Fascial Manipulation

How fascia is involved in musculoskeletal pain?

1. Dr. Leonid Kalichman PT, PhD
Stecco’s Fascial Manipulation approach

3. Fascia: definition and
examples
Innervation of fascia
Pathological changes in
fascia(hyaluronic acid)
Basics of “fascial manipulation” method

4. Dr. Leonid Kalichman, PT, PhD
Fasciae (singular, fascia) are connective tissue layers
and wrappings that support and surround all organs,
bones, muscles, nerves, and blood vessels.
superficial fascia
deep fascia
subserous fascia

5. “Fascia is an uninterrupted three-dimensional web of dense
connective tissue”
The soft-tissue component of the connective tissue system that
permeates the human body, forming a whole-body continuous
three-dimensional matrix of structural support.

6. A - epidermis
B – dermis
C – superficial fascia (and
subcutaneous fat)
D – deep fascia
(aponeurotic+epimysium)
E - muscle

7. Dr. Leonid Kalichman, PT, PhD

10. Fascia is a continues tissue that connects all
parts of the body.

14. Fascia is reach by nociceptors and
mechanoreceptors.
Fascia is a pain sensitive structure and
involved in proprioception and movement
regulations

16. Dr. Leonid Kalichman, PT, PhD
The average 70 kg person has roughly 15 grams of hyaluronic
acid in the body, one-third of which is turned over every day.
It is part of the extracellular matrix, a major component of
the synovial fluid, and was found to increase the viscosity of the
fluid.

Hyaluronic acid is a component of articular cartilage and skin.

17. Dr. Leonid Kalichman, PT, PhD
Recent study showed a layer of hyaluronic acid
between fascia and muscle and inside deep fascia, in
particular inside the loose connective tissue separating
the fibrous sub- layer of the fascia.
This means that the fascia thus provides an
extracellular matrix that is a gliding lubricant over
muscle, permitting the free contraction of muscles,
but also a unique matrix for its repair and regeneration.
STECCO, C., PORZIONATO, A., MACCHI, V., STECCO, A., STERN, R., DE CARO, R.. Analysis of the presence of the
hyaluronic acid inside the deep fasciae and in the muscles. Italian Journal of Anatomy and Embryology, North
America, 116, Nov. 2011 . Available at: <http://www.fupress.net/index.php/ijae/article/view/10258 /9467>

18. Dr. Leonid Kalichman, PT, PhD
“By increasing the concentration of HA, HA
chains begin to entangle conferring to the
solution distinctive hydrodynamic
properties: the viscoelasticity is
dramatically increased”.

19. HA increased
viscosity
and mechanorecptors

20. Dr Leonid Kalichman PT, PhD
Stecco family

21. The Myofascial Unit (Stecco’s definition):
1. A group of motor units that move a body segment in a specific
direction by activating fibres (monoarticular and biarticular) in one
or more muscles
2. The joint that is moves
3. Nerve and vascular components
4. The fascia that connects these elements together
Dr Leonid Kalichman PT, PhD
Motor Unit (Sherrington’s definition): A motor
unit is made up of a motor neuron and the
skeletal muscle fibers innervated by axon of this
neuron.

22. 1.Each Myofascial unit has its
own CENTER OF
COORDINATION (CC)
2.CC = Small areas on the deep
fascia where the sum of
tensional vectors coincide .
3.Located in epymisium
Dr Leonid Kalichman PT, PhD
CC

23. CC
CP
ME LA
Symptoms in the Center of Perception
(CP)
Phase of compensation
Mechanical incoordination in the joint
The resulting vector becomes faulty
Improper recruitment of muscle fibres
Decrease of the sliding system in the CC
Increase of the viscosity of HA in the
Centre of Coordination

24. Friction
.
.
.
.
Heat
develops
Perception of
change in tissue
mobility
Patient
reports pain
reduction
Dr Leonid Kalichman PT, PhD
Tissue sliding
improvement

25. Images of the sonoelastography state before and
after fascial therapy in the L5eS1 interspace. In
addition to the color scale evaluation, elasticity was
quantitatively measured in the zone of interest and
local elasticity demonstrated a x10 increase after
fascial therapy.

27. Performed by PTs (highly trained professionals)
Science based treatment
Initial research evidence for effectiveness
Holistic (treat entire body, not only site of
symptoms)
Treat source of problem, not the site of
symptoms
Eliminates consequence of previous (old)
traumas and surgery
Very effective, especially for chronic problems

28. Dr. Leonid Kalichman PT, PhD