A Practical Guide to Fascial Manipulation

an evidence- and clinical-based approach

Tuulia Luomala, Mika Pihlman, Warren I Hammer

• Publisher: Elsevier
• Year: 2016
• Print ISBN:
  9780702066597
• eBook ISBN:
  9780702066580
• Topic: Medicine
• Subtopic: Physiotherapy, Physical Medicine & Rehabilitation

Grounded in scientific and clinical evidence, this highly illustrated new guide gives an introduction to the diagnosis and treatment of musculoskeletal disorders using the Fascial Manipulation (FM) method developed by Luigi Stecco – the foremost scientifically valid method of evaluating and treating fascial dysfunction. It describes FM's history, anatomy and physiology of fasciae, indications and contraindications, mechanisms of action, and details of the subjective and physical techniques used to manage disorders.A Practical Guide to Fascial Manipulation focuses on concepts around evaluating the fascia based on functional testing, movement and direction in specific spatial planes, and the location of specific areas to treat safely. With an emphasis throughout on accessible practical information, the book is also supported by a website – www.guidefascial.com – containing procedural video clips and an image bank.

Chapter 1

History of Fascial Manipulation

“The most important thing is to be enthusiastic and to have the passion for the work you do.”

Luigi Stecco

Italian physiotherapist Luigi Stecco (born in 1949) is the inventor of fascial manipulation (FM). Nothing illustrates his motto better than the image of Luigi Stecco as a boy developing an early fascination for vertebrate anatomy as he dissected a fish his mother had brought home for dinner. Over the next decades, this interest became focused on the thus far little studied but ubiquitous tissue: the fascia. Eventually, the understanding of the fascia as a system—a system with specific vital functions—led Stecco and his colleagues to develop a method of evaluating and treating dysfunctional fascia.

Luigi Stecco has devoted his career to developing and teaching others to develop “knowing hands” in their treatment of pain and dysfunctions. Manus sapiens, potens est (a knowledgeable hand is a powerful one). Knowing more will enhance your skills more. Better results in treatments will come with practice and knowledge. In this way FM can be your map of understanding (Fig. 1.1) (see Video 1).

Fig. 1.1 Luigi treating one of the participants in the fascial manipulation course.

The evolution of FM began over 40 years ago when Luigi was working as a trainee in a hospital. He started developing his own biomechanical model because he realized that many of the treatment techniques he had been taught as a physical therapist were not effective enough—some were even useless. He wanted to find a better way. He started to observe the work bonesetters were doing and realized that they were helping people. However, he was dissatisfied with even these techniques, so he decided to explore different treatments more thoroughly. Luigi gradually started to create his own technique, the Stecco method, later known as FM.

From 1972 to 1984, Luigi worked on his own treatment techniques, building on the inspiration of other treatment methods and basing everything on careful and incessant dissection to gain a profound understanding of anatomical function. He explored osteopathic techniques, then relaxation techniques with the idea that pain could come from psychosomatic factors. Subsequently, he investigated psychomotricity, postural gymnastics, and the Vayer method, which concentrate on dynamic balance and coordination. He was still dissatisfied with the level of clinical results: they were not good enough. He wanted more. He wanted to find a way to turn practitioners’ hands into more effective healing hands (Fig. 1.2).

Fig. 1.2 Building blocks of fascial manipulation.

In 1976 Luigi was introduced to connective tissue massage and he identifies this as the turning point for meaningful improvement in patient results. This heightened his determination to explore the architecture of connective tissue. He studied the works of Elisabeth Dicke, who was a physiotherapist in Germany in the late 1920s. She especially influenced Luigi’s focus on the importance of connective tissue. He became an expert in transverse friction massage. A study of James Cyriax, the father of orthopedic medicine, underscored the importance of the use of the therapist’s hands and manual therapy. Combining the knowledge of transverse friction massage and acupuncture meridians confirmed Luigi’s theories on the tensional network of the body. The vectorial forces, which act along this network, can be understood and thus lead the practitioner to the areas in the network that need treatment.

