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Fascia: The Tensional Network of the Human Body
The science and clinical applications in manual and movement therapy
- 2nd Edition - December 8, 2021
- Editors: Robert Schleip, Carla Stecco, Mark Driscoll, Peter Huijing
- Language: English
- Paperback ISBN:9 7 8 - 0 - 7 0 2 0 - 7 1 8 3 - 6
- eBook ISBN:9 7 8 - 0 - 7 0 2 0 - 8 4 1 3 - 3
The role of the fascia in musculoskeletal conditions and as a body-wide communication system is now well established. Fascia: The Tensional Network of the Human Body constitut… Read more
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Request a sales quoteThe role of the fascia in musculoskeletal conditions and as a body-wide communication system is now well established. Fascia: The Tensional Network of the Human Body constitutes the most comprehensive foundational textbook available that also provides the latest research theory and science around fascia and their function.
This book is unique in offering consensus from scientists and clinicians from across the world and brings together the work of the group behind the international Fascia Research Congress. It is ideal for advanced sports physiotherapists /physical therapists, musculoskeletal/orthopaedic medicine practitioners, as well as all professionals with an interest in fascia and human movement.
The comprehensive contents lay the foundations of understanding about fascia, covering current scientific understanding of physiology and anatomy, fascial-related disorders and associated therapies, and recently developed research techniques.
- Full colour illustrations clearly show fascia in context
- New content based on latest research evidence
- Critical evaluation of fascia-oriented therapies by internationally trusted experts
- Chapter outlines, key points and summary features to aid navigation
- Accompanying e-book version include instructional videos created by clinicians
- Cover image
- Title page
- Table of Contents
- Copyright
- Foreword
- Online video resources
- Contributors
- Introduction
- List of Tables
- List of Illustrations
- Section I. Scientific Foundations
- Part 1. Topographical Anatomy
- 1.1. Evolution of fascia-focused anatomy
- Introduction
- Anatomy
- Ancient awareness of fascia
- The illumination of fascia
- Fascia in the age of science
- Combined portrayal of fascia
- References
- 1.2. General anatomy of the muscle fasciae
- Introduction
- General structure and composition of muscle fasciae
- Functional anatomy of the endomysium
- Functional anatomy of the perimysium
- Perimysial–endomysial junction zones
- Perimysium and intracellular subdomains
- Conclusions
- References
- 1.3. Somatic fascia
- Global organization of fascia in the body
- Architecture of fascia—the four primary layers
- References
- 1.4. Fascia superficialis
- Introduction
- Gross structure and distribution
- Components and their relation to function
- Aging changes in subcutaneous tissue
- References
- 1.5. Deep fascia of the limbs
- Introduction
- The deep fascia of the shoulder
- The deep fascia of the arm and forearm
- The palmar aponeurosis
- Deep fasciae of the lower limbs: Fascia lata and crural fascia
- The retinacula
- References
- 1.6. The thoracolumbar fascia
- Introduction
- The thoracolumbar fascia
- The two-layered model
- The three-layered model
- Compartmentalization of the paraspinal muscles
- Proposed model of the thoracolumbar fascia
- The posterior layer of the thoracolumbar fascia
- Disposition of the latissimus dorsi
- Fiber orientation for the latissimus dorsi
- Attachments of the serratus posterior inferior
- Unifying theory of the superficial lamina
- Deep lamina of the posterior layer of the thoracolumbar fascia
- Inferior border of the deep lamina
- Superior border deep lamina
- Lateral border of the deep lamina
