Interest in facia research has grown enormously since the first congress held at Harvard University in 2007. Understandably some complementary therapists have mixed feelings about the medical and scientific community that once dismissed facial work as quackery but who are now getting in on the act. However for the most part the spirits that characterised the 2012 congress (and previous ones) were of cooperation and excitement at recent breakthroughs in the scientific understanding of fascia and of how myofascial release works to reduce pain and restore movement.

While physical therapists take a holistic (whole body) approach to patient care, scientific research is minutely focused on isolated areas of the body. This is why scientific research can be frustratingly slow to validate and explain effective physical therapies like myofascial release. However, here are some highlights from the research which are directly relevant to my every day clinical work:
• research from the Southern Medical University in Guangzhou, China showing that fascial therapy can significantly improve cell activity in connective tissue to support the body’s healing processes
• research from the University of Limerick, Ireland showing that self myofascial release can strengthen the foot and have a positive effect on physical performance (in this case jumping exercises)
• research from Bond University in Australia showing how deficiencies in the fat pads on the soles of our feet can deform the underlying fascia and lead to chronic heel pain ( plantar fasciitis )
• research from the Commonwealth Medical College in Pennsylvania highlighting the need to work with both muscles and fascia when treating pelvic floor dysfunction
• research from around the world highlighting the damage done to fascia during surgery, and the role of scar tissue in creating and transmitting pain to apparently unrelated areas of the body
• research showing the effectiveness of massage in reducing post-operative complications following abdominal and pelvic surgery
• a clinical trial showing the effectiveness of trigger point therapy and myofascial work, along with changes to diet, in ending long-term chronic pain where surgery in distant parts of the body had apparently created the problems

The next international fascia congress will be held in Orlando, Florida in 2015. In the meantime it is still up to complementary therapists and their clients to take the intuitive leaps to apply this important scientific research to their own situations.

The workshop was lead by Dr Carla Stecco of the University of Padua who is an expert in fascia. The purpose was to illustrate some of the recent scientific research into the composition and properties of fascia.

A fascial dissection is very different from an ordinary dissection. Ordinary dissections are based on the idea that human bodies are made up of a collection of individual muscles and organs. A fascial dissection is based on the idea that bodies are created from a web of connective tissue that connects the superficial layers of the body to tissues deeper in, allowing them to shift and to influence one another. These are differences of perspective. It’s not that the body does not contain muscles and organs; it’s just that these are not the whole story. And it’s not that the existence of fascia is disputed by the medical community; it’s just that until relatively recently it wasn’t thought to be worth studying.

Now the success of techniques like myofascial release and the work of Dr Stecco and other scientific researchers has put fascia into the spotlight as the missing link that can explain the persistence of chronic pain in the absence of medical explanations.

In medical dissections, and in surgery, fascia is seen as something to cut through and to clear out of the way before starting the real work. In a fascial dissection more intricate care is taken to preserve the integrity of the fascia and to trace its connections. The results are illuminating.

In the fascial dissection of a female in her 70s I was able to see for myself:
• sheets of normal, properly hydrated fascia, like cling film wrapping around muscles
• the tiny ligaments that attach layers of superficial fascia to the skin
• the network through which these superficial layers connect deeper into the body
• the sliding mechanisms that allow unrestricted movement in properly aligned fascia
• the thickening of collagen fibres in fascia that had become dehydrated and stuck, and the resulting tangle of muscle fibres and connective tissues
• the solid mass of fascia surrounding a left knee replacement and thickening and distortion of fascia all the way to the subject’s right hip (specifically to her tensor fasciae latae muscle, AKA TFL, the main muscle used in hip rotation and walking)

These observations reminded me of several clients with whom I have discovered a connection between problems in one knee and pain in the opposite hip. They have also deepened my own understanding of the properties of fascia.

In having the opportunity to participate in a fascial dissection my overwhelming feeling was one of gratitude and respect to those brave donors who left their bodies for medical education.

The research was conducted with the help of the University of Medicine and Dentistry in New Jersey, USA. Researchers studied three groups of rats over 12 weeks, giving them repetitive tasks to do for just half an hour at a time, for a total of two hours a day, 3 days per week. The rats were required to pull a lever to release a morsel of food. What differed was the work rate and the force required to pull the lever.

