Notes and Quotes from Andreo Spina

In November I had the privilege of attending the Functional Anatomic Palpation and Functional Range Release (spine module) course hosted by Somatic Senses.

This course was taught by Drs. Andreo Spina and Michael Chivers, and while I've known both of these bright individuals  for over 10 years, it's always a treat to hear what they have to say.

Because it would be difficult for me to write a summary for those who were unable to attend (the course is full of contextual information), I thought I would do something a little different and recap some of Dr. Spina's quotes from the seminar and directly ask him for follow up clarification.

He kindly agreed so enjoy!
.
"Don't focus on the muscles, focus on the connective tissues"

• "When you stop to think about it, what is a muscle?  Is a collection of components – proteins (actin, myosin, etc.), the innervating motor neuron, and the connective tissue encasements.  When one applies a ‘release’ technique what is the intent?  It’s not to pull apart Actin and Myosin cross bridges as that simply requires movement.  Its not to rip out the innervating motor neuron for obvious reasons.  So we are left with connective tissue, which is in fact where “fibrosis” or “scar” tissue develops as these two terms simply refer to disorganized connective tissue.  So if connective tissue is in fact the target, we must employ strategies that most strongly influence change in it.  This isn’t simply a matter of nomenclature.  The literature is quite clear about how connective tissue adapts to applied loads vs other tissues and thus, we cannot simply assume that our approaches are affecting it.  This change in mentality/focus is really at the heart of the FR Release® system."

"Instead of flossing the nerve, load it"

• "I don’t recall why I used the word ‘instead’… “Load the nerve in addition to flossing techniques” would be more accurate.  The reason for the loading comment stems from the fact that approximately 80% of neural tissue is composed of connective tissue.  Thus, as with all other forms of connective tissue, it will adapt to applied demands.  Very briefly, progressively loading neural tissue can produce beneficial results by way of improving the tissues resilience and load absorption capacity.  This will in turn decrease the likelihood of neural tissue damage during movement/physical activity.  Of course this doesn’t mean that one should utilize nerve loading on everybody…there are steps and progressions that one must employ to create the desired effect safely that you will recall we discussed at the certification seminar.
• A quick note on ‘flossing’…I always found it bizarre that some practitioners prescribe flossing exercises on the first visit for patients with radicular symptoms.  If the premise is that there is some sort of “entrapment” or frictional irritation affecting the nerve, presumably due to the build up of scar tissue/fibrosis, why then would some recommend flossing the nerve repetitively along said irritant?  I would always recommend that the tissue should to be re-sculpted (by way of manual treatment…provided over a course of time) PRIOR to implementing such exercises."

"The first job in rehab is to influence (aka normalize) the healing of damaged tissue"

• "If you look at any definition of ‘rehabilitation’ you will find the word ‘restore’ which is to repair something so as to return it to its original condition.  When any injury/tissue damage occurs, the bodies inherent restorative systems are looking to do just that.  However, as we all know, these systems are far from perfect stemming from the fact that they were not created by design, but rather by the evolutionary process of natural selection that produces adaptations that are often imperfect.
• With proper, focused rehabilitative technique however, the literature demonstrates that one can influence the process such that it will optimize the healing of the damaged tissue itself.  All biological tissue is subject to anisotrophy, which is the property of being directionally dependent.  This means that with focused force inputs, we can optimize the directionality of tissue healing along the lines of applied stress, and thus ultimately reduce fibrotic deposition stemming from uncontrolled tissue healing.  This leads to tissue of better quality, and higher resilience/strength.
• This goal should be obvious in my opinion.  However it seems all to common for practitioners, especially when following a pre-set rehabilitation ‘plan/program,’ to bypass this important step and begin the process of joint stabilization, proprioception training, etc.
• Take for example a case of inversion ankle sprain.  Many would correctly focus on reducing pain and swelling first, but would then proceed to prescribe “range of motion exercises” followed by progressive balance/proprioceptive training, and general ankle strengthening exercises.  The question is, what in the aforementioned plan ensured that the actual damaged ligament healed correctly?  What force inputs were applied that directed the fibroblastic cells in the area to deposit new, good quality tissue in the proper direction?  This is a problem because it is known that without such ‘communication,’ the healing process tends to produce disorganized tissue of poor quality; otherwise known as fibrosis."

"If something is neurologically tight, do not try to 'release' it...you need to apply neurological inputs - i.e. isometric contractions"

• "When someone tells me that something is “tight,” I immediately have to ask for clarification.  “Tightness” is an example of a scientific analogy that is commonly utilized in our industry.  Such analogies work well for the patient population, but lack the specificity needed to allow a colleague to understand what you are referring to.  If a muscle is “tight,” do we mean that there is mechanical deposition of fibrotic tissue?  Or do we mean that there is an aberrant, ongoing, increased neural drive maintaining a higher level of contraction?  If one is referring to the latter, then it would be best dealt with using inputs that are able to specifically alter neural drive;  “neurological inputs” so to speak.  One of these inputs commonly utilized in the FR system is PAILs (Progressive Angular Isometric Loading), which is able to cause rapid alterations in neurological output to a muscle.
• Conversely, if one is referring to an area of aberrant tissue structure or fibrosis, then that area is better treated by utilizing techniques that can alter soft tissue structure (FR, Myofascial work, etc.).
• In my seminars we spend a lot of time on this distinction so as not to waste time applying treatment inputs that do not match the assessment findings."

