2015 Post-Conference Workshops

This workshop will introduce participants to the Fascial Manipulation® method. This manual therapy is based on an innovative biomechanical model for the human fascial system that is supported by numerous fascial anatomy studies. Developed by physiotherapist Luigi Stecco, the biomechanical model represents a 3-dimensional interpretation of the human fascial system (Stecco L, 2004) that facilitates the comprehension of fascial dysfunctions. The focus of this workshop will be on the musculoskeletal system and its relationship with the deep fascia.

In the morning session, the gross and histological anatomy of the human fasciae, as studied by the Stecco group from Italy, will be presented by two experienced practitioners and teachers of the method.

These studies include:

• histology of superficial and deep fasciae(Stecco et al, 2006),
• innervation of the deep fascia (Stecco et al, 2007),
• structure of the deep fascia(Stecco et al, 2008),
• the potential role of deep fascia in proprioception (Stecco et al, 2010),
• physiological mechanisms of manual techniques and their influence on extracellular matrix components (Stecco et al 2013; Pavan et al, 2014)
• fascial continuity between different body segments via myotendinous expansions and mechanisms of tensional force distribution (Stecco C, 2014).

These studies have validated aspects of the biomechanical model currently applied in the Fascial Manipulation® method. The biomechanical model will also be explained in the morning session.
It introduces the concept of myofascial units united in myofascial sequences. The Fascial Manipulation® method involves an initial interpretation of fascial dysfunction by means of movement and palpation tests followed by manual friction over selected small areas known as centers of coordination, which are located on the deep muscular fascia (Stecco L & Stecco C, 2009).

The afternoon session will be dedicated to practical sessions and demonstrations, including:

• a hands-on session where participants will learn the 6 centers of coordination for the knee segment and the basics of the manual technique applied in this method.
• a demonstration of a treatment using the Fascial Manipulation® method

A brief introduction to the Fascial Manipulation® approach to internal dysfunctions will conclude this workshop.

In the human embryo the fascia is (in combination with blood) the main appearance of the quality of ’meso‘ (mesenchyme), which is one of the three basic germ layers of the human organism. Actually the usual term ’Mesoderm‘ is not correct, because it does not value the functional architecture of ’meso‘ as ’inner tissue‘ and as being a different quality than ectoderm and endoderm, the latter two functioning as body limiting dimensions (body walls). Actually it are not the viscera that represent the ’Inner‘ of our body organization but that is done by the ’meso‘. This might also refer to the quote by AT Still mentioning the fascia as the domain where soul is dwelling. What do soul and fascia actually have to do with each other? A phenomenological approach of the morphology and embryology of the human body might throw some light on this.  First, the embryo clearly shows that the body is a process, in this way respecting one of the central notions of AT Still‘s philosophy: Man is Mind, Motion and matter. Secondly the embryo shows clearly that the body is NOT constituted from or by elements like cells, organs or germ layers. The germ layers will be introduced as more than just morphological principles, is are also functional and even psycho-morphological principles. The typical Blechschmidt view on the human embryo as phase or being with morphing ’behavior‘ will be extended to the theme that Soul is pre-exercised in the body‘. The body (including fascia) as behavior. This phenomenological approach might throw new light on the MEANING of the bodily organization including connective tissue, fascia en the so-called posture-locomotor-system.

In this seminar it will be demonstrated that not structural anatomy but a functional architecture is the suitable approach to fascia and that the fascia might be considered as the major representative of the meso-quality in the body and best may be understood by a holistic approach instead of the usual analytic approach. Therefore the fascia may be considered as an (the) organ of innerness where the soul is dwelling (AT Still).

