By Julia Belluz

Millions of back patients are floundering in a medical system that isn’t equipped to help them. They’re pushed toward intrusive, addictive, expensive interventions that often fail or can even harm them, and away from things like yoga or psychotherapy, which actually seem to help. Meanwhile, Americans and their doctors have come to expect cures for everything — and back pain is one of those nearly universal ailments with no cure. Patients and taxpayers wind up paying the price for this failure, both in dollars and in health.

More and more people are seeking out alternative therapies for back pain. While yoga, massage, and acupuncture have been around for a long time, there was little high-quality research out there to understand their effects, and doctors often looked down on the practices. But over the past decade, that’s changed.

… Massage therapists work by manipulating the muscle and soft tissue of the back and body. There are many, many different styles of massage: Swedish, deep tissue, sport, myofascial release, Thai, the list goes on. Massages also vary in how long they last, how much pressure is used, and how frequent sessions are, which makes the evidence for massage pretty difficult to interpret. But there’s good news here: Massage is pretty harmless, and the researchers who study back pain say the approach makes sense from a pain relief perspective.

See the entire (long and detailed) article at vox.com/science-and-health/2017/8/4/15929484/chronic-back-pain-treatment-mainstream-vs-alternative.

From Myofascial Release Blog. (See also the author’s “Let Your Stories Mature and Grow” and “The Good (and Bad) of a Simpler Narrative“.)

By Walter Fritz

[Though fascial massage can feel like the most effective treatment for many people, there are a few different hypotheses about how it actually works — and sometimes conflicting evidence for each. -Jonah W.]

What if I asked you to strip away the story you tell when describing your modality? Could you describe the actions of your hands without the jargon inherent in the story of your modality? It might be pretty hard to do, as it may be hard to separate actual plausible science, anatomy, and physiology from what you were taught as the science that supports the work you use. You have to use something that sounds science-like, but what if you had to change your story? Could you do it and would you even wish to try? You would need something to explain your work, though my explanation seems to get simpler by the year.

Changing one’s story is often viewed as shifty or even indecisive, as if you cannot decide or are trying to cover up something. I disagree. I’ve written extensively about how I moved from a narrative (story) of myofascial release in the traditional, folkloric sense, which credits so-called fascial restrictions as being the cause of most pain as well as the key to the remediation of pain, into a story of simplicity and plausibility. Apparently my story was so compelling it garnered a request to tell it earlier this year at the RMTs of British Columbia Manual Therapy 2016 Conference. The story I now tell and teach is a simple one, one deconstructed from the stories of fascial fantasies. But as a therapist (PT) with over 30 years in practice, I’ve heard literally hundreds of stories on how we are creating change in the body, as well as the cautions as to what will happen if we do not follow the recipe set forth in that line of training’s rulebook.

The story told by most manual therapy trainings might be called inherited narratives in that the beliefs and explanatory models have been passed down over time. While new science might be sprinkled in for good effect, most of these narratives have remained unchanged for long periods of time. The narrative I was taught in my initial myofascial release training was certainly an inherited one, as the concepts of MFR (and its explanatory model) stem from osteopathic literature from the early 1900’s. I have begun to use the term folklore to describe the way MFR is taught; as many therapists repeat the inherited narrative verbatim without questioning its validity or authenticity. But this is true for much of the work that we all do. If I attempted to deconstruct most of what I was taught in physical therapy school and eliminate all that was not fully vetted as valid, I may have little to do with my days. Though I’ve allowed the MFR story I was taught to slip away over time, initially it served me well and I questioned little of its truth. Over time, as I moved away from my MFR roots, the inherited narrative of MFR seemed to matter less and less. I also learned drastically conflicting stories from other people. Recognizing that my biases clouded my abilities to see real truth, I began to embrace the concept of attempting to be less wrong. Saying that I am less wrong, when it comes to explaining my work, may sound condescending or superior, but I believe that it comes from a place of humility. With a broad-based education, credible continuing education, and critical thinking, I do think we can be less wrong about the work we do. I do not mean to criticize those who believe differently and certainly not those who taught me these concepts. Science moves forward and I thank those in my past.

Many different influences caused me to change my story, though the need to do so was not due to a lack of efficacy, as I think the MFR work I did has always been effective. But the story I was taught way back in the early 1990’s always bothered me a bit. I found it hard to believe that in a continuing education class we were being taught concepts of anatomical/physiological structure and function not taught to other health professionals, including physicians. But I like a good story, so I played along… just to hear the ending. One key point of the MFR work I was taught was the concept that fascial restrictions go beyond the origins and insertions of individual muscles, which was said to explain why patients feel far-reaching symptoms while we are treating them. Such far-reaching sensations were a key aspect of explaining MFR from a fascial perspective, and I used this explanation with my patients for many years, as well as teaching it in the early days of my Foundations in Myofascial Release Seminars. It was a good story told by some pretty good storytellers and I had no better story to explain the phenomenon, until I learned one. Let me tell you about that new story.

Frequent feedback I heard when performing a technique that is termed a thoracic outlet release are reports of sensation or referral of familiar symptoms throughout the face. When my patients told me this, I used the story I had been taught and explained the concept of fascial restrictions and how they reach beyond the origins and insertions of individual muscles and can refer into far-reaching areas of the body (By then I told that story really well!). Most patients would just nod or grunt in apparent understanding, but I started to notice how frequently I heard these reports. This was surprising, since it was the belief that fascial restrictions were unique to each individual, based on their history of physical (and emotional) trauma. Why were so many people telling me nearly the identical referral pattern? I filed it away for future worrying (I do that a lot. Why waste good time worrying about such things when there were more pressing things to worry about? I tend to compile worry to-do lists). It seemed that with a sustained hold in the above mentioned (and pictured below right) sequence, symptoms improved not only in the area of treatment, but also into the referral patterns through the face. Seeds of skepticism were planted.

