Leon Chaitow

Criteria for topic inclusion in this chapter

As research into, and knowledge of, connective tissue and fascia have grown over the past decade, so has interest grown amongst practitioners and therapists in respect to their multiple roles in the body.

The renewed and expanded focus on this topic has resulted in two World Congresses on Fascia Research First International Fascia Research Congress, Harvard Medical School, Boston, October 2007 Second International Fascia Research Congress, Free University, Amsterdam, October 2009. As demand has grown for an evidence-base to support the safe use of manual and exercise-based therapeutic modalities (Sackett 2000), it has become increasingly important to attempt to establish which of the many techniques, modalities, systems and methods currently in use by manual therapists, practitioners and physicians, actually do influence fascial behavior.

Additionally, the mechanisms involved when fascial structures are treated, manually or by other means (needling, mechanical force, exercise, etc.), have attracted growing research interest.

The selection of topics in this chapter therefore reflects a wide spectrum of modalities, ranging from approaches where fascia is clearly and directly affected by the therapeutic methods under discussion, to those where effects on fascia are more speculative and general.

In some examples there is compelling evidence of a fascial connection, as in descriptions by Stecco and Stecco, of Fascial Manipulation^®, in Chapter 7.7.

In other chapters, the connection between the method under review and fascia is more hypothetical; for example, in descriptions (Chapter 7.22) of the possible influences on fascial structures of Pilates methods. This in no way implies that Pilates does not influence fascial structures, for clearly that would be unlikely. However, the precise ways in which the exercises, positions, repetitions and activities associated with Pilates (or yoga for that matter) involve fascial structures remain largely under-researched and speculative.

Because lack of proof of efficacy is not the same as proof of lack of efficacy, the methods and modalities discussed in this section have been included either because the proposed mechanisms, associated with the particular method under review, are known to have fascial effects, or because they are proposed by the users of the method to have such effects, and that this proposition has not, as of now, been shown to be unfounded.

Where evidence does exist of connective tissue/fascial influences in relation to particular therapeutic methods, research evidence is presented and discussed, together with further reading suggestions.

Where no research evidence exists to support proposed mechanisms and/or purported fascial connections, the discussions of these are expressed as hypotheses, as though they may be accurate, but that this has not, at this time, been verified.

Old methods updated and new ones emerging

Some methods and modalities that have been in existence for many years, such as connective tissue massage (or CTM, now commonly termed connective tissue manipulation), have seen major growth of interest and application. A greater understanding of the potential for reflex effects that may be obtained via active and sometimes marked stimulation of fascial structures, as well as the benefits to be noted in terms of functionality and mobility when dense areas of fascia are modified by these means, offers credence to some of the early theories associated with CTM. Prendergast and Rummer (Chapter 7.6) offer a comprehensive overview of modern CTM.

Much the same is true of Myofascial Release (MFR) techniques, which have evolved and in some cases been renamed (as has CTM, mentioned above) as a result of current research and investigation via dissection, as well as because of evidence emerging as a result of use of modern investigative tools such as real-time ultrasound and elastography. Myofascial Induction is the name that Andrzej Pilat, the author of Chapter 7.4, has suggested. In that chapter he has elegantly described the methods, as well as the known and hypothetical mechanisms associated with MFR, which appear to achieve its beneficial therapeutic effects via changes in the colloidal state of loose connective tissue, allowing it to modify in response to light sustained forces.

Other approaches have evolved directly from a greater understanding that has emerged from animal studies, as well as human dissection and clinical observation. These include the evolution of Fascial Manipulation^® (FM^®) in which the results of complex assessment and analysis of movement patterns lead to estimations as to the most likely fascial structures that require targeting for treatment. A plethora of clinical studies have helped to refine and confirm the underlying premise of FM^®. In Chapter 7.7, Stecco and Stecco explain both the background and methodology associated with Fascial Manipulation^®.