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Terra Rosa e-magazine, No. 7 (March 2011) 1 Terra Rosa Terra Rosa EEE---MagazineMagazineMagazine No. 7, March 2011 Open information for massage therapists & bodyworkers www.terrarosa.com.au www.massage-research.com Welcome to our special issue. Fascia research has attracted lots of attention among researchers and bodyworkers. Watch an introduction video on fascia here” http://www.youtube.com/watch?v=yj9NqWZ -0ik Fascia is important in muscular force transmission and an amazing sensory organ. Now it is time to put the research into practice. In our last issue, (No. 6, December 2010) Bethany Ward summarises the key findings from the fascia congress and what it means for bodyworkers. Now, we have the first application of fascia research in a new field called Fascial Fit- ness, a new way of training your body, pioneered by Robert Schleip, Divo Müller and Tom Myers. You have the first chance to read about it here. Also read about an ancient application of the fascia theory in Tai Chi coiling movement. We also have an interview with Dr. Jean-Claude Guimberteau, a hand surgeon who for the first time, brings you the images of live fascia. A Massage Pro- ject by Joanne Schoenwald. Great massage articles by Dr. Joe Muscolino on Clinical Orthopedic Mas- sage, Shari Auth on Forearm Massage, and Art Riggs on How to make a transition in your bodywork prac- tice. Don’t forget to read 6 questions to Robert Schleip and Divo Müller. Enjoy reading and Stay Healthy Sydney, March 2011 2 Fascia Fitness—Divo Müller & Robert Schleip 13 Tai Chi Coiling 18 Auth Method: A Guide to Using Fore- arms—Shari Auth 24 An Interview with Dr. Jean-Claude Guim- berteau 28 Fundamentals of- Clinical Orthopedic Mas- sage—Dr. Joe Muscolino 30 The Massage Pro- ject— Joanne Schoenwald 31 Tai Chi for Fi- bromyalgia—Romel Rones 37 Transitioning Your Bodywork—Art Riggs 39 Research Highlights 40 6 Questions to Robert Schleip 41 6 Questions to Divo Müller Contents Disclaimer: The publisher of this e-magazine disclaims any responsibility and liability for loss or damage that may result from articles in this publication. Terra Rosa e-magazine, No. 7 (March 2011) 2 Fascial Fitness When a football player is not able to take the field be- cause of a recurrent calf spasm, a tennis star gives up early on a match due to knee problems or a sprinter limps across the finish line with a torn Achilles tendon, the problem is most often neither in the musculature or the skeleton. Instead, it is the structure of the connec- tive tissue – ligaments, tendons, joint capsules, etc. – which have been loaded beyond their present capacity (Renström & Johnson 1985, Counsel & Breidahl 2010). A focused training of the fascial network could be of great importance for athletes, dancers and other move- ment advocates. If one’s fascial body is well trained, that is to say optimally elastic and resilient, then it can be relied on to perform effectively and at the same time to offer a high degree of injury prevention. Until now, most of the emphasis in sports training has been fo- cused on the classical triad of muscular strength, car- diovascular conditioning, and neuromuscular coordi- nation. Some alternative physical training activities - such as Pilates, yoga, Continuum Movement, Tai Chi, Qi Gong and martial arts – are already taking the con- nective tissue network into account. The importance of fasciae is often specifically dis- cussed; however the modern insights of fascia research have often not been specifically included in our work. In this article, we suggest that in order to build up an injury resistant and elastic fascial body network, it is essential to translate current insights of fascia research into a practical training program. Our intention is to encourage massage, bodywork, and movement thera- pists, as well as sports trainers to incorporate the basic principles presented in this article, and to apply them to their specific context. Fascial Remodelling A unique characteristic of connective tissue is its im- pressive adaptability: when regularly put under in- creasing physiological strain, it changes its architec- tural properties to meet the demand. For example, through our everyday biped locomotion the fascia on the lateral side of the thigh develops a palpable firm- ness. If we were to instead spend that same amount of time with our legs straddling a horse, then the opposite would happen, i.e. after a few months the fascia on the inner side of the legs would become more developed and strong (El-Labban et al. 1993). The varied capaci- ties of fibrous collagenous connective tissues make it possible for these materials to continuously adapt to the regularly occurring strain, particularly in relation to changes in length, strength and ability to shear. Not only the density of bone changes, as for example in