2012 Post Conference Workshops
FULL DAY: Saturday March 31 8:00am – 5:00pm
- Advanced Manual Treatment of Post-Surgical Adhesions
- Integrative Treatment of the Lymph & Fascia: Modern Approaches for Improved Outcomes
- Manual Therapy for the Myofascial System
- Extensore Coxae Brevis: Fascial Release Treatment Options for the Deep Lateral Rotators
- The Fascial Manipulation Technique and its Biomechanical Model – A Guide to the Human Fascial System
HALF DAY – Morning: Saturday March 31 AM 8:00am – noon
- Functional Fascial Taping (FFT) / Upper Limb Tension
- Fascial Stretch Therapy: Theory, Research & Practice
- How to Diagnose Ehlers-Danlos Syndrome & Joint Hypermobility Syndrome
- Sonoelastography & Dynamic Ultrasound in Real Time as a Clinical Tool for Manual Therapy Practitioners
HALF DAY – Afternoon: Saturday March 31 PM 1:00pm – 5:00pm
- Critically Evaluating Research: What Clinicians Need to Know
- What is Moving Under the Skin? Correlating Dissection, Magnetic Resonance Imaging and Ultrasonography of the Thigh with Depth of Touch
- Mapping the Neurofascia: A Derivation & Demonstration of Manual Treatment Principles
- Chronic Pain, Fascia & Feldenkrais; Using Bones to Manipulate Fascia and Influence Chronic Pain
Full Day Workshops
Advanced Manual Treatment of Post-Surgical Adhesions
Susan Chapelle, RMT – Owner of Squamish Therapeutic Massage
Geoffrey M. Bove, DC, PhD – Associate Professor University of New England, keynote speaker, Fascia 2007
All surgeries lead to adhesions between the skin and underlying structures. This can disrupt the normal gliding between the structures, and can affect normal function. Adhesions are expected to cause abnormal afferent input to the central nervous system, leading to altered control patterns. Disrupting the adhesions and facilitating normal healing should allow the tissue functions to return to normal. This course will take an evidence-based approach to the treatment of patients who are suffering from complications due to surgically induced myofascial and viscerofascial adhesions. The process of scarring and adhesion formation will be presented. Throughout the course there will be a focus on diagnostic reasoning. There will be three didactic sessions: 1. Review of literature related to scars and adhesions. 2. Characteristics of adhesion and scars due to various classes of surgeries. 3. Sensory mechanisms relevant to scars and adhesions, including the peripheral and central nervous system. There will be three practical sessions: 1. Palpation methods to distinguish normal from abnormal tissue. 2. Treatment approaches for adhesions. 3. Treatment approaches for prevention or recurrence.
Integrative Treatment of the Lymph & Fascia: Modern Approaches for Improved Outcomes
Diana Kincaid, LMT – Director, Lymphatic Integrative Therapy
This class is derived from clinical experience and current research. There is a direct relationship between the fascial and lymphatic systems, anatomically and physiologically. This workshop combines treatment of these two systems to effectively address a variety of medical conditions. The approach originated from working with lymphedema patients, where lymph nodes were removed or radiated. Combining the treatment of lymph and fascia dramatically improved results: greater reduction of swelling, pain and improved function of the affected region.
It made sense to expand this approach for other medical conditions. The combination proved to be very effective for injury rehab, sciatica, chronic pain conditions (e.g. fibromyalgia and arthritis), allergies, chemical sensitivities and post surgical treatment.
Techniques for lymph, fascia and nerves employ shearing and stretching movements, with specific depth and skilled palpation. Each can be done in a non-invasive manner and produce a deep sense of relaxation. The light pressure makes it possible to help patients who cannot tolerate other forms of bodywork.
The class covers the inter-relationship of the lymphatic and fascial systems. A review of current research and its clinical applications, indications and contraindications, the importance of breath work, and the lymph circulation of the nerves are included in the lecture. The technique portion covers the gentle application of shearing and stretching techniques for both systems, with an emphasis on palpation. Treatment plans for chronic inflammation, post surgical recovery and chronic pain conditions are discussed.
