5/11/2014

Basic Concepts
2014-15 NTWC Allied Health Training Grant
Sharing on overseas study
Fascial Manipulation Level I

Mr. Richard Wong

A myofascial unit
3 elements:
1. Force exerting elements- unidirectional
muscle fibres
2. Coordinating elements- the fascia
3. Perceptive elements- the nerve structures,
the joint capsule and ligaments

PTII
NTWC/TMH

22-10-2014

A myofascial unit (MFU)

A myofascial unit (MFU)

Huijing (2009)
- Biarticular fibers in each MFU:
intervene in synchronizing the activity of two
in-series MFUs
Modifying the position of the proximal
segment in relation to movements of the
distal segments or vice versa
- Monoarticular fibers of the respective MFUs:
provide added stability for joints as they move
www.balanceorlando.com

Superficial and Deep fascia

Superficial and Deep fascia

Superficial Layer

Deep Layer

http://true.massage-research.com/2013/06/fascia-and-reflexology.html

http://gb.ethicon.com/healthcare-professionals/products/wound-closure

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Features of the superficial fascia

1.

Maintain mobility of skin respect to the deep

planes
- Age ptosis and wrinkles

2.

Protection of the superficial vessels and nerves

3.

Lymphatic drainage
- lymphoedema, fasciitis, cellulitis

4.

Separation between esteroception (i.e. skin)

Proprioception (i.e. deep fascia)

Principles of treatment
Center of coordination (CC)
Center of perception (CP)

Comparison of deep fascias

Limbs

Trunk

Thicker (0.5 -1.8 mm)

Thinner

Partially separated from the

underlying muscle

Strongly adherent to underlying

muscle

Multilayered with few elastic fibers

Superficial layer of muscles of the

trunk developed inside the
superficial layer of fascia

Force transmission

Action of muscle is related to

the fascia of the trunk

Center of coordination (CC)

In the deep muscular fascia
Fascia lodges form the myofascial units
permit the movement of the distal
articulation in the three planes of the space
From the muscle spindle to endomysium,
perimysium until epimysium where is present
to the CC

Center of perception (CP)

A precise area of the joint
Point of convergence of the tension of
the ipsodirectional motor units
Vectorial centre of the traction of
capsules, tendons, ligaments
region of proprioception of the joint
movement in one direction
Schleip R et al (2012)

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Distributions of CCs and CPs

14 body segments and 6 directions
Total 84 CC and CP

Principles of treatment
Body segments and myofascial
sequence

Schleip R et al (2012)

Schleip R et al (2012)

Example: ANTEMOTION
1. AN-SC:
forward movement of scapula, motor units: pectoralis major and minor
2. AN-HU:
forward movement of humerus, motor units: clavicular head of pectoralis
major, long head of biceps, anterior deltoid
3. AN-CU:
forward movement of elbow, motor units from biceps brachii, brachialis
4. AN-CA:
forward movement of wrist, motor units from FCR, FPL
5. AN-DI:
forward movement of fingers, motor units from FPL, APB

Schleip R et al (2012)

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Principles of treatment

Hyaluronic Acid

Dysfunction of the myofascial unit

http://erikdalton.com/motion-lotion-how-bodywork-lubricates-joints-fascia/

Dysfunction of fascia
Increased concentration and size of
hyaluronic acid chains
entangle into complex groupings
changing hydrodynamic properties
altering normal viscoelastic properties

Dysfunction of fascia
non-physiological or excessive
tractions mechanoreceptors in the
capsules, ligaments and tendons
(i.e. densification)
excessive stimulation to pain afferent
pain! or joint instability

Dysfunction of fascia
Pedrelli et al. 2009
Reduced elasticity of the fascia
muscle spindle contraction interfere
with motor unit activation
unidirectional forces of the myofascial
unit are unsynchronized
uncoordinated movement

Principles of Fascia
Manipulation
Stecco A et al (2013)
Abnormal HA fragmentation can be reversed by
1. increased temperature
2. local alkalization
3. deep massage or physical therapies
*** Disaggregation of the pathologic chain chain (HA) aggregations.

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Principles of Fascia
Manipulation
Chen & Ingber 1999
Create a deep friction to a precise,
limited area
create increase temperature
enhance fluidity of extracellular matrix
relieve the tension embedded in the
fascia

Principles of Fascial Manipulation

Compares sensations perceived
(e.g. needle- like pain, referred pain)
Compares quality of fascial tissue
(e.g. fibrotic, lack of elasticity)

Treatment techniques

Principles of Fascial Manipulation

A system to evaluate myofascial
dysfunction
Clear recording of patients history
perform specific movement test to
highlight non-functional MFUs
comparative palpation of potentially
altered CC as indicated by movement
test

Treatment techniques
Use of finger tip
Use of knuckles
Use of elbows

Evaluation

Directions of manipulation
- Varies from region to region
- Depth and direction of fascia

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Contradictions and
Precautions
Relative contraindications
1. Fever
2. Suspected fracture
3. Seriously debilitated general health
Applied at a distance from the actual
side of pain (i.e. CP) relatively safe

References
Websites:
1. Motion is LotionHow bodywork lubricates joints and fascia.
http://erikdalton.com/motion-lotion-how-bodywork-lubricates-joints-fascia/
2. What is Myofascial Release?
http://www.balanceorlando.com/we-specialize-in-resolving-chronic-pain/therapeuticmassages/myofascial-release/
3. Wound Closure
http://gb.ethicon.com/healthcare-professionals/products/wound-closure
Literatures and textbooks:
1. Donald E. Ingber. Tensegrity and MechanotransductionJ Bodyw Mov Ther. Jul 2008;
12(3): 198200.
2. Helene M. Langevin and Peter A. Huijing.(2009). Communicating About Fascia: History,
Pitfalls, and Recommendations. Int J Ther Massage Bodywork. 2009; 2(4): 38.
3. Schleip R et al. Fascia: The Tensional Network of The Human Body (1st Edition).
Churchill Livingstone. 2012; Chapter 7.7 p.336-341.
4. Stecco A, Gesi M, Stecco C, Stern R. Fascial components of the myofascial pain
syndrome. Curr Pain Headache Rep, 2013;17:352.

THANK YOU!
Questions?