2009 Post Conference Workshops

HOW SPECIFICALLY DOES THE HUMAN FASCIAE RELATE TO THE WORKSHOP CONTENT?

The human fascia is the main topic of the proposed workshop: by being appreciated in vivo on its real sliding motion on healthy patients, firstly; by assessing its limitations of movement on post-surgical patients or on patients affected by chronic disorders, secondly; by re-evaluating after having performed manual fascial release techniques specifically applied, thirdly.

WHAT AREAS ARE RELEVANT AND/OR SUGGESTED FOR SCIENTIFIC RESEARCH?

• – dynamic ultrasound evaluation could be an useful and a non invasive tool to assess and monitor sliding fascial movements in vivo on any research applied to fascial layers;
• – dynamic ultrasound evaluation can be also an useful and a non invasive tool for educational scope, to appreciate fascial sliding motion in vivo, to demonstrate the effectiveness of manual techniques in situ, to show the influence of any drug injection on fascial contraction;
• – dynamic ultrasound evaluation can be an useful and a non-invasive tool to assess fascial movement restrictions in vivo due to post-surgical adhesions or tissue texture change following acute or chronic disorders;
• – manual fascial release techniques can be an useful mean by which improve fascial motion, and reduce fascial adherences.

WHAT ARE THE CROSS DISCIPLINARY APPLICATIONS?

The application of the subject proposed extends from the clinical to the scientific field. Dynamic ultrasound evaluation can be applied for scientific research to assess fascial sliding movement in vivo, as well as fascial release techniques may have a clinical impact to improve fascial motion in post-surgical patients. In addition, dynamic ultrasound evaluation can be an extraordinary non invasive educational tool for medical and surgical training

OBJECTIVES:

• – to appreciate the extent of sliding movements between fascial layers in vivo, through dynamic ultrasound evaluation;
• – to show the extent of motion impairment of organ related fascia layers on post-surgical patient or on patients with chronic or acute disorders;
• – to demonstrate some of the effects of specific manual techniques on improving fascial range and quality of movement, in relation with contiguous fascial planes or with anatomically related organs;
• – to propose dynamic ultrasound evaluation as one of the most appropriate tool to monitor and evaluate fascial sliding motion in vivo, for clinical, scientific and educational scope

WORKSHOP SCHEDULE (Saturday October 31):
9:00-11:30 AM

METHOD: LECTURE

• 30 mins: it will be delivered an overview of the main fascial layers stratification with both anatomical pictures on power point presentation and the correspondent dynamic ultrasound imaging in vivo;
• 30 mins: the organs related fascial sliding motion in vivo of different layers will be shown as they appear on healthy and asymptomatic patients to be compared with those on symptomatic patients, or on post-surgical patients or on patients with chronic disorders.
• 20 mins: a brief explanation of the physical principles will be given behind the dynamic ultrasound evaluation and the transduction of ultrasound waves into imaging;

METHOD: LECTURE-DEMO

• 20 mins: the rationale behind manual fascial techniques will be given, with the principles and methods of their application;
• 20 mins: the clear difference of the range and quality of fascial sliding motion of the same tissues will be shown, before and after manual fascial release.
• 30 mins: questions and discussion / discussion and incorporation of the conference findings

1:00-3:30 PM

METHOD: LECTURE-DEMO

• 60 mins: attendees‘ volunteers, possibly with chronic symptoms or with past surgery, will be assessed by dynamic ultrasound device (by Dott. Bongiorno). Then treated with fascial release techniques (by Dott. Tozzi) to be re-evaluated on the quality and range of fascial motion.

METHOD: HAND ON PRACTICE

• 70 mins: attendees will be practicing fascial techniques after dynamic ultrasound evaluation of their models, on areas of major clinical interest;
• 20 mins: questions and discussion / discussion and incorporation of the conference findings

PRESENTERS‘ PROFESSIONAL QUALIFICATIONS:

Dott. Davide Bongiorno: Degree in Medicine and Surgery, Master Degree in General Surgery at the "Università degli Studi" of Milan, D.O. in Osteopathy at the A.T.S.A.I. of Bari;

Links:
– www.siumb.it

Dott. Paolo Tozzi: Degree in Physiotherapy at the Catholic University of Sacred Heart in Rome, Bachelor Science Honours degree in Osteopathy at the European School of Osteopathy in Maidstone (UK), Doctorat en Osteopathie and Posturologie, II level Reiki operator.

Links:
– www.airop.it
– www.lumenolis.it
– www.cromon.it
– www.scuoladiosteopatia.it

PRESENTERS‘ BIOGRAPHIES

Dott. Paolo Tozzi: I and II Level Reiki Operator in 1999, at the Shree Papaji Olistic Centre, Nemi, Rome; Degree in Physiotherapy in 2000, at the Catholic University of Sacred Heart, Rome; Bachelor Science Honours Degree in Osteopathy in 2005, at the European School of Osteopathy, Maidstone (UK); Doctorat en Osteopathie and Posturologie in 2006, at the International Association Jean Monnet, amongst the European University Foundation of Bruxelles, Belgium; Viceprincipal of the School of Osteopathy CROMON, since 2006; lecturer of biomechanics and manual therapy in different universities in Rome; lecturer of many post-graduate courses on osteopathic subjects; speaker in many different national congresses; expert on Osteopathy domestic and exotic animals.

Dott. Davide Bongiorno: Degree in Medicine and Surgery at University of Milan 1989;  Post-graduate course on General Surgery at the University of Milan 1994; Degree in Osteopathy at C.E.R.D.O. (Centre pour l‘etudes , la recherché et la diffusion in osteopathie, Rome) in 2002;  Tutor for the S.I.U.M.B. National Congress until 2000; Lecture and speaker of many postgraduate courses on ultrasound evaluation and diagnosis in Italy and North Africa (M.A.S.U. – Mediterranean and African Society of Ultrasound)

We intend to:

1. Outline the anatomical research that has verified and modified the anatomical basis of the biomechanical model currently applied in Fascial Manipulation.
2. Introduce and explain the basic principles of Fascial Manipulation (myofascial unit, centre of coordination, centre of perception).
3. Explain the specific clinical assessment process via illustration of the Assessment Chart and the objective examination for the analysis of movement on the spatial planes
4. Demonstrate the application of this technique in a clinical setting
5. Power Point Slide presentations will be used to illustrate points a., b. and c. and printed material will be available including copies of the Assessment chart. Point d. is a demonstration of the application of the technique, from assessment to treatment.

Full Description

This workshop will illustrate new studies of the gross and histological anatomy of the human fasciae, and explain the biomechanical model for the human fascial system currently applied in the manual technique known as Fascial Manipulation.

The model represents a three dimensional interpretation of the fascial system. Its hypothetical foundations are fruit of more than thirty years of analysis of anatomical texts and clinical practice. More recently, dissections of unembalmed bodies have provided anatomical verification of numerous hypotheses including the fascial continuity between different body segments via myotendinous expansions and the possible distribution of tensional forces.

This workshop will also propose new studies concerning the histological characteristics of superficial and deep fasciae (fibre content, structural conformation, and innervation) and debate the role of deep fascia in proprioception.

Altogether, these new studies could provide the bases for research projects in fields of gross anatomy, histology, biomechanics, and clinical studies.

The Fascial Manipulation technique is based on the concept of myofascial units (mf units) united in myofascial sequences, and involves manual friction over specific points (called Centres of coordination and Centres of fusion) on the deep muscular fascia. As friction causes a localised increase in temperature with consequent hyperaemia, it is hypothesised that this could modify the extracellular matrix, restoring gliding between endofascial fibres and intrafascial planes. Given that many receptors are embedded within fascia, any impediment to gliding could cause anomalous tension and non-physiological movements due to altered proprioceptive afferents, resulting in inflammation within the joint of a malfunctioning mf unit or along a sequence of mf units. This underlying rationale and the resultant analytical process guides the therapist in the combination of points to be treated and allows therapists to work at a distance from the site of pain, which is often inflamed due to non-physiological tension.

