4th International Fascia Research Congress Overview
In 2015, I attended the 4th International Fascia Research Congress, in Reston VA and wanted to share my experience as I think the developing field of understanding fascia will bring us many amazing opportunities to understand how the extracellular matrix is a fundamental piece to the large framework of the body and its functions.
This conference is very unique in that it has so many different types of professionals in attendance. There were Researchers, Scientists, Professors, Surgeons, Physicians, Nurses, Athletic Trainers, Physical Therapists, Chiropractors, Acupuncturists, Massage Therapists/body workers, and Movement Practitioners of Pilates, yoga, tai chi, etc. This made for very interesting questions and conversations. Fascia not only holds us together in our own human shape, but was responsible for brings us together as well.
The opportunity to talk to and listen to many of the top professionals in the field of fascia and fascial research in one location was worth the trip in my opinion. Call me a science nerd but JC Guimberteau, Robert Schleip, Andry Vleeming, Leon Chaitow,Thomas Findley, Thomas Myers, Antonio Stecco, Carla Stecco, James Oschman, Jaap Van der Wal, Gil Headly, and Serge Gracovetsky are like a rock stars to me! I also really appreciated that ability to hear about the current research and research in general straight “from the horse’s mouth”. Having the research interpreted directly from the research is very valuable and helps to not make giant leaps in generalization of research findings.
I was really introduced to fascia in three ways. First in college anatomy lab, like many others, we heard “this is the white cottony materials between all the stuff we really care and want to learn about”. Second, back in 2003 when I first started at Athletes’ Performance I was introduced to fascia via Thomas Myers Anatomy Trains, when learning the importance of whole body movement. This model, which totally made sense to me, but early on didn’t really change my practice. I was introduced to this model again in 2006 when I first learned from Elizabeth Larkam (look out for her new book Fascia in Motion in early 2016 from Handspring Publishing) at Pilates on Tour, where she presented a workshop called “The Core has Arms” and the way she described movement based on Thomas Myers Anatomy Trains, had me feeling like I didn’t know anything, and that perhaps she was speaking a different language all together! Third time was the charm at the 2010 Polestar Pilates World Conference. The keynote speakers were James Oschman and Carol Davis. Both spoke of fascia as a means of cellular communication, whole body connection, and the potential of epigenetics, since fascia connected into the nucleus of each cell in our body, fascia health / movement has the ability to change our DNA! This grabbed my attention, I was “fascia-nated”. The Anatomy Trains world I revisited in and invested in learning more through Elizabeth Larkam’s work and Robert Schleip’s work of fascial fitness, these influences changed how I practiced, how I saw the body move, how I programmed my sessions with athletes. For me, there was still a little disconnect in the anatomical/physiological world of fascia vs. the energy medicine world of fascia, so I was intrigued to attend the Fascia Research Congress to better understand how it all goes together. Here is where it got interesting and made more sense to me. The fascial community doesn’t know. This is a big debate and a hot topic of discussion among everyone. So, I am not the only person who was confused!
At the FRC’s in the past there is always an effort to redefine what fascia is, so that we can all communicate in a better way when collaborating, speaking, and studying these tissues. An article from Thomas Myers in 2011 explained the ever changing role of fascia well “It turns out that it really is all one net with no separation from top to toe, from skin to core or from birth to death (Shultz & Feitis 1996). Every cell in your body is hooked into—and responds to—the tensional environment of the fascia (Ingber 1998). Alter your mechanics, and cells can change their function (Horwitz 1997). This is a radical new way of seeing personal training—stretching, strengthening and shape- shifting—as part of “spatial medicine” (Myers 1998). Given the facts, many would prefer the term neuromyofascial web to the fascia-dissing musculoskeletal system (Schleip 2003).” 1
During this 4th International FRC again an attempt was made to provide a better definition. This definition was settled upon after a committee of experts met to discuss and hopefully come to a consensus. This was spearheaded and presented by Carla Stecco. A definition of fascia was given two categories, the 1st restricted based on anatomy and the 2nd being a more functional description. The anatomical description they came to a consensus on was “a swath, a sheet or dissectible aggregation formed beneath the skin to attach, enclose, or separate muscles and other internal organs.” Also the types of fascia and role of each type of sensory receptor in fascia was described. Including superficial fascia and its role of interoception, deep fascia and its role of proprioception, and the epimysium and its role in motor coordination. The 2nd functional description of fascia is “an organ system of interacting, interrelated, interdependent elements forming a complex whole.” It was explained that the functional description was needed since we have an incomplete knowledge or developing knowledge of what fascia is and does. This was a very heated start to the congress, as some of the fascial experts did not feel that they were included in this consensus committee. So, look to see this change once again by the time the next FRC meets in 2018!
Perhaps the most moving and amazing part of the congress, at least for me was learning and seeing Dr. Jean-Claude Giumberteau’s work of documenting the living fascial environment. This presentation was him describing hours of footage of endoscopic videos of his experiences and interpretation of fascia from his years as a surgeon. His work is a must see in my opinion to have an idea of how amazing and dynamic the fascia is. His work can be viewed in his new book, released the week of the FRC. Architecture of Human Living Fascia: http://amzn.to/1hMiXCV
Of course, over the three days of the Congress their was a ton of information presented, enough to fill a conference proceeding book of 336 pages! The topics covered were anatomy, pathology, biomechanics, histology and cytology, fluid dynamics, cancer, assessment modalities, manual therapy, surgery and scars, low back pain, fascia in sport and movement, and research methods, etc. I will share a few of my favorite presentations and bits of information I came away with. I will also encourage you if you are interested in learning more in this emerging field to check out the proceeding from all 4 for the FRC’s.