- The middle layer of the thoracolumbar fascia
- Acknowledgments
- References
- 1.7. Deep fascia of the neck and deep inner fascia of the anterior wall of the trunk
- Introduction
- Superficial fascia of the neck
- Deep fascia of the neck
- Thoracic fasciae
- Diaphragm development
- Final considerations
- References
- 1.8. Visceral fascia
- Introduction
- Development of visceral fascia
- Formation of the intraembryonic coelom and surrounding visceral fascia
- Formation of the midline mesodermal column and its relationship to the organs of the body
- Formation of the spinal nerve and the viscerotome
- Summary
- Visceral fascia
- Regional visceral fascia
- References
- 1.9. Membranous structures within the cranial bowl and intraspinal space
- Embryonic growth dynamics of the dural membrane according to blechschmidt
- Intracranial membrane system
- Extracranial membrane system
- Vascularization of the meningeal membranes
- Meningeal nerve supply
- Reciprocal tensile membrane and sutherland’s fulcrum
- Future tasks and open questions
- References
- 1.10. Diaphragmatic structures
- The diaphragm and its fascia: Anatomical, embryological, and evolutionary development
- The muscle fascia of the trunk and neck and its connections with the diaphragm
- The visceral fascia of the trunk and its connections with the diaphragm
- The fascia of the diaphragm and its connections
- The role of the diaphragm in respiratory function and the control of static and dynamic posture
- References
- 1.11. Molecular aspects of fascia
- Introduction
- Fascial tissue cells
- The extracellular matrix: Fibrous component and aqueous matrix
- Cell receptors in fascial tissue
- References
- 1.12. Fascia of the pelvic floor
- Introduction
- Body-wide continuity of pelvic fascia
- Inner structure of the pelvic cavity
- Fascial tonicity and organ function
- External anatomy of the pelvis
- Fascial tension and chronic pelvic pain
- References
- 1.13. Embryology of the fascial system
- Introduction
- Neural (meningeal) fascia
- Vascular fascia
- Visceral fascia
- Deep fascia of the musculoskeletal system
- Conclusion
- References
- Bibliography
- 1.14. On the origin of fascia: A phenomenological embryology of fascia as the “fabric” of the body
- About so-called germ layers
- Where does the fascial tissue come from?
- Mesenchyme, “tissue of innerness”? Fascia, “organ of innerness”?
- In fascia it is about two—biotensegrity
- References
- Part 2. Communication
- 2.1. Fascia as an organ of communication
- References
- 2.2. Proprioception
- Proprioception, mechanoreception, and the anatomy of fascia
- Connectivity and continuity
- Architecture is different from and complementary to anatomy
- The substrate of mechanoreception
- The functional role of architecture of the connective and muscular tissue in mechanoreception
- Dynaments: More than ligaments or muscles
- Classification of mechanoreceptors in proprioception
- References
- 2.3. Interoception: A new correlate for intricate connections between fascial receptors, emotion, and self-awareness
- Introduction
- What is interoception?
- Sensual touch
- Interoceptive pathways
- Interoception and somatoemotional disorders
- Fascia as an interoceptive organ
- Manual therapy and interoception
- Movement therapies and interoception
- References
- 2.4. Nociception: The thoracolumbar and crural fascia as sensory organs
- Introduction
- Part 1: Innervation of the thoracolumbar fascia
- Part 2: Electrophysiology
- Part 3: Innervation of the crural fascia
- Part 4: Effects of an experimental fascia inflammation
- References
- 2.5. Fascia as a body-wide communication system
- Introduction
- Communication and information processing
- Defining the fascia
- The living matrix
- Signaling pathways and human performance—the zone: Neurology or biophysics?
