Integrative Fascial Release functions upon the basic premise, that “all soft-tissue release is based upon how the autonomic nervous system is discharging its impulses” (Michael Shea 1995). Accordingly, from this myofascial perspective, the autonomic nervous system is the primary mechanism that allows for the release of fascia.

Connective Tissue Properties

In addition to the autonomic nervous system premise we add therapeutic methods that affect the sol-gel relationship of the connective tissue ground substance. Utilizing thixotrophic effect (fascia becomes for fluid when it is stirred up, and more solid when it sits without being disturbed (Juhan 1987) & piezoelectric events (changing a mechanical force to electrical energy (Mark Barnes 1997), we have the basis for integrative and interactive change in the physiology and structure of the myofascial connective tissue.

Proprioception, Pain Receptors & the Autonomic Nervous System.

Maintaining the premise of the autonomic nervous system-soft-tissue relationship; then pain is considered an autonomic nervous system phenomenon. Pain triggers the neuromuscular system to maintain a sympathetic response. Shea postulates this as sympathetic tone.

Nociceptors register pain that become sensitised when chronically stimulated, leading to a drop in their threshold (Chaitow-DeLany 2000). With acute or chronic pain, soft-tissue dysfunction maintained by the ANS maintains high sympathetic tone. Once you intervene in the decrease of pain, even marginally, then soft-tissue will respond to manual pressure.

Fascia not only holds nociceptors but a host of other receptors. As excerpted from Clinical Application of Neuromuscular Techniques Volume One, (Chaitow-DeLany, Churchill-Livingston 2000); Bonica (1990) suggests that fascia is critically involved in proprioception, and that, after joint and muscle spindle imput is taken into account, the majority of remaining proprioception occurs in fascial sheaths (Chaitow-Delany 2000).

These receptors hold the key for stimulation of the autonomic nervous system. Once reflexively stimulated by manual pressure engaging superficial fascia, the receptors register within the ANS, thus relaxing and lowering sympathetic tone.

Parasympathetic response creates autonomic phenomenon that is visually discernible by manual engagement of the myofascia. It is in the threshold of parasympathetic that we can use indirect methods of myofascial release to lower pain, and neuromuscular and emotional holding patterns that facilitate soft-tissue response.

Myofascial Releasing Methods.

By employing three broad myofascial methods both directly, as manual pressure and movement, and indirectly, by nervous system response, we can affect soft-tissue dysfunction profoundly. This is the basis for how Integrative Fascial Release treats clinical soft-tissue dysfunction.

Two-pointing Technique with the Treatment of Sciatica.

With regard to treatment of sciatica, we have a variety of sciatic nerve dysfunctions; nerve root compression, disc protrusion and nerve impingement usually by contracted musculature (piriformis syndrome). Depending upon the severity of the symptoms, our first approach is the reduction of pain.

Integrative Fascial Release uses manual pressure engaging superficial fascia in the form of two-pointing. Two-pointing refers to the placement of hands usually beginning within the visceral seat of parasympathetic response, the abdomen and the pelvis.

By placing hands superiorly upon the abdomen and inferiorly on or around the sacrum, along with the engagement of the superficial layer of fascia, the autonomic nervous system responds with various autonomic phenomena to lower sympathetic tone and create a parasympathetic response.

Autonomic Nervous System Response

This response usually takes the form of fasciculation activity (trembling or twitch response), shaking, jerking, skin colour changes, clamminess, laughing, peristalsis (tummy rumbles and gurgles) and glazing or glassiness of the eyes; these are all signs of autonomic discharge. (Shea 1995)

Transverse Fascial Planes

Simultaneously two-pointing the abdomen allows reflexive relaxation to the deeper transverse fascial planes known as diaphragms. Relaxing deeper transverse planes allows for more consistent re-organization of fascial restrictions.

Low Force-Long Duration

Since fascia is continuous and ubiquitous, along with its’ ability to respond to low-force and long duration stretch or compressive force (Leon Page 1950), it has the potential to alter the sol-gel relationship; thus relaxing and changing functional and structure dysfunction along with the reduction of pain.

