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Old 07-10-2009, 03:58 PM   #151
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Todd, I certainly consider anything that contains nervous tissue worthy of "knowing", but my point is that I need significant cause to address specific structures manually.

With regards to your stretching question, I do think that there is a very good underlying principle to stretching; all the research has done so far, is shown certain outcomes and they have done nothing to show exactly HOW these outcomes were accomplished within the body. In the conclusions of those studies, you'll see theorizing about lengthening of sarcomeres, myofascial membranes and more.

Yet, the nervous system is very much involved and some other studies have pointed towards crediting this system with any stretch results.

hope that answers your question.
Thanks, Bas. My last comment is that most/all research studies weren't looking beyond the muscle components for an explanation. Again, it's my opinion that the fascial connections will be proven trainable, to one degree or another, like a muscle.
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Old 07-10-2009, 04:07 PM   #152
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You're welcome Todd.
I'll punt this back to you:
What would be the clinical reason to "train" fascia? Is there a demonstrable connection between fascia and a complaint the patient presents with?
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Old 07-10-2009, 04:59 PM   #153
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Here's one PDF about fascia that some of you will find interesting....
I'm glad Schleip checking out fascia so closely. Maybe once is has been investigated scientifically it will lose its power as a central focus for treatment construct for so many bodyworkers.

The paper is interesting in that it suggests that the body/organism finds a cheaper more cost efficient manner of being upright - instead of relying entirely on using muscle (which costs more thermodynamically) it has fascia assume some of the load mechanically.

1. NO is easy, cheap to make physiologically, sensory neurons may even excrete it (I'd have to check to be sure);

2. It makes sense (evolutionarily) that the organism would have fascia that stiffens on stretch - this would give musculature an opportunity to relax underneath and breathe;

3. None of it has any bearing whatsoever on treatment construct, except to help people deconstruct the "fascist" ideas they got from instructors they paid big bucks to, to teach them how to put hands on people. Go Schleip.

I think the idea of breathing into a body area is a good one. It brings the awareness system to selected parts of a body representational map. It helps someone to feel they are regaining of a locus of control over their physicality. It probably helps re-regulate internal regulation systems. It involves the patient. These are all important.
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Old 07-10-2009, 10:04 PM   #154
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Thanks for the link Todd.

This is actually a pretty good analogy for this whole thread. This lady has done some really good research on the statistical correlations between acup pts and fascial planes and also has some great electron microscope pictures of what needle manipulation does to the fascial tissues.

I’ve read some of this research before and there are plenty of quite similar studies. I have no reason to doubt the accuracy and truth of what it shows.

But…. And this is a big but…

What do we do with this sort of research when there is also very compelling evidence that needling at non-acupoints is as effective as true acupoints?

And when there is evidence that superficial or even non-penetrative acupuncture is as effective as deep fascial needling then why is the effect of the needle manip important?

My conclusion is that Acupuncture is an ectodermal modality.

Maybe this is the same with the ‘Anatomy Trains’ concept- no-one’s doubting that you could find myofascial connections through the body in various exciting ways, and I don’t think anyone doubts that you can effect change in your patients by ‘working on’ these ‘meridians’. But when you look at what is really going on to make any changes- I think the evidence all points to the neural system.

To me hard evidence to back something up is more important than mere scientific plausibility. (There are other opinions on this matter).
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Old 08-10-2009, 02:50 AM   #155
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To me hard evidence to back something up is more important than mere scientific plausibility.
The problem is, hard evidence can be misconstrued in the absence of prior scientific plausibility, and then lead to profound misunderstanding.

There's an interesting platform presentation abstract in this month's JMMT showing significant increases in pain thresholds and other somatosensory qualities with knee "joint mobilization" in patient's with OA. The obvious assumption is that the "joint mobilization" is what produced these changes. Yet, the effect of contact onto the patient's skin is completely ignored as it routinely is in manual therapy studies.

It's simply implausible that the effects generated are due to to just "mobilizing the joint, " i.e. physically coercing the joint to move in a way that it wouldn't normally based on some rule of physics describing inert convex and concave surfaces. Obviously, the intervening skin plays a crucial role in any somatosensory changes that are going to occur with manual contact.

But this "mindset" or "worldview" of the joint as the center of the manual therapy universe continues to generate "hard evidence" like this all over the place.