- Biophysics
- Neurology
- Conclusion
- Dedication
- Acknowledgment
- References
- Part 3. Force Transmission
- 3.1. Force transmission and muscle mechanics: General principles
- Introduction
- Myotendinous force transmission
- Myofascial force transmission
- Distribution of forces in a multipath system
- Intramuscular substrates of myofascial force transmission
- References
- 3.2. Epimuscular myofascial force transmission: An introduction
- Introduction: Epimuscular myofascial force transmission and its substrate
- Effects of epimuscular myofascial force transmission
- Complexity of myofascial loading of muscle
- Additional factors to consider
- Effects on functioning of the sensory apparatus
- References
- 3.3. Myofascial chains: A review of different models
- Introduction
- Kurt tittel
- Godelieve denys-struyf
- Joseph schwartz
- Serge paoletti
- Discussion
- References
- 3.4. Anatomy trains: Myofascial force transmission in postural patterns
- Introduction—fascia as metamembrane
- Dividing the indivisible
- Isolating a muscle
- The anatomy trains
- Tensegrity
- Conclusion
- References
- 3.5. Biotensegrity and the mechanics of fascia
- Introduction
- Biotensegrity
- The tensegrity model
- The mechanics of fascia
- References
- 3.6. Human living microanatomy
- Introduction
- The physical factors
- Tissue continuity—no layers, no empty spaces
- Dispersed patterns with no regularity
- Maintaining tissue continuity during mobility: Movements of fibers, mechanical behavior
- Reversing the process of entropy
- Irreversibility of time
- Quantum physics and chaos theory
- Chaos theory is a modern discovery
- Fluids
- Intercrossing fibers in 3D create irregular polyhedral microvolumes
- Turbulence and phase transition
- Adaptation and transformation: Megavacuole
- Fractalization adds another dimension to the chaotic aspect of living matter
- Biotensegrity
- Understanding growth and morphogenesis
- The structural similarity of life
- Conclusion
- References
- 3.7. The fascial net: Resonance frequency with links to thermodynamics
- Introduction
- Locomotion theories
- Linking the locomotion theories with the thoracolumbar fascia: A novel approach
- A simplified lumbar spine finite element model with middle and posterior layers of the thoracolumbar fascia
- Methods
- Results
- Conclusion
- References
- Part 4. Physiology
- 4.1. The physiology of fascia: An introduction
- Connective tissue of the locomotor apparatus
- Construction and function
- Traction or tensile load versus pressure
- Physiological stimuli
- Wound healing and manual therapy
- Conditions for wound healing
- References
- 4.2. Fascia is alive: How cells modulate the tonicity and architecture of fascial tissues
- Cellular populations in fascia
- Fascia and immunology
- Myofascial tonicity
- From myofibroblast contraction to tissue contractures
- Modulators of fascial contractility
- Interaction with the autonomic nervous system
- Indications for rhythmic oscillations of fascial tissues?
- References
- 4.3. Extracellular matrix
- Introduction
- The matrisome
- Main extracellular matrix players
- ECM-associated factors and matricellular proteins
- ECM mechanics and fibroblast mechanosensing
- Conclusion
- Acknowledgments
- References
- 4.4. The influence of pH and other metabolic factors on fascial properties
- pH regulation and influence on fascial tissue
- What is the impact of pH on fascial function?
- Effect of metabolic factors and hormones on fascial function
- Sex hormones
- Relaxin
- Corticosteroids
- Lactate
- References
- 4.5. Fluid dynamics in fascial tissues
- Introduction
- Properties of interstitial water
- Morphological quality of interstitial fluids
- Interstitial fluids as a medium of communication between the cells
- The “breathing” of the tissues
- References
- Bibliography
- Section II. Clinical Application
- Part 5. Fascia-Related Disorders
- 5.1. Fascia-related disorders: An introduction
- 5.2. Dupuytren’s disease and other fibrocontractive disorders
- Introduction
- Dupuytren’s disease
- Who is afflicted by this disease?
- The basic problems of dupuytren’s disease
- Basic anatomy of dupuytren’s disease
- Palmar nodules
- Myofibroblasts
- Palmar cords
- Why are some fingers affected more than others?
- Are all myofibroblasts the same?
- Inflammatory models
- Myofibroblast receptors
- What is the origin of the cells that cause the “pits” at the distal palmar crease?
- What “instructs” the cells in the aponeurosis to contract?
- What “instructs” the cells in the aponeurosis to proliferate?
