Editor’s Note: This article is adapted from Fascia: The Tensional Network of the Human Body by Robert Schleip et al.,1 which is scheduled to be published in 2012. For more information on Fascial Fitness see</i> <a href=’http://www.fascialfitness.de’ target=’_blank’>http://www.fascialfitness.de</a>

 

When a football player is not able to take the field because of a recurrent calf spasm, or a tennis star gives up early in a match due to a knee problem, or a sprinter limps across the finish line with a torn Achilles’ tendon, the problem is usually neither in the musculature nor the skeleton. Instead, it is the connective-tissue structures – ligaments, tendons, joint capsules, etc. – that have been loaded beyond their capacity.2,3 A training regimen focusing on the build-up of the fascial network could be of great importance for athletes, dancers and other movement advocates. If one’s fascial body is well-trained, so to say optimally elastic and resilient, it can be relied upon to perform effectively as well as offering a high degree of injury prevention.4

 

Until now, sports trainers have mostly focused on the classical triad of muscular strength, cardiovascular conditioning, and neuromuscular coordination. Some alternative physical training activities – such as Pilates, yoga, Continuum Movement, t’ai chi, qi gong, and martial arts – are already taking the connective-tissue network into account, acknowledging the effects of the global body network in a mostly intuitive way. However, the insights of current scientific fascia research need to be discussed so as to translate these insights into a precise practical training program in order to build up an injury-resistant and elastic fascial body network. Therefore, we encourage physical therapists, sports trainers, and movement enthusiasts to incorporate the fascial training principles presented in this article and to apply them to their specific context.

 

Fascial Remodeling

 

A unique characteristic of connective tissue is its flowing adaptability: when regularly put under increasing physiological strain, it changes its architectural properties to meet the increasing demand. The varied capacities of fibrous collagenous connective tissues adapt continuously to regularly occurring strain, particularly in relation to changes in length, strength, and ability to shear. Fibroblasts – fiber-producing connective-tissue cells – react to a dominant loading pattern, whether it is an everyday strain or a specific impact of training. These mobile tissue workers continuously remodel the arrangement of the collagenous fiber network. In a healthy body, with each passing year half of the collagen fibrils are renewed. For example, through our everyday bipedal locomotion the fascia on the lateral side of the thigh develops a palpable firmness. If instead we were to spend that same amount of time with our legs straddling a horse, then the opposite would happen, i.e., after a few months the fascia on the inner side of the legs would become more developed and stronger.5

 

Fascial Fitness enhances this renewal via specific training activities which, after six to twenty-four months, will build up a ‘silk-like bodysuit’ that is not only strong, but also allows for a smooth gliding joint mobility over wide angular ranges. Interestingly, the fascial tissues of young people show stronger undulations within their collagen fibers reminiscent of elastic springs; whereas in older people, the collagen fibers appear rather flattened.6 Research has confirmed the previously optimistic assumption that proper exercise loading, if applied regularly, can induce a more youthful collagen architecture, showing a more wavy fiber arrangement and also expressing a significant increase in elastic storage capacity7, 8 (see Figure 1). Yet it seems to matter which kind of exercise movements are applied: a controlled exercise study using slow velocity and low load contractions demonstrated an increase in muscular strength and volume; however, it failed to yield any change in the elastic storage capacity of the collagenous structures.9

<img src=’/imgs/2012/1178-1.jpg’>

Figure 1: Increased elastic storage capacity. Regular oscillatory exercise, such as daily rapid running, induces a higher storage capacity in the tendinous tissues of rats, compared with their non-running peers. This is expressed in a more spring-like recoil movement as shown on the left. The area between the respective loading (up arrow) versus unloading (down arrow) curves represents the amount of hysteresis: the smaller hysteresis of the trained animals (posttraining) reveals their more ‘elastic’ tissue storage capacity; whereas the larger hysteresis of their peers (pre-training) signifies their more ‘viscoelastic’ tissue properties, also called inertia. (Illustration modified after Reeves.10)

