Did I mention he has a 38.2" vertical?

After the first talk by Robert Schleip I could have left and felt very satisfied with attending the conference. WOW. But I’m so glad I didn’t! This conference helped solidify some thoughts and completely open my eyes for a new ways of thinking. Without question there are way too many highlights to write about in a single blog post. So I’ll write about my TOP 8 Highlights. Originally I was going to post highlights of each speaker, but because there were many commonalties between the talks I’ll instead write about the major highlights echoed throughout the conference.

A special “thank you” needs to be delivered to Dr. Glen Harris (MSK Plus) and Dr. Wilbur Kelsick (Maxfit Movement Institute) for making this conference happen! I’m so happy that I attended that I’ve already sent my RSVP for the 3rd International Fascia Research Congress.

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TOP 8 highlights:

1) Our Anatomy is WRONG! Open any text book and you’ll see clearly defined muscles, tendons, nerves and blood vessels. Each tissue can be clearly seen. But where’s the fascia? Fascia is our tendons, ligaments, and all of our collagenous connective tissue that connect all our structures in our body into a single body. Forget about your knee bone is connected shin bone. The reality is more like your knee bone is connected to your ear!

2) You might not be stretching what you’re stretching? Based on the organization of fascia, Vleeming researched the strain transmission that occurs with a straight leg raise. Incredibly the iliotibial band and the lumbar fascia compared with strain to the hamstrings is 240% and 145% respectively. This occurs because fascia is multi-directional and a large portion of the strain that occurs during a straight leg raise is transmitted laterally. To further illustrate this check out Plantar Fascia Magic.

3) BRAIN POWER – Separate the forest from the trees. Our brain is the central processing center of our body. There are over 80,000 sensory inputs per second that enter our brain that must be processed to formulate and make fine adjustments to our movements. Note I didn’t say proper movement. Developing sound movement patterns takes time, based on deliberate training principles that address key movement qualities. This is without question the Forest. It’s the big picture that we must always address. It’s the key factor that determines injury rates and sport performance. The forest is made up of many components, but they are the details. Some details are more important than others. In this analogy fascial issues range in how they impact our ability to perform movement. Some fascial problems would be large trees, but some would be like a shrub, others could be like a blade of grass.

But never mistake that it’s how we process and develop our movements that determines injuries and performance. This concept is surprising lost. Many health care professionals focus on the details beautifully but miss the big picture – THE FOREST. We must always aim to improve our movement qualities by address the most effective and efficient detail.

4) Running Shoes and Orthotics – WOW! I really have to think about the implication shoes and orthotics have on injuries and athletic performance. Currently many people are subscribing to the concepts of Bare Foot Running, popularized by Born to Run (you gotta get this book – it’s amazing), Chi of Running, Pose Running, Vibrams and Barefoot Ted – just to name a few. I’ve known about this concept for a couple of years, but after reading Born to Run, attending this conference, and recently speaking with Dr. Larry Bell the merits of bare foot training are more salient than ever.

5) Stretching and Conditioning Fascia – Let’s get Crimped. There are many methods that need to be integrated to effectively condition our fascial system. Yoga by itself is not enough, nor is strength training. Yes strength training is important to condition your tendons and ligaments. In fact, the tendons of those that don’t strength train lose their elasticity and tensile strength properties. If you examined their tendons compared with a well trained athlete you’ll see that their tendons are straight compared to crimped. You really want crimped tendons because those have enhanced elastic properties. These properties aid in elastic recoil and you become faster and more explosive.

Stretching and flexibility have long been known to help with fascia pliability, but they are not enough. Based on the multi-directional layout of fascia (see point 2) we need not only spiral patterns to address the multi-directional layout of fascia but we need active muscular contraction combined with spiral patterns to address all fascia bands. I’ve been playing with this concept for some time with end-range oscillation techniques.

6) STRETCH ONE HOUR BEFORE COMPETITION. Research on stretching and power has made many afraid of stretching. But there may be more to add to this picture and it might change the minds of many strength and conditioning professionals about stretching. While stretching squeezes out matrix hydration, which contributes to the decrease in subsequent force production, after 1 hour we see a supercompensation of matrix hydration which enhances force and power production. This means if we stretch one hour prior to competition we’ll be in a heighted state of elasticity! Gymnasts have been utilizing this approach for years and the common ancient practice of wetting a rope repeatedly to raise an Obelisk further illustrates this power property of water and mechanical properties.

For those of you as curious as myself as to what an obelisk was

7) We’re ANTELOPES! We have the same elastic properties as an Antelope! Elasticity is the ability to use energy. We’ve talked about this process at length in our four part series about Reactiveness and Stiffness. This ability is a huge quality we develop at FITS and its mind blowing to learn that we have the same elastic properties as an Antelope bounding in the African Saffana.