- Current treatments
- A strategy for a pharmacological approach
- Drugs injected into the cords
- A modern development
- Peyronie’s disease
- Ledderhose’s disease
- Conclusion
- References
- 5.3. Spastic paresis
- Introduction
- Intramuscular connective tissue changes in spastic paresis and control human muscle
- Surgical treatment of the upper extremity in spastic paresis
- Observations during surgery
- Toward an explanation of spasticity-related joint positions
- Conclusion
- References
- 5.4. Diabetic foot
- Introduction
- Methodology of testing
- Nonenzymatic glycosylation
- Plantar fascia
- Achilles tendon
- Limited joint mobility
- Conclusions
- References
- 5.5. Trigger points as a fascia-related disorder
- Trigger points
- Fascia and myofascial trigger points
- Therapeutic consequences
- References
- 5.6. Joint hypermobility due to pathologically increased compliance of extra- and intramuscular connective tissues
- Introduction
- Physical or manual therapy in Ehlers–Danlos syndrome
- Neuromuscular involvement of eds
- Effects of tnx-deficiency on muscle characteristics in a mouse model of eds
- The ultrastructure of muscle extracellular matrix in tnx knockout mice is distorted
- Isometric contractions
- Intramuscular changes: Increased muscle compliance
- Intermuscular changes: Reduced epimuscular myofascial force transmission
- Conclusions
- References
- 5.7. Anatomy of the plantar fascia
- Introduction
- Macroscopic and microscopic characteristics
- Biomechanical implications
- Plantar fascia thickness and stiffness
- Clinical implications and treatment
- References
- 5.8. Fascia and low back pain
- The epidemic of low back pain
- A glimpse into low back pain history
- Effect of low back pain on humans and economies
- Current treatments of low back pain
- Potential sources of low back pain
- Fascia: Foe or ally?
- Why fascia?
- Perspectives on fascia in low back pain
- References
- 5.9. The role of fascia in oncology
- Introduction
- Identifying the mystics of cancer biology—a big challenge
- Mechano-oncology—cancer mechanobiology
- Body-based treatment strategies in the context of cancer
- References
- Part 6. Diagnostic Procedures for Fascial Elasticity
- 6.1. Diagnostic procedures for fascial elasticity: An introduction
- References
- 6.2. Fascial palpation
- Defining palpation
- Active vs passive assessment
- Palpation tools
- Relaxed palpation
- Layers
- Communicating with the client
- Palpating for information
- Palpation objectives
- Palpate by “feeling,” not thinking
- Physiology of touch
- Filtering information
- An experienced palpation perspective
- Practical palpation
- Conclusion
- References
- 6.3. Hypermobility, hypermobility spectrum disorders, and hypermobile Ehlers–Danlos syndrome
- Introduction
- Clinical presentation
- Examination of patients with hypermobility spectrum disorder
- Evaluation, diagnosis, and management planning
- Management principles
- References
- 6.4. Mechanical deformation-based assessment methods
- Introduction
- Terminology
- Devices
- Static deformation
- Bioimpedance
- Ultrasonography and elastography
- References
- Part 7. Fascia-Oriented Therapies
- 7.1. Fascia-oriented therapies: Inclusion criteria and overview
- 7.2. Trigger point therapy from a contemporary pain science perspective
- Introduction
- Integrated trigger points hypothesis
- Fascia, muscles, and myofascial pain
- Some sensory aspects of fascia
- Trigger point therapy
- References
- 7.3. Structural integration
- Premises of the work
- Characteristics of fascia key to structural integration
- Facilitating integrated structure and function
- The traditional structural integration 10-series
- References
- Bibliography
- Random trials in normal persons
- Studies in specific patient populations
- Abstracts of case studies regarding specific conditions
- 7.4. Myofascial induction approaches
- Introduction
- Neurophysiological mechanisms for releasing the restrictions of the fascial system
- Method description
- Scientific evidence related to the results in the myofascial approach
- References
- 7.5. Osteopathy and fascia in clinical practice
- Introduction
- Fascia in the perspective of osteopathic manipulative treatment
- Osteopathic contributions to the understanding of fascia
- References
- 7.6. Connective tissue manipulation
- History and background
- Applications and contraindications
- Principles of connective tissue manipulation
- Effects of connective tissue manipulation
- Clinical benefits
- References
- 7.7. Fascial manipulation
- Introduction
- The biomechanical model for the musculoskeletal system
- The biomechanical model for the internal system
- Treatment
- References
- 7.8. Managing dysfunctional scar tissue
- Introduction
- Connective tissue and the extracellular matrix
- Wound healing
- Scar tissues
- Therapeutic approach
- References
- 7.9. Acupuncture as a fascia-oriented therapy
- Historical background
- Acupuncture mechanism
- Techniques
- Dry needling: A technique approaching muscle and fascia
- Evidence
- References
- 7.10. Gua sha
- Introduction
- Gua sha terms
- Indications
- Contraindications
- Biomechanism/physiology
- References
- 7.11. Prolotherapy as a regenerative injection treatment
- Introduction
- History
- Wound healing, repair, and regeneration
- Mechanism of action and substances injected
- Indications, contraindications, complications, and risks
- Techniques
- Outcomes and clinical evidence
- Fascial neural hydrodissection for entrapment neuropathy
- Future challenges
- References
- 7.12. Neural therapy
- Therapy with local anesthetics
- Neuroanatomy, neurophysiology
- Therapeutic principles
- Indications, contraindications, complications
- Practical procedure
- Research
- Acknowledgments
- References
- 7.13. Instrument-assisted soft tissue mobilization: Emphasizing the fascia
- Introduction
- Normal muscle function requires normal fascial gliding
- Relation of hyaluronan to the gliding of fascia and muscle fibers
- Superficial fascia
- Deep fascia
- Fascial densification/fibrosis
- Retinacula
- Thicker areas of fascia may be normal tissue
- So where do we treat?
