Fascia, Function, and Medical Applications
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Fascia, Function, and Medical Applications

David Lesondak, David Lesondak, Angeli Maun Akey

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eBook - ePub

Fascia, Function, and Medical Applications

David Lesondak, David Lesondak, Angeli Maun Akey

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About This Book

Fascia, Function, and Medical Applications is essential reading for medical and allied health practitioners who want to bring scientific insights of the importance of fascia to human health into their clinical practices.

Fascia – the biodynamic tissue that connects every muscle, bone, organ, and nerve in the body – is fast becoming the latest trend in healthcare and allied health modalities. This book is edited by David Lesondak, University of Pittsburgh Medical Center, author of the international bestseller Fascia: What it is and why it matter s, and Angeli Maun Akey, MD, international physician educator and board certified in both internal and integrative medicine. It contains contributions from a team of top researchers and expert practitioners including physicians, clinicians, therapists, dissectors, and surgeons.

Fully illustrated in color, this book presents the latest scientific knowledge of fascia and explains insights into problems like chronic pain and myriad musculoskeletal symptoms that may not respond to conventional treatments. It gives practitioners the information they need to make better decisions to improve the health of patients often without pharmaceuticals or surgeries.


• Provides comprehensive overview of how fascia, as a tissue and a system, affects various body functions and systems, from musculoskeletal disorders to nervous system, circulatory, and auto-immune function.

• A section devoted to medical applications highlights a comprehensive and critical overview of various fascial therapies.

• Gives practitioners the knowledge they need to refer or add as an adjunct therapy to their department or rehabilitation team.

This is a cutting-edge, practical guide that will appeal to researchers, physicians, and clinicians alike.

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CRC Press

Section III

Medical Applications

Interstitial Notes on Section 3

David Lesondak


According to the anecdote, someone asked Albert Einstein what he knew for sure was actually true. Einstein’s answer was, “Something is moving”.
In the clinical world of medical applications, what is moving would be analogous to the term “release”. In this case, a fascial or myofascial release (MFR). While there is still debate over precisely what constitutes this release, physiologically speaking, in this context release is a sufficient term to describe the subjective, felt experiences on the part of both the clinician and the patient. It is the inner sensation of something “letting go”, usually resulting in a net gain of greater physical ease, improved range of motion, and so forth. It turns out that there may be more to this release that meets the eye or, in this case, the hand.
An in vitro study sought to model repetitive motion strain (RMS) and MFR on an active, living cell culture.1 The monofilaments, intermediate filaments, and microtubules that comprise the cytoskeleton of a living cell are mechanically active, i.e., they respond to mechanical stress. A vacuum-driven, flexible substrate, petri dish was employed to subject the cells to 8 h of RMS. The results were not pretty. The stressed cells exhibited elongated lamellopodia, decentralization, cytoplasmic condensation, reduced cell-to-cell contact areas, and an alarming 30% increase in apoptosis when compared with non-stressed control samples.
After a 3-h interval, the RMS samples were then subjected to a 60-s interval of MFR—compression, stretch, and shear (shear being a strain produced by pressure wherein the layers are laterally shifted in relation to each other). After this intervention, lamellopodia elongation and cytoplasmic condensation (a precursor to apoptosis) were reduced while intercellular distances and cell-to-cell contact areas were mostly restored. There was also a significant increase in the production of GRO, an important neutrophil in the innate immune system, in the RMS + MFR group.
This was the first, and to my knowledge the only time, that a study modeled MFR in an in vitro human fibroblast culture. Furthermore, it points to a deeper understanding of how manual and movement therapies may positively affect the body, right down to the cellular level.
This leads us to the following section—medical, therapeutic, applications. As with the previously highlighted research, many of these applications exist in a climate that has a relative paucity of testing and replications—not to mention robust randomized clinical trials. Our authors underscore this fact. They also point out the logic behind the various approaches and, in some instances, provide some compelling case studies.
In all cases, these modalities are thriving—both as adjuncts to more conventional treatments and as standalone procedures that get consistent results where other efforts have not. The applications covered may be more –well-known than others. Keep in mind what follows is not comprehensive.
As discussed in the preface, whenever anything “new” begins to penetrate the public sphere—especially anything that (among other benefits) purports to relieve pain—there is the inevitable “gold rush” period. During this time, therapies, approaches, and brands seem to proliferate almost overnight.
Use the same best practice principles as you would with any other medical or clinical professional when seeking out qualified individuals who practice any of these therapies.