After having participated in this workshop the student:
– will be introduced to the phenomenological approach as to anatomy and embryology, resulting in a so-celled dynamic morphology and embryology;.
– will be able develop new arguments in the philosophical debate about Body and Soul? Duality, Polarity and/or Unity? in particular in regard to the issue of body and awareness and the functional role of other organs than the brain in this respect;
– has been introduced to the polarity approach in human biology and the contribution that this approach might provide to the understanding of the human being as triune in the sense of AT Stills central item Man is Mind Motion and Matter;
– understands the architectural approach as to function and anatomy of fascia in relation to the functionality of the germ layers, the meso(derm) in particular;
– is able to understand the embryological approach as presented by Erich Blechschmidt as truly psychosomatic morphology: Soul as being pre-exercised in the body.

MORNING SESSION 9 AM TILL 12 PM (WITH BREAK)
Mind and body in the womb?
What are we actually doing as embryo? Gestures of growth as human behavior and expression. The ’body formative soul‘ pre-exercising in shapes and Gestalt.
The embryo in us – Embryonic life not as past but as present
Consciousness & vitality as polarities. The body developed out of us, not we from it. ’Sperm cellularity‘ and ’egg cellularity‘ as manifestations of the Breath of life.

AFTERNOON SESSION 2 PM TILL 5 PM (WITH BREAK)
Polarity Thinking as fundamental approach in biology.
The germ layers, their origin, function and appearance. Individuation of the body. Blood as organ. The Middle and Innerness appears in the fascia and the blood.
Threefoldness of body and soul.
In all body dimensions the polarity principle comes to appearance.  Polarities in the development of the ’musculoskeletal‘ system as expression of two force principles working in the system. The failing concept of bones, ligaments and muscles as the constituting element of the locomotor and posturing system (LPS).

Relevant literature
Wal, Jaap van der, 2003, Dynamic Morphology and Embryology, In: Bie, Guus van der and Huber, Machteld (eds.), Foundations of Anthroposophical Medicine, Floris Books, Edinburgh, ISBN 0-86315-417-4: 87 – 161.
Wal, Jaap van der, 2007, The Speech of the Embryo, In: Michael J. Shea, PhD, Biodynamic Craniosacral Therapy, Vol. 1, North Atlantic Books, Berkeley California, USA: 83 – 102, ISBN 978-1-55643-591-1.
2012, Wal, J.C. van der, Proprioception, Mechanoreception and the Anatomy of the Fascia. In: Robert Schleip et al. (eds.), Fascia: The tensional Network of the Human Body, Chapter 2.2: 81 – 87, Churchill Livingstone Elsevier, ISBN 978-0-7020-3425-1.
Wal, Jaap van der, MD PhD, 2013, The Embryo in us – A phenomenological Search for Soul and Consciousness in the prenatal Body, Journal of Prenatal and Perinatal Psychology and Health, Volume 27, Issue 3, April 2013.

Fasciatherapy DBM stimulates the physiological plasticity of the fascia and in particular the modulation of its tonus. This full day workshop is designed to introduce the theoretical basis of Fasciatherapy DBM to manual and movement therapy practitioners (morning session), and to allow them to experiment this body-mind integrated manual approach (afternoon practice). The participants will begin to learn psychotonic touch and how it can be applied with patients suffering from various forms of tension, muskuloskeletal disorders and symptoms related to stress.

Over the course of the workshop, the following will be covered:

• Presentation of the psychotonic touch as distinguishing feature of the body-mind connection of the fascial system and the manifestation of the living dynamics of human fascia;
• Presentation of its action on fascial and vascular stress (Quéré et al, 2009, Payrau, Quéré, 2011), and on changes in patient‘s general body perception and their psycho-emotional state resulting in a strengthened sense of self (Courraud, 2007, Duval, 2010, Bois, Bourhis, 2010, Angibaud, 2011);
• Experimentation through a manual therapy session during which the participants will be guided to learn to trigger the fascial psychotonic modulation (slowness, supporting points, anchor points) and to recognize the different phases of regulation (time needed for the psychotonus to rise, spread and intensity of the response, peak response, release)
• Verbal feedback from the participants on the various sensations perceived and how this experience furthers their knowledge of human fascia and how it can be approached through touch.