- Instruments
- Important information regarding instrument-assisted soft tissue mobilization
- References
- 7.14. The fascial distortion model
- The patient as expert—the typaldos approach
- The fascial distortions
- The diagnosis of fascial distortions
- Treatment of fascial distortions
- References
- Bibliography
- 7.15. Fascial treatment of axillary web syndrome after breast cancer surgery
- Introduction
- Etiology
- Myofascial techniques
- References
- 7.16. Temperature effects on fascia
- Introduction
- Temperature-dependent tissue components
- Temperature changes are relevant
- Myofascial tonus regulation is temperature dependent
- Lack of temperature undulation is detrimental
- Therapeutic use of heat
- Therapeutic use of cold
- References
- 7.17. Neurodynamics: Movement for neuropathic pain states
- Introduction
- Structures of the peripheral nervous system and their functions
- Movement for neuropathic pain states
- The bigger picture
- References
- 7.18. Stretching and fascia
- Introduction
- Definition
- Mixed evidence
- Stretching: The evidence for tissue change
- Mechanical lengthening
- Tissue hydration
- Proprioceptive stimulation
- Direct cellular effects
- References
- 7.19. Yoga and fascia
- What is yoga?
- Yoga’s effects on fascia
- Fascia research’s effect on yoga
- References
- 7.20. Pilates and fascia: The art of “working in”
- Introduction
- The blend of eastern and western philosophies
- Fusion and integration of various disciplines
- Fascia, bound by lifestyle
- Pilates principles and fascia
- Core ability, a fascia-related girdling concept
- The breath in pilates
- Well-connected
- Alignment support from within
- Specialized equipment: Reformer or transformer
- Reformer versus machine
- References
- 7.21. Nutrition and fascia: An antiinflammatory model
- Musculoskeletal conditions and inflammation
- Inflammatory response
- Fatty acids: Antiinflammatory properties
- Fatty acid dietary supplements
- Culinary spices and herbs
- Fruits and vegetables
- Beverages: Green tea and epigallocatechin-3-gallate
- Gluten and inflammation
- Nutrition: An antiinflammatory model
- References
- Bibliography
- 7.22. Fascial fitness: Suggestions for a fascia-oriented training approach in sports and movement therapies
- Introduction
- Fascial remodeling
- The catapult mechanism: Elastic recoil of fascial tissues
- Training principles
- Fascial fitness and body image
- References
- 7.23. Hydrorelease of fascia
- Introduction
- History of injections with physiological saline
- History and definition of hydrorelease
- Differences between hydrorelease and hydrodissection
- Mechanisms of action of HR and HD
- Indications of HR
- Contraindications, complications, and risks of HR
- Techniques of HR
- Myofascia
- Nerve (paraneural sheath and fascia around peripheral nerves)
- Retinaculum
- Tendon and tendon sheath
- Joint capsule and surrounding tissues
- Fascia in fat pads
- Ligamentum flavum/dura complex
- Acknowledgments
- References
- 7.24. Fascia and traditional chinese medicine
- Introduction
- The basic elements of acupuncture and fascia
- Acupuncture and moxibustion techniques with fascia
- Acupuncture research and fascia
- Conclusion: The contribution of fascia to acupuncture and moxibustion
- References
- 7.25. Extracorporeal shockwave therapy applied to myofascial tissue
- Introduction
- Shockwave basics
- Mechanisms of action of extracorporeal shockwave therapy on tissue
- Effects of ESWT on tendons and myofascial tissue
- Antiinflammatory effects and pain reduction of ESWT
- Antifibrotic effects of ESWT on myofascial tissue
- Promotion of healing processes and effects of ESWT on myofascial tissue
- Therapeutic approach
- Clinical example of ESW application for myofascial pain in a musculoskeletal disease
- Perspectives
- References
- 7.26. Bowen therapy
- What is bowen therapy?