Preparing the Area Indirectly

This greatly assists with any sciatica dysfunction. Thus preparing an area by the fascial use of two-pointing with upmost consideration given to autonomic phenomena, will allow for more rapid and speedy intervention with regard to a dysfunction like sciatica.

Two-pointing with Leverage Compression.

Two-pointing is just the first in a series of fascial techniques employed to work with sciatic conditions. Essentially determine whether stretch or compressive force technique is desirable, and then used in conjunction with movement techniques (usually passive positional release); one can reflexively relax the whole gluteal structure, thus employing deeper and effective muscular intervention. By considering the myofascial component, one can effectively treat sciatica-like dysfunction usually lowering pain significantly.

Preparing the Area.

After parasympathetic response is achieved, the soft-tissue is ready to be cued and facilitated towards release and movement. This can be achieved by using either ischemic direct pressure, stretch or compressive methods. In IFR we will use compressive methods, if possible, over stretching technique. The visceoelastic-plastic nature of the tissue allows for the reflexive phenomena of unwinding. If one attempts to exaggerate a distortion pattern instead of attempting to elongate or stretch, the nervous system response proprioceptively will be to “let go”, unwind and release. Thus achieving critical collangenous inter-fibre “space”.

Fascia as a Functional Joint.

Fascia is actually considered a “functional joint” (Oschman 1997). It allows for freedom of movement when properly relaxed. Creating space and support is the primary function of the fascia. Once a “slackening” is achieved within the “fascial sleeve”, the ability to facilitate muscular change is increased.

References

1. Jobs Body, a Handbook for Bodywork, Deane Juhan, Hill Press, Inc. NY. 1987 Chapter 3 pp 68-69
2. Myofascial Releasing, John Barnes, P.T. & Rehabilitation Services, Inc. 1990
3. Myofascial Release Textbook, Michael Shea, Ph.D Somatic Psychology, Self-Published, 1995 pp 45-56
4. Readings on the Scientific Basis of Bodywork, Energetic & Movement Therapies, James & Nora Oschman, Self-published Collection, 1997
5. Clinical Application of Neuromuscular Techniques Vol. One, Leon Chaitow & Judith Walker DeLany, Churchill Livingston, 2000, Chapter 3 pp 30-31

Ultimate Cumulative Overload Syndrome

Foundation article on the basis of understanding for manual therapists as to how to understand and approach a client with fibromyalgia. The article by Dr.John Gillick was one of the clearest available to contextually understand the syndrome.

Article: UNDERSTANDING FIBROMYALGIA

How to Tame Fibromyalgia © 2001, John S. Gillick
Jgillick@simple-ergonomics.com

FIVE CONCEPTS
To understand Fibromyalgia (FM), it is necessary to understand:

I. Vulnerability; II. Cushion & Overload; III. Trigger & Enabler; IV. Active Fibromyalgia; and, V. Ownership

I. VULNERABILITY

There is an apparent increased vulnerability among certain persons toward development of fibromyalgia. Others, exposed to the same triggers, show no signs of the condition.
Vulnerability (predisposition) appears to be familial with women more vulnerable than men. However, with enough trauma, virtually anyone can develop fibromyalgia. There are not significant cultural, ethnic, geographic, or generational predisposes or protectors.

II. COPING, CUSHION, OVERLOAD, OVERWHELM

People have varying capacities to cope with or cushion ongoing stress and trauma. An intact, healthy capacity allows multi-task coping without exhaustion. Each individual has a limited capacity for trauma with which can be overwhelmed. When the coping mechanism are strained or maladaptive — during illness, severe mental stress, marked sleep depravation –capability (buffering, cushioning) is decreased and an individual can become chronically overwhelmed. Uninjured individuals, with normally resilient and untaxed restorative powers, continue to readily cope with the ongoing large and small traumas of daily life.

While some people can endure prolonged torture without “breaking,” others are more easily overwhelmed. When the micro-traumas of daily tasks cumulate and neuro-muscular restoration (coping) cannot keep pace, even tiny traumas become noxious and cause pain. There is hypersensitivity to the slightest noxious (“hyperalgesia”) with normally non-noxious stimuli perceived as pain (“allodynia”). This is pain amplification.

