The Role of Fascia in Manipulative Treatment of Soft Tissues
Leon Chaitow DO University of Westminster, London UK
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Fascia provides structural and functional continuity between the body’s hard and soft tissues, as an
ubiquitous elastic–plastic, component that invests, supports and separates, connects and divides, wraps and
gives cohesion, to the rest of the body – playing an important role in transmitting mechanical forces between
muscles (Huijing 2009). Due to trauma or inflammation fascia may shorten and what was previously a pain
free range of motion may become painful and restricted. (Langevin 2008) Binding may occur among layers,
that should stretch and glide on each other, potentially impairing motor function. (Fourie 2012). Many
therapeutic manual approaches claim to relieve such dysfunctional states, with some hypohesised
explanations. (Chaudhry et al 2008).
Examples include:
Schleip (In Press) suggests some responses may relate to a sponge-like squeezing and refilling in the semiliquid ground substance.
Loose connective tissue “may be key to the therapeutic mechanism of treatments using mechanical
stimulation of connective tissue”(Langevin 2005)
Collagen architecture responds to loading (Kjaer et al 2009)
Load can be used therapeutically to stimulate tissue repair and remodelling in tendon, muscle, cartilage and
bone (Kahn & Scott 2009)
Trigger point release may involve repetition of voluntary isometric contractions that initiate lengthening of the
series elastic (fascial) component of sarcomeres. (Simons 2002).
Active scars restrict movement and produce pain - relieved by treatment (Kobesová, 2007)
Following visceral mobilization post-operative adhesion severity & number of adhesions were significantly
lower, in a rat model (Bove & Chapelle 2012)
Connective tissue massage (‘skin rolling’) has been shown, via ultrasound imaging, to modify collagen
density. (Pohl 2010)
“Evidence supports the possibility that ligamento-muscular reflexes can have inhibitory effects on muscles
associated with that joint.”(Solomonow 2009)
“Strain direction, frequency and duration, impact important fibroblast functions known to mediate pain,
inflammation and ROM” (Standley & Meltzer 2008)
Fascial Manipulation (FM®)) studies suggests that fascia involves specific organizational relationships with
associated muscles. (Borgini et al 2010)
Tool assisted treatment (e.g. Graston) produces mechanical deformation that influences extracellular matrix,
modulating synthesis of proteoglycans and collagen, apparently influencing connective tissue rehabilitation
(Chiquet 2003)
Klingler (2012) reports that heat in the therapeutic range, relaxes many fascial contractures associated with
myofascial dysfunction. (IN PRESS)
Bove, G Chapelle S 2012 Visceral mobilization can lyse etc JBMT IN PRESS
Borgini E et al 2010 How much time is needed to modify fascial fibrosis? JBMT 14(4):318-325
Chaudhry H et al 2008. Three dimensional model for deformation of human JAOA, 108, 8, August 2008.379.
Chiquet M et al 2003 Matrix Biol. 2:73-80
Fourie W 2012 Scar Treatment Methods. IN: Schleip R Findley T Chaitow L Huijing P (Eds) Fascia - The Tensional Network of the
Human Body:. Elsevier IN PRESS
Huijing PA 2009 Journal of Biomechanics. 42(1):9-21
Khan K M Scott A 2009 Mechanotherapy:. British J Sports Medicine 43:247–251
Kjaer M, et al 2009 From mechanical loading to collagen synthesis. Scand J Med Sci Sports 19(4):500-510
Klingler W 2010 IN: Chaitow L Lovegrove R (Eds.) Practical Physical Medicine Approaches to Chronic Pelvic Pain (CPP) &
Dysfunction Elsevier IN PRESS
Kobesova A et al 2007 Jnl. Manipulative & Physiological Therapeutics 30(3):234-238
Langevin H et al 2005. American Journal of Physiology and Cell Physiology 288: C747-C756
Langevin H 2008.. In: Audette, Bailey (Eds.) Integrative Pain Medicine. Humana
Pohl H 2010 Changes in structure of collagen distribution in the skin JBMT 14(1):27-34
Schleip R 2012 Strain hardening of fascia: Static stretching of dense fibrous connective tissues can induce a temporary stiffness
increase accompanied by enhanced matrix hydration. JBMT IN PRESS
Simons D 2002 Understanding effective treatments of myofascial trigger points. Journal of Bodywork and Movement Therapies
6(2):81-88
Solomonow M 2009 J. Bodywork Movement Therapies 13(2) 136-154
Standley P Meltzer K 2008 Effects of Repetitive Motion Strain (RMS) & Counter-Strain (CS), on fibroblast morphology and actin
stress fiber architecture Jnl.Bodywork & Movement Therapies, 12(3):201-203