The Fascial Distortion Model

Philosophy, principles and clinical applications

Todd Capistrant, Georg Harrer, Thomas Pentzer

• Publisher: Handspring Publishing
• Year: 2021
• ISBN:
  9781912085576
• Edition: 1
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

The Fascial Distortion Model (FDM) was introduced by the American physician Stephen Typaldos (1957-2006). In this model all injuries and other conditions causing pain or disability are seen as arising from specific distortions of the connective tissue.

This highly illustrated and very practical text and manual covers in detail the theoretical framework of the model, and approaches to manual therapy treatment based on an understanding of the FDM. The authors systematically cover all disorders likely to be encountered by the therapist, and provide comprehensive guidance about when it is appropriate to use FDM and how best to employ these approaches in treatment.

The book is therefore of interest and value to all practitioners who want to understand the FDM and to incorporate its techniques into their therapeutic practice. This is also a comprehensive textbook and manual for anyone studying on FDM courses and for specific qualifications.

1

What is the Fascial Distortion Model?

The Fascial Distortion Model (FDM) is a very specific concept. A few preliminary considerations may be helpful to achieve a better understanding of the innovation offered by the FDM.

General considerations with respect to medical concepts

Since the beginning of humanity, we have been accompanied by pain, weakness, and many other ailments. These issues are unlikely to have changed significantly over millennia. Physicians and healers throughout history strove to develop explanations for the illnesses and physical complaints of their contemporaries, and depending on the time and place, the cause of an ailment might be explained as an evil spell, God’s punishment, an imbalance of the four humors, or bone marrow edema. Healers regarded their current explanations as “correct” and all previous and other explanations as at least obsolete, if not wholly wrong.

These explanations of the causes of illness are generally called “diagnoses” from ancient Greek “διαγνῶναι (diagnonai),” meaning “total insight” or “to comprehend something completely”. Diagnoses or commonly shared understandings are beneficial tools to communicate, learn, teach, and develop treatment methods. The concept of diagnosis is ubiquitous: all styles of medicines – be they Western, Eastern, or ancient – use some form of diagnostic practice to guide their treatments. No matter how fundamentally different these diagnoses seem, in the end, they are applied to the same patients, the same diseases, and the same physiology.

Diagnosis

All diagnoses consist of these elements.

•Etiology, explaining the cause of the disease

•Pathogenesis, how the disease leads to the specific changes in the body

•Set of symptoms that the patient is expected to have

•Set of objective findings, which the physician is obliged to look for

•Prognosis, a natural course of the disease, with or without treatment

•Treatment approach, which is mainly based on the pathogenesis

•Prophylaxis, which is mainly based on the etiology

These elements may appear obvious, but we often overlook their transitory nature. All diagnoses are envisioned as a “true understanding” of the disease in the ancient Greek sense of the word, but the explanations may be replaced in a few decades by the next upcoming “truth”. This process of explanations changing and being superseded is understood as scientific progress. The patient’s complaints, however, remain unchanged over the ages.

Findings

Findings, a common basis for diagnoses, are collected by physicians following a given diagnostic pathway. They seem to be even more “real” than the diagnoses: an X-ray, a blood pressure reading, or an electrocardiogram are all objective findings, not subjective interpretations, and so they seem to represent the truth concerning the patient. But in a single patient, myriad findings are possible; far exceeding the capabilities of a physician in terms of time, financial resources, and cognitive capacity, and so all medical approaches are based on reduction to the essential findings. The specifics of this reduction are based on the current understanding of the disease more than on the disease itself. One could say the findings are what is left over when one ignores everything not regarded to be of interest, and as a result, the findings are only a very small part of the truth. A finding is not false, but due to the absence of all other ascertainable findings, it is not the complete or total truth representing the patient’s condition. A finding may have more to do with the background of the physician than that of the patient: in other words, generally orthopedists take X-rays, internists order blood tests, and traditional Chinese doctors observe the tongue and feel the pulse. The patient’s condition hardly influences this process.

Innovation

In general, new medical concepts evolve from older concepts. In the history of medicine, especially in Western allopathic medicine (which is what we usually understand as “medicine”), massive paradigm shifts are rare. Instead, progress is achieved step-by-step. Once there is an alpha-blocker, it is only a question of time before a beta-blocker is introduced, followed by a highly specific alpha-1-blocker, and so on. At no point in the development of these incremental changes is the underlying concept questioned.

There are, of course, exceptions. Examples include Robert Koch’s infection theory, Sigmund Freud’s psychoanalysis, or Edward Jenner’s vaccination (more than a century before the first virus was discovered). These concepts do not represent incremental changes from prior concepts: they are major changes of paradigms; generally less appreciated by their contemporaries, but strongly valued by later generations.

Between 1992 and 1995, the US American physician Stephen P. Typaldos introduced an entirely new medical concept in several publications. He called this concept the Fascial Distortion Model (FDM).