Fast forward to a DermoNeuroModulation class I took from Diane Jacobs, PT. She speaks a decidedly non-fascial language and at a certain place in her lecture she displayed a PowerPoint slide regarding the anatomy and distribution of the facial nerve. She had spoken at-length about neurodynamic technique principles, exposing me to some pretty new and interesting perspectives on evaluation and treatment. She spoke about the potential for engaging a nerve anywhere along its length and having the possibility of impacting and allowing change anywhere along the nerve path. In essence, grab hold of a nerve anywhere and you have the potential to impact the entire distribution of that nerve. The photo to the right shows me performing the sequence formerly known as the thoracic outlet release (I have different names for technique sequences today…but that’s another story). If you can imagine where my patient is feeling a stretch or engagement, a wide range of response is plausible, including the front of the neck and upper chest region.

Now consider the anatomy plate shown below. It is a Grey’s Anatomy plate showing the distribution of the facial nerve. The facial nerve is the seventh cranial nerve and “controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue and oral cavity. It also supplies preganglionic parasympathetic fibers to several head and neck ganglia.“(1) The facial nerve functions as a motor nerve as well as sensory and parasympathetic nerve and supplies the exact areas that my patients were reporting all in all those instances of so-called fascial referral. What might explain this phenomenon?

Take a close look at the anatomy plate below and you will see that the cervical branch of the facial nerve runs down through the upper and middle anterior lateral neck regions. When I engage my patients in the stretch shown above in the photo, I believe that I am lightly engaging the cervical branch of the facial nerve. I believe that I am providing neurodynamic technique-like engagement to the cervical branch of the facial nerve, potentially affecting the entire facial nerve. I believe that I am allowing my patients to feel effect into their faces and treating the facial region from this sequence, not from a fuzzy science explanation of fascial restriction, but from a biologically plausible model of nerve mobilization.

Sitting in Diane’s class and seeing the facial nerve in an enlarged image allowed me to immediately see that old, folkloric story of so-called fascial referral patterns in an entirely new light. Does this mean that fascial restrictions do not explain this phenomenon? Not definitively, but when faced with a decision to choose one explanation over another, I now choose the one that is less wrong. I choose the one that science supports without needing to tell a story.

Stories have their place, but they should be told as either fact or fiction. When stories blur I do not believe they belong in the treatment room, where we give skilled care to patients in pain and dysfunction. Try to be less wrong. Change your story.

What about you? Has your story changed?

For Now,
Walt Fritz, PT

See more: Foundations in Myofascial Release Seminars

(1) Facial nerve text and image courtesy of Wikipedia. https://en.wikipedia.org/wiki/Facial_nerve

By Leon Chaitow

Fascia is fashionable. Over the past few years, you may have noticed the increase in conferences, congresses, symposia, workshops, online courses, books and articles that contain the word fascia in their title.

Fascia was, for many years, seen as a sort of second-class tissue, a form of supportive wrapping, a nuisance during dissection, where it obscured the views of pretty muscles and joints. Fascia’s increased visibility, due largely to the series of International Fascia Research Congresses,  has attracted publication of a huge number of serious basic science research papers, as well as an avalanche of clinically related, fascia-related articles. These articles range from a focus on the fascial influences of foam-rolling, kinesiotaping, connective tissue massage, muscle-energy and other stretching techniques, myofascial release, a variety of exercise models (with plyometrics taking the lead), as well as a range of new trademarked approaches, led by the Italian export Fascial Manipulation.

One of the surprising features resulting from current fascia research (and there is an awful lot of it) is how little our increased understanding of fascia’s functions has changed what manual therapists actually do – or need to do. Rather, I believe, greater fascial awareness and understanding helps most therapists to do what they already do, more effectively, rather than having to relearn their skills. I have outlined a few examples of this here.

Where Does A Muscle End and Fascia Begin?

Before looking at examples of how emerging fascial knowledge refines, but doesn’t necessarily change, what we do – it’s important to establish a basic fact: It is impossible to treat fascia directly (short of actual surgery). In fact, all treatment approaches that target the soft tissues of the body, the muscles, ligaments, tendons and of course the joint-related tissues must involve fascial structures. The key message here is that it is not possible to “treat,” – for example, a muscle (in any way whatever), without fascia being a feature of the process.

This elegantly phrased quote, from a research article by Weppler & Magnusson (2010), summarizes this point: “Skeletal muscles comprise contractile tissue intricately woven together by fibrous connective tissue that gradually blends into tendons…made of fibrous connective tissue [that] attach the muscle to bone. Although contractile tissue and tendons are sometimes evaluated separately for research purposes, they cannot be separated during routine clinical testing and stretching procedures, nor during functional activity,” nor, of course, during manual treatment.

Five Clinically Relevant Examples

Note: This is not a definitive list. I have selected some key examples, there are many others!

Load transfer via fascia. Load-transfer research demonstrates how force is transmitted from one part of the body to another via fascial connections (described by some as “chains” and others or “trains”). For example, Carvalhais and colleagues (2013) demonstrated how contraction of latissimus dorsi – during adduction of the shoulder – produces external rotation of the contralateral hip via the superficial layer of the thoracolumbar fascia; while Stecco et al., (2013) showed how gluteus maximus contractions directly influence the knee via the iliotibial band. Potentially, therefore left-knee dysfunction could involve right latissimus dorsi behavior. Awareness of such links would not necessarily alter your treatment methods, but might well cause you to look at a wider set of possibilities when seeking causes of knee pain.

