Jane Eliza Stark

Ron Murray

Ron Murray: You’re an expert on fascia, and your book Still’s Fascia is being reviewed by a Rolfing® Structural Integration [SI] instructor. [Editor’s note: Andrew Taylor Still was the founder of osteopathy; the book review appears on page 38.] Is it your thesis, or is it a book?

Jane Stark: It’s a new edition of my thesis in book format. RM: How can Rolfers get their hands on it?

JS: It’s rather hard to get. The current publisher is in Germany. Why would Rolfers want to read it?

RM: Your book is about fascia in the osteopathic tradition, and osteopathy is part of the lineage of Rolfing SI. Ida Rolf trained with osteopaths, and she was heavily influenced by them. A huge chunk of Rolf’s work could be considered to be about fascia, depending on how you want to interpret ‘fascia’. For this interview, I would love to hear whatever you would be willing to share about the questions you asked osteopaths for your thesis, as well as some of the answers you received.

JS: Interesting. Regarding the work I do, I synthesized it from everybody in osteopathy I’ve spoken with and everything I’ve read from Still. Still didn’t really tell you in any detail how he treated the fascia. For fibrous fascia, he merely wrote that he rubbed it, to heat it up and to bring circulation to the area. For serous fascia, he would lift it, because he reasoned that most of the serous fascia was being dragged down by the weight of the organs. The serous fascia includes the peritoneum and the mesenteries. The mucous membranes include all kinds of membranes. Still likely referred to a classification system presented by Xavier Bichat in the 1802 book Treatise on Membranes, which was translated into English in 1813. This system was mentioned again in the 1840s in a book written by Johannes Mueller – a physiology text we know that Still owned. So Still classified the fascial tissues as ‘membranes’ and also as ‘fascia’. The mucous membranes Still spoke of were, in fact, of various histological classifications as we know them today. Today, we refer to mucous membranes as epithelial, not connective, tissues. Nevertheless, Still often talked about mucous membranes and the plexus of nerves that supply those membranes. But after two years, 4,000 hours, and 900 pages of research on this matter, I discovered that Still tended to interchange the terms fascia and membranes, and he really didn’t care that he was doing so.

Considering these concepts, I tend to treat patients through a fluidic approach. I know the fibers exist, I know the cells exist, and I know the matrix exists. But I’m really working a fluidic approach to the connective tissue, because you don’t have fibers unless you have cells, you don’t have cells unless you have a matrix, and you don’t have a matrix unless you have fluid. There is no point in attacking the fibers – sorry Rolfers – because that doesn’t make sense! The fibers don’t respond favorably with stretch. When you try and lengthen them, they reinforce themselves. So why not improve their environment, allowing them to float or to imbibe? Well, they don’t actually imbibe fluid, but they do and they must exist within a fluid environment. The more you rub, the more you scrape, the more you pummel, the more you aggress the tissue, the less fluid you have there. Consequently, the fibers are not functioning at their optimum level. So I look at it between the lines, if you wish, or as William Garner Sutherland [DO] would say, at the fluidic aspect.

Another concept to consider is the idea of fascia as a named entity from end to end, from head to toe – as all one piece of tissue that we have to name for no other reason than for communication. I’m not so interested in the continuity of fascia from end to end, but instead how each fascial layer relates to the layer below. This is the contiguity of fascia. Notice the difference between ‘contiguity’ and ‘continuity’. Contiguity is very important, because each layer needs to glide in relationship to the layer below it.

RM: Do all these layers have names?

JS: Not really. You can’t see these fascial layers because they are so extremely thin. I’m going by my memory here, so I hope I have the names and the figures correct, but if you look at the work of the Steccos, they found that the visible fibrous connective tissue of the human leg consists of three layers – two that are each approximately 273 micrometers in width, with an intervening loose connective tissue layer (containing the majority of the fluid) of 43 micrometers in width. The interesting thing is that the 273-micrometer layers can be seen with the naked eye, but the 43-micrometer layer cannot. If you can’t see it, you don’t draw it. You can’t draw matrix, and you can’t draw fluid, but you can draw fibers. So we’ve been indoctrinated with fibers because we can see and draw them, even though it’s really the layer underneath that you have to work with.