A team of experienced practitioners will be assisting in the workshop by guiding the participants to explore the touch.

Patients often present challenging symptoms with chronic pain, which may not show typical dermatomal or myotomal patterns.  The symptoms may be remote from the apparent area of injury, including referred pain, stiffness, muscle weakness, and abnormal sensations.  Many of these clients experience myofascial dysfunction.  Fascial restriction does not appear on standard x-rays, MRIs, or examinations.  It is readily identified by the skill of a manual therapy practitioner, using motion testing and posture analysis.  Myofascial restrictions can influence functional movement patterns.  Symptoms may appear from months to years post-injury.  It may occur at the point when the body has maximized its adaptive potential and loses the ability to compensate for abnormal tension.  Standard treatment protocols using medication, exercise, and modalities may fail to address the problem effectively. Manual release of these abnormal tension barriers is essential to manage painful restrictions and to restore functional, pain-free motion.

In this hands-on intensive workshop, participants will:  

• Explore fascial function and anatomy.
• Learn how to differentiate between conditions, such as myofascial pain syndrome and fibromyalgia.
• Identify motion restrictions through hands on motion testing and palpation lab practice.
• Apply and experience apply myofascial interventions to make a difference in mobility, circulation, and posture, and decrease painful restrictions.
• Discuss current research on fascial function and therapies. 
• Use myofascial release and make an impact to achieve improved functional outcomes in your practice.

Participants must bring body draping such as a sheet and patient gown or halter top and shorts, massage lotion, and hand sanitizer.

This hands-on interactive workshop will give practitioners essential skills to attain more targeted and effective treatment plans for their clients. The workshop will employ lecture, hands-on learning and skill building related to evaluation and treatment of the Myofascial system.

Fascial evolution and human tool use bears relevance in today‘s world of technology. Today, computerized devices are becoming human‘s primary tool and upper extremity injuries are becoming an epidemic.

This workshop examines anatomy, physics and biomechanics of upper extremity evolution in primates & homo sapiens. We will study how and why our thumb, hand and arm came to be and consider the fascial relation to thumb opposition and brachiation through study of primate videography. Myofascial Length Testing will be instructed, a key objective evaluation tool that will standardize nomenclature among structural integrators, a critical component in conducting evidence based research to improve clinical outcomes.

Attendees will explore specific upper extremity pathologies along the Anatomy Trains Arm Lines in order to asses, treat and prevent injury in themselves and in their patients/clients. Lastly, workshop participants will put it all together for an integrated- evolutionary- mindfulness based movement experience!

This workshop teaches participants an innovative way of treating fascial restrictions. The method creates immediate improvements in range of motion and postural symmetry to access symmetrical motor control. Its foundational concepts employ principles of the fascial continuity throughout the body and modified Counterstrain.

This workshop is interactive: combining demonstration, hands-on practical application with feedback, discussion and presentation of numerous case studies demonstrating TMR®‘s use in assessment and treatment. Attendees will leave able to immediately incorporate the concepts into clinical practice.

By the end of this course, the participant will be able to identify and experience basic limitation in mobility related to fascial restrictions and understand the connection between limitations and functional outcomes. They will gain new understanding of how the body heals by using a modified version of modified Counterstrain. They will be able to use this understanding to explain the essential TMR® concepts to patients and caregivers, which will empower them to identify issues in their own bodies and those of the individuals under their care.

The major learning objectives of this workshop are for participants to:

• Understand the relationship between the thoracic and pelvic directions of ease in the CCP.
• Describe the connections of fascial bias in the body and understand the interconnectedness of fascial tissues.
• Understand and describe the 5 grades of tortisoma and their significance in the development of motor control.
• Explore possible connections between immobilization, adaptive shortening and common postural asymmetries.
• Become familiar with the 6 TMR® motions.
• Have ability to describe how the counterintuitive approach allows TMR® motions to indirectly correct mechanical and physiological issues elsewhere in the body.
• Use this knowledge to effectively perform the upper twist TMR® motion on themselves and a partner to improve range of motion both locally as well as elsewhere in the body.

