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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.

If you want to search for other posts by title or by topic, go to www.wellnesstips.ca.

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I just spent the last 4 days at the 3rd International Fascia Research Congress, so thought I would attempt to share this new way of looking at the body.

What is fascia, and why should we care about it? Because it is the tissue that holds our body shape. There is so much fascia in the body that if we took out the muscles, the fat, the blood vessels, the organs, the nerves – everything in the body except the fascia, we’d be able to recognize each other with no difficulty.

Fascia is everywhere, and connects everything to everything else. So why the sudden excitement over a tissue that has always been there?  Because most frequently anatomists have cut it off to better view the other body parts that they were interested in examining.

Some fascia has been considered important for a while, such as the IT band, and the thoracolumbar fascia, which support the side of the hip and the low back respectively. 

For this reason, anatomy books do show that fascia, but most of the images are devoid of fascia, and if you went to BodyWorlds, the muscles were all separated out, hanging as separate pieces which does not represent what is really happening in the body.

Think about the magic that is our skin and the tissue just underneath.  We can pick up a pinch of skin and roll it under our fingers, and when you let it go, no matter what direction you moved the superficial tissue, it pops back into place. 

The fractal grooves in our skin are a reflection of the 3-dimensional spider-web-like, flexible, dewy tissue underneath, designed in a way that allows for movement in any direction via watery sliding fibres and stretch.  Take a look at this video clip to get a feel for what the superficial fascia under the skin looks like.

Veins, the bluish tubes that return deoxygenated blood to the heart, are collapsible, yet the loose superficial fascial web keeps them open while we move and  stretch our bodies.

Human movement does not work entirely as a muscle-lever system as we had previously thought.  Such a lever system would probably result in very robotic movements, but we are capable of very smooth, coordinated movements.

Muscles don't really begin and end – they continue via the deep fascial system something like sausages linked together through their casings.  This means that when we stretch or massage a particular muscle, we will affect many of the muscles within that connective tissue.

You can prove this to yourself easily.  Stand up and bend over, and note about where your fingertips reach with respect to your legs or feet.  Then stand up again, and roll the bottom of left foot only on a golf ball for about 3-5 minutes. 

Bend over again, and what do you notice?  Most people notice that the left fingertips are reaching further than previously.  Even though you only worked the tissue on the bottom of the foot, you have magically become more flexible in the entire back-line of the body on that side!

Fascia not only connects muscles lengthwise to each other, but also glues certain muscle bellies that sit beside each other together.  This allows forces to be transferred laterally (or obliquely or whatever) across muscle bellies as well.

Depending on the movement we are doing, different layers of our muscle-fascia system move us by sliding over each other as needed. 

The ability of the fascial-web system to spread forces out and to dynamically create tension exactly where it is needed, when it is needed in order to move the body makes for a movement system that is far superior and more representative of how we actually move than a mechanical lever system ever could be. 

I wish I were able to find online a copy of the video we saw of a fresh dissection, showing the slide and glide as a leg is moved.  What I saw did not match at all how I had previously imagined movement to work. 

Obviously the movement was passive rather than active but still I did not expect to see so much sliding of layers of myofascia over each other.  What I had in my mind previously was muscles stretching and shortening but staying rather static.  I did not imagine the sliding.

Individual muscles can be useful to designate a particular area of the body, but when it comes to function or treatment it is helpful to consider what is happening in the entire muscle-fascia system involved rather than each muscle individually.

So, instead of learning anatomy by memorizing origins and insertions of muscles that don't really exist as independent functional units as we previously believed, perhaps it would be easier, more accurate and useful to study movement patterns like  the squat pattern, lunge pattern etc., or fascial planes that organize movement, such as the inner-leg line, the side line etc.