David has a particular interest in Deep Fascial Release; especially when combined with other Osteopathic treatment methods. This approach to treatment has been used to great effect within the Osteopathic Medical profession for over 70 years. This treatment method utilises Canadian and US designed therapeutic devices (which generate a wide variation in mechanical percussive strength and frequencies) to soften the deep fascias and activate a therapeutic response from deep inside the body. This therapy also compliments David's other treatment methods; which include Biodynamic Cranial Osteopathy; Breath and Awareness Activated Muscle Energy Technique; Anti-inflammatory Poultice application; and the very occasional softly administered spinal and other joint manipulation.
With a sensing hand placed upon a patient's body and dialing through fine graduations of frequencies with the other, David is able to feel a softening within the deep fascias of the body as inner tissue resistance is overcome. This therapeutic response occurs when the mechanical frequency matches a perfect harmonic resonance within the tissues. With the perfect frequency, the deep fascias 'dissolve' and the body releases unwanted tension from the inside. An intuitive touch assists in locating the correct regions to be treated; like peeling layers off an onion; each will release individually, and only when each is ready to let go. As the deep fascia progressively relaxes in response to the unraveling sequence of locations and frequencies, the nervous system begins to deeply relax. The benefits associated with this treatment this method (like any other), is governed by a practitioner's experience in the field.
Osteopathic practitioners assist in finding the health present within a patient's body, and will work towards removing those barriers or impediments to it's natural expression (an Osteopath will first find the region of the body that feels the best, and will help this to grow). This is in contrast to a practitioner being guided by symptoms (or firstly naming a disease process), and then working towards suppressing these symptoms. This is the essential philosophical difference between the practice of Osteopathic Medicine and Allopathic Medicine.
Why is the Deep Fascia so important?
WHAT IS DEEP FASCIA?
Deep fascia (or 'investing fascia') is a fibrous connective tissue that interpenetrates and surrounds (both inside and outside of) all muscles, bones, nerves, blood and lymphatic vessels, including all organs within the body. It also constitutes joint capsules, ligaments, tendons and all other fascial layers that create structural integrity and functional capacity within the body. In other words, deep fascia is the substance that holds the body together and creates stuctural form; it also allows these structures to function as an integrated whole. Collagen protein (the plastic element of fascia) determines fascial tensile strength and integrity, and the amount of elastin (the elastic element) determines it's extensibility and resilience.
Fascia is richly innervated by nerves and their sensing receptors. These receptors report information to the brain about pain perception (nociception); change of movement (proprioception); change in pressure and vibration (mechanoreceptors); change in the chemical mileau (chemoreceptors); and fluctuations in temperature (thermoreceptors).
The deep fascia has an intimate relationship to all mechanical structures of the body, and so directly influences their function; it also mechanically influence blood, lymphatic and cerebrospinal fluid circulation; and affects the brain directly via a hard wired connection of the nervous system. All of these interconnections mean that deep fascia has a significant and far reaching influence upon the body as a whole, and the body's capacity to remain healthy.
THE PIEZOELECTRIC EFFECT
The Peizoelecric effect refers to the ability of certain materials to generate an electric charge in response to applied mechanical stress. Both bone and fascia have this capacity to generate an electric charge. Within bones, this electrical charge is what guides the remodeling of bone (through osteoblast and osteoclast cell activity), and is the reason why exercise under the effects of gravity will increase bone density. This is also the same mechanism by which the deep fascias can remodel themselves (lay down fibrosis) when under constant strain.
With the therapeutic application of a mechanical therapeutic frequency (of rhythmic compression and release), the fascias of the body will also generate an internal electrical charge. It is this electrical charge that creates a magnetic field, and it is this magnetic field that amplifies the body's own therapeutic response to treatment. In addition to this, the mechanical energy contained within a chosen therapeutic frequency will engage a region of restriction, and unlock the plastic element of the fascia (explained in detail below) which holds the tissue memory. In the case of softening plastic tissue memory, the elastic forces held within the strain pattern will then dominate, and the body will spring back and return to normal structure and function.