Fascia’s sliding and gliding fascial functions. The different layers of the body – for example, between muscles or separating dense fascial structures from muscle or from other fascial layers – contain viscous loose connective tissues that allow a gliding, sliding function, protecting sensitive neural structures, as well as facilitating pain-free, efficient movement and force transmission, as described above. Gliding function may be lost because of trauma, inflammation or aging, resulting in fibrosis, thickening, densification. (Pavan et al 2014). Knowledge of the sliding functions of fascial tissues might not change what you do at all, but may help to explain why attention, lightly applied, as in myofascial release, can offer such dramatic benefits.

Mechanotransduction or changing cell behavior: for example, reducing inflammation and speeding healing of damaged tissues. Mechanotransduction describes the many ways in which cells respond to different degrees of load, such as pressure, tension, stretch, friction, etc. Research using important fascial cells (fibroblasts) that are largely responsible for the early stages of healing traumatized tissues, has shown that when these cells have been distressed by many hours of rapid movement, so that they start producing inflammatory chemicals, a brief period (a minute to 90 seconds) during which the cells are “treated” with the equivalent of myofascial release (MFR) or positional release (strain/counterstrain or SCS) – normalizes them. (Standley & Meltzer 2008.)

When MFR methods are applied to fibroblast cells in damaged tissues, a speeding up of the repair process is observed. (Hicks et al 2012). More recently, Cao et al (2015) conducted research on bioengineered tendons that had been artificially injured, to see how different degrees of light load (as in MFR) would effect the healing process. They tested a variety of degrees and durations of light stretching and identified that particular variations. For example, three minutes of stretch using around 6% of stretch, was effective in speeding up repair, while 12% for five minutes slowed it down. These percentages represent the degree of increased length of the tendon induced by stretching.

This remarkable research does not change the way gentle MFR or SCS are applied in manual therapy treatments of injured, painful, irritated, inflamed tissues – but helps explain why stronger degrees of stretch may not be as effective as light load.

Fluid dynamics and pain reduction. Manual methods that use isometric contraction – such as Muscle Energy Techniques (MET) – have the effect of improving fluid movement, particularly involving fascial fibroblast cells. Changes in the hydrostatic pressure in fascial tissues leads to improved drainage, reducing inflammatory chemicals (Langevin et al 2005, Fryer & Fossum 2009).

This is another example of fascial research indicating why (and how) mild stretching methods, particularly those involving isometric contractions, are effective in pain management. The information doesn’t change the treatment methods, but it does clarify our understanding of what’s happening.

Eccentric MET stretch and fibrosis, post-surgery. Remarkable clinical work in India, by orthopedic surgeons working in rehabilitation of individuals who have had recent hip or knee replacement surgery, or surgical repair of fractures, has demonstrated the value of slowly applied isotonic-eccentric stretching in such cases, thus reducing fibrosis and speeding recovery compared with traditional passive stretching methods. These MET variations have been successfully used for many years, by osteopaths and manual therapists in treatment of musculoskeletal dysfunction and have now been scientifically validated. Although this clinical research adds a wider range of application for MET, it does not change the way many of us already use this valuable method (Parmar, et al 2011).

The Bottom Line

Current fascia research is informing us, refining rather than revolutionizing what we do. Understanding the mechanisms of what we do in practice can help in the choice of what methods are best for particular clinical settings – how to best apply the multiple tools that manual therapists have for the optimal benefit of patients.

You may have noticed that the examples I have given in this article largely focused on biomechanical (and fluid related) effects of manual treatment. Apart from these there are, of course, important neurophysiological effects but that’s a whole other story for another time.

References

1. Cao T et al 2015 Duration and Magnitude of Myofascial Release in 3Dimensional Bioengineered Tendons: Effects on Wound Healing. JNL. American Osteopathic Association. 115(2):72-82.
2. Carvalhais V et al 2013 Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles: An in vivo experiment. Journal of Biomechanics 46:1003–1007.
3. Fryer G Fossum C 2009 Therapeutic Mechanisms Underlying Muscle Energy Approaches. In: Physical Therapy for tension type and cervicogenic headache:. EDS: de las Peñas F et al Jones & Bartlett, Boston.
4. Hicks M et al 2012 Mechanical strain applied to human fibroblasts differentially regulates skeletal myoblast differentiation. J. Appl. Physiol.113(3):465-472.
5. Langevin H et al 2005 Dynamic fibroblast cytoskeletal response to subcutaneous tissue stretch ex vivo and in vivo. Am J Physiol Cell Physiol 288:C747–C756.
6. Pavan PG et al. 2014 Painful connections: densification versus fibrosis of fascia. Curr Pain Headache Rep. 18(8):441.
7. Parmar S et al 2011 Effect of isolytic contraction and passive manual stretching on pain and knee range of motion after hip surgery. Hong Kong Physiotherapy Journal 29:25-30.
8. Standley P Meltzer K 2008. Effects of Repetitive Motion Strain (RMS) & Counter-Strain (CS), on fibroblast morphology and actin stress fiber architecture. J Bodyw Mov Ther 12(3):201-203.
9. Stecco A et al 2013 The anatomical and functional relation between gluteus maximus and fascia lata JBMT 17(4):512-517.
10. Weppler CH Magnusson SP 2010 Increasing Muscle Extensibility: A Matter of Increasing Length or Modifying Sensation? Physical Therapy 90:438-449.

By Kelly Bastone

Research finally reveals just what massages can — and can’t — do for runners.

There is good reason massage therapists are part of an elite runner’s entourage. And why the lines for a postrace massage seemingly extend for miles. A rubdown — even a deep, intense one — feels great. Runners report that massages help lessen muscle tension and improve range of motion, while also making them feel relaxed and rewarded for their hard efforts.

