Emily developed her love of the natural world and science while growing up in Austin, Texas.

She has been a bodyworker since 2000, and began her Rolfing® training in Germany, where she and her husband Chuck lived for six years. Emily is a Board Certified Structural IntegratorCM

and Certified Advanced RolferTM with a Rolfing practice in Frederick, Maryland. In her spare

time, she gardens, studies Japanese classical martial arts, goes on hikes, and tries to avoid writing articles. Her website is www.frederickrolfing.com.

 

“The most exciting phrase to hear in science, the one that heralds new discoveries, is not ‘Eureka!’ (I found it!) but ‘That’s funny . . .’ ”         —Isaac Asimov

In 1877, French chemist Louis Pasteur discovered that a certain type of bread mold caused anthrax bacilli to display inhibited growth. He didn’t understand the significance of his discovery at the time; it was an accident. The discovery of penicillin as an antibiotic changed the quality of life for future generations. In 2006, a German manual therapist in search of answers about his work discovered that fascia itself, not just muscular units, had active contractility (Schleip, 2006). PhD candidate Robert Schleip’s discovery (much to his surprise) began a landslide of research into this previously disregarded and discarded tissue. The First International Fascia Research Congress (2007) brought together clinicians like Robert Schleip and scientists who had been engaged in fascia research for decades.

An aging, sedentary population, increasingly prone to musculoskeletal disorders, now inhabits much of the industrialized world. A three-month study in 2007 (Furlan et al., 2010) found that at least 31% of the population suffered either low back pain (34 million), neck pain (9 million), or both back and neck pain (19 million). Back pain is the fifth most common reason for physician visits in the US alone, costing $26.3 billion in 1998. Back pain is second only to the common cold in terms of work loss (Browning, 2012). Understanding the mechanisms of pain and dysfunctional tissue in the human body may well be the next revolution in health care.

The Realities of Research

This burgeoning problem, common to both laborer and desk jockey alike, and the potential revenues to be generated in search of relief, has spurred billions of dollars in pharmaceutical research. The promise of profits can lead to catastrophes such as Vioxx, which caused heart attacks and strokes in a significant percentage of patients, and was withdrawn in 2004 (Rubin, 2004; Waxman, 2005). Other drugs, such as Humira, for rheumatoid arthritis, make normal life possible for people who were previously unable to function physically. Every stockholder, and every researcher, hopes for positive research outcomes, but previous tragedies underline the importance of rational, neutral, unbiased research. Practitioners’ understanding of research funding sources is equally important. In fact, 58% of funding in the US comes largely from private companies (Dorsey, et al., 2010). The National Institutes of Health takes on “riskier” research, that is, research not directly linked to profitable products (personal communication, Dr J. Turpin, NIH researcher, November 2012).

In the US, the biomedical model of treatment changed in significant ways after the Flexner Report was published in 1910, moving towards what we now call evidence-based medicine, defined as:

“the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, 1997). The problem, as Dr. Tom Findley says, is that you can find research to support “pretty much any idea you can come up with.” This charge is often leveled at fascia researchers: that they are trying to support a flimsy premise, or that they are biased. This problem is simply endemic to research, regardless of who is doing it. Cognitive bias is part of how the human brain functions. This is why research is necessary; optimally, it provides a structure in which to evaluate theories in an unbiased way.

Many different industries and individuals have the capacity to fund research. About 20% is carried out by universities, 10% by government, and the rest is carried out by industry (Whoriskey, 2012). University research, previously the genesis of unbiased curiosity, is now cut deeply by governments facing other priorities. University research is therefore often supported by significant contributions by industry to a university chair or department. This is generous and fortunate, but can cause ethical problems. In 1998, Novartis (previously named Sandoz) donated $25 million  to the Department of Plant and Microbial Biology at UCLA Berkeley. In exchange, Berkeley granted Novartis first rights to negotiate licenses on the results of about one- third of the research conducted in this department (Whoriskey, 2012).

 

Cognitive bias is part of how the human brain functions. This is why research is necessary; optimally, it provides a structure in which to evaluate theories in an unbiased way.

 

Private companies may also have confidentiality agreements, control over publication dates, and control of content published. In specific cases, the dangers of calcium channel blockers, or diet drugs (Fen-fen) were redacted from published research by the funding agency (Press & Washburn, 2000). In 2012, the drug Avandia was revealed to have been shepherded through clinical trials by GlaxoSmithKline by a combination of employees and paid consultants. As reported in the Washington Post:

As is common practice, the company arranged for a group of experts —mostly academics — to form a steering committee to guide and publish the experiment. Four of the eleven committee members were Glaxo employees. !e other seven reported serving as paid consultants or had other financial connections to the company.