 

The Catapult Mechanism: Elastic Recoil of Fascial Tissues

 

Kangaroos can hop much farther and faster than the pure force of the contraction of their leg muscles should allow. Recently, scientists discovered a spring-like action behind that unique ability – the so-called catapult mechanism.11 Here the tendons and the fascia of the legs are tensioned like elastic bands and the release of this stored energy is what makes the amazing hops possible. High-resolution ultrasound examination has made it possible to discover similar orchestration of loading between muscle and fascia in human movements. Surprisingly enough, it has been found that the fasciae of humans have a kinetic storage capacity similar to that of kangaroos and gazelles.12 This catapult effect is made use of not only when we jump or run, but also with simple walking, as the springiness provides a significant part of the energy for the movement.

 

This new discovery leads to a revision of long-accepted principles in the field of movement science. In the past it was assumed that in a muscular joint movement, the skeletal muscles involved shorten actively and this energy passes through the passive tendons, causing the movement of the joint. This classical form of energy transfer is still true for steady movements such as cycling: here the muscle fibers actively change in length, while the tendons and aponeuroses barely grow longer (see Figure 2). The fascial elements remain quite passive in contrast to oscillatory movements with an elastic spring quality: here the muscle fibers contract in an almost isometric fashion (they stiffen temporarily without any significant change of their length) while the fascial elements act in an elastic way, similar to the up and down movement of a yo-yo. In this way, the lengthening and shortening of the fascial elements ”produce” the actual movement.13, 14

 

The work by Staubesand et al.15 suggests that the elastic movement quality in young people is associated with a typical bidirectional lattice arrangement of their fasciae, similar to a woman’s stocking. In contrast, as we age and usually lose the springiness in our gait, the fascial architecture takes on a more haphazard and multidirectional arrangement. Animal experiments have also shown that lack of movement quickly fosters the development of additional cross-links in fascial tissues. The fibers lose their elasticity and do not glide smoothly; instead they stick together and form tissue adhesions, and even worse, they become matted together16 (see Figure 3).

 

The emphasis of the proposed Fascial Fitness training is to stimulate fascial fibroblasts to lay down a more youthful and kangaroo-like fiber architecture. This is achieved through movements that load the fascial tissues using multiple extension ranges while utilizing their elastic springiness. Figure 4 illustrates different fascial elements affected by various loading regimes. Classical weight training loads the muscle in its normal range of motion, thereby strengthening the fascial tissues, which are arranged in series with the active muscle fibers. In addition the transverse fibers across the muscular envelope are stimulated as well. However, little effect can be expected on extra-muscular fasciae as well as on those intramuscular fascial fibers that are arranged in parallel to the active muscle fibers.17

 

Classical hatha yoga stretches, on the other hand, will show little effect on those fascial tissues that are arranged in series with the muscle fibers, since the relaxed myofibers are much softer than their serially arranged tendinous extensions and will therefore ”swallow” most of the elongation.18 However, such stretching provides good stimulation for fascial tissues which are hardly addressed with classical muscle training, such as the extramuscular fasciae and the intramuscular fasciae oriented in parallel to the myofibers. A dynamic muscular loading pattern in which the muscle is both activated and extended seems to be most effective. This can be achieved by muscular activation (e.g., against resistance) in a lengthened position while requiring only small or medium amounts of muscular force. One can also utilize soft, elastic bounces in the end ranges of available motion to achieve such a comprehensive stimulation of fascial tissues.