What was fascinating for me was that in my dissection of the leg of a recently killed deer [dead for about sixty minutes], I found that there were far more than three layers. In fact, there were more layers than I could keep track off, each so thin that it was practically transparent and virtually invisible. [Editor’s note: see the images in Stark’s article “Popular Ruts: Fascia Revisited” on page 30 in this issue.]

RM: So how do you perform this work?

JS: With kind of a suctioning action almost on the skin. Rather than pushing, pulling, shoving, dragging, scraping – in other words, aggressing – I make a space with my hand, allowing the fluid to flow from areas of high pressure to the area of lower pressure where my hand is. At least that’s the mental image I have when I’m working, though I have no proof that it works this way. The work is so gentle that patients actually have fallen asleep while I treated their iliotibial band with my technique – or, as I would prefer to say, with the technique that I’ve synthesized; whether it’s originally mine, I don’t know. Nevertheless, that’s what I do. So my approach is fluidic. The fibers barely exist for me. And a key concept is that of contiguous layers, versus one layer in continuity.

RM: I don’t have the list of questions you asked the osteopaths in your research, but can you share some?

JS: The most interesting question was, “What does healthy fascia feel like?” I didn’t define ‘feel’, and I didn’t define ‘healthy’. Whether they all assumed the same meanings for those words, I’ll never know, but none of the osteopaths asked me to provide definitions. Their responses ranged from “you can’t touch the fascia, only the surgeon can touch the fascia” to “every time you touch the patient, you are touching the fascia” to “you can’t divorce the fascia from anything else in the body.” I discovered that every one of the thirty-seven osteopaths interviewed had a different answer. I could have clumped the answers into groups, but it would have been like a disco ball. If you had only six sides on the disco ball, you had six different answers. If you made more sides on the disco ball, you got more different answers. In other words, nobody was agreeing.

If I were answering the question “What does healthy fascia feel like?” myself, I would want to first ask, “What does it move like?” – in other words, how does it react to the natural waves and motions of the body, like breathing? I think that’s the most important question to answer. You can’t put your hand on it and expect it to answer you. You have got to give it a test. If I touch you, how do you react? You might say, “Hello! How are you? Do you want something?” But I might react by saying, “Help me! Get off me!” Or the fascia might have no reaction at all. RM: When you say “give it a test,” do you listen, or do you induce with your hand? JS: I don’t think anybody can ever listen because if your hand is on the patient, you’re touching the nervous system. In touching the nervous system, I’m touching the fascia. Am I getting a fascial reaction or a nervous system reaction? I don’t know that answer, but this is part of a theoretical model I’m currently working with. For practical purposes, the test comes down to, “Can I feel a motion in the fascia?” The only way you can feel a motion is to have a motor contact with it. And I don’t mean to push it. But if you look at haptics, which is basically the study of touch, you’ll find that every contact is always first a motor one; you can’t have a sensory contact without the motor contact first. So I’m asking if there is a sense of movement. Such a sense doesn’t have to be rhythmical; it may respond to breathing, it may respond to the osteopathic concept of the primary respiratory mechanism, or it may involve a combination of the heartbeat, circulatory pulsations, muscle tonus, and other factors. The key point is to determine whether the fascia is able to react to underlying body motions, or is it stuck like a piece of wallpaper to the underlying tissues?

RM: When you work with fascia, do gravity and posture matter to you as a practitioner?

JS: Posture absolutely matters, but what’s the biggest force on posture? It’s gravity. And once you pass a certain tipping point in your posture, gravity has got the upper hand. So I work with gravity, though probably not consciously. I look at posture all the time. I even do experiments with plants, trying to get them to stand up straight. I’ve found that unless you’re at the equator, you can’t get a young plant to stand up straight because the sun is never directly overhead. The plant always leans toward the sun. So as soon as I see it lean toward the sun, I turn it around the other way, but before I know it, it’s leaning in the sunward direction again. I’m trying to catch it right in the middle. But the point is, I think that posture really has a strong influence on the health potentials in our patients.