Yet despite massage’s popularity and positive reputation, there’s been little scientific evidence to support why athletes feel so good when they hop off the table. “It can be hard to merge basic science with alternative medicine,” says Justin Crane, Ph.D., a McMaster University researcher who conducted some of the first objective studies on massage in 2012. Practitioners say massage relieves muscle soreness, promotes circulation, flushes toxins and lactic acid from the body, and eases joint strain — claims supported by centuries of anecdotal evidence from China, Sweden, and around the globe. But science hadn’t confirmed just what massage actually achieves — until now. Recent research has sorted out what’s true and what’s not.

First, let’s set the record straight: Science doesn’t support some ingrained beliefs about massage. “It can’t push toxins out of the muscles and into the bloodstream,” says JoEllen Sefton, Ph.D., associate professor of kinesiology at Auburn University, who has practiced massage therapy. “There’s no physiological way that can happen.” Nor does it appear to flush lactic acid from muscles, says Crane, who analyzed muscle samples after subjects cycled to exhaustion and then received a 10-minute massage. “People assumed that because lactic acid feels burny, and massage reduces pain, then it must clear away lactic acid,” he says.

What massage does do is apply moving pressure to muscles and other tissues such as tendons, ligaments, and fascia (which sheaths muscles like a sausage casing). “That energy softens fascia tissue and makes clenched muscles relax,” Sefton says. It also removes adhesions between fascia and muscles (places where the two stick together and restrict muscles’ movement). That’s especially great news for runners, who rely on limber joints and muscles for pain-free peak performance.

Science’s biggest discovery is what massage can do for athletic recovery. Studies published in the Journal of Athletic Training and the British Journal of Sports Medicine found that massage after exercise reduced the intensity of delayed onset muscle soreness (DOMS)—that is, the peg-legged feeling you get two days after your marathon. And other research suggests that it improves immune function and reduces inflammation. Emory University researcher Mark Rapaport, M.D., found that just one massage treatment resulted in an increased number of several types of lymphocytes (white blood cells that play a key role in fighting infection) while also decreasing levels of cortisol (the “stress hormone” linked to chronic inflammation). “More research is needed, but it’s reasonable to think that massage could help runners taxed from exertion,” Rapaport says. It may also help curb chronic diseases. “We know that systemic inflammation is associated with a lot of deleterious effects, such as heart attack and stroke, and that it predisposes people to cancers,” he says.

Crane’s research, published in Science Translational Medicine, found less inflammation in massaged limbs—and 30 percent more of a gene that helps muscle cells build mitochondria (the “engines” that turn a cell’s food into energy and facilitate its repair). “What we saw suggests that massage could let runners tolerate more training, and harder training, because it would improve their recovery and speed up their ability to go hard two days later,” he says.

Studies on rabbits confirm Crane’s prediction. At Ohio State University, Thomas Best, M.D., Ph.D., put a device on exercised animals that simulates massage and records the applied pressure. “We’ve shown a 50 to 60 percent recovery in muscle function compared with no massage,” he says.

The new evidence is so convincing that even the researchers have made massage a regular part of their routines: Crane, Rapaport, and Best have all become devotees as a result of their findings, and they recommend that runners follow suit. Regular massage can boost recovery and be a valuable training tool to help you run your best. “Muscle stiffness can throw off your gait, which leads to problems over time,” Sefton says. “And by getting a sense for how your body should feel when everything is in balance, you’re more likely to notice small issues before they turn into chronic problems.” Even beginning runners can benefit from massage, because alleviating the soreness that comes with starting a new sport makes people more likely to stick with it.

Can’t afford weekly treatments? Self-massage with foam rollers and other tools like tennis balls can be beneficial in between visits. They can also help runners prep for workouts, since they loosen muscles. “Just don’t overdo the pressure,” says Sefton, who notes that even a person’s body weight on a foam roller sometimes applies too much force (and causes muscles to tighten in defense). “Bodywork just before a race or hard workout should be light,” says massage therapist Anna Gammal, who worked with athletes at the 2012 Olympics. “We don’t want muscles to feel sore or overworked.”

After a race or grueling workout, a therapist may go deeper in order to help with recovery—or not. It all depends on the individual, Gammal says. “Through talking with the athlete and using touch, a therapist will determine the state of the muscle and if it’s best to use light strokes or deep-tissue techniques to treat an athlete in a safe and productive way.”

By Gabe Mirkin

When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries. Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.

In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004).

Healing Requires Inflammation
When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.

The authors of one study used two groups of mice, with one group genetically altered so they could not form the normally expected inflammatory response to injury. The other group was able to respond normally. The scientists then injected barium chloride into muscles to damage them. The muscles of the mice that could not form the expected immune response to injury did not heal, while mice with normal immunities healed quickly. The mice that healed had very large amounts of IGF-1 in their damaged muscles, while the mice that could not heal had almost no IGF-1. (Federation of American Societies for Experimental Biology, November 2010).

Ice Keeps Healing Cells from Entering Injured Tissue
Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.

Anything That Reduces Inflammation Also Delays Healing
Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:
• cortisone-type drugs,
• almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),
• immune suppressants that are often used to treat arthritis, cancer or psoriasis,
• applying cold packs or ice, and
• anything else that blocks the immune response to injury.

Ice Also Reduces Strength, Speed, Endurance and Coordination
Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling . Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play.

My Recommendations
If you are injured, stop exercising immediately. If the pain is severe, if you are unable to move or if you are confused or lose even momentary consciousness, you should be checked to see if you require emergency medical attention. Open wounds should be cleaned and checked. If possible, elevate the injured part to use gravity to help minimize swelling. A person experienced in treating sports injuries should determine that no bones are broken and that movement will not increase damage. If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.

If the injury is severe, follow your doctor’s advice on rehabilitation. With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your sport as soon as you can do so without pain.

by Rick Chillot

Touch is the first sense we acquire and the secret weapon in many a successful relationship. Here’s how to regain fluency in your first language.