Manual Therapy for the Fascia
Laurie McLaughlin, PT, DSc, FCAMPT, CMAG – Owner/Director of M+D ProHealth, ProActive Education, speaker, Fascia 2007
This workshop will describe and demonstrate a journey of ’Practice Based Evidence‘ where clinical experimentation evolved into a systematic clinical approach, hypothesis generation and ultimately support from the literature for these hypotheses. Clinically the fascial system is engaged through body positioning highlighting the continuity of the system as well as fascia‘s role in transmitting force and load. Layered palpation is used to identify specific restrictions and traditional manual therapy techniques are applied to free the restrictions. Given the typical outcome of reduced pain and improved proprioception, fascial innervation was hypothesized and found to be the case. Fascia also appears to be responsive, as restrictions are often found to be localized to an area of articular dysfunction. Since fascial fibroblasts transition to myofibroblasts in response to mechanical tension and inflammatory cytokines, they may be responsible for this clinical observation.
The clinical aspect of the workshop will involve body positioning following known fascial planes, isolating fascial restrictions in those positions and performing mobilization techniques. This will be demonstrated and practiced. The theoretical aspect of the workshop will use current evidence to support the proposed hypotheses.
Extensore Coxae Brevis: Fascial Release Treatment Options for the Deep Lateral Rotators
Tom Myers, LMT – Director Kinesis, Inc.
This workshop is designed to enhance available treatment and education options for both manual and movement therapists for issues around the posterior pelvis and the postural functions of each of the six deep lateral rotator group (which act as short extensors of the hip – hence ’extensor coxae brevis‘) and surrounding fascial tissues, as it relates to pelvic tilt, and easy functioning of the hip, SI, and lower lumbar joints.
Students will be able to:
- Palpate and distinguish each of the deep lateral rotators, gluteus medius and minimus, sacrotuberous ligament, long dorsal sacroiliac ligament.
- Distinguish the functions of each of these structures as they relate to hip stability and function, SI joint stability and function, and (indirectly) on lumbar spine joints and function.
- Assess pelvic tilt and functional motion in general, and fascial and myofascial tonus of each of these structures in particular.
- Apply manual therapy or movement-based educational techniques to specific patterns of pelvic holding, including those for excessive concentric or eccentric loading.
- Explain the muscle balance between the psoas major and piriformis muscle, and between the iliacus and obturator internus muscle.
The fan of short muscles from the greater trochanter of the femur to the coxae and sacrum are crucial to easy hip function, proper SI joint accommodation, and proper excursion of the lumbar spine in standing, walking, and under load.
- reviews fascial and myofascial anatomy of the area
- gives visual and palpatory assessment tools for planning treatment
- teaches treatment options for both eccentrically and concentrically loaded tissues
Reference will be made to fascial connections to other parts of our locomotor system via the myofascial meridians known as the Anatomy Trains.
The Fascial Manipulation Technique and its Biomechanical Model – A Guide to the Human Fascial System
Antonio Stecco, PM&R, MD and Julie Ann Day, PT
The purpose of this workshop is to illustrate the latest research concerning the gross and histological anatomy of the superficial and deep fasciae of the human body, and to explain the biomechanical model for the human fascial system currently applied in the manual technique known as Fascial Manipulation.
We intend to:
- Outline the anatomical research that has verified and modified the anatomical basis of the biomechanical model currently applied in Fascial Manipulation.
- Introduce and explain the basic principles of Fascial Manipulation (myofascial unit, centre of coordination, centre of perception)
- 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
- Demonstrate the application of this technique in a clinical setting
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.