RM: There was a question you asked the osteopaths about vitalism. JS: Yes, the question was, “What do you feel is the relationship between fascia and vitality?” The problem is that you and I may mean different things by ‘vitality’. A student at the college [Canadian College of Osteopathy] did a qualitative thesis on the meaning of ‘vitality’. She found that it was like the story of the blind men and the elephant – we were all probably talking about the same thing, but our definitions varied because of tangible and intangible elements. So I don’t know how to answer that question unless you can tell me what you mean by vitality. And then the readers need to know what you mean by vitality. And I might not agree with your definition.

For me, vitality pretty much means that there is life inside the body – that there’s an oomph, that the tissue can convey to you that it is alive and hopefully kickin’. Yesterday, I visited an elderly person in hospice care, and I placed my hands on his arms. Other than feeling warm, I couldn’t tell that he was alive. I placed my hands on his legs, and other than feeling very warm actually, I couldn’t tell that he was alive. But his chest was still going up and down, and I could see the blood vessels in his neck filling and emptying. Yet there was no vitality in the tissues of his extremities, and it was clear that death was near. And, in fact, he died about two-and-a-half hours later. To me, it felt like his vitality was slowly leaving the periphery and housing itself in the center just to keep the heart and lungs going for as long as there was still something there.

So back to fascia and vitality – the fascia is going to move, there’s going to be a noticeable movement, a response to that inner oomph. It’s the life force – what people have been pondering for hundreds of years. “What is life?” It’s that question we always come down to. What is life? What keeps us alive? And how do you know you’re fully alive or when you’re tipping toward death. I don’t think it’s the be all and end all in fascia; it’s in the body, it’s in all parts of the body. But the fascia is certainly one of the areas where this life force expresses itself.

RM: I have a Rolfing SI-related question. As I understand Rolf’s bigger question or goal, it was, “What happens to the energy fields of human beings when they are in alignment in the greater field of gravity? What happens to the evolution of the human being?”

JS: Of the individual in his own lifetime? That’s pretty simple, that’s a no-brainer question for me. The more your body aligns itself in gravity, the less muscular tension you need to use to hold yourself upright in space. If you’re off center and you don’t do anything to correct it, you’re gonna tip over. But your body automatically keeps you from tipping over by making corrections through muscle contractions. As soon as you make a contraction, you’re creating a compression. The compression typically involves longitudinal structures – the vertebral segments. But within the contraction, you also have arteries, nerves, veins, and lymphatics – so you are also restricting fluids. And you’re using energy to hold yourself up – and to counteract the actions of compression on your vertebrae, nerves, arteries, veins, blood, and other fluids. The energy you’re using to make the contraction is being taken away from the energy you could use to function, such as the energy needed to maintain the automatic systems of your brain, your digestion, your breathing. Energy can’t be created or destroyed, it’s only transformed somewhere else. So if you are using it to hold yourself up in space, you could be keeping it from going where it really needs to be – maintaining or restoring your health.

RM: Any other thoughts you have?

JS: Remember that I don’t have a complete picture of the Rolfing philosophy, but I think we [Rolfers and osteopaths] are going for the same goal. The Rolfer may be concentrating on the fibers. I want the person straight, in the sense that I want him to use the least amount of energy he can to maintain himself in space. Given that the state of his tissue maybe never reaches my ideal, it is a matter of optimizing his potential. So I just do it, I think, in a much softer way, because if I give him the fluid, he will begin to autocorrect himself. And I don’t know myself what his correct position might be.

RM: Do you have any thoughts on so-called tensegrity?

JS: I’m a mental moron with tensegrity. I’ve been taught it at least five times, been taken by the hand to structures and been told, “that’s a strut . . .” But I can’t stand it, unless you had biotensegrity, because the human body is not tensegrity, it’s 70% to 80% fluid. So I’d rather not talk about tensegrity – I’ll not contribute anything of importance. I don’t consciously pay any attention to tensegrity because I don’t think about the fibers.

RM: Yes, for me tensegrity’s big blind spot is that it left out fluid hydraulics. There are sacks of water and it never really considered that, at least as I understood it.