Here is a synopsis of some of the information I learned that has stuck with me since the Congress:
Andry Vleeming presenting evidence of the 4th peri-axial myofascial ring as an essential component of the myofascial sling system of trunk stability. Specifically, his research is looking at the relationship between the internal oblique and central tendon of the transverse abdominus and the lateral raphe and paraspinals of the thoracolumbar fascia. This relationship is key in maintaining the space and stability between the thorax and the pelvis, hence creating a dynamic ring system like that of the structural stability provided by the rings of the ribs and/or pelvis. His research can be read here: http://www.ncbi.nlm.nih.gov/pubmed/25139243 and related earlier research on this myofascial ring here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512280/pdf/joa0221-0568.pdf
Dr. Siegfried Mense and his work with identifying pain and inflammatory receptors within the thoracolumbar fascia. Inflammation increases the sensory input at the dorsal horn ganglia. When there was this neurogenic inflammation there was an increase in the receptive field of pain, meaning inducing inflammation of the TLF created pain reception of the entire spinal segment, finding pain in the hind limb of the rats in the study. This proves an explanation of the spread of pain in patients with non-specific low back pain.
Andreas Schilder presented his 2014 study on fascia and pain, supporting that the thoracolumbar fascia is a key component in chronic low back pain. His work also shows that fascia changes with stimulation to the muscle resulting in decreased pain. The work also was able to define subjective descriptions of pain correlating with the location of the pain generator. Beating, throbbing, burning, scalding, stinging, or hot sensations are created by fascial pain whereas beating, throbbing and dull pain is created by muscular pain.
There was a lot of research in the field of pain and fascia, one thing that was interesting that Robert Schleip shared in the research of chronic low back pain was that the histology studies reveal a similar myofibroblast makeup to that of the histology from a frozen shoulder.
That leads me into the research by Preeti Ragharan. She is looking at using hylauronase injections to treat peripheral resistance in spasticity patients. As a finding of an increased concentration of hylauron has been found within the fascia after periods of disuse and immobilization such as in the case of stroke.
The last and perhaps most applicable to sport and performance is the continued work to understand tendinopathy, specifically of the achilles tendon.
First there was a presentation from Ms. Brettler presented work from her and her colleagues including the Stecco’s at the University of Padua. She presented that achilles tendinitis is more accurately a paratenonitis. Ultrasound diagnosis finding alterations in the paratenon, specifically an increased thickness of the paratenon is a significant indicator of achilles tendinopathy.
Dr. Michael Kjaer presented his work on tendon remodeling with eccentric exercise. Reviewing that for mid-substance achilles tendinosis the eccentric exercise regimen is help to stimulate collagen synthesis and remodeling. It has been found that just one bout of eccentric exercise was found to increase the pro collagen neuropeptide. Though there is no consensus for pathogenesis it is hypothesized that since collagen is much slower to adapt then muscle to training loads, achilles tendinopathy may likely be the result of this imbalance as a type of overtraining. Also of interest is the achilles tendon is forming from the age of 0-17yrs old, so the tendon you have at 18yo is pretty much what you are stuck with. There is about 5% ability for the structure to change with training after that point. His studies show that in the case of the mid-substance tendinopathies there is a disorganization of collagen fiber alignment, with smaller and rounder nuclei suggesting the the collagen has been de-tensioned and has not been loaded. His work also revealed that jumping exercises did not result in collagen synthesis and improving tendinopathy. The science points to heavy, slow (minimum 3 sec) resistance concentric or eccentric exercise where the key is the intensity not duration of exercise for collagen remodeling and treatment of mid-substance tendinosis. This treatment strategy is the best there is right now, and it is only 75% effective. Unfortunately this treatment strategy is not helpful with insertional tendinopathy, and little is known of that pathogenesis as well.
Lastly Dr. Antonio Stecco shared their work of the anatomy and imaging of the achilles paratenon and tendon, continuing to show support of the pathogenesis of tendinosis resulting from a paratenonitis creating inflammation and thickness, this alteration is what creates degeneration of the tendon. It was also found that the sources of pain was from the paratenon not the tendon itself. His work also found that there is an associated change of the plantar fascia and crural fascia in patients with achilles pain and therefore suggests early diagnosis of tendinopathy through MRI or US imaging of the paratenon, platter or crural fascia.
As the researchers are learning more about the extracellular matrix and the function of the fibroblasts, myofibroblasts, and fluid dynamics there is a huge connection to pathogenesis of many cancers. This November 15th, three professional societies will meet in a joint conference to collaborate and learn from each other and to share this science. The Fascia Research Society, the Society of Integrative Oncology, and the Society for Acupuncture will meet at the Harvard Medical School for the Inaugural Acupuncture, Fascia, and Oncology conference.
In the future look to hearing more about fascia and exercise and manual therapy as there are more ways to measure fascia and changes that occur through ultrasound, elastography, and bioelectrical impedance.
One of my takeaways from the congress was that we need to share what we do as rehabilitation specialists, performance specialists, movement practitioners, strength coaches, and body workers. The more case studies that are out there and the more we as clinicians can interact with and collaborate with researchers the better of we will be in advancing the field of sports, movement, fascia, and spatial medicine.
Order the Fascia Research Congress proceedings book with current papers, abstracts, and poster on fascial research here: http://www.fasciacongress.org/2015/conference/dvd-recordings-and-books/
Myers, Thomas. Fascial Fitness: Training in the Neuromyofascial Web. IDEA Fitness Journal, April 2011 (38-45).