The purpose of the workshop is to enable manual practitioners to perform a precise diagnostic of shoulder dysfunction (especially the impingement syndrome) and to recognize and localize those fascial layers related to the dysfunction.

The workshop will give an introduction to various manual palpation techniques related to parietal fascia and visceral fascia. The focus related to parietal fascial layers will be especially on the subdeltoid fascia, including the layers related to the m.pectoralis minor, to the m. supraspinatus and infraspinatus, to the m.subclavius. It will also include the fascia of the m. latissimus dorsi and m. teres major and to the m.transversus thoracis.

The focus related to visceral fascia will be on the fascia close to the respiratory diaphragm, especially connective tissue enwrapping the lever and stomach and the suspensory ligaments of the lungs. It will also include the endothoracic fascia and the pleura and the different fascial layers of the neck.

The learning objectives are:

• Recognize fascial layers related to viscera and muscles that play a role for shoulder dysfunction
• Recognize areas that show the presence of receptors of the nervous system, related to fascia
• Develop competence for precise and efficient treatment of parietal and visceral layers related to shoulder dysfunction

This workshop will be dedicated to the mechanics of the musculo skeletal system with particular emphasis on the human spine. There will be four sessions of 90 minutes each with additional time for discussion.

The first objective of this workshop is to merge disparate concepts in spine biomechanics into a unified theory integrating the motions of the various components of the musculo skeletal system. In so doing, we will review and debunk hard lived fairy tales that are taken for granted in spite of the evidence. In particular, we will show that anatomy is determined by function and not the other way around. The apparent infinity of movements are, in fact, restricted and coordinated so that the overall energy consumption of the animal is minimized while the stresses within the tissues are as low as possible.

The second objective applies these ideas to the study of the normal and abnormal spine in a way consistent with the observed pathology. The exquisite coordination between fascias and muscles will be laid out in detail for simple tasks such as lifting and walking and running. The critical role of the earth gravitational field in the sequence of energy transfers that makes our bipedal form of locomotion so efficient will be detailed. We will show how the anatomical damages that result from injury can be compensated by other appropriate anatomical deformations so that overall function is maintained in spite of the injury. This suggests that normality ought to be defined in terms of the ability to move optimally rather than anatomical perfection. This brings up the need to avoid over reading radiological, MRI, ultrasonic data and the like in attempting to deduce function from anatomical data.

The third objective proposes a method for assessing the function of the normal and abnormal spine, and demonstrates, on real subjects, the compensation mechanisms that occur after injury. This resulting functional diagnostic has been used on over half a million of cases. In particular, it is possible to assess the effectiveness of manual therapy within minutes after a single manipulation and objectively track the evolution of a subject over any period of time during a treatment. In so doing, restoring the control of lordosis emerges as a critical step in the return to normality. That approach rationalizes the success of many rehabilitation techniques such as yoga, since its modalities are well suited for the restoration of lordosis control.

The fourth objective shows how this knowledge can be captured and executed by an automaton without having to insert subjective information such as pain or clinical data. This illustrates how seemingly complex decisions can be broken down into smaller steps capturable and executable by artificial intelligence techniques. This technique suggests that it may be possible to describe the modalities of the various schools of thought (osteopathy, chiropractic, physical therapy etc.) in terms that can be compared while appreciating the effective ingredients present in a given rehabilitation protocol. Indeed, since a patient‘s pathology is a function of the patient, it would appear reasonable to think that the rehabilitation protocol should be strictly dependent upon the patient‘s pathology rather than the clinician‘s training or philosophical beliefs.