CLINICAL DIAGNOSIS OF THE DEEP FASCIA
An Osteopath's sensing hands are able to distinguish the difference between normally functioning deep fascias, and those that have been affected by a history of stress and trauma. An Osteopath tests for alteration in body position and movement, also variations in tissue tone, texture and tenderness, heat of acute inflammation/cold of a chronic problem, and the sense of general irritability within the nervous system. These observations give the Osteopath a clear picture of where a mechanical problem exists, and to what extent the rest the body has also been affected. The clearer the understanding of a problem, the less physical force that is required in resolve it. Treatment therefore involves 90% listening with feeling and seeing fingers, and 10% doing: this is the key to achieving the deepest possible result with least amount of physical force.
THE PHYSIOLOGY OF DEEP FASCIA
More recent empirical research has shown that deep fascia is able to respond to sensory input by contracting (via myofibroblast cells); by relaxing; or by adding, reducing or changing it's composition through the process of fascial remodeling.
The body's natural fight/flight stress response has also been shown to generate contraction within the fascias (via activation from the nervous system, circulating stress hormones or both), and this allows for an increase in both body strength and resiliency. In times of extreme physical or emotional danger, this acute stress response within the deep fascias of the body is nature's way of improving a person's chance of survival. In circumstances of chronic ongoing stress however (more prevalent in modern societies), this mechanism of fascial contraction actually becomes maladaptive with physiological changes that actually compromise long term health.
Fascia demonstrates elastic and plastic properties. Elasticity allows the fascia to bounce back after a physical force is applied. This can be demonstrated when someone jumps from a height and the elastic nature of the deep fascia (like an elastic band) will absorb some of the blunt impact force of impact; the elastic will then recoil back to it's original shape. Plasticity on the other hand is associated with the fascia's tensile strength. Under normal circumstances, plastic does not stretch. If however the plastic is heated it can then be stretched. If then cooled again, it will greatly resist returning back to it's original shape. Plasticity within the fascia can occurs in such circumstances as a car accident (or other blunt force injuries), where the kinetic energy of an impact effectively melts the fascia, and the 'shape' of the accident is retained as tissue memory. Plasticity also occurs with the pull of gravity in chronic poor posture, where the plastic will eventually fatigue and stretch. The mechanism by which physical force can 'melt' fascia has been shown to be dependent upon the mechanical properties of the cellular matrix (or ground substance) within the fascia itself - it's ability to turn from solid to liquid and back to solid again, once a certain threshold of force has been reached.
The tissue memory of past physical injuries are locked within the tensile plastic element of the deep fascia, and these are resistant to further change. On the other hand, the elastic element of the deep fascia still holds the memory of it's original shape (prior to injury), and will be actively trying to bounce back again. Tissue memory therefore is a holding pattern between opposing plastic and elastic forces. Osteopathic frequency treatment therefore aims to soften the resistant plastic element, and in so doing release the potential energy of the elastic element. The resultant therapeutic response assists in a return to normal structure and function. Interestingly, when an old trauma embedded within the deep fascia is released, the tissues will at times get very hot. This is the result of both an increase in blood flow, and the conversion of original kinetic energy of injury (stored within the body as elastic potential energy) finally released as heat. As we know, energy never disappears, it just gets converted from one type of energy to another.
Chronic emotional stress is also locked within the tensile plastic element of the body as tissue memory, but this occurs via a different mechanism. Under constant (stress induced) contractile tension, deep fascia has the ability to remodel itself; or in other words the fascia will lay down more collagen (scar tissue). As the deep fascia becomes more fibrotic, it also becomes more rigid; this rigidity affects circulation/drainage in the region and will stress the living tissues that require oxygen and the removal of toxins to stay healthy. This additional physiological stress feeds back into the nervous system via the now increasingly stimulated deep fascia sense receptors. Because of stress induced scarring within the deep fascia, a person begins to gradually lose their capacity to relax all together, simply because their nervous system has become over stimulated (not only from outside stresses of life, but also from physiological stress from within their own body).
Likewise when the body's deep fascias sustains a significant imprinting physical injury (such as a fall, concussion, car accident or lifting injury), if this injury is left unattended and allowed to become a chronic pattern, it too will be further reinforced with scar tissue, and the same cascade of physiological responses will be the result..
The good news is that if deep fascia can be 'heated up' enough (with the correct frequency) to release the tissue memory imprint held within the plastic, the elastic aspect of the deep fascia will then be allowed to spring back to normal shape, and the traumatic pattern will be resolved.