1. Meltzer KR, Cao TV, Schad JF et al. (2010) In vitro modeling of repetitive motion injury and myofascial release. J Bodyw Mov Ther. 14 (2), 162–171.


Structural Integration

Michael Polon and Daniel Akins

Structural Integration in Theory
Structural Integration in Practice
The Three Main Interventions of SI: Physiological Mechanisms
Structural integration (SI) is an interactive approach to manual and movement therapy that also incorporates embodiment education. Since the gaining popularity of SI in the United States in the 1960s, people around the world have sought out structural integration for help with relieving pain and discomfort, improving posture and movement, and to enhance overall well-being. Structural integrators help their clients explore ways of experiencing their bodies with greater ease, comfort, and efficiency. Over the course of a series of sessions, usually 10–12, SI’s holistic approach is designed to address body-wide posture, movement, and pain patterns that have become habituated due to injury, stress, trauma, repetitive motion, or personality expression.
Structural integration (SI) is an interactive approach to manual and movement therapy that emphasizes embodiment education. Since SI initially gained popularity in the United States in the 1960s, people around the world have sought out structural integration for help with relieving pain and discomfort, improving posture and movement, and enhancing overall well-being. Structural integrators help their clients experience their bodies with greater ease, comfort, and efficiency. Over a series of (traditionally 10–12) sessions, SI’s holistic approach is designed to address body-wide posture, movement, and pain patterns that have become habituated due to injury, stress, trauma, repetitive motion, or personality expression.
Graduates of basic programs recognized by the International Association of Structural Integrators (IASI) are trained in anatomy, physiology, kinesiology, therapeutic relationship, clinical assessment, and manual therapy application. Graduates of IASI-recognized programs are eligible to sit for an exam administered by the Certification Board for Structural Integration. Passing this exam earns the practitioner the right to refer to themselves as a Board Certified Structural Integrator (BCSI).


Ida P. Rolf, a biochemist, began developing her work of structural integration in the 1940s and founded her original school about 30 years later in Boulder, Colorado, where it still operates today.1 There are currently 22 IASI-recognized SI training programs being offered across the United States, Australia, Europe, India, Brazil, and Japan.2 Graduates of these programs sometimes identify with brand names associated with their respective schools, including Rolfing, Anatomy Trains, and Hellerwork Structural Integration. The term “Rolfing” was originally a nickname given to the work by Rolf’s early students, but today the term is exclusively available to graduates of the Dr. Ida Rolf Institute.
Rolf synthesized concepts from the fields of osteopathy, hatha yoga, biomechanics, various posture and movement awareness therapies, the science and philosophy of consciousness, and somatic psychology.1 She observed that the way a person carried their body was related to a wide range of factors including muscular tone, strength, balance, previous injury history, and learned patterns of movement. Furthermore, she maintained that these patterns could be related to deeply held mind-body relationships with emotionally driven factors like body image, self-concept, and personality expression. Through this awareness, Rolf developed a ten-session process of manual therapy and somatic education that paved the way for many, if not all, of the myofascial/structural bodywork modalities that evolved since her passing in 1979. The art, science, and application of SI have since been developed into a principles-driven approach that still utilizes aspects and variations of Rolf’s ten-session series. Although the SI schools each present their own take on that series, the differences between their interpretations are considered relatively marginal.3


Although common use of the term structure tends to emphasize the physical structure of the body, modern perspectives favor more holistic definitions that are consistent with current understandings of the body as a complex biological event. Structure, when considered as any “slow pattern of long duration”,4 may include our soft tissues as well as our established neural patterns represented by our habits of posture, movement, language, and ascribed meaning.5 Structure is both ...

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