as- tronauts who spend most time in zero gravity, their Fascial Fitness Fascia oriented training for bodywork and movement therapies Divo G. Müller, Robert Schleip Figure 1. Increased elastic storage capacity. Regular oscilla- tory exercise, such as daily rapid running, induces a higher storage capacity in the tendinous tissues of rats, compared with their non- running peers. This is expressed in a more spring-like recoil move- ment as shown on the left. The area between the respective loading versus unloading curves represents the amount of 'hysteresis': the smaller hysteresis of the trained animals (green) reveals their more 'elastic' tissue storage capacity; whereas the larger hysteresis of their peers signifies their more 'visco-elastic' tissue properties, also called inertia . Illustration modified after Reeves 2006. Terra Rosa e-magazine, No. 7 (March 2011) 3 bones become more porous; fascial tissues also reacts to their dominant loading patterns. With the help of the fibroblasts, they react to everyday strain as well as to specific training; steadily remodelling the arrangement of their collagenous fibre network. For example, with each passing year half the collagen fibrils are replaced in a healthy body. The intention of fascial fitness is to influence this re- placement via specific training activities which will, af- ter 6 to 24 months, result in a ‘silk-like bodysuit’ which is not only strong but also allows for a smoothly gliding joint mobility over wide angular ranges. Interestingly, the fascial tissues of young people show stronger undulations within their collagen fibres, remi- niscent of elastic springs; whereas in older people the collagen fibres appear as rather flattened (Staubesand et al. 1997). Research has confirmed the previously opti- mistic assumption that proper exercise loading – if ap- plied regularly - can induce a more youthful collagen architecture, which shows a more wavy fibre arrange- ment (Wood et al. 1988, Jarniven et al. 2002) and which also expresses a significant increased elastic storage ca- pacity (Figure 1) (Reeves et al. 2006). However, it seems to matter which kind of exercise movements are ap- plied: a controlled exercise study using slow velocity and low load contractions only demonstrated an increase in muscular strength and volume, however it failed to yield any change in the elastic storage capacity of the collagenous structures (Kubo et al. 2003). The Catapult Mechanism: Elas- tic Recoil of Fascial Tissues Kangaroos can hop much farther and faster than can be explained by the force of the contraction of their leg muscles. Under closer scrutiny, scientists discovered that a spring -like action is behind the unique ability: the so-called catapult mechanism (Kram & Dawson 1998). Here the tendons and the fascia of the legs are tensioned like elastic bands. The release of this stored energy is what makes the amazing hops possible. Hardy surprising, scientist thereafter found the same mechanism is also used by gazelles. These animals are also capable of per- forming impressive leaping as well as running, though their musculature is not especially powerful. On the contrary, gazelles are generally considered to be rather delicate, making the springy ease of their incredible jumps all the more interesting. Through high resolution ultrasound examination, it is now possible to discover similar orchestration of load- ing between muscle and fascia in human movement. Surprisingly it has been found that the fasciae of human have a similar kinetic storage capacity to that of kanga- roos and gazelles (Sawicki et al. 2009). This is not only made use of when we jump or run but also with simple walking, as a significant part of the energy of the move- ment comes from the same springiness described above. Fascial Fitness Figure 2. Length changes of fascial elements and muscle fibres in an oscillatory movement with elastic recoil properties (A) and in conventional muscle training (B). The elastic tendinous (or fascial) elements are shown as springs, the myo-fibres as straight lines above. Note that during a conventional movement (B) the fascial elements do not change their length significantly while the muscle fibres clearly change their length. During movements like hopping or jumping however the muscle fibres contract almost isometri- cally while the fascial elements lengthen and shorten like an elastic yoyo spring. Illustration adapted from Kawakami et al. 2002. Terra Rosa e-magazine, No. 7 (March 2011) 4 This new discovery has led to an active revision of long accepted principles in the field of movement science. In the past it was assumed that in a muscular joint movement, the skeletal muscles involved shorten and this energy passes through passive tendons which re- sults in the movement of the joint. This classical form of energy transfer is still true for steady movements