From only week 6 researchers noticed significant changes in the rats’ anatomy and physiology including:
• An increase in collagen (a protein which gives fascia strength, but also rigidity)
• An increase in fibroblasts (the cells that build more body tissue)
• Disorganisation of muscles and connective tissue (tangles and stuckness in muscles and fascia)
• Thickening of the tendon sheaths that should aid smooth movement
• An increase in central nervous system pain (ie learned pain)

While some of these changes coincided with an increase in task-related skills, there were declines in actual performance across the board by week 9, as the rats begun to experience systemic pain, extending throughout their bodies right down into their tails. At the height of their pain the rats became less sociable and were increasingly aggressive.

A small group were given Ibuprofen from week 5 to see if that helped and there was some difference up until week 9, due to the anti-inflammatory effect of the drug. After week 9 Ibuprofen no longer helped. Meanwhile other rats opted to stop work and rest, and they began to get better.

Something to ponder next time you skip your break and pop a pill to keep up with the rat race.

Here’s a link to a summary of the research http://www.ncbi.nlm.nih.gov/pubmed/22087754?dopt=Abstract.

About myofascial release

Myofascial release is a gentle, non-invasive bodywork technique based on an understanding of how muscles and fascia work together deep within the body to produce movement and communicate pain. Fascia is believed by many complementary therapists to be an alternative communication system connecting body with mind.

Understanding the body in a myofascial way offers exciting possibilities for self-help techniques to aid physical movement and enhance well-being. These can be particularly beneficial for people living with chronic pain conditions such as fibromyalgia and RSI.

The Pain Care Clinic Workshops

Pain Care Clinic is running two relaxing and informative workshops including myofascial anatomy, myofascial stretching and self-help bodywork techniques. Workshops take place in Brighton and Hove and London.

Full workshop timetable and booking.

2. the training and approach of massage therapists, osteopaths and physiotherapists

They arise from a recent panel discussion with an osteopath and a physiotherapist, in which degree level massage therapy students asked questions about our respective training and approaches to treating clients. What struck me were the similarities although there are certain differences. Here are some of them:

Similarities between osteopath, physio and massage training

• all are trained in anatomy, physiology and biomechanics
• all are trained in the workings of the nervous system, muscular and skeletal systems, cardiovascular and respiratory systems
• all can accept referrals from medical doctors or self-referrals from patients and clients.

Differences between osteopath, physio and massage training

• only osteopaths can diagnose medical conditions
• osteopaths have compulsory training in pharmacology (the use and effect of drugs)
• only physios have compulsory training in the use of electro-magnetic equipment
• only advanced massage therapists are trained in the treatment of certain medical conditions.

Approaches in osteopathy, physiotherapy and massage therapy

• osteo means bone, so public perception is that osteopaths deal only with bone structure. While only osteopaths are trained in certain (sometimes controversial) techniques such as high velocity thrusts, they do also work on the soft tissues of the body
• physiotherapists are often associated with NHS rehabilitation and care of the elderly, but they do also work in a variety of settings including private practice, hospital intensive care and mental health services
• massage therapists are often associated with relaxation and health spas but, while massage is known for its relaxing effect, like physios and osteopaths, clinical massage therapists usually work with clients with injuries or chronic pain.

While we may differ on the importance we give to the psychological, cultural and social factors which
influence our clients, all three professions agree that pain-free human movement is central to the health of an individual.

Regulation of osteopaths and physiotherapists

Osteopathy and physiotherapy are both protected occupations in the UK. This means they are regulated by a professional body which sets standards for training and behaviour, and the law says no one can call themselves an osteopath or a physiotherapist unless they are registered with those professional bodies. Osteopaths are regulated by the General Osteopathic Council GOsC. Physios are regulated by the General Health Council, along with art therapists and speech and language therapists.

Regulation of massage therapists

Massage therapy, however, remains an unregulated profession. This means that in theory anyone, whether they are trained or not, can call themselves a massage therapist. Hence the professional differences between so-called ‘massage parlours’, massage by beauty therapists (known in the business as ‘fluff and buff’), and sports massage and other advanced clinical massage therapies.

In practice, although they are not regulated by law, massage therapists can choose to register voluntarily with a number of different professional bodies, which will check their standard of education and training before allowing a massage therapist to join. Membership will then enable the massage therapist to obtain professional indemnity insurance. For these reasons in 2011 the government confirmed it was abandoning plans for statutory regulation of massage therapists, as the costs of administering a scheme would outweigh the benefits to the public. In effect they were saying that voluntary regulation works well enough, partly because massage therapy has less potential to do harm than more invasive medical treatments.

