For the progress of any profession, it is essential to be aware of new information regarding one’s practice.
The chiropractic subluxation has proven to be an important factor for attaining superior results. But it must be accepted that the spine is a passive structure moved by muscles, and recent data demonstrates that muscle coordination and function depends on the fascia that surrounds and penetrates the muscle.
It is imperative to be an expert in the tissues that move and support the function of the joints, and often these factors are more related to a patient’s complaint than the subluxation.
A missing link in chiropractic is treatment of the fascial system.
Fascia literally covers everything in the body including nerves, blood vessels, organs, and muscles. But until recently, science has virtually ignored fascia.
As Carla Stecco, MD, PhD, states in her recent text, most anatomists recognize fascia as something to be removed so muscles, joints, organs and tendons may be studied carefully.1
She states that “muscles move in relation to one another as a function of the fascial structures that give them form and permit the proper amount of glide.”
The “proper amount of glide” of fascia surrounding and within muscles is the essential element responsible for muscle coordination. Fascia is now considered a sensory organ rather than just a protective covering.
Many techniques are available, including the use of various instruments, to enhance this glide. All of these methods are helpful, but new information about fascia and its relationship to the central nervous system (CNS) is critical if you want to effectively restore coordination and restore the kinetic chain, instead of just freeing up painful restrictions.
The CNS requires accurate sensory input to control muscles, and the information it receives from muscle receptors is critical. The chief sensory input receptor controlling how muscles work comes from muscle spindle cells. These are responsible for reporting to the CNS the status of the muscles and joints.
Research shows that it’s the spindle cells, rather than joint receptors, that play the most important role in postural sensations of joint angle.2
They control fine motor movements, joint range of motion, and body position. They control and maintain muscle tone and contraction.
The most extraordinary information about this important sensory system is that muscle spindle cells are located in fascia within muscles and not in muscle tissue. In reality, muscle spindles should be called fascial spindle cells.
Interestingly, the acupuncture system is in the fascia. Fascial manipulation (FM), which last year was taught in 40 countries, provides an ideal system of restoring fascial glide at particular locations located in muscular or fascial sequences.
Pathways of dysfunction
The practitioner must first determine which of the fascial acupuncture pathways are implicated based on functional testing and palpation. If a fascial pathway contains tender, dense points from an old ankle injury (and the patient may not even be aware of it), and these points correspond to similar points along a pathway, e.g., to a painful knee, hip, or lower back, then often during the initial visit the treatment of a 10-year-old “painless” ankle sprain will immediately relieve the proximal compensatory area of complaint.
Most therapies concentrate on the location of pain that is often a compensatory area overworking due to a previous injury. When treating these areas, it is essential that the practitioner re-palpate the designated points to feel the restoration of glide and then determine if the painful motion is relieved. Rarely is one point sufficient.
The big question is why glide is so necessary. All receptors in the musculoskeletal system must be able to stretch to send sensory impulses back to the CNS. This is so critical that a nerve from the CNS called the gamma has the principal job of making sure spindle cells stretch. This gamma nerve controls more than 30 percent of the motor supply to muscles along with the alpha motor neuron, which causes muscle contraction. These two nerves work together.
So the gamma tells the spindle cell to stretch to inform the CNS about muscle function and the spindle cell may report that it can’t stretch as much as it needs to because it’s stuck in the fascia.
Muscle bundles and muscle fibers need to glide within the fascia as muscles contract or stretch. A lack of free gliding of the fascia within the muscle prevents normal feedback of sensory impulses back to the CNS, resulting
in muscle weakness, pain, and alteration of muscle vector force and coordination. Many of the points used in FM are acupuncture points and directions of muscle and fascial relationships have been shown on dissection.3
Fortunately, more chiropractors are adding soft-tissue methods to their approach to healthcare. The future of the profession depends on it. It is always prudent to evaluate a method as to the research behind it and its results. Visit fascialmanipulation.com, fascialmanipulationworkshops.com, fasciaresearch.com, and warrenhammer.com for further information.
Warren Hammer, DC, MS, DABCO, has lectured internationally on soft-tissue modalities and chiropractic. He wrote the third edition of Functional Soft-Tissue Examination and Treatment by Manual Methods, 2007. In 2013, he became a certified instructor in fascial manipulation and, along with Antonio Stecco, MD, has introduced FM in the U.S. He is the English editor for the text Functional Atlas of the Human Fascial System, by Carla Stecco, MD. He can be contacted at firstname.lastname@example.org or through warrenhammer.com.
1Stecco C. (2015). Functional Atlas of the Human Fascial System. London: Elsevier.
2 Kandel ER, et al. (2013). Principles of Neural Science. (5th ed, pp. 475-497). McGraw-Hill: New York.
3 Stecco C, Gagey O, Macchi V, et al. Tendinous muscular insertions onto the deep fascia of the upper limb. Morphologie. 2007;91(292):29-37.