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10 physiological considerations of fascia-focused therapy

This is an excerpt from Understanding Fascia, Tensegrity, and Myofascial Trigger Points by John Sharkey.

Regardless of our chosen field, whether it’s osteopathy, structural integration, medical studies, neuromuscular therapy, physiotherapy, fascia therapy, chiropractic, or massage, our goal is to reshape our perception of muscles and movement. The shift required is from a focus on singular muscles and isolated contractions to acknowledging the involvement of multiple muscles (myofascial synergistic units) in a whole-body kinetic system. In essence, movement isn’t a solitary note but a harmonious combination of finely tuned body-wide notes, culminating not just in a singular melody of motion but in a symphony of movement. But specific fascial structures can experience inhibition or hypertonicity, leading to inappropriate neuromuscular patterns, a perspective known as “fascia tuning pegs” (see chapter 3).

As you read through the anatomy and neurophysiology sections, I would like you to consider the sequence and use of neuromuscular, fascia-informed techniques and phased introduction of medical exercise,
based on the following models, A and B.

Model A: The Ten Considerations
Considering the following factors when treating a patient can give you a comprehensive and holistic approach to healthcare. Each of these factors plays a role in the overall well-being of the individual. Understanding them can contribute to a more effective and targeted treatment plan. Here is a breakdown of each consideration:

1. Monosynaptic Reflex Arc
Understanding the monosynaptic reflex arc (see figure 3.12) helps in assessing and addressing the body’s rapid, involuntary 184 Understanding Fascia, Tensegrity, and Myofascial Trigger Points responses to stimuli. This can be crucial in neurologic assessments and rehabilitation.

2. Ischemia
Ischemia refers to inadequate blood supply for current physiological demands. Restoration of appropriate blood supply is essential for healthy, pain-free fascia.

3. Myofascial Trigger Points (MTrPs)
Identifying and addressing myofascial trigger points is crucial in managing myofascial pain. These specific points can mimic neurological and discogenic pain, as well as being a source of headaches and elbow and foot pain. It is essential when treating unresolved chronic pain to give due consideration to the possibility of MTrPs being the true source or a significant contributing factor.

4. Fascial Considerations
Fascia changes morphology and can migrate based on changes in tension and compression.

5. Nerve Insult
Nerve insults, such as compression, stretching, or tethering, can result in various neurological symptoms. Addressing nerve health is crucial in the treatment and management of insults like neuropathies or radiculopathies. Keep in mind the three Ps—places of perilous passage— locations of high risk for nerve compression and adhesions.

6. Posture
Poor posture can contribute to various myofascial issues, affecting the spine, joints, and muscles. The most common posture of the twenty-first century is forward head posture. As a very general statement, postural influences can be a bottom-up or head-down issue, requiring expert intervention from the therapist, who needs to translate the information gained during assessment.

7. Alignment
Proper alignment is crucial for optimal function and movement. Tissues out of alignment fail to receive or dissipate forces in a nutritious or healthy manner.

8. Nutrition/Hydration
Nutrition and hydration are fundamental for overall health. Considering the patient’s nutritional habits and fluid intake is essential for promoting healing, tissue repair, and overall well-being.

9. Stress (Strain)
Both physical and psychological stress can impact the body. A little stress is good for all of us; however, too much results in strain on the fascial net; nervous, endocrine, and immune systems; and mental health.

10. The Individual
Recognizing the uniqueness of each patient, including their medical history, lifestyle, and other preferences, is essential for tailoring treatments to their specific needs. A personalized approach contributes to better
patient outcomes.

Model B: The Temporal Sequence of Tissue Insults

Injury or insult with resulting protective spasm leads to:
1. reciprocal inhibition,
2. synergistic dominance (altered force couple relationships),
3. arthrokinetic dysfunction (altered joint motion),
4. neuromuscular inefficiency,
5. myofascial fatigue,
6. cumulative injury cycle.

Changes in posture coupled with repetitive movements can be the basis for dysfunction in the myofascial and musculoskeletal systems and the formation of MTrPs. The fasciafocused approach is to achieve optimum neuromuscular efficiency by restoring length-tension relationships, force couple relationships, and correct arthrokinetics. When postural alignment is not correct, the body will not effectively cope or deal with the forces generated through its tissues. Rather than being effectively dissipated, these forces will now provide ongoing traumas throughout the myofascial and osseofascial systems, not only resulting in faulty movement patterns but also causing excessive breakdown or overproduction of tissues. The result is pain and changes in sensation (e.g., numbness, itching, tingling, or burning).

This text teaches that certain myofascial tissues become hypertonic when stressed, resulting in an inhibition of others. In turn, this creates muscular imbalances, which must first be identified and treated before the patient is encouraged to challenge the muscles through physical activity. To appreciate the wonderful techniques of fascia-focused therapy, and other modalities, will require an expert understanding of anatomy, and so this is where we will start.

More Excerpts From Understanding Fascia

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