This workshop will summarize the assessment process and present a clinical case.

The Fascial Manipulation technique, presently applied by growing numbers of clinicians in Italy, Spain, Poland, France and Portugal, is particularly indicated for athletes as it often allows for a rapid return to sport. Musculoskeletal disorders commonly treated include low back pain; tendinitis, sprains, peripheral nerve compressions, and neck pain syndromes, whereas visceral dysfunctions can include gastritis, irritable colon syndrome, constipation, and dysmenorrhoea.

The above-mentioned anatomical and physiological studies provide groundbreaking information about the human fascial system that can be integrated into the application of a wide-range of manual techniques.

PRESENTERS‘ CURRENT AFFILIATIONS

Dr. Carla Stecco: Member of Italian Society of Anatomy and Histology and of the Association Française des Morphologistes.

Julie Ann Day: Member of AIFI, Associazione Italiana Fisioterapisti,Via De‘ Menabuoi 2/b – 35132 Padova

Both presenters are founding members of the AMF (Associazione Manipolazione Fasciale), Via Piacenza 3, Arzignano, Italy

PRESENTERS‘ BIOGRAPHIES

Carla Stecco: Researcher and assistant professor at the University of Padova, Dr. Stecco collaborates with the Descartes University, Paris, to study the macroscopic anatomy of the fasciae by cadaver dissections. Assistant reviewer for Clinical Anatomy and Surgical Radiological Anatomy Journals and author of more than 30 articles, among which 29 indexed in MEDLINE and one book (Manipolazione Fasciale, Parte Pratica, Piccin, 2007), translated in English in 2009. Her scientific activity is devoted to the study of fasciae from a macroscopical, histological and physiopathological point of view. Since 2000, she organizes and holds theoretical-practical courses about Fascial Manipulation technique in Italy and in other countries.

Some Related Publications:

1. Stecco C, Pavan PG, Porzionato A, Macchi V, Lancerotto L, Carniel EL, Natali AN, De Caro R. Mechanics of crural fascia: from anatomy to constitutive modelling. Surg Radiol Anat. 2009 Feb 26. PMID: 19242635
2. Stecco C, Porzionato A, Lancerotto L, Stecco A, Macchi V, Day JA, De Caro R. Histological study of the deep fasciae of the limbs. J Bodyw Mov Ther. 2008 Jul;12(3):225-30. PMID: 19083678
3. Stecco A, Macchi V, Masiero S, Porzionato A, Tiengo C, Stecco C, Delmas V, De Caro R. Pectoral and femoral fasciae: common aspects and regional specializations. Surg Radiol Anat. 2009 Jan;31(1):35-42. PMID: 18663404
4. Stecco C, Porzionato A, Macchi V, Stecco A, Vigato E, Parenti A, Delmas V, Aldegheri R, De Caro R. The expansions of the pectoral girdle muscles onto the brachial fascia: morphological aspects and spatial disposition. Cells Tissues Organs. 2008;188(3):320-9. PMID: 18349526
5. Stecco C, Gagey O, Belloni A, Pozzuoli A, Porzionato A, Macchi V, Aldegheri R, De Caro R, Delmas V. Anatomy of the deep fascia of the upper limb. Second part: study of innervation. Morphologie. 2007 Mar;91(292):38-43. PMID: 17574469

Julie Ann Day: Originally from Adelaide, South Australia and currently lives in Padova, Italy. Physiotherapist since 1977, she has worked mostly in the Orthopaedic field. Specialised in Connective Tissue Massage (Dicke, Teirich-Leube methods) and Foot Reflexology, Julie has explored various forms of therapeutic exercise (Feldenkrais, Hatha Yoga). She has been involved in Fascial Manipulation since 1999; authorized teacher of this method since 2002 and translator (from Italian to English) of "Fascial Manipulation for Musculoskeletal Pain", L. Stecco, (Nuova Libraria Piccin, 2004.) and "Fascial Manipulation – Practical Part", L. and C. Stecco, (Nuova Libraria Piccin, 2009.)

Some Related Publications:

1. Day JA, Stecco C, Stecco A. Application of Fascial Manipulation technique in chronic shoulder pain–anatomical basis and clinical implications. J Bodyw Mov Ther. 2009; 13(2): 128-35. PMID: 19329049
2. Pedrelli A, Stecco C, Day JA. Treating patellar tendinopathy with Fascial Manipulation. J Bodyw Mov Ther. 2009; 13(1): 73-80. PMID: 19118795
3. Stecco C, Porzionato A, Lancerotto L, Stecco A, Macchi V, Day JA, De Caro R. Histological study of the deep fasciae of the limbs. J Bodyw Mov Ther. 2008; 12(3): 225-30. PMID: 19083678
4. Stecco A, Macchi V, Stecco C, Porzionato A, Ann Day J, Delmas V, De Caro R. Anatomical study of myofascial continuity in the anterior region of the upper limb. J Bodyw Mov Ther. 2009; 13(1): 53-62. PMID: 19118793

Links:
– http://www.fascialmanipulation.com
– http://www.medicina.unipd.it/

Clinical reasoning is presented from a broad perspective with respect for the integration of articular, muscular, fascial and neurogenic structures. Based upon the international classification of functioning different aspects as yellow and red flags, guidelines, structural and functional diagnosis, pain physiology and psychosocial factors are integrated.

Concerning the causes of LBP, the functional relation between the different structures are discussed with an important emphasis on the new insights of connective tissue. Functional anatomy and kinesiology of the ventral and dorsal slings will intensively be studied and the role of fascia structures will be discussed from a new perspective.

In this overview some specific anatomical findings will be presented, muscle recruitment in several postures and movements will be discussed. Concerning dysfunction, results of different studies about the influence of low back disorders and induced muscle pain will be presented. Finally, related to rehabilitation, results of some performed clinical trials will be presented.

Giving a critical insight into the complex anatomy and function of the musculo- fascia-skeletal system, analysing the mechanism behind possible dysfunctions and providing new data about rehabilitation strategies, this workshop is hopefully interesting for you!

MAIN OBJECTIVES:

1. Giving a critical insight into the complex anatomy and function of the musculo- fascia-skeletal system
2. Presenting a clinical reasoning model that enables us to analyse the mechanism behind possible dysfunctions
3. Providing new data about rehabilitation strategies

Dr. Andry Vleeming was co-founder of the research group locomotor system at the Medical faculty at the Erasmus University in Rotterdam. He works and founded the "Spine & Joint" rehabilitation centre in Rotterdam and is chairman of the world congress of Low Back and Pelvic pain, organised each three years. He is (co)author of many international publications, especially on the clinical anatomy of the lumbopelvic region in international peer reviewed journals. In recent years he was intensively involved in the development of the European guidelines on lumbopelvic pain and studies and dissertations within the topic of LBP. Recently, a new version of the book ’Movement stability en Low back pain‘ was published in cooperation with national and international experts.

Some Related Publications:

1. Vleeming A, Stoeckart R, Volkers ACW, Snijders CJ. Relation between form and function in the sacroiliac joint, part I. Clinical anatomical aspects. Spine 1990;15(2):130 132
2. Vleeming A, Volkers ACW, Snijders CJ, Stoeckart R. Relation between form and function in the sacroiliac joint, part II. Biomechanical aspects. Spine 1990;15(2):133-136
3. Vleeming A, Buyruk HM, Stoeckart R, Karamursel S, Snijders CJ. An integrated therapy for peripartum pelvic instability; a study of the biomechanical effects of pelvic belts.American Journal of Obstetrics & Gynaecology 1991;166(4):1243-1247
4. Stoeckart R, Vleeming A, Simons JL, Van Helvoirt RP, Snijders CJ. Fascial deformation in the lateral elbow region: a conceptual approach. Clinical Biomechanics 1991;6:60-62
5. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. Part I – Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clinical Biomechanics 1993;8:285-294.
6. Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. Part II – Loading of the sacroiliac joints when lifting in a stooped posture. Clinical Biomechanics 1993;8:295-301.
7. Vleeming A, Pool-Goudzwaard AL, Stoeckart R, Wingerden JP van, Snijders CJ. The posterior layer of the thoracolumbar fascia; its function in load transfer from spine to legs. Spine 1995;20(7):753-758.
8. Robert Schleip, Andry Vleeming, Frank Lehmann-Horn, Werner Klingler.A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction.Eur Spine J. 2007. DOI 10.1007/s00586-006-0298-2
9. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008 Jun;17(6):794-819. Epub 2008 Feb 8.

