What the Fascia, is There Pain in the Release?

By Stacey Thomas, LMT, FMS, SFMA, NKT, CF-L2
May 10, 2017

What the Fascia, is There Pain in the Release?

By Stacey Thomas, LMT, FMS, SFMA, NKT, CF-L2
May 10, 2017

It's the age-old adage of "No pain. No gain." As a species we seem to apply this sentiment to nearly everything we do; bodywork is no exception. Age-old techniques that employ forceful methods of "releasing" fascial adhesions have been around for hundreds, some even thou-sands of years touting the benefits of therapeutic bruising and manual torsion techniques to rid the body of pain, ironically by inflicting it.

Into the Deep

"Deep tissue" massage is often regarded as the only method that actually accomplishes anything therapeutic and clients come back time and again for it or seek out another therapist that can "go deeper" if their current practitioner just doesn't seem to cut it.

Many clients and therapists alike subscribe to the belief that pain is unavoidable if change is to be made. We've all been indoctrinated into the same dogma that the intent and benefit of our work is to "release" the demons otherwise known as adhesions that must surely be at the root of our clients ailments.

Harder is better. Deeper is best. Our clients report feeling like they're stretchier and maybe a little taller when they get off of our tables and we confidently state that we've "released" their problematic fascia. But, really if truth be told, we haven't "re-leased" anything other than $60-$90 bucks from their wallets for a likely painful session that left them sore and bruised.

In the most egregious cases of deep myofascial "release" therapy, clients can be left with permanent scarring or pain sensitivities albeit from the most well intentioned therapist. However, according to NOI Group, "Aggressive and intense manual therapy with no regard for the client's central nervous system is problematic."

More Effective, Less Trauma

So, why do we keep repeatedly beating up our clients with painful modalities only to have them come back within a week or two citing the same symptoms because the effects of the last session only lasted a day or two? Now, if you are a therapist that hangs your hat on your reputation for "deep work," take a few diaphragmatic breaths and keep on reading before you conclude that this is nothing more than blasphemy.

I'm not suggesting that the mechanical effects of massage aren't literal nor therapeutic. I'm not even suggesting that deep tissue therapy is unwarranted or dangerous, nor am I suggesting that we don't actually feel palpable tissue change as a result of our treatments.

The question at hand is whether what we're really doing is "releasing" fascial tissue and at what cost. Is there a more effective and less traumatic method we could be exploring? I believe there is.  There is value in stepping away from the monocular lens of mechanical tissue manipulation.

Let's take a much broader, open minded, neurological view at the effects of manual body work and consider that less might be more as it pertains to our effectiveness as practitioners. This discussion offers a viewpoint from the lens of the central nervous system in regard to our treatments as it has been researched and reported by some of the leading pioneers in fascial and movement science.

It is not intended to be anything other than a stimulus for intelligent conversation and consideration amongst us as a profession. Touch the skin and you're touching the brain. An over simplified statement but one with pro-found depth none the less; pun intended.

Mechanoreceptors

The intra-fascial mechanoreceptors (Golgi, Ruffini, Pacinian, and Interstitial) within our tissues are the communication lines to our central nervous system each responding differently to types of touch or external stimuli. Our proprioception, our exteroception, and interoception feed our brain with information that dictates how we perceive and react to our environments. Our sensation of heat, cold, pressure, texture, pain, pleasure; all of these qualities and characteristics are communicated to the brain through these receptors within the skin.

As manual therapists we instantly send input into our client's their nervous system with even the lightest touch to which it responds with physiological reactions to the effected tissue and surrounding areas. The outcome is either a relaxation response or one of guarded retreat depending on its perception of our treatment tactics; i.e., light pressure, deep pressure, shearing or feathering, rapid or slow movement, heat therapy, cold therapy, etc. If we review Hilton's Law we know that the same trunks of nerves whose branches supply groups of muscles also furnish a distribution of nerves to the skin over the insertion of the same muscles as well as the interior of the relevant joint space.