Half Day / AM Workshops
Functional Fascial Taping (FFT) / Upper Limb Tension
Ron Alexander, RMT – Director/Founder of the Functional Fascial Taping Institute
Chris Murphy, MCSP, MSc, MMACP – Director of PhysioUK
The FFT workshop teaches participants an innovative way of taping to create an immediate and often significant analgesic effect, and an increase in range of movement facilitating accelerated rehabilitation of musculoskeletal pathologies. The workshop is a mixture of demonstration and practical application, with hands on guidance and discussion. Participants will learn an objective assessment procedure that is functionally assessed and functionally applied for pain-free movement to encourage normal movement patterns. The presentation will include a three-year follow up case study, and in light of evidence-based medicine, clinical overview of a randomized double blind placebo controlled trial for Non-Specific Low Back Pain. Participants will observe the presence of mechanical load applied to the body via real time ultrasound investigation [potentially Myofascial Fascial Release]. This workshop may facilitate interest for scientific investigation of the mechanism by which it works. This interactive workshop will provide the knowledge and skill to immediately incorporate elements of the FFT principles and concepts into clinical practice. The benefits of using FFT and tips for employing zinc oxide tape will be covered. Participants will see and experience the effects of FFT for upper limb tension, and observe dynamic assessment and tape application with movement. Numerous case examples will be presented in order to demonstrate FFT‘s clinical use in real time.
Fascial Stretch Therapy: Theory, Research & Practice
Ann Frederick and Chris Frederick, PT – The Stretch to Win Institute, PhD Cand. University of Arizona
A. Theory & Research
- To stretch or not to stretch: is that the question?
There is a growing circle of anti-stretch advocates especially since studies about these negative effects have been published, with the debate well chronicled by editor Chaitow (1,2). We will examine the debates, science & semantics of stretching. (1,2,3).
- Stretching isolated muscles
Summaries of research by Huijing, Van der Waal, Hodges, & Stecco will be presented, that suggest new anatomical and physiological models prompting us to question this assumption (8,9,10,11).
- Stretching reduces injuries
Research to support this stance as well as studies that question this perception will be discussed along with our clinical observations (5,6,7,8,9,10,11).
- Stretching and its effects on nerve receptors
Findings from scientists Ingber, Van der Waal, and Bove indicate other mechanisms besides spindles and GTOs that play an important role in this as well (9,12,13).
- Parameters of stretching
The variety of parameters— intensity, duration, frequency— found in different techniques & systems of stretching will be evaluated in the light of fascia research (2,3,4,5,6,9,10,12,13,14).
Eight key myofascial regions will be used to demonstrate & then practice the Fascial Stretch Therapy technique.
How to Diagnose Ehlers-Danlos Syndrome & Joint Hypermobility Syndrome!
Lars Remvig, MD, DMSc – Senior Consultant University of Copenhagen
The most common syndrome within the group of Hereditary Disorders of Connective Tissue is the Ehlers-Danlos Syndrome (EDS), which according to the criteria recommendation is divided into 6 different sub-types characterized by their own specific combination of symptoms and signs. Closely related to EDS – and specifically to EDS of the hypermobile type (EDS-HT) is the Joint Hypermobility Syndrome (JHS). The most important clinical signs in these two syndromes are joint hypermobility and skin signs. The two criteria sets differ very much in their demands to major and minor criteria items, but most importantly none of them demonstrate how to perform the clinical tests and specifically how to perform the tests in a reliable (reproducible and valid) way. A review will be presented on
- How to perform reproducibility studies.
- The different ways by which general joint hypermobility is diagnosed and the various ways the Beighton scoring system- the most used scoring system for joint mobility – is performed.
- The different ways by which tests for skin signs is used.
This is to be followed by a clinical demonstration, including hands-on, of how to perform, in a reproducible way, the Beighton tests and the skin tests.
Sonoelastography & Dynamic Ultrasound in Real Time as a Clinical Tool for Manual Therapy Practitioners
Raúl Martínez Rodríguez, PT/DO
Spanish National Football Federation (RFEF)/ European University of Madrid (UEM)
This workshop has three main blocks as follows:
- Theoretical introduction. There will be a theoretical and technical presentation with power point support.
- Practical demonstration through Hitachi‘s SRT equipment. Facial therapy in myofascial and tendinous injuries.
- Question & answer. Discussion time.