8) THE SAIL AND MAST – Mechanoreceptors in our superficial layer of fascia are our most abundant and perhaps our most sensitive prioprioceptors. I’ve been taught that our self-awareness of our bodies in space (prioprioception) is based on the integration of information from our eyes, vestibular apparatus (housed in our ears), and joint mechano-receptors. Interestingly, research has shown that joint mechano-receptors are active near to end range. But what happens in between???? It appears that mechanoreceptors in our skin are in the perfect position to serve this function. The analogy that Dr. Schleip used was a sail and mast. While the mast only moves slightly the sail is incredible sensitive to changes in the wind.

BONUS!! “Any hockey player that becomes concussed will have a hip or hernia problem” – Mark Lindsay

Thanks for reading… I look forward to exploring these concepts in more depth in the near future stay tuned.

In the meantime here are some great resources regarding fascia. This list is by no means complete.

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RESOURCES

Robert Schleip. This website is easily the most well linked site on fascia. The amount of great content about fascia is staggering. If you’re interested in learning about fascia you MUST CHECK THIS SITE OUT: http://www.somatics.de/somatics.html

Journal of Bodywork and Movement Therapies. The journal is a great resource for healthcare practitioners. http://www.sciencedirect.com/science/journal/13608592

Fascia Research Project. This site highlights the amazing research being conducted out of Ulm University. http://www.fasciaresearch.com/

3rd International Fascia Research Congress. http://www.fasciacongress.org/2012/

Stretch to win. I really like this technique. I’ve had the pleasure of meeting Ann and Chris Frederick and they’re amazing. This is a great approach that integrates many proprioceptive neuromuscular techniques from all around the world. http://www.stretchtowin.com/

Rolfing. While I don’t understand too much about Rolfing I’ve met some great Rolfers who have really changed my thinking so I believe there is a lot to learn from them and their techniques. http://www.rolfing.org/

Carrick Institute for Clinical Neurology. I know of three great health care practitioners (Dr. Mark Linsay and Sam Gibbs) that are enrolled in this program and I’m most likely going to enrol shortly. http://www.carrickinstitute.org/

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Thanks, Dr. Lam!

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Toronto
January 15 to 16, 2011

See MSK+ for more information.

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Think your approach to the anatomy dissection lab would be different this time around?

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Saturday, January 15, 2010

7:45 am – 8:15 am

• Registration

8:15 am – 9:45 am

• Robert Schleip: Fascial tonicity & fascial force transmission

9:45 am – 10:00 am

• Break

10:00 am – 11: 00 am

• Wilbour Kelsick: Aquatic therapy in enhancing movement dynamics; the effects of tissues of mobile segments

11:00 am – 12:00 pm

• Tom Findley: Fascia research – what do we know and what does it mean for the practicing therapist

12:00 pm – 1:15 pm

• Lunch – provided on site

1: 15 pm – 4: 15 pm

• Workshops

4:15 pm – 4:30 pm

• Break

4:30 pm – 5: 30 pm

• Christopher McDougall, author of “Born to Run” (tickets available for this talk only)

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Workshop Saturday afternoon: Bridging science into clinical practice

This workshop will consist of specific hands-on instruction of different approaches and working techniques aimed at stimulating the four different types of fascial mechanoreceptors. This will include work on the periosteum, on muscular septae, and on adhesions within the ‘superficial shearing zone’ at the bottom of the superficial fascia. During many of these techniques, the clients will be instructed to support the hands-on work with active micro movement participations from the inside, thereby making the tissue work more specific, more cooperative and more sustainable. Guidelines for the best orchestration of such micro movement participations will be given and integrated into the clinical sessions.

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Sunday, January 16, 2011

8:00 am – 8:30 am

• Registration

8:30 am – 10:00 am

• Robert Schleip: Fascia as a regulatory system

10:00 am – 10:30 am

• Mark Lindsay: Fascial involvement in sports related pelvic injuries

11:30 am – 12:30 pm

• Tom Myers – Webcast

12:30 pm – 1:00 pm

• Break

1:00 pm – 2:00 pm

• Case presentations – Mark Lindsay and Wilbour Kelsick

2:00 pm – 3:00 pm

• Panel discussion

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The “small foot” or the “short foot” is a commonly used term in the rehabilitation industry and is of paramount importance for facilitating upright whole body stability. With the vast amount of receptors located at the sole of the foot, the small foot helps to increase afferent input thereby sending important information higher up the system to aid in motor system regulation.

Here is an ideal progression for the facilitating the short foot.