However, the government’s decision is unfortunate for clinical massage therapists because it implies that clinical massage therapy is a less serious profession than other healthcare professions, and it undermines NHS recognition of massage therapy.

The reality is that the training of osteopaths, physiotherapists, and clinical massage therapists is similar, as is the way they approach treatment and therapy for medical conditions. These differences and similarities in education and treatment are the subject of my next blog: Massage therapy, osteopathy & physiotherapy 2.

Many people can make light of festive aches and pains as they will be short-term and soon forgotten about. But spare a thought this Christmas for RSI – repetitive strain injury – sufferers for whom chronic pain is part of their daily lives all year round.

RSI is one of the most persistent and least understood chronic pain conditions and annually prevents an estimated 500,000 people in the UK from performing everyday tasks, ranging from brushing their hair to working at their computer, without pain and discomfort. To my mind RSI is also one of the more preventable chronic pain conditions.

Read the Pain Care Clinic PDF RSI_NotJustForChristmas.

1. Improved educational standards (18%)
2. Published research validating the effectiveness of massage (26%)
3. Acceptance by the medical community (38%)
4. Other (18%)

This is a fairly good summary of the issues that are likely to be important to massage therapy professionals in the UK in 2012. Leaving ‘other’ aside for the moment, the first three are interrelated.

Great work on educational standards is being done at an individual level. For example, the Jing Institute in Brighton now runs the first accredited degree-level advanced massage training diploma in the UK. But work to improve educational standards at a more general level appears to have been hampered by poor coordination between the various self-appointed representative bodies to which massage therapists may choose to belong. Some progress has been made by the General Council for Massage Therapies to set a basic core curriculum for bodywork training, but what continues to disappoint is the lack of recognition for advanced massage therapists with a demonstrable record of high-level knowledge and training well above minimum standards.

Without improved educational standards, and better links with academic and research organisations facilitated by our representative bodies, it seems unlikely that individual massage therapists will themselves be able to fund the type of research necessary to ‘validate’ the effectiveness of massage therapy, however willing they may be to cooperate with that research. In my role as an educator, I spend a lot of time talking to massage therapists who are more than willing to participate in research. This willingness is only partly motivated by the expectation that properly framed research will ‘prove’ what massage therapists and their clients have known for years about the effectiveness of their methods. There is also a genuine desire among massage therapy professionals to participate in any research that improves standards and outcomes for clients – and to be part of a wider and expanding debate about healthcare and wellbeing.

Greater acceptance by the medical community would almost inevitably follow from improved educational standards and proper research. The medical community is trained to respond to scientific ‘results’. But there is also a question of attitude here. And attitudes are already changing. More and more GP practices, NHS clinics and private healthcare providers are offering some form of complementary therapy to their patients as they have seen the improvement to patient health in those patients who have independently sought out complementary therapies.

So, now the ‘other’ issues for 2012? Private health insurance schemes that allow customers to choose complementary therapies? More massage therapists holding their representative bodies to account by asking them hard questions about what they are actually doing to raise the standing of the massage therapy profession? Your comment here?

Due to increasing client demand, Pain Care Clinic is expanding its clinic hours in Brighton & Hove, East Sussex to now include Wednesday appointments at the Hove clinic, with new consultant therapist, and myofascial release specialist, Melanie Smith.

Melanie is an ITEC qualified massage therapist with additional advanced training in deep tissue work, myofascial release and pregnancy massage. Before joining Pain Care Clinic Melanie worked as a therapist in a sports centre, dealing with a range of sports injuries, and at RSI clinics, specialising in massage therapy for work-related pain conditions. Melanie has been teaching advanced massage to other therapists since 2006, and has a special interest in massage therapy for digestive disorders.

Pain Care Clinic lead therapist Amanda Oswald says:

‘I’m very excited to have Melanie on board at Pain Care Clinic. I have trained and worked alongside her now for several years and consider Melanie to be one of the most competent and intuitive massage therapists I know.’

Melanie in her own words:

I find massage practice creative and freeing, and I love the way massage is so beneficial to different body systems.’

See Melanie Smith’s full profile.
See Hove clinic location and appointment times.

RSI Action is national charity working to facilitate the prevention of RSI (Repetitive Strain Injury) conditions and for the relief of sickness, hardship and distress among those suffering with RSI conditions.

Click here to download the article as a PDF 11_10_Article_RSI_Action

Please click here to for more information, or to join RSI Action