You’re in a crowded subway car on a Tuesday morning, or perhaps on a city bus. Still-sleepy commuters, lulled by vibrations, remain hushed, yet silently broadcast their thoughts. A toddler in his stroller looks warily at his fellow passengers, brows stitched with concern. He turns to Mom for reassurance, reaching out a small hand. She quietly takes it, squeezes, and releases. He relaxes, smiles, turns away — then back to Mom. She takes his hand again: squeeze and release. A twenty-something in a skirt and blazer sits stiffly, a leather-bound portfolio on her lap. She repeatedly pushes a few blonde wisps off her face, then touches her neck, her subconscious movements both revealing and relieving her anxiety about her 9 a.m. interview. A couple propped against a pole shares messages of affection; she rubs his arms with her hands, he nuzzles his face in her hair. A middle-aged woman, squished into a corner, assuredly bumps the young man beside her with some elbow and hip. The message is clear; he instantly adjusts to make room.

Probing our ability to communicate nonverbally is hardly a new psychological tack; researchers have long documented the complex emotions and desires that our posture, motions, and expressions reveal. Yet until recently, the idea that people can impart and interpret emotional content via another nonverbal modality — touch — seemed iffy, even to researchers, such as DePauw University psychologist Matthew Hertenstein, who study it. In 2009, he demonstrated that we have an innate ability to decode emotions via touch alone. In a series of studies, Hertenstein had volunteers attempt to communicate a list of emotions to a blindfolded stranger solely through touch. Many participants were apprehensive about the experiment. “This is a touch-phobic society,” he says. “We’re not used to touching strangers, or even our friends, necessarily.”

But touch they did — it was, after all, for science. The results suggest that for all our caution about touching, we come equipped with an ability to send and receive emotional signals solely by doing so. Participants communicated eight distinct emotions — anger, fear, disgust, love, gratitude, sympathy, happiness, and sadness — with accuracy rates as high as 78 percent. “I was surprised,” Hertenstein admits. “I thought the accuracy would be at chance level,” about 25 percent.

Previous studies by Hertenstein and others have produced similar findings abroad, including in Spain (where people were better at communicating via touch than in America) and the U.K. Research has also been conducted in Pakistan and Turkey. “Everywhere we’ve studied this, people seem able to do it,” he says.

Indeed, we appear to be wired to interpret the touch of our fellow humans. A study providing evidence of this ability was published in 2012 by a team who used fMRI scans to measure brain activation in people being touched. The subjects, all heterosexual males, were shown a video of a man or a woman who was purportedly touching them on the leg. Unsurprisingly, subjects rated the experience of male touch as less pleasant. Brain scans revealed that a part of the brain called the primary somatosensory cortex responded more sharply to a woman’s touch than to a man’s. But here’s the twist: The videos were fake. It was always a woman touching the subjects.

The results were startling, because the primary somatosensory cortex had been thought to encode only basic qualities of touch, such as smoothness or pressure. That its activity varied depending on whom subjects believed was touching them suggests that the emotional and social components of touch are all but inseparable from physical sensations. “When you’re being touched by another person, your brain isn’t set up to give you the objective qualities of that touch,” says study coauthor Michael Spezio, a psychologist at Scripps College. “The entire experience is affected by your social evaluation of the person touching you.”

If touch is a language, it seems we instinctively know how to use it. But apparently it’s a skill we take for granted. When asked about it, the subjects in Hertenstein’s studies consistently underestimated their ability to communicate via touch — even while their actions suggested that touch may in fact be more versatile than voice, facial expression, and other modalities for expressing emotion.

“With the face and voice, in general we can identify just one or two positive signals that are not confused with each other,” says Hertenstein. For example, joy is the only positive emotion that has been reliably decoded in studies of the face. Meanwhile, his research shows that touch can communicate multiple positive emotions: joy, love, gratitude, and sympathy. Scientists used to believe touching was simply a means of enhancing messages signaled through speech or body language, “but it seems instead that touch is a much more nuanced, sophisticated, and precise way to communicate emotions,” Hertenstein says.

It may also increase the speed of communication: “If you’re close enough to touch, it’s often the easiest way to signal something,” says Laura Guerrero, coauthor of Close Encounters: Communication in Relationships, who researches nonverbal and emotional communication at Arizona State University. This immediacy is particularly noteworthy when it comes to bonding. “We feel more connected to someone if they touch us,” Guerrero notes.

There’s no phrase book to translate the language of touch; if anything, experts have barely begun documenting its grammar and vocabulary. “We found that there are many different ways to indicate a given emotion through touch,” Hertenstein notes. What’s more, how a touch gets interpreted is very context dependent. “Whether we’re at the doctor’s office or in a nightclub plays a huge role in how the brain responds to the same type of contact,” Spezio explains. Still, examining some of the notable ways that we communicate and bond through touch (and how we develop the capacity to do so) reveals the versatility of this tool and suggests ways to make better use of it. There’s much to be gained from embracing our tactile sense — in particular, more positive interactions and a deeper sense of connection with others.

Learning the Language of Touch

We begin receiving tactile signals even before birth, as the vibration of our mother’s heartbeat is amplified by amniotic fluid. No wonder then that touch plays a critical role in parent-child relationships from the start: “It’s an essential channel of communication with caregivers for a child,” says San Diego State University School of Communication emeritus professor Peter Andersen, author of Nonverbal Communication: Forms and Functions.

A mother’s touch enhances attachment between mother and child; it can signify security (“You’re safe; I’m here”) and, depending on the type of touch, it can generate positive or negative emotions. (Playing pat-a-cake makes infants happy, while a sudden squeeze from Mom often signals a warning not to interact with a new object). Mom’s touch even seems to mitigate pain when infants are given a blood test. University of Miami School of Medicine’s Tiffany Field, director of the Touch Research Institute, has linked touch, in the form of massage, to a slew of benefits, including better sleep, reduced irritability, and increased sociability among infants — as well as improved growth of preemies.

