Fascia: Clinical and fundamental scientific research

Considering the scientific process

Many of the chapters of this book deal with fascia in relation to practical aspects of the manual therapies.

The chapters within this section (and a few that, for practical reasons, ended up in other sections of the book, see Chapters 1.1, 3.1–3.2, and 5.8) are in some ways quite different: The knowledge described in the chapters of this section is mostly a result of fundamental scientific research, which in most cases did not have the manual therapies or other application in mind, and initially, may not even have had the fascia as the target. An example in case is the work on force transmission that was aimed at studying muscle function per se. However, unexpected and thought-stimulating results have indicated a new direction in which all kinds of fascial structures of the body are likely to play a major role.

Fundamental scientific work is necessary for future developments in science, but also in therapy in general, and likely also in the manual therapies. A problem with fundamental scientific work is that it is impossible to predict which work and which specific results will be highly relevant for practical application in the clinical fields. To politicians, science managers and clinicians, without an open mind, as well as a clear understanding of the actual process of scientific advancement, the scientific process described is highly unattractive, because money needs to be spent on projects for which the full outcome is unclear. The only thing that can be tested for is scientific quality, and even that is not always an objective process. Only in retrospect (sometimes many decades or in exceptional cases centuries later) is clarity provided as a few relatively small scientific steps ahead are combined into something very new. Then it also becomes clear that a lot of work was performed that did not yield any results for practical application even though some of it may have advanced general understanding of fundamental principles.

However, Comroe & Dripps (1974) analyzed and reported crucial sources of the top ten clinical advances in cardiovascular and pulmonary medicine and surgery over a period of 30 years (within the last century). Their conclusion was that 41% of over 500 key articles that allowed or contributed to these advances in a major way were written by scientists who had no direct interest in disease, and that 62% were the result of basic research. These results have later been the subject of sometimes heated scientific debate (e.g., Smith 1987) that does not always seem fully free of external motives (competition for limited available resources). Regardless of the proper scientific questions that may be asked concerning this, it is clear that both clinical and fundamental research activity is essential for the advancement of knowledge that may allow changing clinical practice.

The above may create the impression that the role of scientists is limited to just creating new knowledge. Even though that is their primary task, scientists have a moral obligation to be interested in the application of their work as well, if the knowledge gathered has reached a level where application is likely. The authors of more fundamentally oriented chapters of this book seem to be fully aware of this.

After contact between clinicians and scientists has been established, difficulties of language will inevitably arise (it should be clear that we do not mean different mother tongues by this, even though that can contribute to the confusion) and need to be overcome through agreement on a common set of ideas and nomenclature, before fundamental–clinical collaboration can work to advance knowledge and understanding.

Since both types of workers do that from a quite different perspective, the exchange of ideas will certainly not be unidirectional, but create potential chances for new insights on both sides. The recent interactions between clinicians and scientists in the so-called Fascia Research Congresses are good examples of willingness to create such common conditions, and also one of the major drives for the present book.

One factor in science may be quite puzzling to the non-scientist, and that is controversy. Actually, controversy on content and ideas is a major driving force of science and therefore an essential part of it. The intellectual clash of minds is crucial to filter out confounding information and select generally accepted methods and concepts. For that reason we have chosen not to remove all controversy from the content of the chapters. For example, among the scientific authors of this book, ideas about the importance of the continuity of the connective tissues in, for example, a limb may differ quite a bit: Some are convinced that the physiological effects of such continuity are limited to the borders of a fascicle within a muscle, and others think that they have sufficient evidence that intermuscular mechanical interaction is a prominent feature. If you read with an eye for detail you may even notice that the co-authors of one chapter may differ.

This means that the scientific (but probably also the clinical) material of this book should not be looked at as a static feature, but as knowledge that will be developing continually. In that sense we are certainly not presenting “the truth” as an unchanging character. By incorporating such aspects, this book will not be like most textbooks.

The dynamics of this process also require of both scientists and clinicians that they try to keep up with developments in each others’ fields. That is certainly not an easy task, but it remains an essential one. It requires also from both sides that “unwanted” results (deviating from the preconceptions of each profession) should be fully considered in detail and accepted if sufficient evidence is presented.