"It's the nervous system's decision as to what it does with the muscles, not the decision of the origin and insertion"

• "I have a handful of patients in my practice who are Neurologists.  When I speak to those in this profession, I always as them how much they think they really understand the nervous system.  In every case the answer has been “VERY little.”  I tend to share this sentiment.  However for some reason, there are various individuals in the manual therapy and conditioning professions that tend to believe that they have a superior understanding of its inner workings that others are not privy to.  In fact, many have developed complex systems of assessment, treatment, and training based on this perceived superior understanding!
• In my experience, and when taking a look at the literature as a whole, I tend to side with the specialists in the field and agree that with regards to the nervous system, we are just scratching the surface with our current understanding.
• With regards to the function of muscular tissue, we tend to try to simplify their function as being to simply approximate their origins and insertions.  However, their function is far more complex than this.  Does the bicep simply bend the elbow?  No.  In fact, it is also involved in extending the elbow…as well as various other functions on the shoulder…in an infinite number of planes and angles.  It even has a role in the function of distal articulations when considering how contraction propagates messages via mechanotransductive means.
• The truth is that the neurologic control of the muscle isn’t simply to say “shorten.”  The messages can involve great amounts of specificity in terms of contraction speed, duration, amplitude, direction, etc…which is far beyond our current understanding.  Even the “sliding filament theory” is simply an over simplified analogy!"

"Force is the language of cells"

• "I tend to think of the treatment/rehabilitative process as a communication between the treating practitioner and the cells of the tissues that we intend to alter.  This communication dictates how injured tissue heals, or how healed tissue is remodeled.  For both of these processes, it is the cells, which produce the tissues components that guide the process.  Thus for the treating practitioner, if we can influence cellular activity, we can influence the resultant tissue structure.
• As cells obviously don’t “speak” per se, then how can we alter their function? With force.  Mechanical forces have been long known to directly influence how cells produce, and re-form or remold tissues.  Thus, its force that is the “language of cells. “
• We as manual practitioners do indeed “speak” this language and provide force inputs in two forms:
  • External force application – those forces that we apply from the outside with our contact (ie. soft tissue/manual therapy application)
  • Internal force application – forces that are created internally via contraction (ie. specific exercise/rehab prescription)
• When we are able to direct these forces in specific ways, we can dramatically influence the structure of tissues."

"The idea that fascial lines exist negate the idea that everything is connected...and everything IS connected"

• "I am a great admirer of the work of Tom Myers and others who have introduced the concept of fascial lines.  I think it provided those in our profession with a more realistic understanding of how anatomy exists in the living body.  One that is far removed from the “dissected” anatomy found in textbooks who’s images are depicting “art” more than realism.  By art I mean that in order to get the anatomy to look that way, it takes the hard work of an anatomist and a scalpel to demonstrate a preconceived idea of what structures ‘should’ look like in a highly segmented fashion.
• However I believe that to truly understand the continuity of human tissue, we need to appreciate it not at the gross tissue level, but at the microscopic level.  When it is said, “everything is connected,” this statement is true at a cellular, and even subcellular level.  Each cell of the body is intimately connected with each neighboring cell, which forms a true body wide continuity (See the work of Ingber on the topic of cellular tensegrity, solid state biochemistry, and cellular signaling).  This means that the connections between tissues extend in every direction.
• For someone to say everything is connected, but then attempt to separate said connection into “lines,” we fall back into thinking that the bodies tissues are somehow “segmented”…which they are not.
• Further, while stronger fascial connections do indeed exist, some take that to believe that they are there to achieve a functional goal.  That somehow the anatomy was created in this fashion for a purpose.  They then take this idea and develop training programs based on the “fascial lines.”  However, while some may think that anatomy dictates function…it is actually function that dictates anatomy.  Thus lines are created, and reinforced based on utilization.  If I were to dissect a former hockey player and a former gymnast, I should be able to tell which is which based on the development/reinforcement of fascial lines that I find.
• From a manual therapists perspective, I think it dangerous for people to treat based on “fascial lines” as aberrant tissue tension can develop in an infinite number of directions…
• I can go on for days on this topic!  I will end here by saying that at both my FR and FRC certifications I lecture on what I call the principle of BioFlow Anatomy which is a new term I use to describe, and conceptualize the extend of continuity found in human tissue at the microscopic level."

"When taking a clinical history, think histology"

• "In my opinion, many practitioners get lost in the clinical history taking process because they loose site of its purpose.  In school, we are taught to run through a predetermined “check-list” of questions with very little instruction as to why we are asking certain things, nor how to interpret the answers.  The real purpose of the clinical history is to determine the diagnosis.  A diagnosis that is useful to manual practitioners is one that can then guide the clinical decision making process.  In order to do that, we need to come up with a diagnosis that describes the histological process occurring in the injured tissue so that we can then develop a focused treatment plan geared at reversing, or controlling said process.
• So when we are taking a clinical history, we should ask questions that provide us with clues as to the histology resulting from the pathology.  Is it inflammatory? Degenerative? Etc.
• Once we nail down the histology, we can easily make decisions as to which of our treatment ‘tools’ to pull out."

.
Thank you again to Dr. Spina for taking the time to clarify his thoughts (quotes). If you're a manual therapist, I highly suggest you check out his site and better yet, one of his courses. In the meantime to tide you over, here's a short video I recorded directly from the course.