2

Conceptual Basis for the Fascial Distortion Model

The Fascial Distortion Model (FDM) is an anatomical perspective in which injury and disease are considered to be comprised of one or more of six specific distortions in the body’s connective tissue (Typaldos, 2002).

This statement is so clear and simple that the radical differences between this and other paradigms is not readily apparent to the majority of those exposed to it. Even Typaldos, with his medical background, had difficulties applying the FDM to all disorders, so he reduced its application to “… virtually every musculoskeletal injury (and many neurological and medical conditions as well) (Typaldos, 2002, p. 3).”

While the clinical application of the FDM historically focused on so-called “musculoskeletal” disorders, the number of indications outside this category grew within a few years. With the burgeoning list of indications, Typaldos struggled with determining the limits of this new concept. The situation was not unlike that of Robert Koch and his postulates, with regular discoveries of infectious agents as causes of conditions not previously considered to be infectious, like gastric ulceration and H. pylori, or cervical cancer and human papillomavirus (HPV). In the fourth edition of his FDM textbook, Typaldos (2002, p. 3) predicted “… perhaps the biggest impact of all will be on cardiology …” even though most of the book focuses on “musculoskeletal” conditions.

While this book is intended to provide a framework for the contemporary application of the FDM in medicine, the authors will not attempt to define the limitations of the FDM itself.

Why fascia?

Stephen P. Typaldos was a doctor of osteopathic medicine and worked in many emergency departments around the USA. At no point in his career was he focused on “fascial research” or “fascial science.” These fields of study barely existed in those days, and if a few physicians, anatomists, or other scientists took an interest in fascia, it was primarily academic rather than clinical.

Typaldos focused on his patients’ descriptions of complaints, discussed treatment approaches with them, and observed their perception of these treatments. He was frustrated by his inability to match the patients’ descriptions with any diagnoses in which he was trained. The location and types of complaints he observed in his patients had only one tissue in common that could reasonably explain the disorder: fascia. In addition, the patterns of pain followed pathways that could only be associated with fascial fibers. He undertook dissections in the pathology lab to look for muscles or other tissue missing in the anatomical textbooks, but his findings confirmed fascial fibers were the tissue involved.

Through his experiences in clinic and in the dissection lab, Typaldos understood fascia as a vast and important sensory organ that has exclusive access to information by measuring the tension of its fibrous web throughout the entire body.

Why distortion?

Typaldos struggled to define these fascial abnormalities to make targeted treatment possible. Immediately he understood the importance of clear distinctions between these new diagnoses, which he called “distortions.” Later, his definitions would prove valuable in teaching and research. Once a specific distortion is identified, a meaningful treatment, even a treatment that does not exist yet, can be imagined when the concepts of the FDM are applied to the patient’s complaint.

Why only six distortions?

Between Spring 1991 and Fall 1992, Typaldos defined six different conditions, which, though interacting with each other, appeared to be distinct, reproducible entities. Typaldos, and later his students, continued to search for further distortions up to the present day, but additional distortions have yet to be identified. However, neither Typaldos, nor others who now work with the model, exclude the possibility of discovery of further distortions in future.

Why is it called the Fascial Distortion Model?

A model is a meaningful, comprehensible abbreviation of reality.

In natural science, there is no truth. Reality itself cannot be comprehended, because humans can only perceive what they are looking for, driven by their expectations, their senses and the tools they have available to them. Despite these limitations, humans tend to mistake their interpretation of reality with reality itself. In physics and other natural sciences, models are frequently used to help distill and codify data for ease of visualization and extrapolation. Models also provide a framework for the interpretation of novel data and are capable of evolving as more data is obtained.

It is important to realize that the FDM is not merely a kluge of diagnoses and techniques patched together. The FDM is a way of thinking as much as it is an approach to treatment.

3

The Distortions

On a supracellular level, form is defined by fascia. Without fascia, tissue is rather amorphous. Fascia defines the architecture in the body and guides the distribution of forces (van den Berg, 2017). In order to distribute forces, a three-dimensional layout of fibers and the liquid between them is essential. It seems reasonable to define an ideal form of fibrous arrangement for certain tasks, since the optimal transfer of forces requires an optimal arrangement of load-bearing structures. Unfortunately, given the complex multi-directional forces the human body is exposed to, and the limitations of visualization technologies, this ideal form cannot be visualized in nature. These limitations are not at all exclusive for fascia; they are intrinsic elements of all visualization strategies.

Triggerbands: twisted fascial bands

Parallel fibers are an ideal arrangement for the transmission of longitudinal forces. Within the Fascial Distortion Model (FDM), there is a type of fascia defined as “banded fascia” (Typaldos, 2002, p. 9). This type of fascia can be found in the entire body, wherever longitudinal forces have to be absorbed or created.

A triggerband is a pathology within this banded fascia (Fig. 3.1)....