December Reading - Fascial Release

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My book for December's reading was Fascial Release for Structural Balance by James Earls & Thomas Myers. Tom Myers is well known to me because of his work with integrative structural therapy. His book Anatomy Trains should be in every massage and soft tissue therapists library. This months book is also worthy of a place in the library. James Earls studied with Tom Myers and also follows the anatomy trains approach to bodywork, something we incorporate in our work too. Knowing the authors credentials alone gave me confidence that my book for the month was going to be a good read.

As with Tim's book choice, this is one which I have dipped in on numerous occasions. The bulk of the book is made up of chapters corresponding to individual areas of the body - a review of anatomy and a look at relevant techniques and concepts of fascial release that are applicable. In the introduction the authors are keen to note that the body is not made up on separate and isolated components. Comparing the body to a car is an oft used analogy, but humans are not the same - we cannot simply take out a muscle when injured and replace it like a broken spark plug. There are much wider reaching implications for damage to one part of the body, and it is those connections - through the fascial webbing which pervades all of our body - which Earls & Myers explore in this text.  Paraphrasing them, the reality of human anatomy is that we have one muscle poured into 600 (or so) pockets of fascial webbing - the distinctions between muscles are useful, but the reductive process shouldn't block the reality of the unifying and connected whole.

Key messages I will take from this book (some of which reinforce reading from other sources):

• Fascial webbing that pervades our bodies has been building, refolding and remodelling since the foetus was 2 weeks old - it remains constant (ever present) and changing (adapting) throughout all our life.
• Everything is a compromise - the stability vs mobility balance is always being played out in our body.
• Congestion and mechanical strain often affects the body in distant parts - because the fascial web is altered.
• Fascia is contractile*.
• Tensegrity** is key; "The body is designed to distribute strain globally, not focus it locally".
• The fascial system is a repository for chronic issues because of its ability to accept change slowly and retain the changes it makes. Chronic tension because of inappropriate fascial shortness can lead to trigger points, fascial thickening and compensation patterns throughout the body.
• Fascial tissue deforms because of injury, abuse, misuse or disuse - but because of its plasticity it can be reformed with manual therapy, stretching and awareness (such as changing postural habits).

* Until recently it was thought that only muscles contracted but it is now known that myofibroblasts exert a force on the fascia causing contractions. Not as quick to respond as muscles (perhaps 20mins), fascia does however retain the contraction for hours - leading to sustained mechanical tension and postural changes.

** A word on tensegrity - engineers build houses and structures to withstand forces applied to them, just as the body does - but, the body is able to maintain its structure when, for example, held upside down or when pressure it exerted on one area.  Through deforming one part of the body small amounts of deformation are felt throughout the body, and a tensegrity model can demonstration this. An amazing Christmas present was given to me this year which allows me to demonstrate this to our clients:

No tension applied

Tension applied by right hand

The two photos above aim to demonstrate what happens when there is tension applied to one area of the tensegrity model. The right hand is pulling on a cord at the top, and you can imagine this is a tight muscle, tendon or area of restricted fascia within the body. On a quick glance you will notice that the whole structure has become deformed, squashed and distorted a little if you like. On closer inspection you will see that there are changes visible throughout the model. As one example, take the yellow node held in the left hand - it forms a triangle with a blue node above and another out of sight node; see how that triangle has altered in size. So while the cord at the top of the model is being pulled it has affected this distant area, just as fascial restrictions in for example the calf can affect the hip, lower back or elsewhere. It is difficult to demonstrate a 3D model with a photograph, but I hope you can see the basic idea behind strain being applied globally, not just locally. It is this principle which we apply in our massage and remedial treatments.

I will be continuing to read this book over the coming months - there are six chapters on the different body areas (foot & lower leg; knee & thigh; hip; abdomen, thorax & breathing; spine; and shoulder & arm). There is good guidance on postural assessment and clear diagrams on various anatomical structures - so don't be surprised if I show you this book (or the tensegrity model) when you come for a treatment. It really is a good tool for all manual therapists who are keen to educate their clients and give them the best possible treatment and home care advice.

Lynne Taylor

By request - Recovery Techniques

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So. I ache. I was out flipping tyres and throwing medicine balls around yesterday, and although I warmed down a bit, I didn't really do any recovery - hence, I ache.

Generally at the end of a session it's common to think that you can't be bothered to do a cool down, or you don't have time - you shoot off and do something else, and it's not until the next day that you curse yourself for a fool as you wander around the house trying to make a coffee with what feels like battery acid coursing around your veins.

After the post on DOMS which seems to have generated some interest, I received a couple of missives to ask what kind of recovery practices are good in order to minimise the pain, and are there any diet changes that can make a difference - like chugging protein after a workout etc.

