The Importance of Fascia in Osteopathic Medicine

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Myofascial Release
Steve Sanet, D.O.
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History of Fascia

• Fascia has been observed and explored throughout
  history. It has been palpated and manipulated
  from the early days of mankind. It has been
  evaluated during anatomy dissections and through
  microscopy, experimented upon in the laboratory,
  and utilized in surgical procedures.

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Fascia Connective Tissue Facts

• 16 of bodys total weight
• 25 of bodys total water content

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Structure of Fascia

• Structure
• Loose areolar vs. dense irregular
• Cellular components
• Fibroblasts
• Mast cells
• Histiocytes
• etc. (adaptability)
• Subcellular components
• Collagen (reticular fibers)
• Elastic fibers
• GAG
• etc. (adaptability)

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Collagen

• /- 15 types
• Type I is dominant
• Triple helix
• Cross-linking Periodicity
• Tensile strength

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Reticular fibers

• Scaffolding
• Turbulence
• Example
• Lymphoid tissue

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Elastic Fibers

• Cross-linked
• Relaxed vs. Stretched
• Elasticity and flexibility
• Response to variable physical demands
• Examples
• Aorta
• Lung
• (lymphoid)

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The Extracellular Matrix

• Collagens GAGs, etc.
• Elastic fibers elasticity
• Tensile strength
• Cellular components
• H20 component

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General Properties of Fascia

• Viscosity
• Elasticity
• Plasticity

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General Functions of Fascia

• Mechanical
• support (vascular structural)
• compartmentalization
• conduit somatic-autonomic neurovascular
• Metabolic
• diffusion
• energy storage
• Immunologic
• line of defense
• barrier

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Fascia- Examples Locations

• Superficial (under the skin)
• panniculus adiposus
• specializations abdominoperineal, foot pads,
  breast, head
• Deep (almost everywhere)
• general deep fascia is continuous and
  everywhere its definition is expandable
• specializations thoracolumbar,
  brachial/antebrachial/palmar, lata/crural/plantar,
  retinacula, neck, pericardium, dura, etc.
• epimysium, epineurium, adventitia
• Subserous (under and in the linings of cavities)
• mesenteries, ligaments, etc.

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Fascial Mechanical Concept - Support
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Fascial Mechanical Concept - Compartmentalization

• 3-Dimensional System

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Compartmentalization - Another View

• 3-Dimensional System

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Fascial Mechanical Concept - Conduit

• Neurovascular bundles
• Epi-, peri-, endoneurium

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Key Myofascial Regions

• Diaphragms

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Myofascial Responses

• Acute

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Myofascial Responses

• Acute

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Myofascial Responses

• Chronic

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Myofascial Responses

• Chronic

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Myofascial Responses

• Chronic

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Myofascial Responses

• Chronic

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Myofascial Responses

• Chronic

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Myofascial Chronic Pattern Comparisons
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Fascial Pattern Diagnostics

• Compensated
• Non-compensated

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How Do We Assess?

• Bio Psycho - Social Model
• Body Mind Spirit (The body is a unit)
• We look (and feel) for somatic dysfunction
• Asymmetry
• Restriction or Alteration of Motion
• Tissue Texture Changes
• Tenderness or Sensorial changes

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Evaluation TreatmentThe Barrier Concept

• Bind going into the restrictive barrier
  (direct)
• Ease going away from the restrictive barrier
  (indirect)

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How Do We Treat?

• Myofascial Release makes use of barriers,
  pressure and temperature. Sustained treatment
  effort (manual pressure) in the direction of a
  barrier will result in myofascial creep. This
  is due to the fascias structure it will respond
  following the normal physiologic properties
  possessed by its intrinsic elements.

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