It is worth keeping in mind, that as human bodies get older, there is a natural reduction in elastin fibres, and an increase in collagen fibres (we naturally develop proportionately more fibrosis/scar tissue as we get older). This essentially means that we don't bounce back from injury quite the same as we did when we where younger, and likewise as we age, treatments take longer to get the result we are looking for.
Chronic contraction and fibrosis within the body deep fascias adversely affects the local mechanical functions of muscles, joints, bones, nerves, blood, lymph vessels and organs, and also local and 'downstream' effects upon fluid and nerve functions (fluid congestion, lack of oxygenated blood and altered nerve supply).
The receptors within deep fascia are intended to provide feedback to the brain about body position, movement and threat to the tissues, and this works particularly well when the body is functioning normally. When the deep fascia holds the chronic imprint of a traumatic injury however, these sensing receptors work to create maladaptive responses within the body, that begin the compromise a person's health. Stretched fascia within the elastic element of a traumatic imprint is constantly under load, and this force stimulates pressure and stretch receptors within the deep fascia. This information being sent to the brain informs that the body is trying to move (when in actual fact it isn't). The brain (and spinal cord reflexes) will try to counter this perceived (agonist) attempt at movement with antagonist muscle contraction. Local muscle tension will result in localised mechanical imbalance, and this in turn will result in a compensatory reaction throughout the entire body as it attempts to equilibriates to the effects of gravity; a dysfunctional pattern within the body that adds additional stress to the nervous system. Likewise, chemical receptors within the deep fascia will begin to alert to the build up of toxins and change in pH as a result of reduced fluid flow within the region. Pain receptors within the deep fascia will also alert to the presence of any tissue injury (when the force of injury has exceeded the plastic/elastic tolerance of the deep fascia and other tissues). An inflammatory process that is unable to resolve due of lack of drainage and therefore fluid congestion, will become chronic and continue to send alarm signals to the brain. All of this stimulation from different quarters has an ongoing and significant over-stimulating affect upon a person's nervous system, and begins to trigger a feedback loop which progressively worstens the situation (instead of fixing it).
Tension and fibrosis within the deep fascia will result in an over-stimulation of the deep fascia sense receptors (which activate when the fascia is in trouble), this in turn increases stimulation within the nervous system. Stimulation within the nervous system trigger a further contraction of the deep fascias. This additional tightening of the fascias creates an ongoing tension-stimulus-tension feedback loop which continues until the person eventually begins to experience marked loss of movement and significant pain.
Myofascial pain is a further progression; a feedback loop that activates between the deep fascia, the nervous system and the muscles of the body. Acute muscular spasm with pain, subsequent inflammation and trigger points will exponentially add to the pain and immobility experienced by someone with a deep fascia problem. When the fascias are in trouble, the nervous system will tighten the muscles in the region as a protective measure (which under normal circumstances helps the body to repair), but when the problem becomes chronic this muscle spasm becomes maladaptive. When a pain-spasm-pain feedback loop becomes established, it is followed by a cascade of other effects that compromises long term health.
It is worth keeping in mind also, that without a nerve supply a muscle initially behaves like a piece of flaccid steak in the supermarket. It is clinically helpful to understand how dysfunction within the deep fascias can generate muscle spasm. The ultimate method of resolving ongoing pain is to find a fix the underlying problem.
The connection between chronic stress and heart disease, gut health, immunity and cancers are all well documented. An understanding of deep fascia physiology further highlights how unresolved physical trauma and emotional stress, has the potential of generating long-term physical health problems.
The response within the fascia to both emotional stress and physical trauma therefore is the beginnings of a self perpetuating and expanding pattern of whole body dysfunction. If this dysfunction remains unresolved within the body, it will slowly progress through a series of stages including; movement restriction, pain and illness, then decades later disease and final decline.
OSTEOPATHIC TREATMENT OF THE DEEP FASCIA
Being checked over a minimum of 3-4 times a year as preventative maintenance treatment is most commonly recommended, after-all the human body is just like any other machine and will accumulate wear and tear. Resolving stress and injury promptly (when it does happen), may avoid developing a chronic problem further down the track. If one does have a significant history of chronic stress and trauma, then of course finding one's health again may take some time. In an ideal world, a expectant mother's treatment before birth and a baby soon afterwards is the best of preventative healthcare, but for the majority of us, we don't have the option of turning back the clock. It is the intention of treatment however, to assist in reducing the physical effects of a traumatic past.