During one of our 2021 webinar series, we have had four incredible lectures from author, physiotherapist and Vetrehabber Tuulia Luomala, who has found her passion in the exploration, understanding and teaching of the fascia.
If you remember the series, I am sure that, like me, you walked away from it with a change of perspective, a new tint to your glasses, and adjustments made to the way you clinically reason through the connections you find in the evaluation and treatment of every patient that passes through your hands and mind. And if you are anything like me, then you also need a little bit of a reminder right about now, on some of the main points that were covered during that series.
Here are some of the real highlights for me from this series of webinars.
What is fascia?
Fascia encompasses and forms a part of all connective tissue; it connects, separates, attaches, divides, holds, shapes and feeds most of the body. We can’t separate the fascial system from the muscular, neurological or skeletal systems. Indeed, we cannot consider any of these systems in isolation – we need to think about how they are connected, and the impact this connection has on the rest of the body.
Whatever our area of special interest, the fascia forms a big part of it. Fascia is not only made up of the loose connective tissue that is so stunningly photographed and put on display through social media. It includes dense connective tissue – the epimysium, perimysium, tendons and ligament. They are all a part of the fascial system.
‘Nothing’ is just as important as ‘something’. The fascia shows us that it is not only the cells which pay a critical role in the body’s functioning – the extracellular fluid or ground substance is just as important. Without this ground substance, the cells cannot function or maintain their health.
In this webinar we learned about the properties of the fascia – how the fascia provides support and stability to the body, how force is transmitted through the fascia, the role fascia plays in proprioceptive feedback, and much more.
When it comes to force transmission, we think of force generated by a muscle, acting towards the origin and insertion of the muscle. But the truth is, only 70% of force is transmitted in this way, while 30% of muscle force ‘goes missing’. This missing force is transmitted laterally through the fascia, to the synergistic and antagonistic muscles, as well as to the deeper fascial layers.
When we think about this 70-30 rule, we start to think a little differently about the muscles that don’t have a bony or ligamentous insertion point. Consider some of the muscles we work with most often:
- The abdominal muscles insert onto the linea alba.
- Gluteus medius originates in the thoracolumbar fascia.
- Superficial gluteus originates in the gluteal fascia.
- Biceps femoris inserts onto the crural fascia, and originates in the caudal fascia.
- The crural fascia is a part of the insertion of biceps femoris, semitendinosis, gracilis and sartorius.
Muscles will activate in the way that they can, and not always in the way that they should. The body is designed to work in an optimal way, but when there is a dysfunction, the body will adapt and the muscular system will activate in the ways that are available to it. In such cases, force will be transmitted through the fascial system in whatever ways it can be transmitted. The possibilities of compensatory movement patterns and muscle recruitment patterns become as many and varied as the number and extent of injuries or pathologies that the body may suffer from.
No wonder set protocols and a ‘recipe’ approach has never worked.
Fascia doesn’t lengthen when stretched. Think about tendons, ligaments, the epimysium and perimysium. Stretching as a treatment intervention doesn’t increase the elasticity or stretch capability of fascia.
Fascia is, however, subject to creep over time, a finding called ‘locked long’. When fascia is subject to abnormal loads over months and years, it will start to lengthen. A good example is the sway back we see in some elderly horses.
We learned about the difference between small hysteresis and big hysteresis, and how different breeds of horses will have fascia adapted to their specific function. It is important that we recognise the energy storage capacity of the fascia in the patient in front of us, and how it will impact that patient’s movement, efficiency, speed and risk of injury.
And most importantly, every animal should be moving every joint and muscle through a full range of motion at least every third day, in a controlled manner. When we have control over the nervous system, we have control over the myofascial system.
Myofascial slings and connections
Tuulia and her team have assessed these connections through dissection. She shared photos and videos, giving observations of these images. When we understand how the body is connected from one end to the other, from one area to another, from one muscle to another, from the skin to the bone, from the back to the hoof, then we start to understand how patterns of compensation and movement changes occur in our patients, and we can start to anticipate them. We can also more effectively treat the origin of the compensatory pattern we might be seeing.
We looked at the dorsal and ventral connections of the skin, the connections of the head to the poll and neck, we looked at the connections of the crural fascia and the impact it has on the hindquarter, and at the connections among the limbs. These videos, and the movements seen, are hard to translate into words. You really have to watch it.
Finally: How to build a strong and elastic myofascial system
I am still processing many of these insights, all of which resonate so closely with my own observations and thinking, and the work I do with my patients.
Movement is absolutely essential to the health of the body and all its systems, but of course we must ensure the movements we incorporate are correct.
This webinar focused on fascial recoil; how to recognise it and train it into our patients. Tuulia spoke about slow and controlled movement, and the impact on the neurological system and the fascial system. She spoke about bouncing, and how this impacts the quality of movement and the elegance of the patient. She spoke about proprioceptive refinement and micromovements, really focusing on the impact that the rider has on the horse in the smallest details, such as their breathing, posture and emotional state. We also discussed fluid dynamics and incorporating rotation through the spine in motion, along with the role of nutrition and hydration.
All of these aspects of training came together as Tuulia discussed the role of variety in the training programme. Every aspect of training must be varied, including work with and without a rider, the speed, surface, tempo, rhythm and load. This variation is what will truly train a resilient myofascial system and ultimately aid in reducing the risk of injury. We must also consider that the training of one system of the body is not more important than another – the cardiovascular system, neurological system, muscular system and skeletal system must all be given equal priority in a training programme.
And lastly, we discussed injuries, healing timelines and the effects of scarring. Tuulia has left me with the profound thought that the fascial system can hold memories, and when we approach and work with old scars, we will likely be faced with emotional responses from our patients as well.
As I think about this very strange and interesting statement, a few patients come to mind. Patients where we have struggled with major behavioural and psychological challenges, that have been linked – perhaps in my mind very loosely – to an old wound or injury that the patient sustained years earlier. Perhaps the connection was not quite as loose as I initially considered it to be.
The question now is, how do I change my approach? What adjustments will I make with this new knowledge?
I would love to hear from you. I would love to know how this series has changed your thinking and your perspective.