You and I both know that prior plausibility is sorely lacking in this and many other manual therapy research studies on many levels, but it keeps getting churned out.

It's getting downright embarrassing.
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Old 08-10-2009, 03:12 AM   #156
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regnalt says:

Quote:
Again, it's my opinion that the fascial connections will be proven trainable, to one degree or another, like a muscle.
Muscles aren't trainable, only the brain's messages to them can be.

This is not splitting hairs or a matter of semantics, it is an acknowledgment of the nervous system's actual role in behavior. As Bobath said her entire career, "The brain knows nothing of muscle - only movement."

We might similarly say, "The brain knows nothing of fascia - only the messages sent from the nervous tissue within it."
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Old 08-10-2009, 03:42 AM   #157
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You're welcome Todd.
I'll punt this back to you:
What would be the clinical reason to "train" fascia? Is there a demonstrable connection between fascia and a complaint the patient presents with?
Remember, I focus on restoring motor control, movement efficiency, and conditioning, but not pain. I do believe fascia is very relevant in this regard, because of the distinct connections that cross multiple joints.
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Old 08-10-2009, 03:56 AM   #158
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The fascial folks always allude to the fact that there's a lot of it and that it stretches all over the place.

So what? Oxygen's everywhere but that gives it no special power beyond what we understand of it already.

How is it that they don't typically mention the ubiquity of the nervous system; something that we know is capable of signaling, interpreting and sending out exactly what our patients report?
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Old 08-10-2009, 03:56 AM   #159
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Remember, I focus on restoring motor control, movement efficiency, and conditioning, but not pain. I do believe fascia is very relevant in this regard, because of the distinct connections that cross multiple joints.
How are those facts relevant to "training fascia"?

It seems like you're saying this in the same way someone might say, "I'm training the navicular" when they go for a run.
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Old 08-10-2009, 04:00 AM   #160
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regnalt says:



Muscles aren't trainable, only the brain's messages to them can be.

This is not splitting hairs or a matter of semantics, it is an acknowledgment of the nervous system's actual role in behavior. As Bobath said her entire career, "The brain knows nothing of muscle - only movement."

We might similarly say, "The brain knows nothing of fascia - only the messages sent from the nervous tissue within it."
You are correct about muscle function and I should have worded my reply more accurately. Earlier in the thread I mentioned that muscles don't actually lengthen during a contract/relax stretch, but the nervous system creates a new set point. I imagine the fascial connections being altered in the same way.

BTW your comment "the brain knows nothing of fascia - only the messages sent from the nervous tissue within it" is interesting to a brain neophyte like me... would connective tissue still be in the brain's schema/representational map of the body if it lacked neural tissue?
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Old 08-10-2009, 04:08 AM   #161
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BTW your comment "the brain knows nothing of fascia - only the messages sent from the nervous tissue within it" is interesting to a brain neophyte like me... would connective tissue still be in the brain's schema/representational map of the body if it lacked neural tissue?
I think it's possible but that representation would probably be somehow different.
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Old 08-10-2009, 04:20 AM   #162
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The fascial folks always allude to the fact that there's a lot of it and that it stretches all over the place.
I don't know any "fascial folks" but I have already alluded to a book (it's not the only one) that illustrates more defined connections than "all over the place"....

Quote:
Originally Posted by Barrett Dorko View Post
So what? Oxygen's everywhere but that gives it no special power beyond what we understand of it already.

How is it that they don't typically mention the ubiquity of the nervous system; something that we know is capable of signaling, interpreting and sending out exactly what our patients report?
I've repeatedly mentioned the nervous system, and it's intelligence, but this doesn't mean I need to ignore other components of the body....
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Old 08-10-2009, 04:23 AM   #163
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How are those facts relevant to "training fascia"?

It seems like you're saying this in the same way someone might say, "I'm training the navicular" when they go for a run.
Sure, why not, if the navicular had sensory/motor/contractile tissue and distinct connections that crossed multiple joints...
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Old 08-10-2009, 04:25 AM   #164
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I think it's possible but that representation would probably be somehow different.
Thanks, Jon. I'll look at the thread, for sure.
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Old 08-10-2009, 04:31 AM   #165
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The problem is, hard evidence can be misconstrued in the absence of prior scientific plausibility, and then lead to profound misunderstanding.