(Whoriskey, 2012, p. 5)

These scenarios potentially undermine the capacity of researchers to conduct unbiased research. On the other side are enthusiastic clinicians who are perhaps too quick to adopt hypotheses to justify what they feel is happening through their chosen therapies.

Manual Therapy in the Mix

When asked to comment on the use of studies to justify modalities, Dr. Schleip explained that it is mutual learning and interdisciplinary enrichment, in his opinion, that characterizes the best qualities of the current fascia research field:

There is hardly a more dangerous attitude among therapists than the hero healer, who is damn sure about his diagnosis and supposed treatment effects…. While scientists can learn a whole lot from the intuitive and experiential wisdom of complementary therapists, particularly about the non-fragmented and connecting properties of the fascial net, we bodyworkers can learn at least as much from the careful, questioning approach of good scientists, who are willing to doubt their own assumptions and to refrain from premature confidence and over interpretation of their findings. It is this mutual learning and interdisciplinary enrichment which in my opinion characterizes the best qualities of the current fascia research field, as expressed in the international Fascia Congress series and associated activities.

(Ingraham, 2012, n.p.)

Pedro Prado, in his article The Case Study Method: Scientific Exploration of Rolfing® SI in the Holistic Paradigm, writes:

“Besides being a philosophy, a professional practice and a calling, Rolfing SI is also a science—and science is no simple task. The scientific investigation of Rolfing raises particularly thorny questions: Because Rolfing is premised upon and practiced through an integrative paradigm, it eludes the classical approaches and experimental methods focused on cause and effect” (2011, p. 34).

Clinical understanding and practice evolves when practitioners are deeply informed about the science behind their methods. If manual therapists could be more articulate about the science supporting their treatment methods, it would serve their practices and the general public, which is often under-informed about manual therapy modalities.

Manual therapists deserve the chance for inquiry as much as any other practice claiming to be evidence-based medicine. Methods of accurately reproducing mechanical actions and the resulting effect on fascial tissues are continually improving.

The public deserves the best information available, not just the best information money can buy.

Understanding not only how tissue, but the whole organism, responds to treatment, improves both specificity and the entire treatment paradigm. To claim that a treatment stands within the paradigm of “health” means not just treating pathology, but understanding and supporting the entire system.

Research that Affects Structural Integrators

Research makes it possible to understand and explain the relevance of even the smallest things, such as breath and posture coaching. A seemingly simple question (behavior of bread molds or fascia) leads to a seemingly simple discovery (inhibition of anthrax bacilli or active contractility of fascial fibers). Often, the result of finding the answer is to change lives, and human possibilities, now—never mind the endless possibilities of further questions.

Pertinent Studies

Here are some of the questions already explored. Links to the research can be found in the References section of this paper, which, in many cases, will take you to the full text of the article. You can also get in touch with the Fascia Research Society through the website (www.fasciaresearchsociety.org) or on their Facebook page.

How Does Fascial Tissue Behave? Is it Active or Passive?

Fascia is able to contract in a smooth muscle-like manner and thereby influence musculoskeletal mechanics by Schleip, Klingler, & Lehmann-Horn (2006):

These results suggest, that fascia is a contractile organ, due to the presence of myofibroblasts. (p. 3)

How much force does it take to actually change tissue? Which fascia in the human body is the most resilient?

Three-dimensional mathematical model for deformation of human fasciae in manual therapy by Chaudhry et al. (2008):

The palpable sensations of tissue release that are often reported by osteopathic physicians and other manual therapists cannot be due to deformations produced in the firm tissues of plantar fascia and fascia lata. However, palpable tissue release could result from deformation in softer tissues, such as superficial nasal fascia. (p. 379)

How does scar tissue remodel itself on the cellular level?

Fibroblast cytoskeletal remodeling contributes to connective tissue tension by Langevin et al. (2011):

Thus, by changing shape, fibroblasts can dynamically modulate the visco-elastic behavior of areolar connective tissue through Rho-dependent cytoskeletal mechanisms. !ese results have broad implications for our understanding of the dynamic interplay of forces between fibroblasts and their surrounding matrix, as well as for the neural, vascular, and immune cell populations residing within connective tissue. (n.p.)

 

Is There Any Evidence to Support the Theory of Anatomy Trains or Functional Fascial “Chains?”

The architecture of the connective tissue in the musculoskeletal system—an often overlooked functional parameter as to proprioception in the locomotor apparatus by van der Wal (2009):

A mutual relationship exists between structure (and function) of the mechanoreceptors and the architecture of the muscular and regular dense connective tissue. Both are instrumental in the coding of proprioceptive information to the central nervous system. (n.p.)