With coping mechanisms overwhelmed, “pain-begets-pain.” Neuro-physiological and pharmacological equivalent for diminished “coping”. Chronic pain researchers have shown reproducible neuro-anatomical and biochemical changes from induced chronic pain in the nervous systems of animal-model experimentation.

With chronic pain, there is on-going hyper-stimulation of the nociceptors, anti-nociceptors, and dorsal horn cells, resulting in dendritic nerve remodeling with inhibition of the normal thalamic down regulation of pain stimulus transmission.

The anti-nociceptive system is not allowed to recover, the inter-relationship between dorsal horn dendrites and the nociceptive and anti-nociceptive receptors doesn””t recover. There is nerve remodeling with dendritic new growth toward the thalamus. There is sympathetic nerve sprouting as well as crossing over of fibers between lamina in the spinal cord. Experimental over stimulation in animals can produce retrograde activation of nociceptors, nerve remodeling, dorsal horn hyper-excitability with the allodynia and hyperalgesia that is common to the chronic pain syndromes. This process can be halted and may be partially reversible.

III. TRIGGERS AND ENABLERS (T&Es)

Triggers. Fibromyalgia is started (triggered) by painful stimuli (traumas) which
overwhelm an individual”’’s physical and mental defenses or coping mechanisms.
In my view, fibromyalgia (FM) can be categorized by how it starts. “Secondary” FM (10-30%) has a rapid (within three months) onset associated with a specific traumatic episode or event (macro trauma).

“Delayed-secondary” FM: (20-30%) onsets six months to several years after a traumatic episode or disease that leaves an ongoing, chronic measurable residual (i.e., whiplash, chronic inter-vertebral disc syndrome, rotator cuff injury…).

“Primary” FM: (50% +/-) – also called “idiopathic” — has a gradual onset without
immediately obvious trigger(s). My experience suggests that multiple, chronic,
cumulative micro-traumas are its usual trigger(s).

Enablers. Once activated, the global condition of active FM is kept active by ongoing irritations or traumas, which I dub enablers. Enablers are usually multiple. They may be ongoing residuals of macro-trauma triggers (i.e., whiplash, coccydynea, systemic diseases) or ongoing (micro) traumas (i.e., chronic sinusitis, repeated impact trauma, musculoskeletal dysfunction in the upper or lower extremities, positional sleep traumas…).

IV. THE FIBROMYALGIA SYNDROME (FMS)
THE ULTIMATE CUMULATIVE TRAUMA OVERLOAD SYNDROME

Active Fibromyalgia is manifest or hypersensitive (“hyperalgesia”) widespread myalgia
with extreme sensitivity to the slightest noxious stimulus (“allodynia”). The FMS persists as a widespread neuro-muscular-spasm condition with “pain-begetting-pain.” Living with fibromyalgia is like living in a “pain-amplification-chamber.”

I prefer to use “pain amplification” to express hyperalgesia and allodynia. Fibromyalgia continues because of uninterrupted daily activity trauma amplification (DATA). Amplification of daily activities traumas continues to further injure and prevent recovery of the individual”’’s normal coping responses. The fibromyalgic is unable to adequately blunt or cope with even small daily traumas. Until the enablers and the triggers are corralled, the fibromyalgics diminished physical/ mental coping mechanism (thalamic down-regulation) is overwhelmed.

V. OWNERSHIP – RESPONSIBILITY

Control of fibromyalgia is dependent upon the individual, not the health professional.
Fibromyalgia cannot be turned off by some doctor, some special treatment, pill, diet or supplement from the outside. Tools for control are education (understanding), behavior modifications with removal of the T&E”’’s, adjunctive medications, physical modalities, and emotional support. These tools can be made available to the Fibromyalgic, however only the Fibromyalgic can elect whether to employ them.

Fibromyalgia can control the individual when it is hyper-active. It becomes a dominant factor that limits home and employment activities, etc.. .

Fibromyalgia may co-exist within the individual when the individual has some ownership of the condition and can temporarily “shut-down” the condition (the echo or amplification effect) by willpower and concentration.

The Fibromyalgic owns the condition when the individual can “turn-down,” then “turn-off” the condition by removing the triggers and the DATA — daily activity trauma amplifiers – that keep it active.