<img src=’/imgs/2012/1178-2.jpg’>
Figure 2: Length changes of fascial elements and muscle fibers (A) in an oscillatory movement with elastic recoil properties, and (B) in conventional muscle training. The elastic tendinous (or fascial) elements are shown as springs and the myofibers as straight lines above. Note that during a conventional movement (B) the fascial elements do not change their length significantly while the muscle fibers clearly change their length. During movements like hopping or jumping (A), however, the muscle fibers contract almost isometrically while the fascial elements lengthen and shorten like an elastic spring. (Illustration adapted from Kawakami et al., see note 14)

<img src=’/imgs/2012/1178-3.jpg’>
Figure 3: Collagen architecture responds to loading. (A) Fasciae of young people more often express a clear two-directional (lattice) orientation of their collagenfiber network. In addition, the individual collagen fibers show a stronger crimpformation. As evidenced by animal studies, application of proper exercise can induce an altered architecture with increased crimp-formation. (B) Lack of exercise, on the other hand, has been shown to induce a multidirectional fiber network and a decreased crimp-formation.

<img src=’/imgs/2012/1178-4.jpg’>
Figure 4: Loading of different fascial components. (A) Relaxed position: the myofibers are relaxed and the muscle is at normal length. None of the fascial elements are being stretched. (B) Usual muscle work: myofibers contracted and muscle at normal length range. Fascial tissues, which are either arranged in series with the myofibers or transverse to them, are loaded. (C) Classical stretching: myofibers relaxed and muscle elongated. Fascial tissues oriented parallel to the myofibers are loaded as well as extra-muscular connections. However, fascial tissues oriented in series with the myofibers are not sufficiently loaded, since most of the elongation in that serially arranged force chain is taken up by the relaxed myofibers. (D) Actively loaded stretch: muscle active and loaded at long end range. Most of the fascial components are being stretched and stimulated in this loading pattern. Note that various mixtures and combinations between the four different fascial components exist. This simplified abstraction serves as a basic orientation only.

Training Principles

The following training principles make such fascial training more efficient.

<i>1. Preparatory Counter-movement</i>

Before performing the actual movement, we induce a slight pre-tensioning in the opposite direction, intentionally using the catapult effect. This pre-tensioning is comparable to using a bow to shoot an arrow; just as the bow needs sufficient tension in order for the arrow to reach its goal, the fascia becomes actively pretensioned in the opposite direction. In a sample exercise called the Flying Sword, the pre-tensioning is achieved as the body’s axis is slightly tilted backward for a brief moment; at the same time there is an upward lengthening (see Figure 5). This increases the elastic tension in the fascial bodysuit and as a result allows the upper body and the arms to subsequently spring forward and down like a catapult as the weight is shifted in this direction. The opposite is true for straightening up – the mover activates the catapult capacity of the fascia through an active pre-tensioning of the fascia of the back. When standing up from a forward bending position, the muscles on the front of the body are briefly activated first. For a moment the body pulls even further forward and down and at the same time the fascia on the posterior fascia is loaded with greater tension.

 

The energy stored in the fascia is dynamically released via a passive recoil effect as the upper body ‘swings’ back to the original position. To be sure that the individual is not relying on muscle to do the work, but rather on the dynamic recoil action of the fascia, requires a focus on timing, much the same as when playing with a yo-yo. Timing is necessary to determine the ideal swing – the individual will recognize he has achieved this swing when the action is fluid and pleasurable.

<img src=’/imgs/2012/1178-5.jpg’>

Figure 5: Training example – The Flying Sword. (A) Tension the bow: the preparatory counter-movement (prestretch) initiates the elastic-dynamic spring in an anterior and inferior direction. Free weights can also be used. (B) To return to an upright position, the ‘catapulting back fascia’ is loaded as the upper body is briefly bounced dynamically downwards followed by an elastic swing back up. The attention of the person doing the exercise should be on the optimal timing and calibration of the movement in order to create the smoothest possible movement.
<i>2. The Ninja Principle</i>

 

This principle is inspired by the legendary Japanese warriors who reputedly moved as silent as cats and left no trace. To practice this principle, when performing bouncing movements (such as hopping, running, or dancing), one must execute each movement as smoothly and silently as possible. One should gradually decelerate before any change in direction and gradually accelerate afterwards; each movement should flow from the last, and any extraneous or jerky movements should be avoided (see Figure 6).