How does acupuncture affect tissue?

Relationship of acupuncture points and meridians to connective tissue planes by Langevin & Yandow (2002):

We found an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections. We propose that the anatomical relationship of acupuncture points and meridians to connective tissue planes is relevant to acupuncture’s mechanism of action and suggests a potentially important integrative role for interstitial connective tissue. (n.p.)

[Authors note: There is also an excellent chapter, “Acupuncture as a Fascia-Oriented Therapy” by Irnich & Fleckstein, in Schleip, Findley, Chaitow & Huijing’s textbook, Fascia: !e Tensional Network of the Human Body.]

What Changes, and How, With Feldenkrais?

Does the Feldenkrais Method make a difference? An investigation into the use of outcome measurement tools for evaluating changes in clients by Connors, Pile, & Nichols (2011):

Evidence-based practice confirms the need for outcome measures. Feldenkrais Method practitioners struggle to use such tools because of the broad range of applications of the Feldenkrais Method and the difficulty identifying suitable measurement tools . . . Eleven Feldenkrais practitioners submitted data on 48 clients. Changes were detected in the clients’ ability to perform everyday tasks.

. . levels of pain decreased . . . and quality of life improved significantly in six of the eight . . . domains. !ese three tools have been found to be suitable for detecting changes in client function before and after a series of Feldenkrais sessions. (n.p.)

How do Alexander Lessons Change Movement Patterns?

Prolonged weight-shift and altered spinal coordination during sit-to-stand in practitioners of the Alexander Technique by Cacciatore, Gurfinkel, Horak, & Day (2011):

We hypothesize that the low hip joint stiffness and adaptive axial postural tone previously reported in AT teachers underlies this novel ‘continuous’ STS strategy by facilitating eccentric contractions during weight-shift. (n.p.)

Has Structural Integration Been Shown to Positively Affect Outcomes in Studies?

Structural integration, an alternative method of manual therapy and sensorimotor education by Jacobson (2011):

Limited preliminary evidence exists for improvements in neuromotor coordination, sensory processing, self-concept and vagal tone, and for reductions in state anxiety.

Preliminary, small sample clinical studies with cerebral palsy, chronic musculoskeletal pain, impaired balance, and chronic fatigue syndrome have reported improvements in gait, pain and range-of-motion, impaired balance, functional status, and well-being. . . Evidence for clinical effectiveness and hypothesized mechanisms is severely limited by small sample sizes and absence of control arms. In view of the rapidly increasing availability of SI and its use for treatment of musculoskeletal pain and dysfunction, more adequate research in [sic] warranted. (n.p.)

Rolfing structural integration treatment of cervical spine dysfunction by James, Castaneda, Miller, & Findley (2009):

This investigation demonstrates that the basic 10 sessions of RSI, when applied by a physical therapist with advanced RSI certification, is capable of significantly decreasing pain and increasing AROM in adult subjects, male and female, with complaints of cervical spine dysfunction regardless of age. (n.p.)

“There is hardly a more dangerous attitude among therapists than the hero healer, who is damn sure about his diagnosis and supposed treatment effects.” —Robert Schleip

Conclusion

The fascia research revolution is changing understanding and, as a result, treatment. When research can explore mechanisms through testing, practitioners can make better informed decisions about treatment. Even better, we develop more questions to explore via continued research.

Disclaimer: Author owns stock in Novartis

Resources

In addition to the articles and books mentioned above, I recommended the following research reading:

Guimberteau, J. C., Delage, J. P., & Wong, J. (2010). The role and mechanical behavior of the connective tissue in tendon sliding. Chirurgie de la main, 29(3), 155-166. doi: 10.1016/j.main.2010.04.002

Purslow, P. P. (2010). Muscle fascia and force transmission. Journal of Bodywork and Movement !erapies, 14(4), 411- 417. doi: 10.1016/j.jbmt.2010.01.005

 

References

Browning, G. W. (2012). Mechanical low back pain prevalence and costs. [Virtual Health Care Team® Case Studies. University of Missouri-Columbia School of Health Professions]. Retrieved from http://www.vhct. org/case1699/preval_costs.htm

Cacciatore, T. W., Gurfinkel, V. S., Horak, F. B., & Day, B. L. (2011). Prolonged weight-shift and altered spinal coordination during sit-to-stand in practitioners of the Alexander Technique. Gait Posture, 34(4), 496-501. doi: 10.1016/j.gaitpost.2011.06.026

Chaudhry, H., Schleip, R., Ji, Z., Bukiet, B., Maney, M., & Findley, T. (2008). Three-dimensional mathematical model for deformation of human fasciae in manual therapy. Journal of American Osteopathic Association, 108(8),379-390. Retrieved from http://www.ncbi.nlm. nih.gov/pubmed/18723456

Connors, K. A., Pile C., & Nichols, M. E. (2011). Does the Feldenkrais Method make a difference? Funding of US biomedical research, 2003-2008. Journal of the American Medical Association. 303(2).

