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Dr. Leonid Kalichman PT, PhD
Steccos Fascial Manipulation approach
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Fascia: definition and examples
Innervation of fascia
Pathological changes in fascia(hyaluronic acid)
Basics of fascial manipulation method
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Dr. Leonid Kalichman, PT, PhD
Fasciae (singular, fascia) are connective tissue layers
and wrappings that support and surround all organs,
bones, muscles, nerves, and blood vessels.
superficial fascia
deep fascia
subserous fascia
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Fascia is an uninterrupted three-dimensional web of dense
connective tissue
The soft-tissue component of the connective tissue system
that
permeates the human body, forming a whole-body continuous
three-dimensional matrix of structural support.
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A - epidermis B dermis C superficial fascia (and subcutaneous
fat) D deep fascia (aponeurotic+epimysium) E - muscle
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Dr. Leonid Kalichman, PT, PhD
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Fascia is a continues tissue that connects all parts of the
body.
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Fascia is reach by nociceptors and mechanoreceptors.
Fascia is a pain sensitive structure and involved in
proprioception and movement regulations
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Dr. Leonid Kalichman, PT, PhD
The average 70 kg person has roughly 15 grams of hyaluronic acid
in the body, one-third of which is turned over every day.
It is part of the extracellular matrix, a major component of the
synovial fluid, and was found to increase the viscosity of the
fluid.
Hyaluronic acid is a component of articular cartilage and
skin.
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Dr. Leonid Kalichman, PT, PhD
Recent study showed a layer of hyaluronic acid between fascia
and muscle and inside deep fascia, in particular inside the loose
connective tissue separating the fibrous sub-layer of the
fascia.
This means that the fascia thus provides an extracellular matrix
that is a gliding lubricant over muscle, permitting the free
contraction of muscles, but also a unique matrix for its repair and
regeneration.
STECCO, C., PORZIONATO, A., MACCHI, V., STECCO, A., STERN, R.,
DE CARO, R.. Analysis of the presence of the hyaluronic acid inside
the deep fasciae and in the muscles. Italian Journal of Anatomy and
Embryology, North America, 116, Nov. 2011. Available at:
http://www.fupress.net/index.php/ijae/article/view/10258/9467
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Dr. Leonid Kalichman, PT, PhD
By increasing the concentration of HA, HA chains begin to
entangle conferring to the solution distinctive hydrodynamic
properties: the viscoelasticity is dramatically increased.
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HA increased viscosity
and mechanorecptors
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Dr Leonid Kalichman PT, PhD
Stecco family
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The Myofascial Unit (Steccos definition): 1. A group of motor
units that move a body segment in a specific
direction by activating fibres (monoarticular and biarticular)
in one or more muscles
2. The joint that is moves 3. Nerve and vascular components 4.
The fascia that connects these elements together
Dr Leonid Kalichman PT, PhD
Motor Unit (Sherringtons definition): A motor unit is made up of
a motor neuron and the skeletal muscle fibers innervated by axon of
this neuron.
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1. Each Myofascial unit has its own CENTER OF COORDINATION
(CC)
2. CC = Small areas on the deep fascia where the sum of
tensional vectors coincide.
3. Located in epymisium
Dr Leonid Kalichman PT, PhD
CC
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CC
CP
ME LA
Symptoms in the Center of Perception (CP)
Phase of compensation
Mechanical incoordination in the joint
The resulting vector becomes faulty
Improper recruitment of muscle fibres
Decrease of the sliding system in the CC
Increase of the viscosity of HA in the Centre of
Coordination
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Friction . . . .
Heat
develops
Perception of change in tissue mobility
Patient reports pain reduction
Dr Leonid Kalichman PT, PhD
Tissue sliding improvement
http://www.webgif.org/gif_animate/oggetti_cose/strumenti_medicina/immagini/05.htm
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Images of the sonoelastography state before and after fascial
therapy in the L5eS1 interspace. In addition to the color scale
evaluation, elasticity was quantitatively measured in the zone of
interest and local elasticity demonstrated a x10 increase after
fascial therapy.
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Performed by PTs (highly trained professionals) Science based
treatment Initial research evidence for effectiveness Holistic
(treat entire body, not only site of
symptoms) Treat source of problem, not the site of
symptoms Eliminates consequence of previous (old)
traumas and surgery Very effective, especially for chronic
problems
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Dr. Leonid Kalichman PT, PhD
The fascial connectionHow fascia is involved in musculoskeletal
pain?The fascial fashion Plan Fascia (classical definition)Slide
Number 5Dermis - SkinMuscle envelopesFascial envelopesFascia
(examples)Conclusion 1Innervation of fasciaInnervation of
fasciaInnervation of fasciaConclusion 2Sliding between tissues and
organsHyaluronan (hyaluronic acid)Hyaluronan (hyaluronic
acid)Hyaluronan (hyaluronic acid)Fascial densificationFASCIAL
MANIPULATIONThe motor and myofascial unitsThe center of
coordination (CC)Fascial DysfunctionFascial manipulation
techniqueEffect of FM on tissue elasticityInitial evidence for FM
efficacyFM treatment (characteristics)Thank you for your kind
attention !