There's an interesting platform presentation abstract in this month's JMMT showing significant increases in pain thresholds and other somatosensory qualities with knee "joint mobilization" in patient's with OA. The obvious assumption is that the "joint mobilization" is what produced these changes. Yet, the effect of contact onto the patient's skin is completely ignored as it routinely is in manual therapy studies.

It's simply implausible that the effects generated are due to to just "mobilizing the joint, " i.e. physically coercing the joint to move in a way that it wouldn't normally based on some rule of physics describing inert convex and concave surfaces. Obviously, the intervening skin plays a crucial role in any somatosensory changes that are going to occur with manual contact.

But this "mindset" or "worldview" of the joint as the center of the manual therapy universe continues to generate "hard evidence" like this all over the place.

You and I both know that prior plausibility is sorely lacking in this and many other manual therapy research studies on many levels, but it keeps getting churned out.

It's getting downright embarrassing.
John,
How do you contact the skin? For instance, how is it different now then before you had so much awareness/experience with the nervous tissue? My memory might be failing, but you mentioned performing high velocity/low amplitude mobilizations, right? What would be the difference between a "regular" mobilization and one performed with the understanding of the skins involvement?
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Old 08-10-2009, 04:56 AM   #166
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Sure, why not, if the navicular had sensory/motor/contractile tissue and distinct connections that crossed multiple joints...
I suppose the reason I wouldn't is because that idea seems to already be adequately covered by the physical stress theory.

Perhaps you're giving the fascia properties that aren't covered by this theory?
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Old 08-10-2009, 07:33 AM   #167
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Here's one PDF about fascia that some of you will find interesting....
The Schleep papers are already on the site.
The Langevin's one, too.
Energy Medicine
Significance of microtubules
Connective tissue: A body-wide signaling network?
I loved (really) the study of Dr Langevin. The conclusion is clear: No signal or energy or what else was found in fascia but she is still... searching.
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Old 08-10-2009, 05:16 PM   #168
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The Schleep papers are already on the site.
The Langevin's one, too.
Energy Medicine
Significance of microtubules
Connective tissue: A body-wide signaling network?
I loved (really) the study of Dr Langevin. The conclusion is clear: No signal or energy or what else was found in fascia but she is still... searching.
I've emailed Dr. Schleip and asked if there's any new research available, because his last paper, at least that I'm aware of, is a few years old....
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Old 08-10-2009, 05:21 PM   #169
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Passive muscle stiffness may be influenced by active contractility of intramuscular..
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Old 13-10-2009, 04:44 PM   #170
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My simplistic understanding is that chronic pain has little to do with tissue deformation, but rather the brain perceives a threat exists. So, it?s interesting that people with LBP have morphological ?abnormal? differences in connective tissue of the thoracolumbar fascia.



http://www.fasciacongress.org/2009/a...e%20tissue.pdf

http://www.fasciacongress.org/2009/a...0FASCIA%20.pdf

http://www.fasciacongress.org/2009/a...ack%20pain.pdf
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Old 13-10-2009, 04:56 PM   #171
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It seems that those findings could be very easily be explained as an effect of the body's altered neuromuscular biomechanics (as a result of the pain) over a long time - resulting in a morphological change in many tissues. Is that not a simple, yet elegant, and thus likely explanation?
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Old 13-10-2009, 09:56 PM   #172
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My simplistic understanding is that chronic pain has little to do with tissue deformation, but rather the brain perceives a threat exists. So, it’s interesting that people with LBP have morphological “abnormal” differences in connective tissue of the thoracolumbar fascia.
Correlation does not equal causation.
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Old 14-10-2009, 01:55 AM   #173
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It seems that those findings could be very easily be explained as an effect of the body's altered neuromuscular biomechanics (as a result of the pain) over a long time - resulting in a morphological change in many tissues. Is that not a simple, yet elegant, and thus likely explanation?
I feel altered biomechanics, or sensory motor amnesia, are at the root of many conditions. However, tissues morphing due to pain, and not faulty movement patterns, is something a bit different, right? The papers haven't been presented yet, but it seems people are using this information as a way to work with the (morphed) connective tissue in order to relieve pain. It's still about engaging the nervous system, but as far as I can tell it would be through "neurofascial" work (i.e. not skin).
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Old 14-10-2009, 01:57 AM   #174
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Correlation does not equal causation.
Agreed, but a correlation might provide more ways to address pain.
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Old 14-10-2009, 02:06 AM   #175
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One other tidbit Dr. Schleip mentioned via email correspondence is the different layers of the morphed thoracolumbar fascia become adhesed with chronic LBP and apparently responds to slow shearing force (not yet published).
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Old 14-10-2009, 03:06 AM   #176
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Hi Regnalt,

What is your interpretation of this finding?