Using stairs, one can practice gentle stepping. Try producing as little noise as possible for the most useful feedback – the more the fascial spring effect is utilized, the quieter and gentler the process will be.

<img src=’/imgs/2012/1178-6.jpg’>

To practice dynamic stretching, we suggest a more flowing stretch rather than a stretch that holds a motionless, static position. In Fascial Fitness there are two kinds of dynamic stretching: fast and slow. The fast variation may be familiar to many athletes as it was part of past physical training techniques. For the past several decades this bouncing stretch was considered to be generally harmful to the tissue, but recent research has confirmed the method’s merits. Although this way of stretching immediately before competition can be counterproductive, it seems that long-term use of such fast, dynamic stretching can positively influence the architecture of the connective tissue, as connective tissues becomes more elastic when this type of stretching is correctly performed.19

 

Before using fast, dynamic stretching, one should first warm up the muscles and connective tissues and avoid jerking or abrupt movements. Each turn should have a sinusoidal shape to the deceleration and acceleration so that motions are both smooth and ‘elegant.’ Fast, dynamic stretching has even more effect on the fascia when combined with a preparatory countermovement as was previously described by Fukashiro et al.20 For example, when stretching the hip flexors, we suggest introducing a brief backward movement before dynamically lengthening and stretching forward.

 

In contrast to the bouncing movement of fast dynamic stretching, slow dynamic stretches engage multidirectional movements with slight changes in angle. This engagement is not done by passively waiting, as in a classical, lengthening hatha yoga pose, or in a conventional isolated muscle stretch. Instead, these movements might include sideways or diagonal movement variations, as well as spiraling rotations (see Figure 7). With slow, dynamic stretches, large areas of the fascial network are involved simultaneously. Instead of stretching isolated muscle groups, slow, dynamic stretches target body movements that engage the longest possible myofascial chains.21

<i>3. Dynamic Stretching</i>

To practice dynamic stretching, we suggest a more flowing stretch rather than a stretch that holds a motionless, static position. In Fascial Fitness there are two kinds of dynamic stretching: fast and slow. The fast variation may be familiar to many athletes as it was part of past physical training techniques. For the past several decades this bouncing stretch was considered to be generally harmful to the tissue, but recent research has confirmed the method’s merits. Although this way of stretching immediately before competition can be counterproductive, it seems that long-term use of such fast, dynamic stretching can positively influence the architecture of the connective tissue, as connective tissues becomes more elastic when this type of stretching is correctly performed.19

 

Before using fast, dynamic stretching, one should first warm up the muscles and connective tissues and avoid jerking or abrupt movements. Each turn should have a sinusoidal shape to the deceleration and acceleration so that motions are both smooth and ‘elegant.’ Fast, dynamic stretching has even more effect on the fascia when combined with a preparatory countermovement as was previously described by Fukashiro et al.20 For example, when stretching the hip flexors, we suggest introducing a brief backward movement before dynamically lengthening and stretching forward.

 

In contrast to the bouncing movement of fast dynamic stretching, slow dynamic stretches engage multidirectional movements with slight changes in angle. This engagement is not done by passively waiting, as in a classical, lengthening hatha yoga pose, or in a conventional isolated muscle stretch. Instead, these movements might include sideways or diagonal movement variations, as well as spiraling rotations (see Figure 7). With slow, dynamic stretches, large areas of the fascial network are involved simultaneously. Instead of stretching isolated muscle groups, slow, dynamic stretches target body movements that engage the longest possible myofascial chains.21

<img src=’/imgs/2012/1178-7.jpg’>

Figure 7: Training example – Big Cat Stretch. (A) This is a slow stretching movement of the long posterior chain, from the fingertips to the sit bones, from the coccyx to the top of the head and to the heels. The movement goes in opposing directions at the same time – think of a cat stretching its long body. By changing the angle slightly, different aspects of the fascial web are addressed with slow and steady movements. (B) In the next step, we rotate and lengthen the pelvis or chest towards one side (here shown with the pelvis starting to rotate to the right). The intensity of the feeling of stretch on that entire side of the body is then gently reversed. Afterwards note the feeling of increased length.a