We’re never touched as much as when we’re children, which is when our comfort level with physical contact, and with physical closeness in general (what scientists call proxemics), develops. “The fact that there’s a lot of cultural variation in comfort with touch suggests it’s predominantly learned,” Andersen says.

Warm climates tend to produce cultures that are more liberal about touching than colder regions (think Greeks versus Germans, or Southern hospitality versus New England stoicism). There are a number of hypotheses as to why, including the fact that a higher ambient temperature increases the availability of skin (“It pays to touch somebody if there’s skin showing or they’re wearing light clothing through which they can feel the touch,” Andersen says); the effect of sunlight on mood (“It increases affiliativeness and libidinousness — lack of sunlight can make us depressed, with fewer interactions”); and migratory patterns (“Our ancestors tended to migrate to the same climate zone they came from. The upper Midwest is heavily German and Scandinavian, while Spaniards and Italians went to Mexico and Brazil. That influences the brand of touch”).

What goes on in your home also plays a role. Andersen notes that atheists and agnostics touch more than religious types, “probably because religions often teach that some kinds of touch are inappropriate or sinful.” Tolerance for touch isn’t set in stone, however. Spend time in a different culture, or even with touchy-feely friends, and your attitude toward touch can change.

By the time we’re adults, most of us have learned that touching tends to raise the stakes, particularly when it comes to a sense of connectivity. Even fleeting contact with a stranger can have a measurable effect, both fostering and enhancing cooperation. In research done back in 1976, clerks at a university library returned library cards to students either with or without briefly touching the student’s hand. Student interviews revealed that those who’d been touched evaluated the clerk and the library more favorably. The effect held even when students hadn’t noticed the touch.

More recent studies have found that seemingly insignificant touches yield bigger tips for waitresses, that people shop and buy more if they’re touched by a store greeter, and that strangers are more likely to help someone if a touch accompanies the request. Call it the human touch, a brief reminder that we are, at our core, social animals. “Lots of times in these studies people don’t even remember being touched. They just feel there’s a connection, they feel that they like that person more,” Guerrero says.

Just how strong is touch’s bonding benefit? To find out, a team led by University of Illinois at Urbana-Champaign psychologist Michael Kraus tracked physical contact between teammates during NBA games (consider all those chest bumps, high fives, and backslaps). The study revealed that the more on-court touching there was early in the season, the more successful teams and individuals were by season’s end. The effect of touch was independent of salary or performance, eliminating the possibility that players touch more if they’re more skilled or better compensated.

“We were very surprised. Touch predicted performance across all the NBA teams,” says Kraus. “Basketball players sometimes don’t have time to say an encouraging word to a teammate; instead, they developed this incredible repertoire of touch to communicate quickly and accurately,” he explains, adding that touch can likely improve performance across any cooperative context. As with our primate relatives, who strengthen social bonds by grooming each other, in humans, “touch strengthens relationships and is a marker of closeness,” he says. “It increases cooperation but is also an indicator of how strong bonds are between people.”

If a post-rebound slap on the back or the brush of a hand while delivering a bill can help us all get along a bit better, it may be because “when you stimulate the pressure receptors in the skin, you lower stress hormones,” says the Touch Research Institute’s Field. At the same time, warm touch stimulates release of the “cuddle hormone,” oxytocin, which enhances a sense of trust and attachment.

The release also helps explain our propensity for self-caressing, which we do hundreds of times each day as a calming mechanism. “We do a lot of self-touching: flipping our hair, hugging ourselves,” Field notes. Other common behaviors include massaging our foreheads, rubbing our hands, or stroking our necks. Evidence supports the idea that it’s effective: Self-massage has been shown to slow the heart rate and lower the level of the stress hormone cortisol.

A Touch of Love

Every evening at bedtime, DePauw’s Hertenstein gives his young son a back rub. “It’s a bonding opportunity for the two of us. Oxytocin levels go up, heart rates go down, all these wonderful things that you can’t see.” Moments like these also reveal the reciprocal nature of touch, he says: “You can’t touch without being touched. A lot of those same beneficial physiological consequences happen to me, the person doing the touching.”

In fact, when we’re the ones initiating contact, we may reap all the same benefits as those we’re touching. For example, Field’s research has revealed that a person giving a massage experiences as great a reduction in stress hormones as the person on the receiving end. “Studies have shown that a person giving a hug gets just as much benefit as a person being hugged,” she adds.

Moreover, touching another person isn’t just a one-way street when it comes to signaling; aside from sending them a message, it reveals a great of deal information about their state of mind, Hertenstein notes. Are they open to touch or do they pull away? Are they relaxed or tense? Are they warm — or perhaps cold and clammy? “Sometimes I’ll touch my wife and can tell instantly — even if my eyes are closed — that she’s stressed,” he says. “You can sense that through muscle tightness and contraction, and this kind of information can guide our behavior with that person — it influences what we think, how we perceive what they say.”

Perhaps because touch affects both the person being touched and the one doing the touching, it is one of the most fundamental ways of fostering and communicating intimacy in a romantic relationship. One paper proposed a sequence of 12 behaviors of increasing intimacy that couples generally follow:

After the first three (eye-to-body contact, eye-to-eye contact, and speaking), the remaining nine involve touching (starting with holding hands, then kissing, and eventually sexual intimacy). “Touch functions a bit differently depending on the stage of the relationship,” says Guerrero. “In the beginning, it’s kind of exploratory. Will the other person reciprocate if I touch?” As the relationship progresses, touching begins to spike. “You see lots of public touch,” she notes, “people holding hands the whole time they’re together or with their arms around each other’s shoulders. It signals they’re intensifying the relationship.”