1. Begin with soft tissue and joint mobilization to free up any restriction and stimulate the exteroreceptors and mechanoreceptors. Massage balls and walking on pebbles are excellent ways of doing so.
2. Passive modelling should first be performed by a therapist in a seated position to enable the individual to “feel” the ideal position and movement.
3. This should be followed by active assisted modelling to slowly encourage independence. Here the logitududinal and transverse arches should increase in height. It is important that the toes stay flat on the floor, as do the heels, the first and fifth metatarsal heads.
4. Finally, the individual should now practice active modelling of the foot by narrowing the forefoot and pulling it heelwards. Relaxation should follow each repetition. Progression should be made to a standing position, first in the forward and non-weightbearing foot, then to the weightbearing foot.

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For more information on the short/small foot, check out Patrick Ward’s blog, Chapter 22 of Liebenson’s Rehabilitation of the Spine or Page, Frank, & Lardner’s Assessment and Treatment of Muscle Imbalance: The Janda Approach (click on Educational Resources above).

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Part 2: The research behind the technique

Part 3: What is P.A.I.L’s™ and how is it used in this system?

Part 4: Assessment techniques, and how the system sets itself apart

For more information on Functional Range Release and any of Dr. Spina’s other seminars, please visit Functional Anatomic Palpations Systems.

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The Deep Line as Patrick states, consists of the following:

Posterior tibialis > interosseuos membrane > Knee capsule > adductor hiatus > intermuscular septum > femoral triangle > psoas > anterior longitudinal ligament > diaphragm > pericardium > mediastinum > parietal pleura > fascia prevertebralis > scalenes

Patrick goes on to explain how breathing plays a very important role in the function of this line and provides some excellent strategies for correction and progression.

This got me thinking…

Often times I will use the Bunkie Testing method to assess the various lines throughout the body. I wrote a piece about the Bunkie Test late last year and it can be viewed here. Kevin Neeled also wrote a piece and shot some video on how and why this testing method may play an important role in kinetic linking for hockey players. You can read that here.

As mentioned last fall, the Bunkie Test consists of tests for the following

• Anterior power line
• Medial stabilizing line
• Lateral stabilizing line
• Posterior stabilizing line
• Posterior power line

Do we truly know that we’re testing each of the above? Who knows, but based on Patrick’s article, I think we need to revisit the test and see how we can start testing the DEEP FRONT LINE. That is, the Deep Stabilizing Line. Maybe we can’t. But perhaps we can. I am not trying to reinvent the testing method here. I am simply seeing a flaw in the testing procedure and am now looking for a way to improve it. Joe Heiler of Sports Rehab Expert recently invited me to do an interview and discuss the Bunkie Method of Testing. I hope to do this interview in July so maybe I’ll have some answers by then.

Perhaps there are other ways to test this. I can’t remember off the top of my head right now so if you can think of one, make sure you let me know.

When a patient does present with “dysfunction” of this Deep Front Line, aside from attacking their breathing patterns, I progress to improving their rolling patterns as well. Generally, I will work the supine to prone rolling pattern to improve this line and specifically target the right arm / left leg or left arm / right leg combinations as needed. Carson Boddicker has written several pieces on these topics, one of which is a must read.  For an introduction, make sure you read Core Competencies. Mark Young makes a good argument about testing the roll, but personally, I think quality is more important than quantity in this case…but that’s just my opinion!

Progression from here would be to the Dead Bug tract (not dissimilar to Patrick’s videos) and onward to chops and lifts (thanks Mike) and beyond to really attack their stabilizing function. Check out Nick Tumminello’s video of the Vertical Pallof Press for anterior stabilization (to combat lumbar extension).

Lots of info to digest here and certainly plenty of hot links to click on. So thanks to Patrick, Mike, Kevin, Mark, Carson, Nick, and Perry for unknowingly being participants in this post!

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• An inability to stabilize the pelvis while performing dynamic lower body movements (i.e. performing lunges in the weight room or skating in hockey) may result in shear forces sustained by the spine, creating a compensatory pattern of inefficient/lack of gluteal activation, muscle spasm, and undue stress on the hip joints and muscles.

Therefore, to minimize the risks to specific muscles that cross this joint, we must maximize the integrity of the slings that cross it. Four myofascial slings are involved here, and they include:

• Posterior oblique sling – located across the back from gluteus maximus, through the thoracodorsal fascia, and up to the latissimus dorsi.
• Anterior oblique sling – in the front of the body from the external oblique, through the anterior abdominal fascia, to the contralateral internal oblique and the adductor musculature
• Longitudinal sling – from the peroneii/fibularis group in the lateral lower leg, up the biceps femoris, the sacroiliac ligaments, through the deep thoracodorsal fascia, and up the erector musculature
• Lateral sling – containing the PRIMARY frontal plane stabilizers for the hip joint – the gluteus medius, tensor fascia lata, and the lateral stabilizers of thoracopelvic region (i.e. quadratus lumborum)

Therefore, to assess and correct one’s risk for hip and groin injuries, it would be prudent to test the integrity of these slings and their myofascial components through such testing procedures as the BUNKIE TEST.