 

<i>4. Proprioceptive Refinement</i>

 

We maintain that proprioception – the ability to sense one’s own body in posture and movement – should not be neglected in the practice of Fascial Fitness. Babies who are not stimulated properly, caressed, carried, rocked, etc., will be retarded in their motor and mental development. It is surprising to note that the former classical proprioceptive receptors, located in joint capsules and associated ligaments, have been shown to be of lesser importance for everyday proprioception since they are usually stimulated only at extreme joint ranges and less during physiological motions.22 On the contrary, proprioceptive nerve endings located in the more superficial layers are a better target for proprioceptive attention, as in this area even small angular joint movements lead to relatively distinct shearing motions. Recent findings indicate that the superficial fascial layers of the body are, in fact, more densely populated with mechanoreceptive nerve endings than tissue situated more internally.23

 

We therefore suggest focusing our perceptual refinement efforts on producing shearing, gliding, and tensioning motions in superficial fascial membranes. During our proprioception refinement exercises, it is important to limit the filtering function of the reticular formation as it can markedly restrict the transfer of sensations from movements that are repetitive and predictable. To prevent such a sensory dampening, the idea of variation, creative combination, and surprise becomes crucial: a shift in rhythm from vibration to bounce; a change in timing from slow to fast motions; or a variation in the range of motion from long stretches to subtle micromovements (see Figure 8). Another approach is for the stimulations to play with unfamiliar positions in the gravitational field: moving on all fours, hanging upside down from a chair, or stretching front to back against a wall.
<img src=’/imgs/2012/1178-8.jpg’>

Figure 8: Training example – Octopus. With the image of an octopus tentacle in mind, a multitude of extensional movements through the whole leg are explored in slow motion. Through creative changes in muscular activation patterns, tensional fascial proprioception is activated. This goes along with a deep myofascial stimulation that aims to reach not only the fascial envelopes but also into the septa between muscles. While avoiding any jerky movement quality, the action of these tentacle-like micromovements leads to a feeling of flowing strength in the leg.

 

<i>5. Hydration and Renewal</i>

 

The video recordings of live fascia, Strolling Under the Skin, by Dr Jean- Claude Guimberteau have helped our understanding of the plasticity and changing elasticity of the fascia based on its affinity to water. An essential basic principle of these exercises is the understanding that the fascial tissue is predominantly made up of both free-moving and bound water molecules. During the strain of stretching, the water is pushed out of the more stressed zones, as if squeezing a sponge.24 During the release that follows, this area again fills with fresh fluid which comes from surrounding tissue, as well as from the lymphatic and vascular networks. The sponge-like connective tissue can lack adequate hydration at neglected or strained areas. The goal of these exercises is to have the drained areas in the body improve their hydration and encourage the flow of fluids.

 

Therefore, proper timing of individual loading and release phases is important. It is now recommended in modern running training to frequently interrupt the run with short walking intervals.25 From the fascial point of view this makes sense – under strain fluid is pressed out of the fascial tissues causing a less optimal functioning as their elastic and springy resilience slowly decreases. During the short walking breaks the tissues rehydrate, taking up nourishing fluid. For an average beginning runner, for example, the authors recommend walking pauses of one to three minutes every ten minutes. More advanced runners with more developed body awareness can adjust the optimal timing and duration of these breaks based on the presence (or lack) of that youthful and dynamic rebound – if the running movement begins to feel and look more dampened and less springy, it is likely time for a short pause. Similarly, if after a brief walking break there is a noticeable return of that gazelle-like rebound, then the rest period was adequate.

 

This cyclic training, with periods of more intense effort interspersed with purposeful breaks, is recommended in all facets of fascial training. The person training then learns to pay attention to the dynamic properties of their fascial ‘bodysuit’ while exercising, and to adjust the exercises based on this new body awareness. This also carries over to an increased ‘fascial embodiment’ in everyday life. Preliminary anecdotal reports also indicate that fasciaoriented training may help prevent overuse injuries in connective tissue.