Prof dr Lieven Danneels is licentiate in Motor Rehabilitation and Physiotherapy (1993) and Doctor in Motor Rehabilitation and Physiotherapy (2001 – Ghent University). He is fulltime Professor at the Dept of Rehabilitation Sciences and Physiotherapy, Ghent University, from 1 October 2003. He is combining teaching, research and clinical activities. He is head of the research unit Musculoskeletal Physiotherapy, section Spine. Within this unit he is supervising several PhD students. He is (co)author of about 50 publications in international peer reviewed journals and several book chapters. He participated in several national and international projects

He is also Director of the Institute of Postgraduate Activities in Physiotherapy of Ghent University (http://ipvk.ugent.be), director of Postgraduate Training In Musculoskeletal Physiotherapy of Ghent University (http://www.revaki.ugent.be) and vice president of the executive Board of the Belgian Back Society

He is Member of the Advisory Editorial Board of the Journal "Manual Therapy" and reviewer for different international journals.

Some Related Publications:

1. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE. De Cuyper HJ. Clinical science award 2000 : CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur. Spine J 2000; 9:266-72. (IF 2007: 2.021; ranking 10/48)
2. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, Stevens VK, De Cuyper HJ. A functional subdivision of hip, abdominal, and back muscles during asymmetric lifting. Spine 2001;26:E114-E121. (IF 2007: 2.499; ranking 3/48)
3. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, Bourgois J, Dankaerts W, De Cuyper HJ. The effects of three different training modalities in the cross-sectional area of the lumbar multifidus. Brit J Sports Med 2001;35:186-91. (IF 2007: 2.463; ranking 7/72)
4. Danneels LA, Coorevits PL, Cools AM, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. Differences in multifidus and iliocostalis lumborum activity between healthy subjects and patients with subacute and chronic low back pain. Eur Spine J 2002;11:13-19. (IF 2007: 2.021; ranking 10/48)
5. Danneels L. Clinical anatomy of the multifidus. In Vleeming & Stoeckaert (eds) : Movement, Stability and Low Back.Pain, Elsevier, 2007: 85-94.

What is Muscle Repositioning (MR)

MR is a myofascial release technique, initially derived from Rolfing® in its employment for the treatment of musculoskeletal disorders. MR‘s manipulation characteristically combines a set of forces that link the body segments in a single block.

The specific manual input apparently tenses the fascial system so that the body segments become united (see video links at musclerepositioning.blogspot.com). Moreover, this mechanical condition seems to stimulate afferents to the central nervous system, systematically evoking tonic reflexes, detectable by electromyography.

Clinical observations suggest that such reflexes enhance the effectiveness of the treatment by different hypothetical mechanisms. The current hypotheses is that it stimulates auto-regulatory responses-of which pandiculation is the main prototype-.

Purpose

This workshop is aimed to manual practitioners of various backgrounds (e.g.: structural integrators, osteopaths, quiropractors, physical therapists and others).

The purpose of the workshop is to initiate the participants in the application of this technique (two maneuvers are planned: thoracic and pelvic regions) and to discuss the theoretical aspects and models involved.

Theoretical Contents

• Myofascial compartments and their spatial relations.
• Distribution of forces in the musculoskeletal system.
• Tissue compliance and tissue length.
• Myofascial force transmission and relative muscle position.
• Blunt dissection in planes of cleavage. "Surgical" touch.
• MR‘s touch: uniting (integrating) body segments.
• Neural motor reactions to the touch (tonic, clonic, eyes movements).
• Shifts in states of consciousness during manual therapy.
• Auto-regulatory mechanisms: pandiculation, spontaneous movements, autonomic reactions.

Main objectives

• Palpatory diagnosis: identifying tissue restrictions through sonar-like manual vibration.
• Snaps among myofascial compartments: detection and diagnostic significance.
• Recognition of tonic reactions: employment to release restrictions efficiently and precisely.
• Recognition of sensations (experienced by client and practitioner) to orient the work.

Suggested areas for scientific research include:

• Nature of the neural reactions during manipulation (e.g.: EMG, EEG), their relationship with qualities of movement and maintenance of health.
• Effects of touch remotely (e.g.: elastometry).
• Dynamics of fascial compartments and their relative position in function (dynamic imaging techniques).
• Other physiologic and clinical effects in health and disease (e.g.: stabilometry, movement analysis, qualitative questionnaires, algometry, among others).

Conclusion:

Muscle Repositioning is a particularly precise and economic myofascial technique that can be used in various therapeutic settings–either as the principal technique, or as an adjunct to a variety of principal approaches. Objectivity and reproducibility may result from its association with detectable tonic reactions.

PRESENTER PROFESSIONAL QUALIFICATIONS:

• ABR (Brazilian Rolfing Association, São Paulo, SP, Brazil). Anatomy and Myofascial Release Faculty.
• Rolf Institute ( Boulder, CO, USA) Anatomy Faculty.
• Núcleo Anthropos, Integrative Medicine study and research group at the Psychiatry Department at UNIFESP ( São Paulo Federal University), São Paulo, SP, Brazil.

PRESENTER BIOGRAPHY:

L Fernando Bertolucci first graduated in Biology at University of São Paulo (USP) and then in Medicine, also at USP, and specialized in Physiatry (Rehabilitation). He graduated as a Rolfing practitioner in 1990 and focused in using it for the treatment of musculoskeletal disorders. Dealing with severe conditions, he was stimulated to explore various ways to manipulate soft tissues, aiming to alleviate his clients‘ symptoms. Such experience led him to develop the Muscle Repositioning technique. Currently, besides electromyographic and clinical studies about MR, he is carrying on an investigation about qualities of movement and the maintenance of musculoskeletal health.

Some Related Publications:

1. Bertolucci, LF: Anatomia Funcional do Aparelho Locomotor, in: Síndrome Dolorosa Miofascial e Dor Músculo-esquelética. Teixeira, MJ, Yeng, LT and Kaziyama, HHS, Editors: 71-78. Editora Roca, São Paulo, 2007
2. Bertolucci, L.F. 2008. Muscle Repositioning: A new verifiable approach to neuro-myofascial release? Journal of Bodywork and Movement Therapies 12, 213–224

Links:
– http://musclerepositioning.blogspot.com/
– http://www.nucleoanthropos.com/

This workshop will be approximately 40% theory and 60% practice.  Bearing in mind the goal of "Taking the Line into Motion" and the free horizontal movement of the joints, participants will analyze each others habits in such activities as walking, breathing and sitting.   There will be a Power Point presentation to illustrate highlights of a series of sessions – each one designed for specific goals (e.g. increased use of the ankle hinge, medial arch, and toe hinge in walking).  This will also show the use of different types of touch to achieve specific goals.   Participants will work with each other in pairs, exploring the touch, effect on movement patterns and together evaluate the results.

Since Fascia is the organ of form and contains nerve endings that affect habit, we will be addressing the FOLLOWING ; 1) THE CAUSES OF innapropriate fascial density which inhibits movement  2) WAYS to increase the freedom of the tissue, 3) The use of gravity in movement, which is optimized once dense fascia is not inhibiting this potential.