- How prevalent is bowen therapy?
- Foundations
- Bowen practice: The classic move
- Bowen practice: The pause
- Hypothesized mechanism of action
- Clinical research
- References
- 7.27. Fascia and mental imagery: Can the two walk together?
- Introduction
- Mental imagery: Definitions and roles
- Similarities between fascia and mental imagery
- Suggested associations between fascia and mental imagery
- Fascial dynamic neurocognitive imagery: A brief history
- Fascial dynamic neurocognitive imagery exercises for mental imagery and fascia
- Exercise 1: Fascial concentration and awareness
- Exercise 2: Fascial concentration and awareness
- Exercise 3: Fascial sliding integrated touch and mental imagery
- Exercise 4: Lungs’ fascial sliding
- Acknowledgments
- References
- 7.28. Foam rolling
- Introduction
- Possible mechanisms of foam rolling
- Research contexts
- Variations and implementation
- Conclusion
- References
- 7.29. The functional aspects of fascia during human performance and sports
- Wheel of history
- No human is limited
- What to train?
- Release the restrictions
- Strengthen the weak part
- Fine-tune the network
- The art and science of training
- References
- Section III. Research Directions
- Part 8. Fascia Research: Methodological Challenges and New Directions
- 8.1. Fascia—clinical and fundamental scientific research: Considering the scientific process and its potential for creating clinical applications
- Introduction
- The need for ongoing fundamental scientific work
- Retrospective research analyzing what is needed to attain potential new clinical applications in the future
- Conclusions
- References
- 8.2. Imaging: Ultrasound
- A short history
- Form and function of muscle–tendon–fascial structures revealed by ultrasonography
- Hypertrophic muscles
- Ultrasound elastography
- Structures around skeletal muscles visualized and tested by ultrasonography
- New techniques applied to analysis of ultrasound images
- References
- 8.3. On the problems of oversimplification in experiments and modeling of the body as a multilevel organizational unit
- Introduction
- A serious example of the effects of oversimplification
- Different levels of organization within the body distinguished
- A model and experiments dealing with more than one level of organization
- Limitations of experiments on myofascial force transmission
- Does epimuscular myofascial force transmission play a role in vivo for healthy subjects?
- Advantages and limitations of the applied MRI techniques
- Advantages and limitations of studying myofascial force transmission by measuring moments
- References
- 8.4. Myofascial force transmission and molecular pathways involved in adaptation of muscle size
- Introduction
- Mechanical loading induces muscle adaptation in vivo
- Training
- Muscle strain
- Molecular mechanisms of adaptation of muscle size
- Machinery for protein synthesis
- Translation of mRNA
- Completion of the protein synthesis
- Machinery for protein degradation
- Mechanochemical signaling and mechanotransduction for protein synthesis and degradation in muscle
- The roles of fascia in the regulation of myofiber size
- Ex-vivo culture of mature, single myofibers
- References
- 8.5. Myofascial effect on muscle stem cell function and muscle regeneration
- Introduction
- Mechanical linkage of muscle stem cells to their niche components in the extracellular matrix
- Force transmission from myofiber to muscle stem cell
- Potential effect of physical cues on muscle stem cell function
- References
- Glossary
- Index
- No. of pages: 744
- Language: English
- Edition: 2
- Published: December 8, 2021
- Imprint: Elsevier
- Paperback ISBN: 9780702071836
- eBook ISBN: 9780702084133
RS
Robert Schleip
CS
Carla Stecco
MD
Mark Driscoll
PH