Flexner, A. (1910). Medical education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching (Carnegie Foundation Bulletin No. 4). Retrieved from The Carnegie Foundation for the Advancement of Teaching: http://www.carnegiefoundation.org/ publications/medical-education-united-states-and- canada-bulletin-number-four-flexner-report-0

Furlan, A., Yazdi, F., Tsertsvadze, A., Gross, A., Van Tulder, M., Santaguida, L., … Galipeau, J. (2010). Complementary and alternative therapies for back pain II

(Evidence Report/Technology Assessment No. 194. University of Ottawa Evidence-based Practice Center). Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ncbi.nlm.nih.gov/ books/NBK56295/

Ingraham, P. (2012, October 8). What does Dr. Schleip think? An important statement about fascia science from Dr. Robert Schleip, famous for his discovery of fascial contractility [SaveYourself blog post #415]. Retrieved from http://saveyourself.ca/blog/0415.php

Irnich, D., & Fleckstein, J. (2012). Acupuncture as a fascia-oriented therapy. In Schleip, R., Findley, T. W., Chaitow, L., & Huijing, P. A. (Eds.), Fascia: !e Tensional Network of the Human Body (349-357).

Churchill Livingstone, Elsevier.

Jacobson, E. (2011). Structural integration, an alternative method of manual therapy and sensorimotor education. Journal of Alternative and Complementary Medicine, 17(10), 891-899. doi: 10.1089/acm.2010.0258

James, H., Castaneda, L., Miller, M. E., & Findley, T. (2009). Rolfing structural integration treatment of cervical spine dysfunction. Journal of Bodywork and Movement !erapies, 13(3), 229-238. doi: 10.1016/j. jbmt.2008.07.002

Langevin, H. M., Bouffard, N. A, Fox, J. R., Palmer, B. M, Wu, J., Iatridis, J. C., … Howe, A. K. (2011). Fibroblast cytoskeletal remodeling contributes to connective tissue tension. Journal of Cell Physiology, 226(5),1166-1175. doi: 10.1002/jcp.22442

Langevin, H. M., & Yandow, J. A. (2002). Relationship of acupuncture points and meridians to connective tissue planes. Anatomical Record, 269(6), 257-265.

Prado, P. (2011). The case study method: Scientific exploration of Rolfing® SI in the holistic paradigm. Structural Integration, 39(2), 33-35.

Press, E., & Washburn, J. (2000, March). The kept university. !e Atlantic. Retrieved from http:// www.theatlantic.com/magazine/archive/2000/03/ the-kept-university/306629/1/

Rubin, R. (2004, October 12). How did Vioxx debacle happen? USA Today. Retrieved from http://usatoday30. usatoday.com/news/health/2004-10-12-vioxx-cover_x. htm

Sackett, D. L. (1997). Evidence-based medicine. Seminars in Perinatology, 21(1), 3-5.

Schleip, R., Klingler, W. & Lehmann-Horn, F. (2006). Fascia is able to contract in a smooth muscle-like manner and thereby influence musculoskeletal mechanics. In (Liepsch, D. Ed.), Proceedings of the 5th World Congress of Biomechanics: Munich, Germany, July 29-August 4, 2006 (pp. 51-54). Retrieved from http:// www.fasciaresearch.de/wcb2006.pdf

Van der Wal, J. (2009). The architecture of the connective tissue in the musculoskeletal system-an often overlooked functional parameter as to proprioception in the locomotor apparatus. International Journal of Therapeutic Massage and Bodywork, 2(4), 9-23. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21589740

Waxman, H.A. (2005). The lessons of Vioxx — Drug safety and sales. New England Journal of Medicine. 352, 2576-2578. doi: 10.1056/NEJMp058136

Whoriskey, P. (2012, November 24). As drug industry’s influence over research grows, so does the potential for bias. The Washington Post. Retrieved from http:// www.washingtonpost.com/business/economy/ as-drug-industrys-influence-over-research-grows-so- does-the-potential-for-bias/2012/11/24/bb64d596- 1264-11e2-be82-c3411b7680a9_story.html

[:]Research and Relevance: Sometimes the Best Answer is a Question