 

<i>6. Sustainability: The Power of a Thousand Tiny Steps</i>

 

An additional aspect of fascial training is the concept of long-term renewal of the fascial network. In contrast to muscular strength training in which big gains occur early on and then a plateau is quickly reached with only very small gains thereafter, fascia changes more slowly, but the results are more long-lasting. Individuals can work without a great deal of strain so that consistent and regular training pays off. When training the fascia, improvements in the first few weeks may be small and less obvious on the outside; however, improvements have a lasting cumulative effect which, after years, can be expected to result in marked improvements in the strength and elasticity of the global fascial net.26

 

We therefore suggest that fascia-oriented training be consistent, and that only a few minutes of appropriate exercises, performed once or twice per week, is sufficient for collagen remodeling (see Figure 9). The related renewal process will take between six months to two years and will yield a lithe, flexible, and resilient collagen matrix. For a sincere yoga or martial arts student, the focus on long-term practice is nothing new. For newcomers who are getting into physical training, such knowledge of modern fascial research can go a long way in convincing them to train their connective tissues. Of course, Fascial Fitness training should not replace muscular strength work, cardiovascular training, and coordination exercises; instead it should be thought of as an important addition to a comprehensive training program.

 

<img src=’/imgs/2012/1178-9.jpg’>
Figure 9: Collagen turnover after exercise. The upper curve shows collagen synthesis in tendons increasing after exercise. However, the stimulated fibroblasts also increase their rate of collagen degradation. Interestingly, during the first one to two days following exercise, collagen degradation outweighs collagen synthesis, whereas afterwards this situation is reversed. Therefore, to increase tendon strength, the proposed Fascial Fitness training suggests appropriate tissue stimulation one to two times per week only. While the increased tendon strength is not achieved by an increase in tendon diameter, recent examinations by Kjaer et al. (2009) indicates that it is probably the result of altered cross-link formations between collagen fibers. (Illustration modified after Magnusson et al.27)

Endnotes

1. Schleip, R., L. Chaitow, T.W. Findley, and P. Huijing (eds.), Fascia: The Tensional Network of the Human Body. Edinburgh: Elsevier, 2012 (scheduled).

 

2. Renström, P. and R.J. Johnson, “Overuse injuries in sports – A review.” Sports Medicine, 1985, 2(5), pp. 316-333.

 

3. Counsel, P. and W. Breidahl, “Muscle injuries of the lower leg.” Seminars in Musculoskeletal Radiology, 2010, 14(2), pp. 162-175.

 

4. Kjaer, M., H. Langberg, K. Heinemeier, M.L. Bayer, M. Hansen, L. Holm, S. Doessing, M. Kongsgaard, M.R. Krogsgaard, and S.P. Magnusson, “From mechanical loading to collagen synthesis, structural changes and function in human tendon.” Scandinavian Journal of Medical and Science in Sports, 2009, 19(4), pp. 500-510.

 

5. EI-Labban, N.G., C. Hopper and P. Barber, “Ultrastructural finding of vascular degeneration in myositis ossificans circumscripta (fibrodysplasia ossificans).” Journal of Oral Pathology and Medicine, 1993, 22 (9), pp. 428-431.

 

6. Staubesand, J., K.U.K Baumbach and Y. Li, “La structure find de l’aponévrose jambiére.” Phlebol, 1997, 50, pp. 105-113.

 

7. Wood, T.O., P.H. Cooke and A.E. Goodship, “The effect of exercise and anabolic steroids on the mechanical properties and crimp morphology of the rat tendon.” American Journal of Sports Medicine, 1988, 16 (2), pp. 153-158.

 

8. Jarvinen, T.A., L. Jozsa, P. Kannus, T.L. Jarvinen and M. Jarvinen, “Organization and distribution of intramuscular connective tissue in normal and immobilized skeletal muscles. An immunohistochemical, polarization and scanning electron microscopic study.” Journal of Muscle Cell Research and Motility, 2002, 23(3), pp. 245-254.