JS: There’s so much pressure dynamics from fluid, I don’t know how you can ignore it. I got so fed up reading about tensegrity without fluid that when the fluid model [biotensegrity] came out, I wasn’t too interested in reading it. But it’s just a mental block for me more than anything else.

RM: Do you have any thoughts on Robert Schleip’s work and the more modern fascia research, and the Fascia Research Congress?

JS: I had teaching conflicts with all three of the Fascia Research Congresses, so I could not attend. But, believe it or not, I’ve known Robert since 2004, when he was a Rolfer living in Germany. I had just finished my own thesis and he had gotten a photocopied copy of it from somebody. He met me in Germany when I was teaching there and wanted to know more about it. He hadn’t gone into his PhD yet, but he was more interested in what I had done than any osteopath was. At that time, Robert had a lot of information and experience to share with the profession as well as the academic world. But you know that academics really talk among themselves, so as I recall Robert explaining it to me, it was difficult to get the attention of academics because his primary credential was that of a Rolfer. I recognize that bias as well. Whether he had already intended to get a PhD or not, I’m not sure, but now that he has his degree his voice is a recognized part of the scientific world.

I think it was he and his partner in Ulm who discovered the myofibroblasts in the fascia around the organs and in the visceral ligaments and mesenteries. Still had been saying that for a hundred years, but here came the proof that mesenteries could contract and react under neural influence. As far as I know, nobody had brought that to the attention of the people who worked with those kinds of tissues before. So I really like what Robert did. I haven’t been following his career, and I don’t see him very often, but I did take a course in Montreal from him, and I found that everything he taught, I didn’t teach, and whatever I taught, he didn’t teach. So we completely complemented one another as far as “What is fascia, and what can you do with it, and what do you have to take into consideration when you are doing things with it?” He’s also the only instructor I’ve had who can take a purely scientific paper that is abstract in every way – meaning it seems to have no direct application for those of us who use our hands on human tissues—and make it have a direct connection to not only our work, but to how we perform our work; really, from bench to bedside. He can do that. He can do it for osteopaths, I suppose for Rolfers, for massage therapists, for bodyworkers of any kind. So we need more Roberts in the world.

RM: Thanks for your time. I hear your book is getting a rave review in this issue of the Journal.

JS: I’d love to come to the U.S. to teach a course to Rolfers if people are really interested in a fluidic approach to fascial treatment. [Editor’s note: contact [email protected] if interested.] I do think we take the same approach, [though] whenever you ask Rolfers what they do, they say they can’t tell you about it, and you have to take the ten sessions to find out. But in the little bit I’ve seen, you take crooked people and try to make them straighter.

RM: Well, there’s more to it than that. I’ll fill you in!

Jane Eliza Stark is a 2003 graduate of the Canadian College of Osteopathy (CCO), where, upon graduation, she received the Andrew Taylor Still Award for the most representative thesis on the advancement of osteopathy in philosophical or sociological research. In 2006, she received the Andrew Taylor Still Foundation Award for her contribution to the advancement and recognition of osteopathy in Canada. She serves on the faculty of the CCO and the Collège D’Etudes Ostéopathiques. She has a master’s degree in clinical research administration and is the director of research for the CCO. She is recognized internationally as an osteopathic historiographer, author, and lecturer on osteopathic history and on the biographies of Still, Sutherland, and Littlejohn. She is a workshop leader on the fluidic approach to treating connective tissue and has lectured or taught in ten countries. She will be giving a seminar on the History of Osteopathy in November in Toronto; see http://foundersdayweekend.ca/Seminars/ Seminars%20Description/ for information.

Ron Murray studied at the Rolf Institute® completing Unit 1 in 1985, Basic Training in 1988, and Advanced Training in 1996. He graduated from the Canadian College of Osteopathy in 2003. He is a Loren Berry Method Instructor since 1990 and a professor at the Canadian College of Osteopathy since 2006. He also teaches workshops (see his website http://osteoron.com). He can be contacted at [email protected].Fascial Fluidity and Contiguity[:pb]Fascial Fluidity and Contiguity[:]