Nervous System Response

To fully comprehend this means that as clinicians, we are acutely aware that instead of a one dimensional surface level effect on the tissue we are touching, our treatments elicit a nervous system response deep within the tissues of the body and joint spaces that ultimately dictates physiological reaction and tone.

In fact, more and more research is challenging the belief on whether we actually create mechanical change in tissue at all but, more likely that we incite a neurological response that creates viscosity changes within the fascial ground substance and thus a decrease in tissue tension as a result of the intra-fascial mechanoreceptors input to the CNS.

In other words, our touch and how it is applied either convinces the nervous system to reduce tone or increase it. The widely adopted notion that fascia can be "released" by way of manual therapies was debunked by famous fascial researcher and key organizer of the first Fascial Congress, Dr. Robert Schliep in his published article Fascial Plasticity-A New Neurological Explanation.

Schliep dismisses the traditional explanations of thixotropy and peizoelectic-effect-adaptation and suggests that the actual toughness of fascia would require shearing forces far greater than any living human could actually handle before any measurable structural change to the tissue is actually made. How much pressure exactly? Try 2,000 pounds per square inch.1

Even if you were able to deliver that much force, your clients could never tolerate it. As it pertains to the idea of thixotropy, Shleip is quoted as saying, "Fascial sheets are incredibly tough, and you can't "change their density and arrangement" quickly or easily. And thixotropy just isn't fast enough to explain the relatively speedy, dramatic effects on tissues that therapists claim to achieve."2 So, if we're not actually "releasing" fascia, what are we doing? Most of our clients seek our help due to chronic pain, stress relief, injury rehabilitation, or movement limitations.

Body Mapping

Let's look at these things differently by visiting the concept of Body Mapping as presented by David Nesmith of the Alexander Technique. Body Mapping is the conscious correcting and refining of one's body map to produce efficient, graceful, and coordinated movement. It is the self-representation in our brain. If our representation is accurate, we move well.

If our representation is faulty, our movement suffers which can lead to injury and/or chronic pain.3 Through tactile stimulation, we feed the brain information via the intra-fascial mechanoreceptors which ultimately controls the motor responses we observe. The appropriately applied stimulation (i.e.,soft touch, glide, shearing, feathering, pressure, etc.) incites either an up-regulation or down-regulation of tone within the fascia and muscle tissue and ultimately a palpable tissue response of either priming or relaxing due to the nervous system's response.

If it's the sensory nerves that we're ultimately effecting, it seems logical that a less aggressive tactic can be used to achieve the outcome we're going for rather than one that leaves our clients white knuckling, cursing, and jaw clenching for the duration of their treatment. Using a model of graded exposure therapy, in which tissue tolerance is the focus, allows us to apply any deeper work in a way that works with the client's nervous system rather than against it.

If our client's are suffering from chronic pain, understanding the neurology of body mapping arms us with the ability to help them not only with pain relief using milder and more effective tactics but, also assist them with recreating proper movement patterns and proprioception that have long lasting positive, clinical outcomes. Becoming efficient at assessing and understanding movement patterns can greatly assist in your clinical decision making.

When we approach our work from the other side of the body, i.e., our clients' neurological experience, pain presentation, and movement limitations, it's easy to grasp that we should be using the infinite and inherent knowledge of the human body to aid us in our clinical methods rather than quite literally fighting it with our bare hands. Lorimer Mosely and David Butler of the NOI Group said it best. "Modern rehabilitation will be via normalization of sensation, motor control and the congruence of these factors."  As manual therapists, it's exciting to know that we are at the leading edge of redefining therapy with a more mindful approach.

References:

  1. Schleip R. "Fascial Plasticity – A New Neurobiological Explanation." Journal of Bodywork and Movement Therapies, Jan 2003; 7 (1) , Apr 2003; 7 (2).
  2. Chaudhry H, Schleip R, et al. "Three-dimensional mathematical model for deformation of human fasciae in manual therapy." J Am Osteopath Assoc, Aug 2008; 108(8):379-90.
  3. Nesmith D. "Body Mapping."