 

9. Kubo, K., H. Kanehisa, M. Miyatani, M. Tachi and T. Fukunaga, “Effect of low-load resistance training on the tendon properties in middle-aged and elderly women.” Acta Physiologica Scandinavica, 2003, 178(1), pp. 25-32.

 

10. Reeves, N.D., M.V. Narici and C.N. Maganaris, “Myotendinous plasticity to ageing and resistance exercise in humans.” Experimental Physiology, 2006, 91(3), pp. 483-498.

 

11. Kram, R. and T.J. Dawson, “Energetics and biomechanics of locomotion by red kangaroos (Macropus rufus).” Comparative Biochemical Physiology, 1998, B 120(1), pp. 41-9. http://stripe.colorado.edu/ ~kram/ kangaroo.pdf.

 

12. Sawicki, G.S., C.L. Lewis and D.P. Ferris, “It pays to have a spring in your step.” Exercise Sport Science Review, 2009, 37(3), pp. 130-138.

 

13. Fukunaga T., Y. Kawakami, K. Kubo and H. Kanehisa, “Muscle and tendon interaction during human movements.” Exercise Sport Science Review, 2002, 30(3), pp. 106-10.

 

14. Kawakami, Y., T. Muraoka, S. Ito, H. Kanehisa and T. Fukunaga, “In vivo muscle fiber behaviour during countermovement exercise in humans reveals a significant role for tendon elasticity.” Journal of Physiology, 2002, 540 (2), pp. 635-646.

 

15. Staubesand, J., op. cit.

 

16. Jarvinen, op.cit.

 

17. Huijing, P.A., “Muscle as a collagen fiber reinforced composite: a review of force transmission in muscle and whole limb.” Journal of Biomechanics, 1999, 32(4), pp. 329-345.

 

18. Jami. A., “Golgi tendon organs in mammalian skeletal muscles: functional properties and central actions.” Physiology Review, 1992, 72(3), pp. 623-666.

 

19. Decoster, L.C., J. Cleland, C. Altier and P. Russell, “The effects of hamstring stretching on range of motion: a systematic literature review.” Journal of Orthopedic Sports Physical Therapy, 2005, 35(6), pp. 377-387.

 

20. Fukashiro, S., D.C. Hay and A. Nagano, “Biomechanical behavior of muscletendon complex during dynamic human movements.” Journal of Applied Biomechanics, 2006, 22(2), pp. 131-147.

 

21. Myers, T.W., “The ’anatomy trains’.” Journal of Bodywork and Movement Therapy, 1997, 1 (2), pp. 91-101.

 

22. Lu, Y., C. Chen, S. Kallakuri, A. Patwardhan and J.M. Cavanaugh, “Neural response of cervical facet joint capsule to stretch: a study of whiplash pain mechanism.” Stapp Car Crash Journal, 1985, 49, pp. 49-65.

 

23. Stecco, C., A. Porzionato, L. Lancerotto, A. Stecco, V. Macchi, J.A. Day and R. De Caro, “Histological study of the deep fasciae of the limbs.” Journal of Bodywork and Movement Therapy, 2008, 12(3), pp. 225-230.

 

24. Schleip, R. and W. Klingler, “Fascial strain hardening correlates with matrix hydration changes.” In: Findley, T.W. and R. Schleip (eds.) Fascia Research – Basic science and implications to conventional and complementary health care. Munich: Elsevier GmbH, 2007, pg.51.

 

25. Galloway, J., Galloway‘s Book on Running. Bolinas, CA: Shelter Publications, 2002.

 

26. Kjaer, op. cit.

 

27. Magnusson, S.P., H. Langberg and M. Kjaer, “The pathogenesis of tendinopathy: balancing the response to loading.” National Review of Rheumatology, 2010, 6(5), pp. 262-268.

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