The fifth objective shows how these methods have been assessed using the type of blind studies with control groups recommended by the NIH. In so doing, the performance of human clinicians versus the automaton raised serious concerns about the type and quality of information capturable during a clinical examination, while laying out in ruthless detail the role of pain the decision making process. In so doing, pain appears to be both a blessing and a curse that may sometimes obscure the real condition of the subjects by altering the objectivity of the clinician. Time permitting, a proposal to resolve this conundrum will be also suggested.

All surgeries/traumas lead to adhesions between the skin and underlying structures. This can disrupt the normal gliding between the structures, and may affect normal function.  Adhesions are expected to cause abnormal afferent input to the central nervous system, leading to altered function. Prevention of adhesions and facilitating augmented healing in connective tissue may allow for less pathological presentation.

Surgery is often very invasive, and typically involves significant damage to fasciae.  The result is scar tissue and associated abnormal function.  It is important for therapists to be able to educate their patients on the effects of scarring and adhesions on fascia structures and interfaces.  Therapists will be capable of instructing patients on the mechanism and timing of their injury, as well as prescribe home care.

This course will take an evidence-based approach to the treatment of patients who are suffering from complications due to surgically or trauma induced adhesions.  The process of scarring and adhesion formation will be presented with an eye to effective timing and science available for treatments. 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, and
3. Sensory mechanisms relevant to scars and adhesions, including the peripheral and central nervous systems.

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 of recurrence.

Learning outcomes include:

• Knowledge of surgical and medical interventions.
• Knowledge of presentation patterns.
• Understanding cellular level healing mechanisms
• Confidence and understanding sufficient to initiate safe treatment.
• Evidence informed approaches to treatments.

This seminar-workshop is based on current research and clinical experience in the diagnosis and treatment of Lateral Epicondylalgia (LE). The diagnosis and treatment of LE is challenging due to its unclear pathology. This leads to an increasing number of patients suffering from chronic elbow pain which in turn affects their work.

This course is underpinned by evidence based reasoning guiding the diagnosis and treatment of LE. The course is divided in two didactic sessions:

1. The Fascia in the Lateral Aspect of the Elbow Joint Complex: A Cadaver Dissection and;
2. The Diagnostic Accuracy of Provocation Tests and Musculoskeletal Ultrasound in Determining LE.

There are two practical sessions:

1. Ultrasound of the Elbow and;
2. Biomechanical Taping. 

Through research and clinical practice, Biomechanical Taping was developed and continuously improved by Dr Valentin C. Dones III. In unpublished case studies which were conducted by Dr Dones with the University of Santo Tomas (a premier educational institution in rehabilitation sciences in the Philippines), Biomechanical taping decreased the pain and improved the function of patients suffering of LE. Since its inception in 2007, Biomechanical taping has been used by Filipino physiotherapists in treating LE. According to clinicians, this taping technique was effective in providing immediate pain relief to elbows of patients with LE thus enabling them to participate in exercises and consequently maximizing their rehabilitation potential.

Various studies on the optimal management of acute ankle sprains prefer a functional treatment approach. In practice, however, patients tend to be impaired by pain and limitation of movement, especially in the acute phase. This can lead to unnecessarily long Immobilization times.

Treatment along the premises of the Fascial Distortion Model FDM after Typaldos focus on manipulation of the fascia in the area of injury to improve pain, mobility and resilience shortly after the injury and thus support the rapid return to work and sport.

Stephen Typaldos D.O., an US-American osteopath, developed the FDM  in the 1990s based on empirical research. With ankle injuries he observed various posttraumatic complaint patterns, which express patients through their verbal description and the presentation of intuitive gestures. Fascia due to the FDM acts as the organ, which is mainly responsible for pain and functional limitation and is the objective of any manual techniques for the correction of the so-called fascial distortions.

This workshop presents the basic principles of the Fascial Distortion Model FDM after Typaldos and explains the approach to diagnosis of fascial distortions in theory and practice on the example of ankle sprains. Specific handles are presented and practiced, so that the knowledge gained from the workshop can be applied immediately in practice.