Principle of movement work (explained) – The human body can be educated (both by touch and movement cues) to move freely, without effort, when freed to use the support of the gravitational field that acts upon it.

Definition of work – Movement includes such activities as walking or breathing and more stationary activities as sitting or standing.   In addition, there are specializes movements used in activities like athletics, sports, musical performance, dance, etc.  These specialized movements are enhanced by the implementation and education of the above concepts.

Areas that are relevant and/or suggested scientific research: The relationship between the force of gravity and the quality of fascia. The Mechanoreceptors affected by different types of touch and the feed-back loop between the brain and the body

Why and how fascia responds specifically to different types of touch.

Cross Disciplinary applications: A deeper understanding of how to approach trauma (physical, functional, emotional) with hands-on work within the framework of the goals of movement work and Structural Integration.   

HYPOTHESES

1. The two types of touch taught at the workshop tend to activate different fascial Mechanoreceptors, predominantly.
2. Application of approximately ten sessions of this movement work tends to result in measurable improvements in treadmill walking:

•    – knees tracking more straightforward (indicated by the position of the Patela)
•    – Less pronation/supination of feet during moment of maximum load being on foot
•    – Increased dorsiflexion of metacarpal-phalangeal joint during push-off

3. A combination of fascial touch (as taught by myself) AND movement instruction results in significantly larger improvements (as outlined above) than pure movement instruction alone.

ADDITIONAL INFORMATION

There will be two sets of hand-outs –

1. To be sent in September – information related to topics from the ‘07 Conference
2. To be given out at workshop – information from this conference to be discussed.

SCHEDULE

PRESENTER PROFESSIONAL QUALIFICATIONS:

• Certified Rolfing Movement Teacher 1984
• Certified Rolfer (SI) Practitioner 1989
• Certified Advanced Rolfer (SI) 1999
• Experience in teaching both SI and Rolfing Movement in the US, Europe and Brazil.

TEACHING EXPERIENCE – Including but not limited to the following:

Movement

1985 – 1990

• Movement segment of Pre-Requisite training for European students – London.
• Workshop in Rome
• Several workshops in New York City
• Workshops in other parts of New York State
• Workshops in Chapel Hill, NC
• Lead-In segment of Basic Rolfing training with Annie Duggan – Boulder

1990 -2000

• Several workshops in Paris, Rome and London.
• Workshop for European Annual Meeting.
• Workshops in New York City

2000 – Present

• Movement trainings in Boulder, Dallas and Brazil.

Structural Integration

1989

• Basic Training in Munich – Assisted, with Robert Schleip, Peter Melchior, Lead Instructor.

1990 -2000

• Workshop with Peter Melchior for Hellerworkers in Seattle
• Workshop with Peter Melchior in Turin, Italy.

2000 – Present

• Assisted Peter Melchior – Basic Training – Boulder
• Assisted Nilce Silvera twice – Basic Trainings – Brazil
• Workshop with Rosemary Feitis and Nilce Silvera – New York City

Biotensegrity is the unifying mechanical structural concept that bridges the islands of information that we now have about fascia and its role in body functions, and makes them a unified archipelago for understanding fascia‘s role in anatomy and physiology.  The physics of biology has been stuck in the reductionist concepts where biologic organisms are considered ’rigid bodies‘ and statics, the study of bodies at rest or constant velocity, seems divorced from dynamics, the constantly changing environment that is life.  Most of what is now accepted as classical biomechanics is based on static analysis of rigid bodies with bones acting as levers, joints as fulcrums, and the skeleton as the frame that supports the corpus.  Twentieth century concepts of, complexity, chaos theory and dynamical systems theory have been ignored.  The fascial system interconnects the entire body from cell to organism, and is not a ’rigid body‘, but a colloidal structure whose mechanical rules that govern its physical properties are very different from the one that pertain to rigid bodies.  Biotensegrity models the fascial system, from the cell cytoskeleton to the organism, as a hierarchical dynamical system, and updates the physics of biology to the twenty-first century. The colloidal mechanics of fascia are recognized as vital to the evolution of biologic structure. In a biotensegrity modeled musculoskeletal system, the bones are enmeshed in the interstices of the fascial network and act as space-makers in a construct referred to as ’floating compression‘ or ’tensegrity‘.

To complement the biotensegrity model, an application to body movement is proposed by creating mental images in accordance with this principle in order to develop a more holistic perception of the internal landscape of the body.  Using techniques originating from three-dimensional movement coordination patterns and Asian martial arts, we will enhance the creation of a balanced tension to optimize movement, making it mechanically and energetically more efficient.  The application of the biotensegrity principle using the presented methods can be seen as a fascial training and be integrated in therapy, movement disciplines, and daily movements. 

Goals of the course are to question the classical biomechanical model based on the lever system, define a new paradigm for the physics of biology, and contrast the biotensegrity model with the lever based Newtonian/Borellian model.  We will demonstrate how the proposed model can be applied in clinical practice, and propose further avenues of research to prove or falsify presently accepted models and the biotensegrity model.

Dr. Levin is the originator of the concept of BioTensegrity, the application of tensegrity-balanced forces in organisms from viruses to humans.  His clinical experience was as an orthopedic surgeon whose clinical practice focused on non-surgical back pain.  Academic appointments have been Distinguished Visiting Professor of Orthopedic Surgery Louisiana State University College of Medicine, Associate Clinical Professor at Michigan State University College of Osteopathic Medicine and Assistant Clinical Professor of Orthopedic Surgery at Howard University.  He was the Medical Advisor to the National Park Service, National Capital Region and a consultant for the American Ballet Theater.  Presently, Dr. Levin devotes his professional time to research in the field of biomechanics.

Some Related Publications:

1. Levin SM. 1982. Continuous tension, discontinuous compression, a model for biomechanical support of the body.  Bulletin of Structural Integration, Rolf Institute, Boulder:31-33.
2. Levin SM. 1995. The Importance of soft tissues for structural support of the body. In: Dorman T, editor. Prolotherapy in the Lumbar Spine and Pelvis. Philadelphia: Hanley & Belfus. p 309-524.
3. Levin SM. 1997. Putting the shoulder to the wheel: a new biomechanical model for the shoulder girdle.  Biomed Sci Instrum 33:412-7.
4. Levin SM. 2002. The tensegrity-truss as a model for spine mechanics: Biotensegrity. Journal of Mechanics in Medicine and Biology, vol. 2, #3&4, 375-388.
5. Levin SM. 2007. A Suspensory system for the sacrum in pelvic mechanics: biotensegrity. In: Andry Vleeming PhD, Vert Mooney MD, Rob Stoeckart PhD editors. Movement, Stability & Lumbopelvic Pain. 2nd ed. Edinburgh: Churchill Livingstone. p 229-238.

These papers are available at: http://www.biotensegrity.com/.

Links:
– www.biotensegrity.com
– web.mac.com/stephenlevin1/_StephenLevins_Biotensegrity/Welcome.html
– www.youtube.com/watch?v=8ajowL0T4bM&feature=channel_page

Physicist, movement researcher and educator. For 20 years Dr. Martin has been practicing Chinese arts of movement (Qi Gong, Tai Ji Quan, and more recently Yi Quan); She is further trained in dance therapy and in Spiraldynamik® (three-dimensional movement coordination) and worked as a movement therapist at a psychosomatic clinic for eight years.  Dr. Martin studied biotensegrity with Dr. Stephen Levin and Tom Flemons. She has developed movement concepts based on her diverse background and integrated them into a unified program. She now practices as a freelance "living biotensegrity" teacher.

The Osteopathic and Chiropractic literature on cranio-sacral and sacro-occipital techniques states that there are connections between the bones of the cranium and pelvis. These links are purported to be based on myofascial connections and can be observed clinically as postural patterns. What is not often recognized is the dental contribution to the sacro-occipital/cranio-sacral links.

