Consider the fascia to get past knee pain

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Understanding how fascia works will alter movement protocols when addressing musculoskeletal pain issues. Here is how this new understanding might alter physical therapy for the knee.

Interesting how things shift when a paradigm that one has believed for a very long time comes crashing down.  There is no going back.  The other way of looking at the world simply no longer makes any sense, and the illogicality of it makes it hard to understand how anyone at all can live under the old belief system.

This has happened to me on two previous occasions, and when the other paradigms fell, both times I felt very alone.  Almost everyone I knew was still living under the old belief systems, and many thought I had lost it when I started to suggest there was another, perhaps better way.

The first paradigm that fell for me was the idea that allopathic medicine was the best way to treat all ailments.  Although it can't be beat for acute care, I realized that treating symptoms instead of causes, and treating a disease instead of the person with the disease was not going to work well for chronic conditions.

The second paradigm to fall for me was with respect to diet – the ideas that eating fat makes one fat, and that animal fats were extremely harmful, whereas vegetable fats were healthier.  I spent many years on a very low-fat diet. I'd have bread with jam or honey, without butter, and I bought low-fat everything.

After studying nutrition in general, and the biochemistry of fats in particular, I realized how completely backward those ideas were. Furthermore, I realized that the advice to lower saturated fats, and choose vegetable fats was likely to harm the health of far more people than it would help. 

I couldn't understand how this could be the nutrition gospel that was being disseminated by everyone, from governments via food guides, to physicians, even  to dietitians. So I researched how this nutrition advice came into being, and that explained everything.

Even though intellectually I understood that pastured saturated fats were not harmful, it did take me a while to "get it" emotionally. It is hard to switch away from the "society approved" low-fat diet to one that includes higher fat meats, cream, cheese etc. But when I did not get fatter eating more fat, I became more comfortable with the idea.

I decided to start my blog in order to attempt to counter the mountain of wrong information out there.  I was worried about people I cared about eating a diet that I felt might harm them, and it took me a long time to realize I can't make that my business as all I do is damage important relationships.

And I created my "Why the Food Guides are Wrong" nutrition course to help people see the other paradigm on how to eat.  Suddenly everything becomes crystal clear – there is no more confusion about what food is healthy and what is not. If you want to learn more about the course, click here.

Now the studies are coming out thick and fast that support the notion that quality saturated fats have been demonized for no reason, and cholesterol is not the enemy.  How many years it will take before the food guides are altered to reflect the science is anyone's guess. 

This third paradigm that muscles move bones has been problematic for me in my practice for many years, and I actually feel relieved that the science agrees with my experience.

I had noticed in my practice that it is not only possible but frequently desirable to activate one end of a muscle, while the other end remains quiet.  That does not fit with the old mechanistic lever concept which would entail the entire muscle being activated driving force along the length of the muscle and into the bone.

Dr. Tom Findley, in his editorial in this month’s Journal of Bodywork and Movement Therapies explains the change in concept this way:

“The point is that in real bodies, muscles hardly ever transmit their full force directly via tendons into the skeleton, as is usually suggested by our textbook drawings.  They rather distribute a large portion of their contractile or tensional forces onto the fascia sheets.  These sheets transmit these forces to synergistic as well as antagonistic muscles.  Thereby they stiffen not only the respective joint, but may even affect regions several joints further away.  The simple questions from musculoskeletal textbooks regarding “which muscles” are participating in a particular movement thus become almost obsolete.  Muscles are not functional units, no matter how common this misconception may be.  Rather, most muscular movements are generated by many individual motor units, which are distributed over some portions of one muscle, plus portions of other muscles.  The tensional forces of these motor units are then transmitted to a complex network of fascial sheets, bags, and strings that convert them into the final body movement.  “

When motor units within a muscle are activated they get thicker which tightens the fascial bags that contain them, which in turn directs the forces wherever the fascial connections are – not necessarily only along the line-of-pull of the muscle.

I think research will continue to map exactly where the various fascial connections go in the body, as that has a direct impact for rehabilitation and movement practice.

Physical therapists and movement teachers spend a lot of time getting their patients and clients to strengthen particular muscles and stretch others, which is important.

I think this new knowledge will result in physical and movement therapists paying far more attention to teaching people to relax certain muscles, thereby reducing tension through particular fascial connections in order to lower tensile strength going through painful joints.

For example, I have noticed that those with knee pain frequently over-activate the muscle in the front of the shin (anterior tibialis), which tightens the fascial bag in the lower front leg, pulling that fascia down towards the foot.

When the quad (front of the thigh) is also activated, particularly when the knee is quite bent, the tension over the front of the knee joint is increased dramatically, as the quad fascia is pulling up towards the hip at the same time as the shin fascia is pulling down towards the foot.

I believe people activate the front of the lower leg in an effort to keep the heel on the floor, which I propose is usually unnecessary. 

The other reason one may not be able to relax the ankles is that one is not fully centered over the foot, but is instead trying to use the shin muscles to stop from falling backwards.  Getting one's weight directly over the feet should resolve that issue and make it possible to relax the feet and ankles.

When moving from a seated position to standing with relaxed ankles, even if initially the heels are not on the floor, as the weight of the body comes over the feet the heels will come down as the fascia along the bottom of the foot and calf is passively stretched.

If the muscles around the ankle including those in the front, are relaxed, and the foot is simply sinking into the floor, the tension over the knee is reduced as the fascia is not being pulled down towards the foot.

When we go up stairs, we place our forefoot on the stair and sink into it, keeping the muscles around the ankle relaxed. This same concept should be also be applied to squats, lunges, step-ups and deadlifts in my opinion, as it will reduce the tensile force around the knee.

Obviously this won't fix all knee pain, but I have had good success with this concept for a few months, even before the Fascial Research Congress confirmed that there is merit to the idea.

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Our body web

3rd International Fascia Research Congress, Vancouver BC, March 28-31, 2012

Enig, Mary; Know Your Fats: The Complete Primer For Understanding the Nutrition of Fats, Oils, and Cholesterol Bethesda Press, Silver Spring, MD, 2003.

Felton C. et al. Dietary
polyunsaturated fatty acids and composition of human aortic plaques
Lancet, 1994, 344:1195

Copyright 2008/2012 Vreni Gurd

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