such as cycling. Here the muscle fibres actively change in length, while the tendons and aponeuroses barely grow longer (Figure 2). The fascial elements remain quite passive. This is in contrast to oscillatory movements with an elastic spring quality in which the length of the muscle fibres changes slightly. Here, it is the muscle fibres contract in an almost isometric fashion (they stiffen temporarily without any significant change of their length) while the fascial elements function in an elastic way with a movement similar to that of a yoyo. Here, it is the lengthening and shortening of the fascial elements that ‘produces’ the actual movement (Fukunaga et al. 2002, Kawakami et al. 2002). Work by Staubesand et al. (1997) suggested that the elastic movement quality in young people is associated with a typical bi-directional lattice arrangement of their fasciae, similar to a woman’s stocking. In contrast, as we Fascial Fitness Figure 4. Loading of different fascial components. A) Relaxed position: The myo-fibres are relaxed and the muscle is at normal length. None of the fascial elements is being stretched. B) Usual muscle work: myo-fibres contracted and muscle at normal length range. Fascial tissues which are either arranged in series with the myo-fibres or transverse to them are loaded. C) Classical stretching: myo-fibres relaxed and muscle elongated. Fascial tissues oriented parallel to the myo-fibres are loaded as well as extra-muscular connections. However, fascial tissues oriented in series with the myo-fibres are not sufficiently loaded, since most of the elongation in that serially arranged force chain is taken up by the relaxed myo-fibres. D) Actively loaded stretch: muscle active and loaded at long end range. Most of the fascial components are being stretched and stimu- lated in that loading pattern. Note that various mixtures and combi- nations between the four different fascial components exist. This simplified abstraction serves as a basic orientation only. Figure 3. Collagen architecture responds to loading. Fasciae of young people express more often a clear two-directional (lattice) orientation of their collagen fibre network. In addition the individual collagen fibres show a stronger crimp formation. As evidenced by ani- mal studies, application of proper exercise can induce an altered architecture with increased crimp-formation. Lack of exercise on the other hand, has been shown to induce a multidirectional fibre network and a decreased crimp formation. Terra Rosa e-magazine, No. 7 (March 2011) 5 age and usually loose the springiness in our gait, the fascial architecture takes on a more haphazard and mul- tidirectional arrangement. Animal experiments have also shown that lack of movement quickly fosters the development of additional cross links in fascial tissues. The fibres lose their elasticity and do not glide against one another as they once did; instead they become stuck together and form tissue adhesions, and in the worst cases they actually become matted together (Figure 3) (Jarvinen et al. 2002). The goal of the proposed fascial fitness training is to stimulate fascial fibroblasts to lay down a more youthful and kangaroo-like fibre architecture. This is done through movements that load the fascial tissues over multiple extension ranges while utilizing their elastic springiness. Figure 4 illustrates different fascial elements affected by various loading regimes. Classical weight training loads the muscle in its normal range of motion, thereby strengthening the fascial tissues which are arranged in series with the active muscle fibres. In addition the transverse fibres across the muscular envelope are stimulated as well. However, little effect can be expected on extra-muscular fasciae as well as on those intramus- cular fascial fibres that are arranged in parallel to the active muscle fibres (Huijing 1999). Classical Hatha yoga stretches on the other side will show little effect on those fascial tissues which are ar- ranged in series with the muscle fibres, since the relaxed myo-fibres are much softer than their serially arranged tendinous extensions and will therefore ‘swallow’ most of the elongation (Jami 1992). However, such stretching provides good stimulation for fascial tissues which are hardly reached with classical muscle training, such as the extra-muscular fasciae and the intramuscular fas- ciae oriented in parallel to the myo-fibres. Finally, a dy- namic muscular loading pattern in which the muscle is both activated and extended promises a more compre- hensive stimulation of fascial tissues. This can be achieved by muscular activation (e.g. against resistance) in a lengthened position while requiring small or me- dium amounts of muscle force only. Soft elastic bounces in the end ranges of available motion can also be utilized Fascial Fitness Figure 5. Training example: The Flying Sword A) Tension the bow: the preparatory counter movement (pre-stretch) initiates the elastic-dynamic spring in an anterior and inferior direction. Free weights can also be used. B) To return to an upright position, the ‘catapulting back fascia’ is loaded as the upper body is briefly bounced dynamically downwards followed by an elastic swing back up. The attention of the person doing the exercise should be on the optimal timing and calibration of the movement in order to create the smoothest movement possible. A B Terra Rosa e-magazine, No. 7 (March 2011) 6 for that purpose. The following guidelines are developed to make such training more efficient. Training Principles 1. Preparatory Counter-movement Here we make use of the catapult effect as described above. Before performing the actual movement, we start with a slight pre-tensioning in the opposite direction. This is comparable with using a bow to shoot an arrow; just as the bow has to have sufficient tension in order for the arrow to reach its goal, the fascia becomes ac- tively pre-tensioned in the opposite direction. Using one’s muscle power to “push the arrow” would then rightfully be seen as foolish, in this extreme example of an elastic recoil movement. In a sample exercise called the flying sword, the pre-tensioning is achieved as the body’s axis is slightly tilted backward for a brief mo- ment; while at the same time there is an upward length- ening (Figure 5). This increases the elastic tension in the fascial bodysuit and as a result allows the upper body and the arms to spring forward and down like a catapult as the weight is shifted in this direction. The opposite is true for straightening up – the mover activates the catapult capacity of the fascia through an active pre-tensioning of the fascia of the back. When standing up from a forward bending position, the mus- cles on the front of the body are first briefly activated. This momentarily pulls the body even further forward and down and at the same time the fascia on the poste- rior fascia is loaded with greater tension. The energy which is stored in the fascia is dynamically released via a passive recoil effect as the upper body ‘swings’ back to the original position. To be sure that the individual is not relying on muscle work, but rather on dynamic recoil action of the fascia, requires a focus on timing – much the same as when playing with a yoyo. It is necessary to determine the ideal swing, which is ap- parent when the action is fluid and pleasurable. 2. The Ninja Principle This principle is inspired by the legendary Japanese warriors who reputedly moved as silent as cats and left Fascial Fitness Figure 6. Training example: Elastic Wall Bounces. Imitating the elastic bounces of a kangaroo soft bouncing movements off a wall are explored in standing. Proper pre-tension in the whole body will avoid any collapsing into a ‘banana posture’. Making the least sound and avoiding any abrupt movement qualities are imperative. Only with the mastery of these qualities a progression into further load in- creases – e.g. bouncing off a table or window sill instead of a wall – can eventually be explored by stronger individuals. E.g. this person should not yet be permitted to progress to higher loads, as his neck and shoulder region already show slight compression on the left picture. Terra Rosa e-magazine, No. 7 (March 2011) 7 no trace. When performing bouncy movements such as hopping, running and dancing, special attention needs to be paid to executing the movement as smoothly and softly as possible. A change in direction is preceded by a gradual deceleration of the movement before the turn and a gradual acceleration afterwards, each movement flowing from the last; any extraneous or jerky move- ments should therefore be avoided (see Figure 6). Normal stairs become training equipment when they are used appropriately, employing gentle stepping. The production of ‘as little noise as possible’ provides the most useful feedback – the more the fascial spring effect is utilized, the quieter and gentler the process will be. It may be useful to reflect on the way a cat moves as it pre- pares to jump; the feline first sends a condensed im- pulse down through its paws in order to accelerate softly and quietly, landing with precision. 3. Dynamic Stretching Rather than a motionless waiting in a static stretch posi- tion a more flowing stretch is suggested. In fascial fit- ness there is a differentiation between two kinds of dy- namic stretching: fast and slow. The fast variation may be familiar to many people as it was part of the physical training in the past. For the past several decades this bouncing stretch was considered to be generally harmful to the tissue, but the method’s merits have been con- firmed in contemporary research. Although stretching immediately before competition can be cou