Dental research published over many years has supported the finding that head posture and masticatory muscle activity are linked and that a variation in the position of the mandible can have an effect on head and body posture. Patients with Temporomandibular disorders and oro-facial pain often have neck, shoulder and back problems. Their posture is frequently observed to be poor.

The anatomical hinge position of the Temporo-mandibular joint (TMJ) is in the glenoid fossa. However, the true mechanical centre of rotation of the mandible is at the junction of the bodies of the cervical vertebrae C1 and C2. As all cervical vertebrae have three articular facets except for C1 that articulates with the occiput via two articular facets, the implication of this is that the bite, made of the upper and lower teeth forms the third articular facet. It has been reported that TMJ problems can be improved by combining dental treatment and physical therapy.

There is scope for multi-disciplinary collaborative research into the myofascial mechanisms by investigating the clinical techniques including dentistry, used to treat patients with compensatory postures and chronic pain.

To diagnose and arrive at an appropriate treatment plan, patients must be comprehensively evaluated. This should involve an osteopathic/chiropractic assessment, an assessment of their biochemical and nutritional status and a dental examination to include not only dental health but also their TMJ function.

Participants will be presented with the following information:

1. The anatomy and normal function of the masticatory system.
2. How to examine the temporo-mandibular joints and to recognise pathological function.
3. How occlusion (bite), head posture and gross posture are linked.
4. To distinguish between descending and ascending factors which contribute to symptoms.
5. Examples of multi-disciplinary case management will be presented.

This workshop will enable participants to:

1. Recognize and classify the common dental bite patterns and their associated postural compensations.
2. Describe what clinical tests are available to diagnose if there is a dental contribution to a postural problem.
3. Identify when it would be appropriate to recommend specific specialists to provide optimal treatment for their patients.

Malcolm Levinkind, BDS, MSc, PhD, FDS RCS, qualified in 1978 from University College Hospital Dental School, London, UK. He is a full-time paediatric dentist with an interest in managing growth and development problems as they relate to posture. He worked as a full-time Senior Lecturer in paediatric dentistry at the Royal London Hospital. The Wellcome Trust and major industrial sponsors (Procter & Gamble, Unilever) funded him to research topics that included the development of clinical diagnostic techniques and the bio-electrochemical evaluation of tooth decay.  He has trained in osteopathic and chiropractic techniques and now also lectures to post-graduate osteopaths, chiropractors and dentists.

Publications:

1. Consideration of whole body posture in relation to dental development and treatment of malocclusion in children. Malcolm Levinkind.  Oral Health Report, Volume I, 2008 British Dental Journal Supplement http://www.drlevinkind.com/images/uploads/publication_consideration-of-whole-body-posture%20v1.0.pdf
2. Dental Posture Interactions for Optimal Health. Malcolm Levinkind. Positive Health Issue 88 2003 (http://www.positivehealth.com/article-view.php?articleid=1315)
3. Effect of canal preparation and residual root filling material on root impedance. A Al-bulushi, M Levinkind, M Flanagan, Y-L Ng, K Gulabivala. International Journal of Endodontics, 2008 International Journal of Endodontics, 2008; 41: 892- 904. http://www3.interscience.wiley.com/journal/121403052/abstract
4. The development and validation of an occlusal site-specific plaque index to evaluate the effects of cleaning by tooth brushes and chewing gum. Levinkind, M. Owens, J. Morea, C. Addy, M. Lang, N. P. Adair, R. and Barton, I. J Clinical Periodontology 1999; 26: 177-182
5. Scanning microradiographic studies of rates of in vitro demineralization in human and bovine dental enamel. Anderson, P. Levinkind, M. Elliott, J. C. Archives of Oral Biology 1998; 43: 649-656

Links:
– www.drlevinkind.com
– drlevinkind@btinternet.com (email)

Recent research has revealed the extraordinary nature of the human fascia in regard to its structure, physiology and mechanical dynamics. Research has also suggested the hypothesis that the effects of acupuncture treatment may be explained by the behavior of the fascia. This workshop will explore this hypothesis by:

• Comparing the anatomy of the fascia to acupuncture meridians
• Discussing the physiology of the fascia as a possible mechanism of acupuncture
• Discussing the somato-visceral and viscero-somatic mechanism of myofascial treatment
• Revisiting acupuncture concepts and principles, including the concept of qi, in terms of the fascia
• Exploring acupuncture research from a fascial perspective, particularly confounding issues surrounding placebo acupuncture
• Discussing and demonstrating the efficacy of acupuncture treatment that utilizes a myofascial approach
• Considering the application of these principles to other forms of myofascial treatment including trigger point injection, deep tissue stroking, rhythmic manipulation, ischemic pressure/trigger point pressure techniques
• Discussing future directions for fascia and acupuncture research including the mapping of fascial planes in comparison to the complete meridian system and exploring the role that the fascia may play in acupuncture‘s local and distal effects on the musculature and the viscera

At the completion of this workshop, participants will be able to:

• Integrate fascia research findings with principles of acupuncture treatment
• Describe a new fascial paradigm of acupuncture, including the nature of qi
• Describe the clinical application of this paradigm
• Formulate general hypotheses for future research

Donna and Steven Finando have been practicing acupuncture and oriental medicine for over 30 years. They are co-authors of Trigger Point Therapy for Myofascial Pain, a text that has been translated into several languages. As a result of their studies with Dr. Janet Travell, they formulated a treatment approach which they call Myofascial Meridian Therapy which is an integration of Dr. Travell‘s work with their extensive background in oriental therapies.

Donna and Steven were involved with the development and evolution of the Wholistic Health Center in Manhasset, NY in 1976, the first large scale health center on the east coast of the United States; and the New Center for Wholistic Health Education and Research in 1982, the first accredited school of massage in the state of New York that required the study and practice of the oriental healing arts.

Donna Finando, L.Ac., L.M.T. has written a number of books and articles on the treatment of myofascial pain and oriental treatment techniques as well as methods for self care. A long-time educator, Donna has developed and taught a wide range of courses related to myofascial methods of treatment and the oriental healing arts.

Steven Finando, Ph.D., L.Ac. has a background in research as well as acupuncture. Steven was the first chair of the examination committee for the U.S. national certifying body in acupuncture and oriental medicine. He was also the vice-chair of the national accrediting body in acupuncture and oriental medicine, thus having a background in both standards of acupuncture practice as well acupuncture education.

Publications:

1. Tina Sohn, Donna Finando, Amma: The Ancient Art of Oriental Healing, Healing Arts Press, VT, 1988
2. Simon Mills, Steven Finando, Alternatives in Healing, NAL Books, New York, 1988
3. Donna Finando, Steven Finando, Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch, Healing Arts Press, VT, 1999, 2005 (originally published under the name Informed Touch)
4. Donna Finando, Trigger Point Self Care Manual, Healing Arts Press, 2005
5. Donna Finando, Acupoint and Trigger Point Therapy for Babies and Children: A Parent‘s Healing Touch, Healing Arts Press, VT, 2008

Functional Fascial Taping®

This interactive workshop demonstrates an innovative way for clinicians to use tape to assist in the treatment of musculoskeletal pathologies and for scientists it provides a measurable system with an observable effect. The taping technique has two main purposes. The first is a simple alternative for pain management, as FFT ® can quickly decrease pain, improve functional performance and allow rehabilitation in a pain free environment.

The second purpose is to offer a sustained load to tissues. This may be the way that pain is reduced using FFT. During this workshop, participants will observe 3 key benefits: altered load at rest; active increased load (patient self administered treatment) and frequent alterations of load with activity, which is custom made for each patient/athlete for an extended and pre-determined period of time. 

This method can be used in conjunction with any standard treatment of musculoskeletal pathologies and encourages patients to actively participate in their own treatment and rehabilitation. For the patient this can mean an earlier return to work, for an athlete this has the ability to help maintain higher levels of training and competition, for the clinician it allows for a more accurate way to address the other presenting signs and symptoms of musculoskeletal pathologies.