Ice Baths-
or - if you can't get any ice - really cold water bath. The colder the better, the more ice the better - within reason. The idea of this is that the ice has an anti-inflammatory effect - the muscles have already been over-heated from the exercise you were just doing- you need to cool them down. A general guideline is filling the bath up as high as it need go to cover the muscles you have been using, and try to accumulate 15- 20 mins in total. It doesn't need to be all at once, you can have several shots at it for a few minutes. (I find that heating a flannel and using it to cover slightly more sensitive areas for the duration of the bath makes it slightly more bearable).

If you've just been for a fell run and there is a nice, ice cold stream to lie in - that will do the job nicely. Just ignore the weird looks from other people - you'll be feeling fresh as a daisy tomorrow.

Recovery shower -
Start warm to hot - massaging muscles for a few minutes (less than 5), then slowly turn the heat off until its properly, ridiculously cold. Unbearably so.
Man up.
for 5 minutes.
Turn the heat back on for a couple of minutes. And repeat at least twice, finishing with cold water.
Remember, 5 mins of cold water is better than feeling stiff as a board for the entirety of the next couple of days.

Foam roller -
I've mentioned these a couple of times in various blogs - use foam ones, expensive ones, pressurised coke bottles, beer bottles, slosh pipes, anything that is cylindrical and solid. You use the roller over muscle, which has the effect of stretching and separating muscle and fascia, breaking down cross fibres which make muscles less efficient. The pain you will feel is an indication of the muscles that are bound together (a bad thing), so the more it is hurting, the better it is for you, and the more you need it.

Also, the more you use a foam roller, the easier it will be for a massage therapist to treat the areas that actually need treating as they won't have to waste time getting through all the superficial knots and tension to get to the structural issues which may be causing inefficiencies in the way you use your body.

What should I eat?
Back in the day when I was primarily an indoor climber, I used to chug protein shakes on the way back home from a climbing session. They tasted lovely, but I was heavier than I needed to be because I really didn't need any of the extra stuff that I was pumping into my body. No matter how much protein you take on board directly AFTER a session, it will make no difference to the immediate recovery of muscles. The protein already in your system is what helps...
they keys to recovery after workout are twofold
1- a pre-workout snack - or taking on food before the work out - and
2- the replacement of Glycogen after the workout.
At this point in time, sports nutritionists are recommending 3:1 or 4:1 ratios of carb to protein- but at best this is a generalisation. (chocolate milk has an approximate 3:1 ratio. That's just normal chocolate milk - not some fancy expensive shake. It's what I use when I need a quick recovery drink at the end of a hard work out and I know that I won't be getting proper food for a while...) It will depend on the kind of effort you are expending.
Short intense workouts need little more than water, and a normal meal, up to 120 mins at a moderate pace may need up to 250cals followed by a normal meal (note, the numbers are not gospel, it will depend on your body and what you, as an individual needs), and long, long efforts will need up to 900 cals. You will know when you have got to that point. There will be no doubt.

The most important of the food advice I can possibly give is eat a balanced and intelligent diet. Eating crap, and then having energy bars and protein shakes will not get you anywhere near as good as just eating decent food. I'm not going to get into one type of diet versus another, because that is all secondary to the quality of food. Spend money on decent food. Your body is one of the best things you can invest in.

Other recovery methods -
The main one is long term cross training. If you are a triathlete you bike, run and swim - this, however, is not cross training for you. There will be massive imbalances between your quads and your glutes which will inhibit your ability to go faster - find another activity to do which will help keep the non-tri muscles working.
If you just lift weights- find something else to do,
you get the picture... the reason for this is if you constantly and consistently train for a single sport imbalances will develop and the muscles that you are using will get more and more tired.

Sleep -
Most important. Good quality sleep. I hate people that say sleep when you are dead. That's like saying you can have a drink while you're drowning. Sleep time processes toxins that you have accumulated in the day - poor quality food, water, air, alcohol etc. If you suffer from poor sleep quality or quantity, do something about it. Black out curtains, music, etc. Magnesium extract is a good sleep preparation dietary addition.

Maintenance massage -
Yes - regular massage can of course help - not just from a soothing and remedial point of view, ridding muscles of toxins, increasing muscle length and reworking myofascia via myofascial release to give better range of motion, but it is a time in which the therapist can see which muscles are healthy and are working in conjunction with others, and which are not taking on responsibility for their movements- and are contributing to inefficiencies in your daily life and sport. By discovering this, you can take pre-emptive care of your body, using the information to correct muscle imbalances before they become too ingrained, and your quality of life suffers from pain. The longer you leave muscles to become inefficient, and build up pain, the longer it will take to get you back into working order.

I think I've covered most of the things here - if only in quite a cursory way, but in enough detail for you to go away and have a think about how to recover better.

For those of you that keep a training diary - add a section- a recovery diary. Take note of what you are doing on a daily basis to help your body to recover.

