and nothing more. The important stuff is the nerves, that’s what you’re really interacting with and changes perceived in the tissues are due to nerve activity. On the other side of the debate are the people who say fascia IS the good stuff and it carries within it more good stuff and without the fascia those sensory parts would have nothing to communicate to them what’s going on in the body. That when we work with the body we are changing the fascia by stimulating cells to transmorph and produce fascia juice (hyaluronan) that change the composition and function of the fascial tissue itself. The end result, regardless of which side you follow, seems to be tissues soften, mobility has more ease and pain can be at least modulated if not reduced.
Who’s right?
I have no idea but if being alive has taught me anything the correct answer is usually found somewhere in the murky middle. In the workshop, Tracie talked about the fascial cells called fibroblasts. These cells respond to stretch (or more generally, deformation) by transmorphing into fasciacytes and myofibroblasts. Myofibroblasts seem to be more present in injured tissue and have contractile ability, capable of holding contraction for very long periods of time. This may explain some of the more persistent and diffuse quality of some people’s pain problems. Fasciacytes are more present in normal, uninjured tissue and produce hyaluronan that hydrates and lubricates the surrounding tissues, improving tissue mobility, structure and health. The people who argue that it’s all about the nerves discuss neural relay systems that communicate between the nervous system and peripheral body tissues. When we deliver the “right” input to that body the nerves communicate to the body tissues to decrease protective tension and allow for more movement. Truthfully, I don’t really see why it could not be both and regardless of who is correct, without the ability to collect tissue samples from before, during, and after treatment, or monitor nerve activities while treatment is occurring, it’s not likely a knowable thing for me. While I think knowing may be useful for those working in the scientific arena responsible for developing methods of treating pain problems, between you and me the how of the thing may not be nearly as relevant as whether or not the approach yields a consistent, positive result over time.
Evaluation and Treatment
With all that said, I found the work compelling and really enjoyable to perform. The meditative focus is reminiscent of my mindfulness practice and gave me an internal focal point – my hands – to settle into satisfying the part of me that wants to get mindfulness more embedded into my everyday. Myofascial Work involves a light touch on dry (no lotion or oil) skin or over clothing that generates a bit of drag, or deforms the tissues (and cells) enough to create a stretch on the cells. The techniques are applied slowly and generally held for at least a minute, sometimes longer, as the tissue deforms or “releases.” As the response unfolds, depth is achieved not so much by adding pressure, but by increasing the drag. Tracie taught us to evaluate the tissue with our palpation skills, looking for where the fascia seems to get hung up, where it feels dense or immobile, if it has lost some elasticity, and if it is asymmetrical. We then learned to look for directionality of the bind seeking where there was ease and where there was restriction. Treatment involved much of the same but becomes more conversational; as I move the tissue in one way, I am waiting for a response from the body. Do I feel a softening or receptivity? Do I feel resistance or pushback? I also inquire with my patient “does this feel good or relieving? Neutral? Bad or worsening?” soliciting guidance from them and their living experience of the work as I apply it. Working in concert, myself, my patient, and their body, we find our way to the result of the work, typically different sensation for the patient, and different tissue texture under my hands.
Fascia! Fascia! Fascia!
This approach felt so good to perform and I have had a lot of great responses to it so far and am excited to incorporate more of this work into my practice. I think this technique is suitable for most people but ideally those who have a tolerance for a lighter touch or are sensitive to heavy touch, have persistent feelings of tightness or pain, or who prefer to remain fully clothed during a visit to a bodyworker.
How do you know your fascia needs work? I can't speak for others but I know for me I may feel a somewhat diffuse, superficial tension that starts just below my skin and can sometimes anchor deep down like its tied to my bones. It is not exactly painful but rather irritating like some part of my skin or flesh is too tight. It sometimes feels itchy under my skin, like I need someone to scratch my muscles. This is the feeling of wearing too-tight saran wrap.
If you are interested in trying this technique out hop on over to the online schedule and book a session!