The FFT assessment procedure has specific direction variability, which may indicate the fascia. The applied load from the tape potentially remodels the internal architecture of connective tissue, which includes the fascia and this may change mechanoreceptor activation. The effect of FFT has been demonstrated in an RCT and requires confirmation, as well as further investigations into the mechanism by which it works.  

This workshop will develop participants working knowledge of FFT, which allows the clinician to immediately incorporate elements of the FFT principles and concepts into clinical practice. Participants will learn how to assess and apply FFT. Through demonstration, hands on guidance and presentation of the results of an RCT, participants will see and experience the effects of FFT which should facilitate an interest in further investigation of the mechanism by which it works.

The workshop crosses the boundaries of Physiotherapy, Osteopathy, Chiropractic, Massage Therapy and Science, for FFT is non-invasive, immediate, functional and an objective way to decrease musculoskeletal pain. 

SCHEDULE: 

Morning 9:00 – 11:30 am

9:00 – 9:30am
Introduction and benefits of technique.
Case study and follow up.
Clinical overview of RCT for NSLBP.
RTU investigation demonstration local and global effects of FFT.
Integrating FFT in clinical practice. Tips use of zinc oxide tape including skin allergy.

9:30 – 9:50
Practical demonstration. Q+A
Assessment procedure
– Digital distraction
– Tape application.

9:50 – 10:20
Demonstration and group exercise to increase global Trunk Flexion, SLR or Slump. Group retest. Q+A.

10:20 – 10:40 Break

10:40 – 11:10
Demonstration and group exercise for specific loading of the Neuro-fascial Interface.
Group retest. Q+A.

11:10 – 11:30
Demonstration dynamic movement assessment and tape application with movement.
Relevant insights from the Fascia Congress. 
Q+A, Conclusion.

Afternoon (Workshop repeated) 1:00 to 3:30 pm

1:00 – 1:30pm
Introduction and benefits of technique.
Case study and follow up.
Clinical overview of RCT for NSLBP.
RTU investigation demonstration local and global effects of FFT.
Integrating FFT in clinical practice.
Tips use of zinc oxide tape including skin allergy.

1:30 – 1:50
Practical demonstration. Q+A.
Assessment procedure
– Digital distraction
– Tape application.

1:50 – 2:20
Demonstration and group exercise to increase global Trunk Flexion, SLR or Slump. Group retest. Q+A. 

2:20 – 2:40 Break

2:40 – 3:10
Demonstration and group exercise for specific loading of the Neurofascial Interface.
Group retest Q+A.

3:10 – 3:30
Demonstration dynamic movement assessment and tape application with movement.
Relevant insights from the Fascia Congress. 
Q+A, Conclusion.

Ron Alexander: FFT was founded and refined by Ron Alexander during eight years continuous service as the Principal Remedial Musculoskeletal Therapist for the Australian Ballet Company. Currently co-investigator of a randomized clinical trial of FFT for low back pain (PhD), conducted at Deakin University Melbourne. Ron has presented FFT to the Football Association (UK), the World Congress on Lower Back and Pelvic Pain, Barcelona and the Inaugural Fascia Research Congress, Harvard.

Website: www.fft.net.au

Some Related Publications:

1. Alexander R. Functional Fascial Taping for lower back pain: A case report.
2. J Bodywork Movement Ther 12 (3): 263-264, 2008.
3. Alexander R. Functional Fascial Taping Realtime Unltrasound Investigation.
4. J Bodywork Movement Ther 12 (3): 390-391, 2008.
5. Spina R, Cameron M, Alexander R. The effect of Functional Fascial Taping on Morton’s Neuroma. The Australasian Chiropractic and Osteopathic Journal. July Vol 10, No. 1. 2002.
6. Khan K, Brown J, Way S, Vass n, Crichton K, Alexander R, Baxter A, Butler M, Wark J. Overuse injuries in classical ballet. Sports Med, May;19(5):341-57. 1995.

Shu-Mei Chen: Shu-Mei Chen PT, PhD is a senior lecturer at the School of Physical Therapy in Kaohsiung Medical University, Taiwan and has been lecturing on the evaluation and treatment of musculoskeletal disorders. During the past 10 years, she has been both principal and associate investigator in a series of clinical studies, with a special interest in spinal research. She is also an experienced clinician. Currently she is a PhD candidate at the School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia. The main area of her PhD was Functional Fascial Taping (FFT), where she conducted a clinical trial of FFT for the treatment of non-specific low back pain, as well as investigating the potential mechanism of pain relief of FFT.

Some Related Publications:

1. Wang HY, Ju YH, Chen SM, Lo SK, Jong YJ: Joint ROM limitation in children and young adults with SMA. Archive Physical Medicine Rehabilitation 2004; 85:1689-93.
2. Liu MF & Chen SM: Electromyographic analysis of thigh muscles during four kinds of closed kinetic chain exercises. Formosan Journal of Physical Therapy 2003; 28: 308-316.
3. Lue YJ, Chang JK, Liu MF, Chen SM, Lu YM: Anxiety with lower extremity arthroplasty. Formosan Journal of Physical Therapy 2003; 28 317-323.
4. Chen SM, Liu MF, Wang BM, Huang MH: Chinese translation and adaptation of the Roland-Morris low back pain disability questionnaire. Formosan Journal of Physical Therapy 2003; 28: 324-332.
5. Wang WY , Chen SM: Balance and muscular strength in normal children aged 9-12 years. Kaohsiung Journal of Medical sciences 1999; 15:226-233.
6. Lin JH, Chen SM, Liaw LJ, Lee CH. Study of isometric lifting strength in normal Chinese adults. Kaohsiung Journal of Medical sciences 1996; 12: 400-408.
7. Lin JH, Liaw LJ, Chen SM, Lee CH. A study of different postures on isometric lifting strength in normal college students. Kaohsiung Journal of Medical sciences 1995; 11: 678-685.

The workshop will comprise three components: Theory, Practical Demonstrations, Question & Answer/Discussion:

Theoretical component (Brief introduction to MFR. Hypotheses & supporting rationale.)

Practical demonstration(s) + practice opportunity for delegates (Demonstrate MFR application on delegate- ‘patient’, re-assess, discuss outcome. Delegates to pair up and apply MFR on one another on the same basis as demo above.)

Question & answer/discussion time, notably with reference to material presented during the Congress, and PNI perspective.

Workshop Outline:
The workshop will comprise three components as follows:

Theoretical component

– Brief introduction to MFR (subject to requirement)

– Hypotheses & supporting rationale

Practical demonstration(s) + practice opportunity for delegates

– Demonstrate MFR application on delegate-‘patient’, re-assess, discuss outcome.

– Delegates to pair up and apply MFR on one another on the same basis as demo above.

Question & answer/discussion time, notably with reference to material presented during the Congress, and PNI perspective.

Workshop Part 1: Theoretical component

(A) Brief definition and description of MFR (subject to requirement)

(B) Hypotheses & supporting rationale

In the context of rheumatological autoimmune conditions such as Systemic Lupus Erythematosus (SLE), Scleroderma, Rheumatoid Arthritis, Multiple Sclerosis, it is hypothesised that appropriately applied MFR may over time:

Decrease key debilitating symptoms

Enhance/maintain improved fascial pliability, extensibility, and mobility

Reduce/help normalise illness-related asymmetries, deformities, contractures, sclerosis, and/or adhesions of the connective tissues

The above in turn will help enhance general and (targeted) local:

– Blood supply/flow

– Neural conduction and sensory, motor, and autonomic neural function

– Decrease/limit pain

– Enhance patient functional performance and hence quality of life

Workshop Part 2: Practical demonstration + practice opportunity for delegates

With the assistance of one or more volunteers – ideally, but not necessarily, a delegate diagnosed with one of the autoimmune conditions under discussion:

– Succinctly demonstrate/discuss history and assessment rationale for hands-on MFR application

– Demonstrate MFR treatment

– Reassess ‘patient’

– Discuss as required

– Provide technique demonstration(s) as per requests

– Oversee/support delegates’ practice.

