Can the Chiropractic Profession Think Out of the Box?
PERSPECTIVE
Warren Hammer
American philosopher William James observed that, “Man can alter his life by altering his thinking.” This holds true for individuals and groups as well—the chiropractic profession, for instance. As new discoveries aie revealed to us, progress is made as this new information is assimilated to produce a paradigm shift.
For example, two orthopedic surgeons found an additional ligament located on the anterior of the human knee,1 and surgical procedures were unproved. Harminder Dua, a professor of ophthalmology at the University of Nottingham, discovered a structure at the back of the comea that helps to focus incoming light.
Researchers say this knowledge will change what ophthalmologists know about human eye anatomy, as well as make operations safer and simpler for patients with an injury in this layer.
While some chiropractors are familiar with soft tissue methods, the majority are not. Just look at the syllabi of most of our colleges. A course or two might pertain to “soft tissue” rehabilitation, and learning about modalities does not constitute the expertise necessary when our hands are placed on the human frame. We must understand profoundly the makeup of the human body to adapt modalities to the lesions we treat. Recently, information about the ubiquitous fascial system has appeared. If understood and used by our profession, this information could catapult us to a dominant role in the health profession.
This year Elsevier (publisher of Gray ’s Anatomy) has published a new textbook entitled Functional Atlas of the Human Fascial System by Carla Stecco,“ orthopedic surgeon and professor of anatomy. Anatomists have always been aware of fascia, but have assumed that fascia is merely an opaque covering of literally eveiything in our body. Based on recent research, and especially on the information expressed in Stecco’s book,
fascia is now understood as another important bodily organ. This text is of fundamental importance for the chiropractic profession. We are beginning to realize the necessity of soft tissue treatment in our arsenal for restoring the neuromusculoskeletal system to full function. The spine, after all, is a passive structure moved by muscles and influenced by connective tissue.
The Atlas explains the role fascia plays in myofascial dysfunction and disease. Abnormal fascia affects muscle function and disturbs proprioceptive input. Rather than only explaining fascia in localized areas as most anatomical texts do, this resource describes the kinetic fascial planes, including the connection of fascia with muscles, nerves, and blood vessels. Excellent dissection views showing the fascia of unembalmed human cadavers taken over the past 10 years are very helpful. Important histological and biomechanical information is included. There is also access to a website showing the actual dissections depicted in the book. As Dr. Stecco proves in her text, the fasciae are responsible for much of the coordination of the motor system. Current knowledge of the fascial system shows that movement depends on much more than individual muscles with their origins and insertions and nerve supply—a paradigm I learned in my professional education. Origin/insertion models were and are taught ubiquitously. These models definitely improved our results, but
recent information about the fascial system—its anatomy and function—moves us into a new age. Knowledge derived from this text will improve the utilization of all soft tissue methods. For more details, see the April, 2014 ACA News article titled “The Fascial System Is a Sensory Organ.” The major location of the muscle proprioceptive system and 30 to 40% of muscle force is dependent upon a properly functioning fascial system.
Contrary to most anatomical and physiological texts, the Atlas demonstrates that the chief proprioceptive organ of the muscle (the muscle spindle cell) is located in the fascia of the muscle and not within the muscle tissue itself. For this reason, Dr. Stecco believes that the name should be changed to “fascial spindle cell.” This crucial information is of extreme importance to everyone who is interested in soft tissue treatment. Spindle cells must shorten and lengthen during muscle activity to inform the central nervous system (CNS) about muscle status. “Muscle spindles inform the CNS of the continually changing status of muscle tone, movement, loss of normal elasticity, positon of body parts, absolute length of the muscle and rate of change (velocity) of the length of the muscle.” 2
When asked if fascial adhesions can have an adverse effect on spindle cells, Siegfried Mense, MD, a leading expert on muscle pain and neurophysiology,3 stated that “structural disorders of the fascia can surely distort the information sent by the spindles to the CNS and thus can interfere with a proper
coordinated movement.” He went on to say that the primary spindle afferents (la fibers) are so sensitive that even slight distortions of the perimyseal fascia will change their discharge frequency.
Everyone in the rehab world uses strengthening, stretching, and exercise modalities. People now use foam rollers over painful areas. All of these treatments are effective to some extent, but what is being done for the system that is responsible for muscle coordination, whereby the vectors of force acting on a joint do so in a balanced, coordinated manner? Treatment
of fascial areas, especially where the majority of spindle cells and other receptors are located, is a missing link.3 In order to reach these proprioceptors, a deep pressure is necessary, and not just anywhere, but in specific areas located with proper examination. Locating the source of fascial restriction is critical since restricted fascia does not allow the normal stretch of receptors to occur. Dr. Carla Stecco quotes Järvinen et al.4 who shows that muscle spindles embedded in restricted perimysium will not function correctly. Ultrasonography has demonstrated painful areas due to lack of sliding between fascia and muscle.5
Hopefully in the near future, the fascial system will be taught as a separate course in all of our colleges. There is plenty of information about fascia and its relation to a normal functioning spine.6’7 8 The Fourth International Fascia Research Congress (FRC) will be held near Washington, DC, September 18 - 20, 2015. The top researchers in the world will lecture and there will be numerous fascial workshops. Try to attend.
References:
1. http://well.blogs.nytimes.com/2013/ll/13/a-surprising-discovery-a-new-knee-ligament/
2. Stecco C. Functional Atlas of the Human Fascial System. Elsevier, Edinburgh, 2015.
3. Stecco A, Gesi M, Stecco C, Stern R. Fascial Components of the Myofascial Pain Syndrome. Curr Pain Headache Rep. (2013) 17:352.
4. Järvinen TA, Józsa L, Kannus P, Järvinen TL, Järvinen M (2002) Organization and distribution of intramuscular connective tissue in normal and immobilized skeletal muscles. An immunohistochemical, polarization and scanning electron microscopic study. J Muscle ResCell Motif 23: 245-54.
5. Stecco A, Meneghini A, Stern R, Stecco C, Imamura M. Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up. Surg Radiol Anat. 2013 Aug 23. [Epub ahead of print] PubMed PMID: 23975091.
6. Langevin HW, Stevens-Tuttle D, Fox JR et al. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC Musculoskeletal Disorders. 2009; 10:151.
7. Day JA, Stecco C, Stecco A. Application ofFascial Manipulation technique in chronic shoulder pain—anatomical basis and clinical implications. J Bodyw Mov Ther. 2009 Apr; 13(2): 128-35.
8. Stecco C, Stern R, Porzionato A. Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat. 2011 Dec;33(10):891-6.
ÍK Warren Hammer DC, MS, DABCO has lectured nationally and internationally on soft tissue and Chitej ropractic. He wrote his third edition of Functional Soft-Tissue Examination and Treatment by Manual Methods, 2007. In 2013 he became a certified instructor in Fascial Manipulation® (FM) and has introduced this method of treatment in the U.S. He is the English Editor for the text: "Functional Atlas of the Human Fascial System". softissu@optonline. net www. warrenhammer. com