Quote:
The LBP group had ~25% greater perimuscular connective tissue thickness
and echogenicity compared with the No-LBP group
I read all three abstracts and it seems as though you're developing a theory here. Can you make it more explicit?
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Old 14-10-2009, 03:39 AM   #177
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I feel altered biomechanics, or sensory motor amnesia, are at the root of many conditions. However, tissues morphing due to pain, and not faulty movement patterns, is something a bit different, right? The papers haven't been presented yet, but it seems people are using this information as a way to work with the (morphed) connective tissue in order to relieve pain. It's still about engaging the nervous system, but as far as I can tell it would be through "neurofascial" work (i.e. not skin).

So... would you remove skin prior to treatment and reattach it later? Just asking..
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Old 14-10-2009, 04:23 AM   #178
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Or another question is: "How would one EVER know it is actually the fascia being 'treated'?"
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Old 14-10-2009, 04:35 AM   #179
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Regnalt,

As the skin is the first contact any manual therapist makes with a patient, it would be hard to ignore it given it is the primary known conduit to the brain. The fact that fascia might tag along for the ride is far less certain, so I'm puzzled about the attention lots of folk pay to fascia....

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Old 14-10-2009, 07:13 AM   #180
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Originally Posted by regnalt View Post
One other tidbit Dr. Schleip mentioned via email correspondence is the different layers of the morphed thoracolumbar fascia become adhesed with chronic LBP and apparently responds to slow shearing force (not yet published).
Seems logical.
If you are suffering of pain you move less and no/less motion is the key of adhesion and muscular reduction. No need of fascia in this explanation.
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Old 17-10-2009, 01:00 AM   #181
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Hi Regnalt,

What is your interpretation of this finding?

"The LBP group had ~25% greater perimuscular connective tissue thickness
and echogenicity compared with the No-LBP group "

I read all three abstracts and it seems as though you're developing a theory here. Can you make it more explicit?
Hi Jon,
I'm not developing a theory on this particular topic (fascia), per se, but always trying to tie things all together in a logical fashion. Connective tissue (ct) will never replace the importance/intelligence of the nervous system, but it seems that research is showing fascia to be a lot more than glue. I always thought ct would simply build up in areas of overuse, but ct morphology due to pain is a significant finding. It means, at least to me, the idea of distinct cords of ct being altered in a therapeutic manner is plausible.
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Old 17-10-2009, 01:06 AM   #182
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So... would you remove skin prior to treatment and reattach it later? Just asking..
Hi Diane,
The research is showing a correlation of morphed connective tissue and pain, but that doesn't detract from the importance of the skin. To the contrary, it's an indication of the multi-layered intelligence of the human body, literally.
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Old 17-10-2009, 01:12 AM   #183
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I always thought ct would simply build up in areas of overuse, but ct morphology due to pain is a significant finding.
It isn't clear to me that this is what they found but I only read the abstracts. In the first abstract they state "Possible causes include genetic factors, abnormal movement patterns, and chronic inflammation."

Quote:
It means, at least to me, the idea of distinct cords of ct being altered in a therapeutic manner is plausible.
I don't know enough about what you mean to comment.
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Old 17-10-2009, 01:26 AM   #184
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Or another question is: "How would one EVER know it is actually the fascia being 'treated'?"
Hi Bas,
You could just as easily flip the question around and ask how do you know it's actually the skin being treated, right?

Please, remember I'm the guy who has been suspected of trying to win a "holistic contest" because of my comments about working with the whole body and not overly focusing on one particular aspect. In my day-to-day practice, which consists of mostly movement therapy, the exact ratio of skin/ct being treated isn't a looming concern, because the body is an intricate and integrated system.
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Old 17-10-2009, 01:30 AM   #185
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Regnalt,

As the skin is the first contact any manual therapist makes with a patient, it would be hard to ignore it given it is the primary known conduit to the brain. The fact that fascia might tag along for the ride is far less certain, so I'm puzzled about the attention lots of folk pay to fascia....

