Condition-Specific Massage Therapy
LWW:
Instructor Resources from Bucci, Celia. Condition-Specific Massage Therapy. © Lippincott Williams & Wilkins/Wolters Kluwer Health
Chapter 2 – Fascia
Lecture Notes
(Lecture notes can be distributed to students as a guide to classroom discussion, and as a study guide)
What is fascia?
soft but dense, fibrous connective tissue forming a continuous, three-dimensional matrix that provides support and shock absorption for the structures of the body; communicates vital information about tension and compression throughout the body; and facilitates the absorption of nutrients and removal of toxins and metabolites
fascial fibers form dense, irregular connective tissue with a multidirectional arrangement.
ground substance gives fascia a fluid character
collagen gives fascia strength and resilience
fascia is thoroughly innervated by mechanoreceptors including golgi receptors, Ruffini and Pacini corpuscles
Types of fascia
superficial fascia, or subcutaneous fascia, is just beneath the skin
deep fascia, also called myofascia, is denser than superficial fascia and covers the muscles
visceral fascia forms the sacs that hold our organs within their cavities and are named according to the organ they support: pericardia (heart), pleura (lungs), and peritonea (abdomen).
Myofascial lines (Fig 2-4)
tracks of myofascia within the matrix, which support the common lines of pull (muscle actions) along which strain and tension are transmitted through the body to move the skeleton
myofascial dysfunction tents to follow patterns along myofascial lines
when stretched abruptly or for an extended period, fascia increases resistance, actively contracting against the stretch
Tensegrity (tensional integrity) (Fig 2-5)
the character of a structure, the integrity of which depends on balanced tension across its rigid parts
tension in one part of the structure must be balanced by tension in another
fascia distributes tensile stress to prevent any single area of the body from being subject to the full force of a movement or gravity
when stress to one part of a structure is increased, myofascial fibers reorganize and stiffen along the direction of applied stress
if local fascia loses function within the tensegrity model, stress is distributed along the fascial line that contains the structure
Causes and contributing factors
mechanical overload, whether caused by an acute incident, repetitive misuse, or postural imbalance
immobility following an injury or as a result of static postures held for long periods
chilling the fascia, whether directly—such as with prolonged use of an ice pack—or indirectly—such as when sitting near an air conditioning vent
prolonged compression of myofascia by external sources, such as the straps of a bag or a utility belt
scar formation binds fibers together and increases adhesions
pathologies including chronic inflammation, infection, hormonal imbalance, and nutritional deficiencies
trauma, fatigue, and physical or emotional stress
congenital conditions such as bone length discrepancies
Contraindications and special considerations
infection
acute injury
reproducing symptoms
hypermobile joints and overstretched muscles
treatment duration and pressure
deep friction if tissue is at risk for rupture, or client has systemic inflammatory condition or takes anti-inflammatory meds or anticoagulants
Assessing and treating myofascia
a client will not likely complain specifically about fascial restrictions but will likely refer to a general or specific area of pain or tension
where muscles are short and tight, the myofascia is likely to be bulky, fluid filled, and adhered to the affected muscles and surrounding tissues in the shortened position
where muscles are lengthened and weak, the myofascia will likely be stretched, flat, narrow, dehydrated, and adhered in the long, strap-like form
palpation will give you the most direct and accurate picture of the client’s myofascial health
it is best to assess and treat myofascial restrictions before applying emollient to prevent gliding
use only enough pressure to access and maintain contact with the affected tissues
during your assessment and treatment, the client may report sensations such as burning, itching, scratching, or pinpricks
feel for independent mobility of each affected muscle, and note the texture of the connective tissues around it
take care not to use techniques that stretch fascia that is already lengthened
move fascia in the direction that you want the affected structure to move
hold a myofascial stretch until you feel the tissue release
skin rolling is an excellent technique for both assessing and treating superficial myofascia
cross fiber strokes are an effective way of initially breaking up adhesions and increasing space between structures or fibers.
for a large area of restriction, a broad stretch is a good beginning
if the restriction is more localized, a more focused technique is recommended
C-stroke is performed by placing one hand in the area of restriction with the thumb and index finger creating the C shape, while one or two fingers of the other hand push the tissues into the curve of the C
S-stroke is performed by placing the thumbs or fingers of one hand parallel to those of the other, and then moving the hands in opposite directions to form the S shape
if you need to work more deeply, adjust the angle of your compression vertically, perpendicular to the target tissue