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Fascial plasticity: mechanical or neurobiological?

PainSci » bibliography » Schleip 2003
updated
Tags: treatment, manual therapy, massage, stretch, fascia, professions, exercise, self-treatment, muscle, contis, controversial, etiology, pro, quackery

Three pages on PainSci cite Schleip 2003: 1. Shin Splints Treatment, The Complete Guide 2. Thixotropy is Nifty, but It’s Not Therapy 3. Does Fascia Matter? 

PainSci commentary on Schleip 2003: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This paper neatly dissects and dismisses as inadequate some prominent historical explanations for the alleged phenomenon of a fascial “release,” such as thixotropy and piezoelectric signalling. Schleip also does a good job of explaining how tough fascia is, and provides a good primer on a menagerie of mechanoreceptors in soft tissue (nerve endings that detect various pressures and tuggings and sheerings).

From there the paper slides into fairly far-fetched speculation about what a “release” might actually be. The general implications are pretty trivial — imagine, the human body might respond to stimuli! — and none of it really has all that much to do with “fascia” per se, and (more importantly) we have no idea whether or not any of it constitutes a meaningful mechanism for a “therapy.” I can make someone twitch their quadriceps by bonking their patellar tendon: does it matter, other than as a test of the reflex itself?

All the speculation rests on a single weak premise: that what therapists believe they are perceiving is a real phenomenon in need of explaining, a palpable movement/shift in the tissue. There may be such a thing, but it’s certainly not a safe assumption. It may well be that the only phenomenon that needs an explanation is why therapists are so convinced that they perceive “releases” in the first place.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

In myofascial manipulation an immediate tissue release is often felt under the working hand. This amazing feature has traditionally been attributed to mechanical properties of the connective tissue. Yet studies have shown that either much stronger forces or longer durations would be required for a permanent viscoelastic deformation of fascia. Fascia nevertheless is densely innervated by mechanoreceptors which are responsive to manual pressure. Stimulation of these sensory receptors has been shown to lead to a lowering of sympathetic tonus as well as a change in local tissue viscosity. Additionally smooth muscle cells have been discovered in fascia, which seem to be involved in active fascial contractility. Fascia and the autonomic nervous system appear to be intimately connected. A change in attitude in myofascial practitioners from a mechanical perspective toward an inclusion of the self-regulatory dynamics of the nervous system is suggested.

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