One of the most important tenets in minimizing these injuries is the ability to CONTROL and STABILIZE this region while power is being generated. We want loads to be generated THROUGH THE JOINT and not to it!

Other considerations include ADDuctor to ABDuctor strength ratio, hip static and dynamic mobility, and joint centration.

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I’m not exactly talking about the wonders of the footballer for self-myofascial release, although I do think these are more effective than regular stretching in many cases. Nor am I speaking about multidirectional ankle mortise mobilizations. The external assistance that I speak of actually comes from a medial arch support.

A recent study published in JOSPT, examined the effect of Standing Wall Stretching on a number of variables in subjects with “neutral” foot alignment and in those with “flat” feet. The variables examined were:

• Displacement of the myotendinous junction (DMTJ) of the medial gastrocnemius
• Rearfoot angle
• Navicular height

The main finding of this study was that following the stretching protocol, the difference in DMTJ was significantly greater in those with flat feet (pes planus). Therefore, for those of you who recommend the Standing Wall Stretch to improve gastrocnemius length, it may be wise to use a medial arch support in those athletes presenting with Pes Planus.

Photo source

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Tendinopathy? “Hmm…too vague. Get some diagnostic skills will ya?”

Tendinosis? “Now that’s more like it. Most tendon pathologies pass the inflammation stage and go directly to the degeneration stage…right?”

But do they?

Well maybe not! Franklyn-Miller et al recently published an editorial piece entitles “Fasciitis first before tendinopathy: does anatomy hold the key?” in the most recent issue of British Journal of Sports Medicine outlining the fact that most research articles have failed to mention the role of the enveloping fascia in tendon pathologies. Specifically, they state that in some conditions involving musculotendinous structures, inflammation of the fascia is actually present, similar to that of conditions such as plantar fasciitis (here we go again!)

Their argument stems from histological evidence of inflammatory infiltrates, the presence of a fascia-tendon interface, and the relatively high number of studies that make reference to the presence of a paratenon enveloping or overlying the Achilles tendon. In fact, this paratenon is actually the posterior fascia of the lower extremity! Note: this paratenon is frequently used as a landmark for guidance of therapeutic injections of the Achilles tendon.

Therefore, this posterior fascia or paratenon, may be  a source of pain and inflammation in very early stage “tendon” pathologies and adhesion of this structure to its underlying tendon may actually lead to abnormal tendon loads and subsequent tendinopathy.

Thus, keeping in line with one of the main outcomes of my post yesterday on Greater Trochanter Pain Syndrome, finding the root cause of pain local to a specific area is perhaps one of the most important, yet difficult, skills of a clinician. Therefore, it may be wise to occasionally ask ourselves do we really know what we think we know?

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Although the assessment and treatment of myofascial and kinetic chain dysfunction has been used for numerous years, its presence in therapy clinics and performance centres have increased tremendously in recent times.  Clinicians and strength coaches are well adept at developing the functional kinetic chain, however, very few understand importance of the fascial system. In order to adequately assess imbalance and dysfunction, a battery of tests must be performed.

An article by de Witt and Venter was published recently in the Journal of Bodywork and Movement Therapies and describes the “Bunkie” test for assessing functional strength. While “functional strength” encompases MUCH more than the myofascial system, let’s look at this testing procedure for assessing the fascial lines.

The Bunkie test has generally been used as the main assessment tool in the Lyno Method and is derived from the Afrikaans word ‘bankie’ for little bench. This testing procedure is comprised of 5 different tests for specific fascial lines.

Anterior power line

Medial stabilizing line

Lateral stabilizing line

Posterior stabilizing line

Posterior power line

The bench height should correspond with the length of the humerus (~ 25 -30cm)

Test position should be held for 20 – 40s (40s is preferred for endurance athletes)

While this testing procedure still warrants validation, it may be useful in challenging cases to reveal areas of “locked-long” fascia along the specific line examined.  A positive test for “locked-long” fascia is indicated by immediate pain upon testing, bodily rotation, and or inability to hold the correct position.

The assessment of “locked-short” fascia must also be performed but is not directly related to the “Bunkie” testing procedure. I will discuss the assessment of such fascia as well as treatment of “locked-long” fascia (weak) lines in a future post. But for now, I would like to know how many of you currently use this testing procedure and if so, what feedback you may have.

And while we’re talking about myofascial and kinetic chain dysfunction, here are two books/manuals that I’ve recently ordered and will be reviewing on this site sometime in the near future.

Photo sources: 1, 2, 3, 4

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