Nari
The research is pointing to the fact ct is not just tagging along for the ride, but we'll have to wait and see. Besides, I work mostly "hands-off" and the skin/ct is being addressed through movement.
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Old 17-10-2009, 01:31 AM   #186
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Seems logical.
If you are suffering of pain you move less and no/less motion is the key of adhesion and muscular reduction. No need of fascia in this explanation.
Even if it's the fascia that's becoming adhesed?
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Old 17-10-2009, 01:39 AM   #187
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It isn't clear to me that this is what they found but I only read the abstracts. In the first abstract they state "Possible causes include genetic factors, abnormal movement patterns, and chronic inflammation."
I based some of my comment from correspondence with Dr. Schleip, but also that research is pointing in this direction.


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I don't know enough about what you mean to comment.
It's in part of this thread...there were quite a few posts.
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Old 17-10-2009, 01:43 AM   #188
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Hi Bas,
You could just as easily flip the question around and ask how do you know it's actually the skin being treated, right?

Please, remember I'm the guy who has been suspected of trying to win a "holistic contest" because of my comments about working with the whole body and not overly focusing on one particular aspect. In my day-to-day practice, which consists of mostly movement therapy, the exact ratio of skin/ct being treated isn't a looming concern, because the body is an intricate and integrated system.
Occam's Razor requires we go with the simplest explanation which covers the most variables.

In order to rule out sensory input from skin and all the neurological cascades from touching or stretching it, in favor of a fascial construct, you'd have to devise a test in which you removed all the skin, treated, then reattached the skin seamlessly after. I just don't think that can be done. Therefore, I rule skin in instead of out. Because effects can be achieved without ever having had to go anywhere NEAR fascia, I rule fascial constructs out.
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Old 17-10-2009, 02:04 AM   #189
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Occam's Razor requires we go with the simplest explanation which covers the most variables.
Yes, but wouldn't that mean accepting the relevance of both skin/ct (i.e. the most variables) in the simplest explanation? Unless you believe all of the the morphology of ct is occurring from the sensory information coming from the skin...if not, it seems more logical to have a construct that includes both, but pays more credence to the skin. It's not mutually exclusive, IMHO.
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Old 17-10-2009, 02:41 AM   #190
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Quote:
It isn't clear to me that this is what they found but I only read the abstracts. In the first abstract they state "Possible causes include genetic factors, abnormal movement patterns, and chronic inflammation.
I based some of my comment from correspondence with Dr. Schleip, but also that research is pointing in this direction.
Lots of questions from me if you're interested.

I'm interested in knowing more about pain causing connective tissue morphology changes. What did Dr. Schleip say about this? What research do you cite to support the proposition that pain causes connective tissue morphology?

Maybe this is just a communication issue. Do you mean pain exists in the causal chain or do you mean pain is the proximal cause of connective tissue morphology change? Do you consider a muscular contraction an example of connective tissue morphology change?
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Old 17-10-2009, 02:50 AM   #191
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The morphology of the ct is of course not getting changed exclusively due to sensory information from the skin; as I and others have said before, the ct can change due to altered motion patterns (inhibition) due to pain and many other factors.

My point is not one of exclusivity - skin and skin alone - but more one where I can firmly state, with great certainty and proof, that if I put my hand on a human being, I contact the skin. Which is more than can be said about manually treating the fascia.

As far as changing the morphology of ct by other means: altered motion (including ideomotion), altered input through all sensory entries into the system (ears, eyes, skin), and addressing the cognitive capabilities of the person can all create changes in many tissues. That includes the fascia.

Again, WHY would the fascia be a concern? Has it been proven to play a common role in persistent pain problems? Or is it just another aspect of a body that does not move regularly and freely?

There are many other tissues that get affected and effected by abnormal (pain-focused) motion and motion inhibition. Those famous spinal joints getting " tight" (a whole industry created to "move" those), muscles that get weak and tight, small bloodvessels that are shutting down, peripheral sensory nerve endings becoming hypersensitised, etc etc. Tons of potential morphological changes that could be a specific focus of treatment. Why the fascia? (Of which the patient does NOT have a conscious awareness - yet they do of the skin and their body positions)
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Old 17-10-2009, 04:12 AM   #192
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Fascia = Mothership

I'm certain many people, especially regnalt, will not like that but it explains this obsession (yea, I said obsession) with the tissue put forth most prominently by Ida Rolf, and then another who shall remain nameless.