But it would be a mistake to think that the amount of touching couples do continues to follow an escalating trajectory. Research involving observation of couples in public and analysis of their self-reports shows that the amount of touching rises at the beginning of a relationship, peaks somewhere early in a marriage, and then tapers off. Over time romantic partners adjust the amount of touching they do, up- or downshifting their behavior to move closer to their significant other’s habits. Inability to converge on a common comfort zone tends to derail a relationship early on, while among couples in long-term marriages, touching reaches an almost one-to-one ratio.

While couples who are satisfied with each other do tend to touch more, the true indicator of a healthy long-term bond is not how often your partner touches you but how often he or she touches you in response to your touch. “The stronger the reciprocity, the more likely someone is to report emotional intimacy and satisfaction with the relationship,” Guerrero says. As with many things in relationships, satisfaction is as much about what we do for our partner as about what we’re getting.

The Laws of Social Contact

The most important things we reveal through touch: “probably our degree of dominance and our degree of intimacy,” Andersen says. Take, for example, the handshake, one of the few situations in which it’s OK to make prolonged contact with a stranger. As such, it’s an important opportunity for sending a message about yourself. “A limp handshake signifies uncertainty, low enthusiasm, introversion,” Andersen says, while a viselike grip can be taken as a sign that you’re trying to dominate. “You want to have a firm but not bone-crushing handshake,” he advises, since it’s better to be perceived as overly warm than as a cold fish. “We like people to have a kind of medium-high level of warmth,” Andersen says. “A person who touches a lot says, ‘I’m a friendly, intimate person.’ More touch-oriented doctors, teachers, and managers get higher ratings.”

Still, outside of close relationships, the consequences of sending the wrong message also increase. “Touchy people are taking some risk that they might be perceived as being over-the-top or harassing,” says Andersen. “Physical contact can be creepy; it can be threatening.” Context matters, which is why we have rules about whom we can touch, where, and when. “Generally, from the shoulder down to the hand are the only acceptable areas for touch,” at least between casual acquaintances, according to Andersen. “The back is very low in nerve endings, so that’s OK too.”

Of course, there are other contextual considerations as well. Different cultures and individuals have different tolerance levels for touch. Same-sex and opposite-sex touches have different implications. Then there’s the quality of the touch, the duration, the intensity, the circumstances. “It’s a complex matrix,” Andersen says. A quick touch and release — like a tap on a cubicle mate’s shoulder to get her attention — no problem. But a stroke on the shoulder could be easily misinterpreted. (“Most cases of sexual harassment involve stroking touches,” notes Andersen.)

A touch will naturally seem more intimate if it is accompanied by other signals, such as a prolonged gaze, or if it is held an instant too long. Meanwhile, a squeeze on the arm could be a sign of sympathy or support, but if it doesn’t end quickly and is accompanied by intense eye contact, it can come across as a squeeze of aggression. Environment changes things too: On the playing field, a man might feel comfortable giving his teammate a pat on the butt for a job well done, but that congratulatory gesture wouldn’t do too well in the office.

Really, the only rule that ensures communicating by touch won’t get you into trouble is this: Don’t do it. Which is likely what it says in the employee handbook for your workplace. Still, leaving your humanity behind every time you leave home isn’t very appealing. Andersen’s slightly less stringent guidelines for touch: Outside of your closest relationships, stick to the safe zones of shoulders and arms (handshakes, high fives, backslaps), and in the office, it’s always better for a subordinate, rather than a superior or manager, to initiate.

If there’s a most appropriate time to communicate via touch, it’s probably when someone needs consoling. “Research shows that touch is the best way to comfort,” says Guerrero. “If you ask people how they’d comfort someone in a given situation, they tend to list pats, hugs, and different kinds of touch behaviors more than anything else. Even opposite-sex friends, for example, who usually don’t touch a lot so they won’t send the wrong signals, won’t worry about being misinterpreted,” she says.

Maybe that’s because there are times — during intense grief or fear, but also in ecstatic moments of joy or love — when only the language of touch can fully express what we feel.

Mice have ‘massage neurons’: Nerve cells that detect gentle touch in mice are a hit with cats too.

Picture the expression on your cat’s face when you stroke it. What makes it so happy? The answer lies in a particular type of sensory neuron that responds to pleasant stroking, say scientists at the California Institute of Technology in Pasadena. The neurons, identified in mice, are similar to certain human neurons, which could explain why we enjoy a massage too.

Stroking skin produces a pleasurable sensation in many mammals, including humans, but until now, it was unclear which neurons detected that stimulus. It is easier to measure responses to pain than to pleasure, so neuroscientists have in general focused their attention on noxious stimulation.

The gentle touch

Writing in this week’s Nature, the Caltech team shows that, in mice, a particular type of neuron, identified by molecular markers, responds specifically to stroking. The researchers used a custom-designed brush to pinch, poke or stroke mice on their hind limbs, as seen in the video above, and identified the responding neurons by imaging spots of fluorescence that represent the increase in calcium that occurs when a neuron fires. Another type was identified that was activated by the uncomfortable pinch stimulus but not by stroking.

The team carried out behavioural experiments to confirm that their mice enjoy the sensation produced by a gentle but firm stroke. The animals were genetically engineered in such a way that the ‘stroking’ neurons could be activated by a drug injection, and in further behavioral tests for ‘place preference’, the mice showed a preference for the special chamber within their experimental set-up in which the injection had been given.

Activating these neurons also helped to alleviate anxiety symptoms, which might explain why animals enjoy being groomed. Although humans are not as furry as mice, the sensory structures in the stroking neurons in mice resemble those on neurons found in at least parts of our skin (though not on hairless parts, such as the palms of the hands), suggesting that we might respond to stroking using a similar mechanism.