Workshop Part 3: Question & answer + further discussion time

– Delegates to ask any further questions

– Discussion with specific reference to material presented during Congress and PNI perspective, namely: ‘To explore from a Psycho-Neuro-Immunology (PNI) perspective, whether, and if so how, MFR might help modulate the underlying excessive auto-immune response(s) and enhance immune response regulation, via the autonomic and endocrine systems coupled with improved psycho-emotional awareness, channelling, and focus.’

FULL WORKSHOP DESCRIPTION:

How, specifically, do the human fasciae relate to the workshop content?

– MFR is a therapeutic modality intrinsically focused on the connective tissues/fasciae of the body in its theoretical underpinning, clinical reasoning, and hands-on application.

– The field of Rheumatology can be defined in summary as comprising of the medical disorders that affect the musculoskeletal system, particularly the joints and surrounding soft tissues, including notably the connective tissue diseases and vasculitides.

– Auto-immune conditions such as (inter alia) Systemic Lupus Erythematosus (SLE), Scleroderma, Rheumatoid Arthritis, Multiple Sclerosis, comprise a significant fascial – and visceral – involvement in terms of both signs and symptoms (S&Ss), even where such involvement may be deemed ‘secondary’ in relation to key differential diagnostic S&Ss.

– Illness-related adverse fascial changes can be responsible for a large proportion of patients’ pain and functional impairment.

– Adverse fascial change can in turn lead to further metabolic deterioration as a result of further impaired blood flow (and associated ischaemic pain, tissue necrosis, etc.), lymphatic drainage (and associated decreased immune function), neural conduction (and associated motor, sensory, and autonomic disturbance).

ThereforeApplying the concepts and practice of MFR to such diseased connective tissues appears a worthy project aimed at relieving patient suffering, enhancing patient care and quality of life, via an exciting inter-disciplinary network of clinical fields with a common interest in ‘Fascia’.

Operating hypotheses / underlying methodology being discussed/presented
Hypotheses & supporting rationale
In the context of rheumatological autoimmune conditions such as Systemic Lupus Erythematosus (SLE), Scleroderma, Rheumatoid Arthritis, Multiple Sclerosis, it is hypothesised that appropriately applied MFR may over time:

Decrease key debilitating symptoms including:

– Decreased/loss of mobility due to fascial thickening/adhesion/contracture

– Musculo-skeletal pain resulting from adverse adaptive posture and associated tissue strain, vascular and neural compression, reduced fascial trophic performance

– Decreased/loss of functional proprioception and performance

– Illness-specific symptoms such as:
(i) Intensity/duration/ frequency of ‘attacks’ when exposed to cold in Scleroderma/Primary & Secondary Raynaud’s patients
(ii) Gastro-intestinal dysfunction in Scleroderma and SLE patients

Enhance/maintain improved fascial pliability, extensibility, and mobility

Reduce/help normalise illness-related asymmetries, deformities, contractures, sclerosis, and/or adhesions of the connective tissues

– Enhance/restore a more ‘neutral’ postural alignment, thereby:

– Reduce adverse musculo-skeletal, myofascial, and visceral stress/strain

– Enhance mobility/flexibility

The above in turn will help:

– Enhance general and (targeted) local blood supply/flow (by relieving excessive vascular compression in shortened/constricted tissue, as well as in over-stretched, lengthened fascia)

– Enhance general and local (targeted) neural conduction

– Enhance sensory, motor, and autonomic neural function

– Decrease/limit pain

– Enhance patient functional performance and independence, hence:

– Enhance patient quality of life

These outcomes would be achieved via appropriate assessment, interpretation, and clinical application of recognised MFR/Structural Integration®/KMI®/Rolfing® principles, with specific reference to the known adverse fascial, neuromuscular, visceral, and/or other changes associated with the specific autoimmune condition. Notably the adverse fascial changes would be interpreted through the perspective of the ‘Anatomy Trains’ as expertly described and discussed by Tom Myers.

Areas relevant and/or suggested for scientific research:

– A more in-depth understanding of the ‘smooth muscle’ in fascia  with specific reference to how it might respond favourably to ‘load’ (such as MFR) in releasing/softening and therefore minimising fascial compression-induced vasoconstriction.

– The above would enhance clinical case studies or trials of applying MFR treatment specifically to the relevant Anatomy Trains that might positively affect Primary and/or Secondary Raynaud’s symptoms.

– Further research into how fascia and immune system interface and mutually contribute to each other’s – and the overall organism’s – healthy balance/homeostasis.

– As already indicated, exploring from a Psycho-Neuro-Immunology (PNI) perspective, whether, and if so how, MFR might help modulate the underlying excessive auto-immune response(s) and enhance immune response regulation, via the autonomic and endocrine systems coupled with improved psycho-emotional awareness, channelling, and focus.

Selective rationale for the above proposed research areas:

To date, the autoimmune conditions under discussion have no known ’cause’ nor cure. There are however a number of relatively established predisposing factors. The rationale for suggesting the above PNI-related research would be that in all probability, the intensity, duration, simultaneity, and combination of various contributing factors eventually result in a person developing an autoimmune condition – or not, as the case may be. It therefore may not be unreasonable to consider the possibility that, if enough of these ‘predisposing conditions’ could be reversed, or at least significantly reduced, this in turn might in due course enable the immune system not to ‘overreact’ as excessively.

PNI has already abundantly demonstrated the two-way pathway of mutual influence between what in Western terms are defined as ‘mind’ and ‘body’, notably via the endocrine system.  According to these findings, ’emotional state’ influences ‘body physiology’, just as ‘physical state’ in turn impacts on ‘psyche’. Thanks at least in part to PNI, there is increasing recognition for the importance of ‘positive thinking’ and ‘mental focus’ in respect of overcoming ill-health. Therefore a pilot clinical study where appropriate MFR would be applied alongside increased patient awareness, ‘education’, and ‘coaching’ in maximising optimal mental focus, would merit consideration.

What are the cross-disciplinary applications? This workshop would be of interest to, and ideally call upon discussion contributions from:

– Rheumatology researchers/clinicians/students

– PNI researchers/clinicians/students

– A wide range of manual therapists – physiotherapists, osteopaths, chiropractors, massage therapists (in the widest sense), notably those with an interest in Fascia, such as Rolfers®, KMI®, Structural Integration®, MFR clinicians/researchers/ students

– The details above clearly outline the potential, if not the necessity, for sound inter-disciplinary collaboration and mutual interaction for this modest workshop subsequently to develop into a fruitful research project involving: Rheumatology, PNI, MFR, clinicians/researchers, as well as any neurologists, psychologists, immunologists, and/or other professionals with an interest in the field.

Objectives:

– To propose and illustrate Myofascial Release (MFR) efficacy as a non-invasive intervention in alleviating/reducing specific symptoms of selective rheumatological autoimmune conditions.

– To discuss/explore from a Psycho-Neuro-Immunology (PNI) perspective, whether, and if so how, MFR might help modulate the underlying excessive auto-immune response(s) and enhance immune response regulation.

– To explain and demonstrate grounds for greater MFR efficacy recognition within primary healthcare in general, and among the connective tissue-related clinical disciplines in particular. 

– To identify strong evidence for, and recommend specific areas for further research within the hereto under-researched interdisciplinary field in question.

– To translate and relate workshop outcomes into enhanced patient care within the field.

– To create an ideal setting for sound interdisciplinary learning and collaboration, in a true spirit of mutual respect and openness among primary and complementary health care professionals.