Half Day / PM Workshops
Critically Evaluating Research: What Clinicians Need to Know
Martha Brown Menard, PhD, CMT – Principal, Sigma Applied Research
Research literacy as a basis for evidence-informed practice remains a key issue for both conventional and complementary/integrative health care practitioners (1,2). Using lecture, discussion and practice, this half-day workshop introduces basic concepts and skills necessary for the critical appraisal of scientific literature. Emphasis is placed on evaluating research in terms of clinical as well as statistical significance. Current examples from studies presented at the Congress will be used wherever possible.
What is Moving Under the Skin? Correlating Dissection, Magnetic Resonance Imaging and Ultrasonography of the Thigh with Depth of Touch
Willem Fourie, PT – Private Practice
Using the human thigh as example and working model, this workshop will be comprised of three components: Theory, practical and discussion. The thigh has the advantage of being accessible for practical work while simultaneously representing all the possible soft tissue relationships encountered in the rest of the body.
We will introduce participants to the general fascial roles within the human lower limb as background before discussing connective tissue classification as found in the different layers under the skin. The two most common relationships between fasciae and muscles will be explained and demonstrated. Using Power Point slides, the theory will be augmented by findings from dissection, MRI and US studies of the extensor compartment of the thigh.
The concept of grading out touch will be explained theoretically with the likely physiological or tissue reactions at different levels.
The levels of touch will be demonstrated and done practically while keeping in mind which tissue layer we are targeting – skin, superficial fascia, deep fascia or myofascia. During the practical session participants will be made aware of how the two dominant fascia/muscle relationships would differ in touch.
3. Participants will be led into discussing where and how the new understanding may be transferred into a clinical setting.
Mapping the Neurofascia: A Derivation & Demonstration of Manual Treatment Principles
Michael Hamm, LMP, CCST – Instructor / Cortiva Institutes, Seattle
This workshop will demonstrate an approach to treating nerves and fasciae as a single mechanical system whose function and pathophysiology are intimately related. Using detailed cross-sectional analysis and 3D computer modeling, the folds of human fascia are named and presented in relation to neural tissues. This results in the designation of three major categories of Nerve-fascia arrangement:
A nerve (along with peri-epi-meso-neurium) traverses and branches out along a single fascial plane. This plane can be flat, twisted, concave, or convex.
A nerve passes through a fascial plane, and either a) spreads out along the plane (e.g. cutaneous nerves) or b) continues within its own sheath (as the popliteal/tibial nerve does with the aponeurosis of soleus).
3) Branching Planar
A nerve exists at the intersection line between multiple fascial planes, and branches into each of them (e.g. the brachial plexus in the proximal thoracic outlet.) These schematic simplifications (or ones like them) allow the practitioner to assemble a holistic picture of the mechanical relationship between nerve and fascia, and spur the development of specific neurofascial techniques. Some example techniques will be demonstrated, but the emphasis will be on an approach that is applicable to a variety of modalities.
Chronic Pain, Fascia & Feldenkrais; Using Bones to Manipulate Fascia and Influence Chronic Pain
Diana Thompson, LMP – Immediate Past President, Massage Therapy Foundation
Barbara Frye, LMP, GCFP
Experience the Feldenkrais Method® as a tool for assessing and treating fascial distortions as they relate to chronic pain. The gentle manipulation of bones is used as a tool for manipulating fascial restrictions, easing the persistent over-stimulation of the nervous system common with chronic pain. While acute pain can often be addressed with direct interventions, chronic pain interferes with the body on a systemic level. Pain no longer provides accurate information that might help one to modify activities and support healing behavior. The nervous system no longer functions normally, the person is unreasonably responsive and reactive to non-noxious stimuli, and typical treatment strategies are no longer effective. A gentle method may be warranted and an indirect approach appreciated. Moshe Feldenkrais, a physicist and contemporary of Ida Rolf, developed a unique method of teaching people to discover ease and grace through movement in spite of their chronic pain and functional or physical limitations. Learn to apply some of these strategies to the fascial distortions and ease the symptoms and expressions of chronic pain.