It's a chemical filter, not a sacred object, and its function and morphology are well known and have been for a long time, unlike the mysteries still to be discovered in the connections of the nervous system. Wake me when the research discovers something clinically significant.
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Old 17-10-2009, 04:22 AM   #193
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Yes, but wouldn't that mean accepting the relevance of both skin/ct (i.e. the most variables) in the simplest explanation? Unless you believe all of the the morphology of ct is occurring from the sensory information coming from the skin...if not, it seems more logical to have a construct that includes both, but pays more credence to the skin. It's not mutually exclusive, IMHO.
Um, from a treatment standpoint, no. As Bas explained.
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Old 17-10-2009, 07:46 AM   #194
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Even if it's the fascia that's becoming adhesed?
Clearly, yes!
What is the process that comes before adhesion?
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Old 18-10-2009, 04:58 AM   #195
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Yes, but wouldn't that mean accepting the relevance of both skin/ct (i.e. the most variables) in the simplest explanation? Unless you believe all of the the morphology of ct is occurring from the sensory information coming from the skin...if not, it seems more logical to have a construct that includes both, but pays more credence to the skin. It's not mutually exclusive, IMHO.
I think it would behoove you to review neuromatrix theory in more detail. As Bas indicated, there is a lot more happening than just sensory information from skin that can lead to CT morphology changes. The brain produces outputs, motor and neuroimmune, that can and do lead to changes in morphology of all kinds of CT. When these outputs are maladaptive as in a persistent pain state, then maladaptive connective tissue changes ensue.

I agree that any kind of special attention or importance given to fascia is not warranted. Is it just by virtue of the fact that fascial connections are so widespread and contiguous that it achieves such high esteem by some? Well, so are blood vessels and these other interesting structures called nerves, which also so happen to provide the conduit for transmission of highly orchestrated information from the brain. Fascia just doesn't do that.

I don't get the fascination with fascia.
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Old 18-10-2009, 05:24 AM   #196
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I'm back where Jono was a while ago. I can't tell whether there is any disagreement here or just communication challenges.
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Old 18-10-2009, 09:09 PM   #197
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I'm back where Jono was a while ago. I can't tell whether there is any disagreement here or just communication challenges.
Mostly the latte. The main difference is my willingness to keep an open mind about fascia, but without losing site of the significance of the nervous system. BTW I agree with Barrett and think some people are obsessed with fascia, but the same goes for stretching, core training, and any other dogmatic approach.
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Old 18-10-2009, 09:32 PM   #198
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Todd, that is a bit trite: your stating that you are the one with an open mind here.

Talking about treating the fascia, or at least making it the focus of treatment:
Quote:
However, it seems reasonable to put the focus on segments/chains of the body that contain neural tissue, because that’s often times the best way to address the nervous system. It’s the difference between an academic and functional understanding of the body.
Could you look at post #191 and see if you can answer some of those questions, please?
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Old 18-10-2009, 09:45 PM   #199
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If fascia ever was an important consideration (and I don't see any evidence of that) those obsessed with it have virtually destroyed the credibility of those who remain interested in it.

They should be held responsible for their excesses, metaphysical flights of fancy and misappropriation of the concept of memory. That last one has proven especially damaging.

And that's the consequence of your "open-mindedness."
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Old 19-10-2009, 02:28 AM   #200
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I strongly agree with Barrett on this point. Keeping an "open mind" with regard to the role of fascia in persistent, mechanical pain states has come to no good whatsoever that I can fathom.

What if you were an astrophysicist who still believed in horoscopes because they were "accurate" once in while? All the other astrophysicists would run you right out of the room. You'd be ostracized and banished from all things astrophysical because there is NO evidence that the predictions from horoscopes have any basis at all in science.

The same is true for fascia. The fact that some propose that memories are stored in fascia is no less fanciful than astrologists saying that Scorpios are prone to having bad tempers (yes, I made that up since, thankfully, I have no idea what Scorpios are prone to). Who would've ever thought that this one relatively banal part of the human anatomy could have taken on such sublime importance!

"Open minds" are precisely what elevated it to such distinction.

Todd, do yourself a favor: let go of and then sloooowly step away from the fascia.
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