A former GB marathon runner and county level basketball player, Tanya Ball runs a full-time Sports Massage & Remedial Therapy practice in Hampshire (UK), treating a broad patient-base, from sedentary to elite/professional athletes, across wide-ranging ages and backgrounds. Her clinical work involves mutual inter-professional referrals and collaboration, with a strong focus on postural & movement dysfunction analysis, treatment, and remedial/preventative exercise prescription.

Her extensive CPD training since graduating from the London School of Sports Massage (LSSM) in 1997 includes a part-time MSc in Bodywork (1998-2001), a number of Kinetic Control’s® ‘Dynamic Stability and Muscle Balance’ courses, and advanced training in Myofascial Release (MFR) with Tom Myers, including his intensive ‘Anatomy Trains’ course. She is currently at the preliminary stages of a Clinical Doctorate aiming to explore MFR efficacy in alleviating specific symptoms of rheumatological autoimmune conditions, and in restoring normal immune function.

A LSSM Tutor since 1998, Tanya nowadays assumes joint overall responsibility for the Southampton-based LSSM Diploma course. She offers graduates a wide range of high quality, small group CPD courses at all levels as well as tailored workshops for chartered physiotherapists and other manual clinicians.

Some Selected Publications:

Ball T. Muscle Talk – Stretching: what? why? how? where? and when? (Parts 1-3). The Coach 15-17, 2003.

Ball T. Sports Massage Therapy and the Athlete (Parts 1-4). Athletics Weekly April, July, Oct, Nov. 2000.

Various other articles in The Coach 1-24, 2000-2004.

Links:
Presenter’s website address: www.tmb-src.co.uk

Full Description: relationship with human fasciae:

– Fascial restrictions are the adhesion of one fascial layer to another with the associated development of elastocollagenous cross-links initiating intramuscular oedema and contraction of the muscle. Myofascial adhesions can contribute to impaired muscle, articular mobility, and connective tissue integrity (Chaitow, Lewit, Lederman, Hertling & Kessler, Huijing).

– The mechanisms leading to the frequent occurrence of muscle pain in the back and hip regions is possibly caused by increased sensitivity of muscle nociceptors or by central sensitization induced by nociceptive input from injured muscles (Mense, Danneels).

– Pressure algometry has been found to be non-invasive, efficient and reliable in the exploration of physio-pathological mechanisms involved in myofascial pain syndromes. The subjective character of the pressure pain thresholds (PPTs) cannot be avoided since the very object of measurement, i.e. the minimum pain perceptible by the person, is a subjective factor (Fischer, Russell, Hong).

– Only one study indicates that PPTs, measured with the aid of a mechanical Fischer algometer, in the M. Erector spinae mass and especially those at the L1, L3 and L5 levels in patients with non-specific subacute low back pain (LBP, n=87) are pathologically lower (> 2 kg/cm) than in healthy control subjects (n=64). Despite the complexity of the findings in function of the employed measurement methods, it seems that non-specific LBP is primarily a myofascial pain syndrome caused by local injured muscular structures within the thoracolumbar fasciae. More equivalent studies are nevertheless needed to confirm those conclusions (Farasyn).

Operating hypotheses:

– The effect of roptrotherapy is hypothesized to be able to regenerate connective scar tissues and reduce muscle hardenings as a possible mechanism of pain relief. The intervention of roptrotherapy consists of a 30-minute deep cross-friction session, with the aid of a myofascial T-bar made of bronze, as a neutral material to skin (see figure).

– This had the only advantage, compared with wooden or plastic made ones, of being easier to use by hand and to contribute to the compression force by their weight (0.8 Kg), resulting in less fatigue for the therapist when employ in current daily practice.

Scientific research: Roptrotherapy in Patients with Non-specific Low Back Pain

– A prospective randomized controlled trial with a 1-week interval evaluating the effect of "roptrotherapy" and applied on the lumbo-pelvic region in patients with subacute non-specific low back pain (LBP) revealed that the disability and pain related measurements were significantly decreased and a minimum clinical change occurred in the group treated with roptrotherapy at the 1-week interval session, while in the placebo and control group no tendency of improvement was noted (Farasyn, J BMR, 2007).

– In another study, considering a group of patients with LBP starting with roptrotherapy sessions, significant positive changes were found at each weekly reassessment in pain sensitivity, disability, and LBP related Pressure Pain Thresholds (PPTs) measured with a Fischer algometer. In the week following two roptrotherapy sessions, the PPTs increased by more than 2 kg/cm at the M. Erector spinae L1, L3, and L5 levels. The 3-month follow-up results revealed that the PPT values of the non-treated and neutral M. Triceps brachii remained unchanged, while the PPT of the most highly LBP related M. Erector spinae and M. Gluteus maximus levels increased in such way that the PPT values became similar to those of healthy subjects of those muscle hardenings may desensitize central neural structures involved in pain perception and is not meaningfully influenced by the possible release of endogenous opioid hormones. The hypothesis that non-specific LBP is primarily a myofascial pain syndrome caused by local injured muscular structures within the thoracolumbar spine and buttock should be supported (Farasyn, J MSP, 2007)

The cross disciplinary applications: Chronic Myofascial Pain Syndromes such as:

– Non-specific low back pain;

– Tension headaches, neck stifness (after wiplash)

– Tendinosis: shoulder problems (PSH); tennis-elbow; Achilles-tendinose etc.

Objectives:

Explaining some important physiopathological processes involved in current myo-fascial pain syndromes.

Defining the basic principles of roptrotherapy.

Practicing of roptrotherapy, with the aid of bronze made myofascial T-bars, involved in musculoskeletal therapies such as low back pain, tension headache and shoulder problems.

SCHEDULE: twice 1/2 day

Bodywork therapies: Roptrotherapy: morning 9-11:30 and afternoon 1-3:30.

Introduction to the Principles of Roptrotherapy
45 min. Unit 1: Basic Principles in current Myofascial Pain Syndromes: Scientific Studies
15 min. Unit 2: Basic Practice of Roptrotherapy: Demonstration of a case with LBP
Module I, Methods of Roptrotherapy: Practice 
30 min. Unit 3: Practice: Session of Roptrotherapy: a case with LBP
45 min. Unit 4: Practice: Session of Roptrotherapy: a case with Tension Headache
15 min. Unit 5: Discussions

Associate Professor, Lecture "Introduction of clinical examination of patients with musculoskeletal pain, manual therapies & bodyworks"; Currently practices Pain Management Dr. Farasyn received his PhD of Physical Therapy degree at the Free University of Brussels and has 18 years experience in clinical research of pressure algometry in non-specific low back pain syndromes. He worked out a new hypothesis for "referred muscle pain" (barrier-dam theory) and even so for the origin of the osteopathic "cranio-sacral motion" (venomotion theory). Co-founder and Member of the Belgian Academy of Osteopathy. Member of the International Myopain Society.

Some Selected Publications:

Farasyn A, Meeusen R. Pressure pain thresholds in healthy subjects: influence of physical activity, history of lower back pain and the use of endermology as a placebo-like treatment. Journal of Bodywork & Movement Therapies 1;53-61, 2003, Elsevier).

Farasyn A, Meeusen R. The influence of non-specific low back pain on pressure pain thresholds and disability. European Journal of Pain 9;375-81, 2004, (Pubmed).

Farasyn A. New hypothesis for the phenomenon of referred muscle pain. Medical Hypotheses 2007;68:144-50, (Pubmed).

Farasyn A, Meeusen R. Effect of Roptrotherapy on Pressure Pain Thresholds in Patients with Non-specific Low Back Pain. Journal of Musculoskeletal Pain 2007;15:41-53 (Taylor & Francis Group, Informaworld).

Farasyn A, Meeusen R, Nijs J. A pilot randomized placebo-controlled trial of roptro-therapy in patients with subacute low back pain. Journal of Back and Musculoskeletal Rehabilitation 2007,14:111-17 (IOS Press).

Links:
http://www.roptrotherapy.info
andre.farasyn@vub.ac.be (email)