If you are taking a lot out of your body with exercise, but not putting enough back in - not recovering enough, there is only one way you are heading- and that is to breakdown and injury.

Your choice, spend a bit of time doing recovery every day, or spend a lot of time out with injury and pain. I know which one I'm choosing.

Fascia. Fascianating stuff

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Fascia. (or myofascia) its the buzz word in physical therapies at the moment. If you are involved in them, you may know pretty much everything I'm about to write, if you aren't a practitioner, and are vaguely intrigued by the thought that there maybe something else in your body - other than muscles and tendons which may be giving you gyp, read on.

When you cut a piece of meat - a chicken breast for example, there is generally that white stringy stuff which is of a very different consistency to the meat around it. A bit like this:

It connects it - and is difficult to cut through because it is strong, kind of stretchy and doesnt break very easily. THIS is fascia. In dissections in the past, for many years, centuries, in fact, this was seen as biological packaging - the bubble-wrap of the body - which had to be cut away and disgarded to enable the dissector to get at what they wanted to see. The muscles and ligaments.

It wasn't until about 30 years ago that people really began to get intrigued about fascia - and it would seem that it was people like Tom Myers who began dissecting according to new "rules" not following directions from previous generations looking for old theories - but looking at tension lines across the bodies - and seeing fascia as a connecting tissue, which really kickstarted the whole thing into a new paradigm.

At this point, I must add a side note about Dr Ida Rolf who originally created Rolfing - which uses fascia as a connective tissue as a basis for treatment, but I should probably leave that for another day, else, I'll be writing a thesis.

So, the body is bound up with fascia. It interconnects all our muscles, tendons, bones, organs, everything. If a part of the fascia in the right leg gets bound up because of a strange way of walking/jumping etc, the repercussions can be felt right through the body. That issue in the leg pulls on tissue around the bum, which in turn pulls on tissue in the back - which at varying levels and layers through the body may pull on other tissues leading up to the neck - or through the body to the organs - and all of a sudden, it's not just the leg that hurts, and a limp which the client has, but potentially, neck ache and disgestive trouble.
From a leg injury.

Fascia is a plastic kind of material. Think back to the stringy bits in the chicken. Imagine if all the fascia in your body was gel like - sticky and not very mobile. The muscles wouldn't glide very well, you would be stiff, and movement would be very inefficient. Think if this stuff was closer to a sol (liquid) state - how much easier it would be to move, muscles would glide, and there would be less chance of binding.

That is exactly what fascia is like. It responds to water. If it is wet - and is closer to sol than to gel, you will be smoother, glidier (if such a word exists), and generally more happy. If you are closer to a gel state - the opposite will be true.

The plastic analogy continues.
If the body is used to doing something a certain way, the fascia will bunch and stretch in specific places to make it more efficient at this activity. If you sit at a desk, the fascia around the muscles in your shoulders will become stiffer, in order to help the muscles around the neck support your head in a slightly incorrect way - forward and looking down. If you are a gymnast, the fascia will become more and more bendible, if you kick right footed, the fascia around your legs will "deform" to make the leg more powerful and stable - and if you were dissected (in the right way)- this plasticness would be easily recognisable.

The plasticity however, takes a while to manifest itself. If fascia is stretched, it goes back to its original shape very quickly. It must be taught over a long period of time. 6 months to 2 years - thats the time it takes for fascia to renew itself.

Now, as a brief intro goes, this is getting a little long.
There is more though - fascia, originally thought to be just packing material, it was discovered had usage throughout the body - and now, from groundbreaking research at Ulm in Germany, fascia has been proved to have movement sensors in it. Fascia is the largest sensory organ that we as humans have. It even seems to have contractile properties - like smooth muscle.
New things are being discovered as we go along - hence the rather exciting feeling of being at the cutting edge of research into the human body.

As an upshot to all this, (which I have skipped over very briefly, and have probably missed out so much), the bodyworker and the physio and the Personal Trainer should no longer be looking at which specific muscle does a single action, which particular bit hurts - on its own or thinking in terms of a limb on its own, diconnected from the rest of the body.
The body as an organism is a whole integral unit. Fascia connects everything to everything else. A bicep curl does not just affect the bicep - the fascia around it links so much more in, although your neck hurts, it could be your ankle that is affecting fascia right the way up the body.
Don't isolate bits of your body - it is not there to be isolated - you will end up disconnected and disjointed. Think globally, think fascially.

I'm sure there are people out there who read this and will say - huh - he's missed X, which is SO important to this discussion... well, write a comment, I'm eager to have my mistakes corrected, and to learn more.

For further reading into this, google Rob Schleip for his research into fascia, Tom Myers for Anatomy Trains or Ida Rolf, for her pioneering development of rolfing and myofascial release.