It’s too early to tell whether the results have any therapeutic potential but, with more work, a drug to please our pets is not unthinkable, says neuroscientist David Anderson, head of the Caltech team.

“Imagine smearing something on their skin that makes them feel like they’re being stroked and petted even when you’re away at work!  It might make your pets feel better and make you feel less guilty for leaving them home alone,” he says.

By Alice (?)

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

Ideas change over time

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

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

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

A neurobiological explanation

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

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

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

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

Why does it matter?

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

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

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

A thought experiment

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

You can hear Dr. Schleip speak about his research:

Further reading:

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

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

Does Fascia Matter? By Paul Ingraham, SaveYourself.ca

Purpose: Fascia is everywhere, provides a fantastic structural support for the body and has the ability to transmit force from force generating muscles. But we as therapists tend to get ahead of ourselves and make statements about treatments and the body’s function that I am not sure make sense and haven’t made sense for the past decade that I’ve questioned it.

The fascial treatment fallacy.

Fascia is laid out everywhere in the body… we can even use some sharp scissors to dissect it in such a way to create lines of fascia that show how muscles that follow a limb or the trunk are connected. We can even give these lines names and call them trains. I think this stuff is really neat. But then we go and suggest that we can actually influence that line with our hands or some tool. Without a doubt I would support the idea that strength training tensions this connective tissue and we would expect adaptations in the fascia. Super, nothing new there. But then we might get in trouble with what we say we can and should do with manual therapy. Two examples…

Two examples of things I wish were true but probably aren’t when it comes to fascia therapy

1. If we “rub, pin, release, contact, shear or roll-out” fascia while pressing our digits/utensils against the skin we can somehow modify fascia.

We also assume that if we palpate the skin we can find “restrictions, adhesions or scar tissue” in the fascia. As if the normal response to activities of daily living or strength training is to build “restrictions, adhesions or scar tissue” in this important connective tissue. Why do we think that rubbing through skin will somehow make fascia change? How is this even possible? Does mechanotransduction work this way? Mechanotransduction is typically meant to refer to how the forces produced within body (e.g strength training) might yield some biological changes in tissues.

But rubbing on skin and hoping that this is influencing fascia is not the same as strength training. No one would suggest that if you rub a muscle it will hypertrophy and become stronger. Yet, we postulate a theory of mechanotransduction to influence fascia that no one would even consider if we applied it to muscle. And what is more responsive to change? Muscle or fascial connective tissue? Why muscle of course. So the more responsive tissue to mechanotranduction would not get stronger after your rub it but fascia, the less responsive soft tissue, will naturally warp and bend to your genius hand wishes. Makes sense to me.

2. If you have pain in one part of the body you have to follow that fascial line/link/chain/train and treat the whole thing.

Lets forget about the questionable possibility of even influencing the mechanical properties of fascia with your hands (if you talk neural properties of the nervous system I will listen) lets just look at the idea that everything is connected and you need to treat that bloody chain. I have two biomechanical questions/issues with this:

Mechanotransduction refers to the many mechanisms by which cells convert mechanical stimulus into chemical activity

a. Why just follow that fascial line that you read about in a book? Fascia seems to be continuous and some brighter than I anatomist even suggests that our fascial lines are just arbitrarily created during dissection (link here). For example, if you have a patient with bicep pain someone might tell you that you have to treat the entire anterior arm line because it is “all connected”. But with fascia I was under the impression that we really know that it is all connected and if you follow this reasoning you should just treat everything around the arm. And why stop there, just treat the whole body since it is one fascial web. Again, this assumes that you can influence it. Good luck.

b. So you have picked the fascial line that you want to treat. You’ve been told that the problem in the biceps could be coming from some “problem/restriction/adhesion” in the fascial line somewhere down or up the chain. Lets assume you even have some reliable way of detecting this. How would a fascial dysfunction 30 cm away from the biceps pain mechanically influence that biceps? I am not talking about regional interdependence when you can make a case based on link segment mechanics. I am talking about the fascial “butterfly effect” which assumes you will be treating dysfunction down the fascial chain because of some “dysfunction” up stream. I don’t know how this works. From the studies that have actually looked at the force transmission of fascia and how different muscles seem linked through fascia (e.g the glutmax and opposite latissimus dorsi) we know that the force transmission along these fascial lines is minimal and only transmits force a few centimeters. Therefore a dysfunction up the chain has limited biomechanical reach. Lets look at the thoracodorsal fascial research in greater detail. Because one, it will illustrate my point and two, it is very cool research. See, I don’t hate fascia. I think its amazing. Its how we extend our reach in our explanations that I hold issue with.

Thoracadorsal fascia – how far can the effects of tension be seen

The thoracolumbar fascia partially links the gluteus maximus with the contralateral latissimus dorsi. Fascially fantastic! Vleeming (1995) did some very interesting cadaver dissections and then pulled on different parts of those dead bodies to show that movement occurred elsewhere in the body. Neat-O. First, lets looks at this beautiful study and some related research.

Vleeming (1995) and Van Wingerden (2004)

The Vleeming study showed us how different muscles attach to the superficial layer of the thoracodorsal fascial. Contracting these muscles will then tension the fascia and the authors propose that this leads to increases in stability. The authors looked at what would happen when they tractioned different muscles to the movement in the superficial fascia. They found the following displacements in the superficial lamina:

– tug on lat dorsi and get homolateral movement of 2-4 cm

– tug on the caudal part of the lat dorsi and get midline displacement of 8-10 cm

-traction of the glut max and get some movement of 4 to 7 cm

-traction the trapezius and you’re lucky to get 2 cm of displacement

Stretching the clinical relevance of this research