Luigi’s understanding of the “tensional network” of the human body was enriched by the studies of Ida Rolf and by works on trigger points as elucidated by Travell and Simmons in the early 1980s. The powerful work on kinetic chains by Francoise Mézières and Herman Kabat was also important in the foundation of Luigi’s theoretical understanding. The previous findings and good results from treatments encouraged him to write down all that he had learned through years of clinical experience and studies.

His understanding of the tensional network of the human body had produced good results in clinical settings so Luigi was finally ready to share his insights in his first book, Myofascial Sequences and Acupuncture Meridians (1987). At the time, Luigi theorized that the excellent clinical results he was getting were a result of freeing the nerve within the connective tissue, so he named this the “neuroconnective technique.” This early technique was the first step in the development of FM as it is known and taught today (Table 1.1).

Table 1.1

Timeline of Luigi Stecco’s Publications

Title	Publication Year	Language
Myofascial Sequences and Acupuncture Meridians	1987	Italian
Pain and the Neuromyofascial Sequences	1990	Italian
La Manipolizione Neuroconnectivale	1996	Italian
Fascial Manipulation for Musculoskeletal Pain	2004	English
Fascial Manipulation Practical Part	2009	English
Fascial Manipulation for Internal Dysfunction	2013	English
Manipolazione fasciale per le Disfunzioni Interne—Parte Pratica	2014	Italian
Atlante di Fisiologia della Fascia Muscolare	2016	Italian

Luigi continued to study and explore. The anatomic work of Chiarugi, Testut, Gray, and Beninghoff inspired Luigi to deepen his understanding of anatomy. Then, in 1989, at the First International Symposium on Myofascial Pain and Fibromyalgia, the idea of the myofascial unit was launched. At this conference, he presented that points formed the centers of vectors caused by muscular tractions operating within a particular plane of fascia. He wrote that the referral of pain due to these points was related to planes of altered fascia. In the symposium Luigi stated: “Knowing the location of the myofascial unit, it is easier to find the starting point of myofascial pain.” This reasoning resulted in what is now defined as the myofascial unit (MFU).

An MFU is a key element in FM (Fig. 1.3). It is composed of a group of motor units that activate monoarticular and biarticular muscle fibers that move a body part in a particular direction, for example, antemotion or antepulsion (movement forward in the sagittal direction). The MFU is also composed of nerves (efferent, receptors, afferents) and vascular components. All of these elements are connected within the fascia and they are responsible for the normal movement of the joint. Since the brain is responsible for a motor direction rather than movement of specific muscles, it must depend upon the MFUs to provide the necessary information to allow the body to function in a unified coordinated manner. Brains only interpret the movement patterns and changes in directions. In the motor cortex, entire areas are controlled (eg, hands, lips, or legs). This point is critical for the understanding of motor function. The muscles function by way of MFUs as they move in different directions and in various ways (Stecco, 2004; Stecco, 2009).

Fig. 1.3 One key element of fascial manipulation: the myofascial unit. The image area highlights the AN-CX; it is located on the anterior part of the thigh, inferior to the inguinal ligament, medial to the sartorius muscle. AN - forward movement, antemotion; CX - area of the hip.

To explain different dysfunctions we need terms and language that our brains can understand. Luigi invented the idea of segments and MFUs to explain the body in an easier way and find the impaired movement in a more specific way. Based on some of the above information, for ease of analysis, Luigi proposed the idea of rela...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Video List
• Forewords
• Acknowledgements
• Introduction
• Chapter 1: History of Fascial Manipulation
• Chapter 2: Anatomy of the Fascia from the Clinical Point of View
• Chapter 3: Physiology of the Fascia from the Clinical Point of View
• Chapter 4: Fascial Manipulation
• Chapter 5: What Kind of Disorders and Dysfunctions to Treat with Musculoskeletal Fascial Manipulation
• Chapter 6: Fascial Manipulation for Internal Dysfunctions
• Chapter 7: Veterinary Fascial Manipulation
• Chapter 8: Conclusion
• Index