Below is my blog about this bizarre request “to break fascia.” In this blog, I am not only presenting this case, but also explaining fascia/muscles relations, pathophysiology, and much more. In addition, I am providing information about the historical developer of this methodology. It’s a fascinating story.
“Breaking fascia” is not the only special memory that I have about fascia misunderstandings. Several years ago, there was a lot of excitement around the fascia congress. Many of my friends and students attended. I have the graduates, a group of personal trainers, who attended my school and for many years, they combined personal training with practicing massage. Through them, I received a lot of information about fascia congress.
I asked one of the attendees: ”why no one at Congress mentioned the name of Elizabeth Dickle, who made known the importance of tension build-up in the connective tissue/fascia and its impact on chronic somatic and visceral abnormalities to the scientific community.
He answered that this Congress wasn’t for massage therapists. I asked was it for personal trainers? I didn't get a clear answer. It's okay.
Five years ago or so, I received a call from a patient referred by MD. Her first question was: “Do you possess enough expertise and experience to break my fascia?”
Jokingly I answered: “I’m in the business of repairing, and not breaking.” Regrettably, she felt that my humor was not appropriate and angrily retorted: ”Boris, I have developed myofascial tissue problem. For two months, I was seeing “fascia chiropractor”, and little by little started feeling much worse. Now my pain us not only in the scapula, but traveling to my arm, and I cannot sleep at night because of pain. In the beginning, it wasn’t like this, I could sleep without pain. Of course, I asked what chiropractor did, the answer was:” he tried to break my fascia, but my case is difficult and he couldn’t succeed. My primary care physician believes you can do it.”
To tell you the truth I don’t know where the terminology “breaking fascia” and “myofascial tissue” come from. No book of histology will support the existence of myofascial tissue. We have fascia and muscle alliance, an anatomical unit that is working together. Yet, histologically speaking, these are different tissues. Fascia is a connective tissue, which means fibers of fascia have no potential to constrict while the function of muscles is to constrict. I have invited her for treatment, and using a very convincing tone of voice, told her: ”clinical picture as you described, can be the result of buildups of tension within fascia and muscles. I possess the expertise to detect these abnormalities and eliminate this tension, in which case you can feel much better.
It was a difficult mechanical pain case. In addition, the patient exhibited anterior scalene muscle syndrome that triggered a neurological picture, radiating pain to the upper extremity. During the first five treatments performing connective tissue massage/fascia release and mobilization techniques, trigger point therapy, and massage techniques addressing muscles I have achieved positive change in the clinical picture. The patient could sleep at night, experienced no radiating pain to the upper extremity, was free of pain movement of the neck and upper back.
Of course, I convinced her to continue treatments in order to increase the threshold of muscular irritability. She agreed, and I have provided seven more treatments. Since then, during all these years I treated her sciatic nerve neuralgia, and knee sprain/strain type of injury. Today she is doing well. Her neck and upper back symptoms have never come back.
Fascia surrounds each muscle, hosts pathways for nerves and blood vessels, participates in a nutritional supply, provides support for muscles when they are under a significant load. For example, when a biceps constricts, flexes forearm, lifts weight, fascia supports biceps action by sharing the load. Still, it is connective tissue; fibers cannot constrict. The physiology of movement relies on a constriction of muscles. Flexion, extension, stabilizations are the results of muscular constrictions. At the time of the movement relaxation in muscles happening due to action of antagonism as muscles cannot relax by themselves.
Due to the negative effects of stress, physical activities, irritation of spinal nerves, etc., muscles can build tension, expressed in shortening of muscles. When muscles build up tension and especially pathological tension, massage techniques especially kneading, can stimulate the decrease of muscular tension while passive stretching can affect buildups of tension in muscles.
However, kneading and passive stretching have no effect on abnormally tense fascia. Being a connective tissue, fascia has no blood vessels anatomical structure. Of course, cells of connective tissue need blood supply like any other cell in our body. Blood vessels in neighboring muscles, release these supplies, and connective tissue cell membrane allowed to this supply in. This process is called diffusion.
When muscles build up tension, blood vessels also constrict, thus making insufficient blood supply, to the fascia. If the insufficient blood supply to the fascia lasts a long time, it leads to tension build up in fascia. This tension is not the result of fibers shortening (as fascia fibers have no potential to constrict) but is the result of wrinkle- like buildup of tension.
To successfully stretch fascia, one needs to pull tense fascia in different directions mechanically. Without releasing buildups of tension in the fascia, it is impossible to sustain normal resting tone in muscles, to prevent reactivation of trigger points, etc. In turn, it makes it impossible to help people who suffer from different painful skeletal muscular disorders.
The inhibition of pain doesn’t imply adequate rehabilitation and sustainable results. Failure to achieve sustainable results would lead to pathology, including faster developments of osteoarthritis, and other degenerative diseases such as tendinosis, developments of muscular syndromes, etc. Besides, even if the pain is inhibited, one shouldn’t expect that the patient will be free of pain, no flare-ups, and will be restored desirable functional abilities.
The works of Austrian physical therapist Elizabeth Dickle made known to the scientific community the importance of tension build-up in the connective tissue/fascia and its impact on chronic somatic and visceral abnormalities.
As with many important discoveries, Dickle’s discovery was an accidental find. For several years, she suffered a failure of arterial circulation in her lower extremities resulting from Thromboangiitis Obliterans. The disease had progressed to the stage when amputation became a real possibility. Dickle also experienced chronic, lower back pain caused by her limping. While rubbing her lower back and trying to relieve tension, she noticed sensations of warmth and weak pulsations in her feet. Intrigued by her finding, she started using various techniques on her lower back. She noticed that pulling the skin on her lower back triggered the most intense warm sensations in her feet. After several months of self-therapy, she was able to restore circulation through her lower extremities and prevented double amputation. Powerful stuff!
Dickle shared her findings with Prof. W. Kohlrausch. Their combined efforts, as well as the later works of Prof. N. Veil and Dr. Luebe in Austrian and German clinics, shaped a major method of somatic rehabilitation they called Bidegewebsmassage or connective tissue massage/fascia release and mobilization techniques as it is known by the rest of the world.
During the extensive research, they developed connective tissue massage/fascia release and mobilization hands-on protocols, including the stipulation regarding the direction of movement. This was presented in a straightforward way so that thousands of massage therapists could learn these techniques and, successfully, implement them on patients. Thousands were replicating their outcomes when treating back and limp disorders, internal organ diseases, etc.
The work of Prof. Sherback, which is a fundamental plateau for medical massage, is also a fundamental groundwork for any massage therapy. Today, the concepts that lay the foundation of his works were tested and massively utilized for many years, and thus proved their clinical viability.
You're welcome to post questions, agreements, and disagreements.
You're also welcome, to watch videos, where I demonstrate the utilization of silicone jars for fascia release and mobilizations. It is very powerful.
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