fascial manipulation
TRANSCRIPT
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Dr. Leonid Kalichman PT, PhD
Steccos Fascial Manipulation approach
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Fascia: definition and examples
Innervation of fascia
Pathological changes in fascia(hyaluronic acid)
Basics of fascial manipulation method
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Dr. Leonid Kalichman, PT, PhD
Fasciae (singular, fascia) are connective tissue layers
and wrappings that support and surround all organs,
bones, muscles, nerves, and blood vessels.
superficial fascia
deep fascia
subserous fascia
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Fascia is an uninterrupted three-dimensional web of dense
connective tissue
The soft-tissue component of the connective tissue system that
permeates the human body, forming a whole-body continuous
three-dimensional matrix of structural support.
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A - epidermis B dermis C superficial fascia (and subcutaneous fat) D deep fascia (aponeurotic+epimysium) E - muscle
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Dr. Leonid Kalichman, PT, PhD
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Fascia is a continues tissue that connects all parts of the body.
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Fascia is reach by nociceptors and mechanoreceptors.
Fascia is a pain sensitive structure and involved in proprioception and movement regulations
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Dr. Leonid Kalichman, PT, PhD
The average 70 kg person has roughly 15 grams of hyaluronic acid in the body, one-third of which is turned over every day.
It is part of the extracellular matrix, a major component of the synovial fluid, and was found to increase the viscosity of the fluid.
Hyaluronic acid is a component of articular cartilage and skin.
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Dr. Leonid Kalichman, PT, PhD
Recent study showed a layer of hyaluronic acid between fascia and muscle and inside deep fascia, in particular inside the loose connective tissue separating the fibrous sub-layer of the fascia.
This means that the fascia thus provides an extracellular matrix that is a gliding lubricant over muscle, permitting the free contraction of muscles, but also a unique matrix for its repair and regeneration.
STECCO, C., PORZIONATO, A., MACCHI, V., STECCO, A., STERN, R., DE CARO, R.. Analysis of the presence of the hyaluronic acid inside the deep fasciae and in the muscles. Italian Journal of Anatomy and Embryology, North America, 116, Nov. 2011. Available at:
http://www.fupress.net/index.php/ijae/article/view/10258/9467
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Dr. Leonid Kalichman, PT, PhD
By increasing the concentration of HA, HA chains begin to entangle conferring to the solution distinctive hydrodynamic properties: the viscoelasticity is dramatically increased.
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HA increased viscosity
and mechanorecptors
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Dr Leonid Kalichman PT, PhD
Stecco family
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The Myofascial Unit (Steccos definition): 1. A group of motor units that move a body segment in a specific
direction by activating fibres (monoarticular and biarticular) in one or more muscles
2. The joint that is moves 3. Nerve and vascular components 4. The fascia that connects these elements together
Dr Leonid Kalichman PT, PhD
Motor Unit (Sherringtons definition): A motor unit is made up of a motor neuron and the skeletal muscle fibers innervated by axon of this neuron.
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1. Each Myofascial unit has its own CENTER OF COORDINATION (CC)
2. CC = Small areas on the deep fascia where the sum of tensional vectors coincide.
3. Located in epymisium
Dr Leonid Kalichman PT, PhD
CC
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CC
CP
ME LA
Symptoms in the Center of Perception (CP)
Phase of compensation
Mechanical incoordination in the joint
The resulting vector becomes faulty
Improper recruitment of muscle fibres
Decrease of the sliding system in the CC
Increase of the viscosity of HA in the Centre of Coordination
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Friction . . . .
Heat
develops
Perception of change in tissue mobility
Patient reports pain reduction
Dr Leonid Kalichman PT, PhD
Tissue sliding improvement
http://www.webgif.org/gif_animate/oggetti_cose/strumenti_medicina/immagini/05.htm
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Images of the sonoelastography state before and after fascial therapy in the L5eS1 interspace. In addition to the color scale evaluation, elasticity was quantitatively measured in the zone of interest and local elasticity demonstrated a x10 increase after fascial therapy.
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Performed by PTs (highly trained professionals) Science based treatment Initial research evidence for effectiveness Holistic (treat entire body, not only site of
symptoms) Treat source of problem, not the site of
symptoms Eliminates consequence of previous (old)
traumas and surgery Very effective, especially for chronic problems
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Dr. Leonid Kalichman PT, PhD
The fascial connectionHow fascia is involved in musculoskeletal pain?The fascial fashion Plan Fascia (classical definition)Slide Number 5Dermis - SkinMuscle envelopesFascial envelopesFascia (examples)Conclusion 1Innervation of fasciaInnervation of fasciaInnervation of fasciaConclusion 2Sliding between tissues and organsHyaluronan (hyaluronic acid)Hyaluronan (hyaluronic acid)Hyaluronan (hyaluronic acid)Fascial densificationFASCIAL MANIPULATIONThe motor and myofascial unitsThe center of coordination (CC)Fascial DysfunctionFascial manipulation techniqueEffect of FM on tissue elasticityInitial evidence for FM efficacyFM treatment (characteristics)Thank you for your kind attention !