Learning Objectives:

• Historical background and development of the FDM through Stephen Typaldos D.O.
• Theory about the six principal fascial distortions in terms of diagnosis (through evaluation of body language and gestures, anamnesis and examination) and general treatment approaches
• Diagnosis of the most common sprained ankle types according the FDM diagnostic procedure including Triggerband sprained ankle, Continuum Distortion sprained ankle, Folding Distortion sprained ankle 
• Clinical reasoning process about manual treatment possibilities with regard to the evaluation of the current sprained ankle management and to contraindications
• Identification of the  adequate FDM treatment approach for the most common sprained ankle types with knowledge about contraindications, additional treatment options, side effects and expected outcome 
• Presentation of basic manual FDM techniques for acutely sprained ankles

The FFT workshop teaches participants fast and often significant analgesic effect which can increase function and accelerate rehabilitation of musculoskeletal pathologies. The workshop is a mixture of demonstration, 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 an overview of a randomised double blind placebo controlled trial which has shown to have a significant effect for Non-Specific Low Back Pain (Chen etal., 2012). Participants will observe the presence of mechanical load applied to the body via real time ultrasound investigation [potentially Myofascial Fascial Release]. This work shop 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. Participants will see and experience the effects of FFT for Low Back Pain, Plantar Fasciopathy and observe tissue assessment and tape application with motion. Numerous case examples are presented to demonstrate its clinical use in real time.

Learning Outcomes – on completion of this workshop a participant will be able to:

1. Demonstrate the use of digital distraction to asses if FFT will be effective in a presenting patient.
2. Safely and effectively apply FFT for Low Back Pain and Plantar Fasciopathy.
3. Justify their rationale for choice of taping direction.
4. Plan how FFT will integrate with other treatment interventions.

Fascial-treatment has become very popular these days, but, as we often hear, the missing link seems to be the precise knowledge of the anatomy of the fascia. Without knowing how and where to palpate a fascia, it becomes very difficult to recognise the fascia´s condition. When is the fascia´s condition physiological? What  does a pathological condition feel like? Where is a fascia supposed to slide and to glide, where should it be stable and anchored?

The Fascia´s state depends on that particular function of the part of the body it is found in and is therefore very differentiated. In some regions the fascial layers must be able to slide, in other parts of the body they function as anchors and in other parts they function as a kind of bumper. In specific regions of the body the fascial layers are strongly connected with each other or with other structures such as bones, joints, muscles and organs to provide physiological stability, whereas in other regions movement and gliding are the main issues.

Appropriate knowledge and understanding of anatomy enables us to recognize which of the connections are physiological and which of them are pathological. It is the only way to make the proper decision where and how to treat.

This workshop provides a detailled understanding of the anatomy and physiology of the fascia, together with their threedimensional location, layering, alignment as well as their territorial arrangement. And it offers an impression of the connections between the visceral and the somatic fascia.

In a practically orientated approach manual accesable fascia layers will be palpated,  their physiologial condition will be evaluated and compared with the assesment of the palpation.

Outcomes of measuring fascial health in individuals with Fibromyalgia, a pilot study in 2014, supported that it is necessary to include protocols that target the fascia. The purpose is to further the understanding and define fascial health protocols. To demonstrate clearly that managing widespread pain must include treatment of the fascia as we are structured determined systems, and to decrease pain is to invite change in the structure through the fascial matrix in order to have a correlating change in the central nervous system. In this way we restore homeostasis in the client.

This workshop will include the history of fibromyalgia (FM), current findings in fascia research that correlate to FM, research that draws parallels between the benefit of structural integration to address symptoms of FM, and a summary of effective alternative medicine and complementary alternative medicine (CAM) therapies for FM. Lastly, I recommend a proven protocol for managing the fascial health of those with FM that includes structural integration, diet and nutrition changes, and gentle exercise that stimulates the mechanoreceptors of fascia. The final section will allow time for demonstration of structural integration techniques and myofascial yoga.