Third International Fascia Research Congress Program
Wednesday, March 28
Mary F. Barbe, PhD
Changes in Fascia Related to Repetitive Motion Disorders
We have developed a voluntary rat model of repetitive reaching and grasping that permits the examination of tissue responses to non-weight bearing muscular loads in upper extremity tissues, as well as mechanisms and effects of repetition induced inflammation. With performance of high repetition tasks, early inflammation was observed that was accompanied by musculoskeletal tissue adaptive remodeling. However, with continued task performance, pathological remodeling was induced, such as fibrotic repair in tendons, muscles, nerves and their fascial sheaths. We have now embarked on an exploration of interventions strategies to target the early inflammatory responses and promote non-fibrotic tissue repair.
Michael Kjaer, MD, DMSc
Adaptation of Tendinous Connective Tissues to Exercise
Connective tissue in tendon and skeletal muscle represents a dynamic structure that adapts to physical activity. The matrix turnover e.g. of collagen can be influenced by the level of mechanical loading, and cells (fibroblast) within the tissue demonstrate remarkable capacity to adjust to environmental conditions. In addition the formation of cross-links contributes to the mechanical properties of the matrix structures in tendon and muscle. Factors like gender, type of training and age will largely influence the adaptation of tendon tissue largely due to influence of growth factors in combination with mechanical loading.
Lunch and Posters
Paper/Oral by Selected Abstract Authors
Scars and Adhesion Panel
Although not openly discussed, manual therapy treatments seem to be designed to identify and treat pathological connections between structures, called adhesions, and to treat scars that form following injury. Both are due to the normal healing process, but both can cause adverse symptoms, and thus patient presentations in the manual therapist’s practice.
Pathological adhesions in the abdomen have been recognized as a source of disease for more than 100 years, but adhesions or scars in the rest of the body have received scant attention. There is but little research on scars as a source of pain or other symptoms. This panel is aimed at raising the concept of scars and adhesions as a source of symptoms within the manual therapist’s practice.
Albert J. Banes, PhD
Mechanical Loading & Fascial Changes —Tendon Focus
Gene array results from positional and power tendons as well as cultured tenocytes have shown that anabolic and catabolic genes associated with matrix formation and degradation are highly expressed. Moreover, tenocytes share common expression patterns with striated skeletal muscle more so than with osteoblasts. Minor injury to a tendon drives a cell survival pathway, decreases cell stiffness, and increases cell-cell communication, while major injury, along with interleukin-1b drives a negative feedback loop stimulating expression of “bad”cytokines, such as TNF-a, resulting in apoptosis. Within hours of stimuli, tenocytes express key transcription factors such as myostatin, scleraxis and Mohawk, that regulate tendon-specific genes. Together, the panoply of modulated genes comprise compartments of a “tendinome”, or a group of genes expressed during development, maturity, repair or in pathology.
The Tendinome: Gene Expression Profile of Tenocytes in Development, Maturation, Response to Injury, Repair and Pathology. Banes, Qi, Sumanasinghe, et al.
Thursday, March 29
Rolf K. Reed, PhD
The lecture will focus on the “active” role of the loose connective tissues in control of transcapillary transport of fluid and protein, i.e. their role in control of edema formation. Normally the extracellular, extravascular volume in the tissues is kept within narrow limits via automatic readjustments by the transcapillary pressures and lymph flow. In inflammation, a lowering of interstitial fluid pressure in this space has been demonstrated to be a major driving force for creating the rapidly forming edema of acute inflammatory reactions. In burn injury to skin, pressure can fall from slightly below ambient pressure to -100 mmHg to become the “active” driving pressure for the edema formation. A similar, although not as extensive, fall in interstitial pressure has been demonstrated in several acute inflammatory reactions and involves perturbation of the collagen binding beta-integrins. Potential therapeutic consequences based on these experimental observations will be discussed.
Gerald H. Pollack, PhD
University of Washington, USA
The Secret Life of Water: E = H2O
School children learn that water has three phases: solid, liquid and vapor. But we have recently uncovered what appears to be a fourth phase. This phase occurs next to water-loving (hydrophilic) surfaces. It is surprisingly extensive, projecting out from the surface by up to millions of molecular layers.
Of particular significance is the observation that this fourth phase is charged; and, the water just beyond is oppositely charged, creating a battery that can produce current. We found that light recharges this battery. Thus, water can receive and process electromagnetic energy drawn from the environment — much like plants. The absorbed light energy can then be exploited for performing work, including electrical and mechanical work. Recent experiments confirm the reality of such energy conversion.
The energy-conversion framework implied above seems rich with implication. Not only does it provide an understanding of how water processes solar and other energies, but also it may provide a foundation for simpler understanding natural phenomena ranging from weather and green energy all the way to biological issues such as the origin of life, transport, osmosis — and fascia.
The lecture will present evidence for the presence of this novel phase of water, and will consider the potentially broad implications of this phase for physics, chemistry and biology.
Fluid Dynamics: Clinical Implications
Purpose: To discuss anatomicophysiological bases for the unique contribution of fascial fluid dynamics in health and disease, linking these to current/postulated clinical strategies. The panel will delineate “IRRIGATION” (fluid flow to and hydration of the extracellular matrix), “DRAINAGE” (fascial and systemic implications of interstitial and interfacial fluid dynamics), and “SYSTEMIC IMPLICATIONS” (immune / systemic implications of extracellular matrix fluid flow .) The intent is to lay a foundation for pragmatic discussion regarding fluid dynamics in the cytoskeletal gel, implications of electro-/chemo- mechanical phenomena, lymphatic drainage mechanisms and their combined impact on tissue remodeling (including lymphangiogenesis and fibrosis) and health.
Lunch and Posters
Paper/Oral by Selected Abstract Authors
Karen J. Sherman, PhD, MPH
Developing Clinical Trials for Bodywork and Massage: A Guide for the Perplexed
This lecture will focus on the design and conduct of clinical trials in bodywork and massage for a massage and bodywork audience. Dr. Sherman will begin by describing the types of questions that trials can answer, and review the key components of clinical trials. She will then describe in greater detail the principal complexities of trials in bodywork and massage, specifically issues related to recruiting appropriate participants and providers, designing and documenting the treatment protocol, and selecting control groups. She will highlight key areas of future research as well.
The first Annual Ida P. Rolf Research Foundation Research Training and Project Funding Symposium
The symposium will focus on career development as a scientist, with presentations on funding mechanisms and priorities, and mentoring from leading scientists in the field. Amongst those speaking during the symposium will be Partap Khalsa DC PhD (representing NIH/NCCAM) who will present regarding training opportunities.
For further information click here
Friday, March 30
Carla Stecco, MD, Orthopedist
Fascial Anatomy Overview
This lecture will illustrate the gross and histological anatomy of the human fascial system, based on the results of more than 100 dissections of fresh cadavers. A general schematization of the subcutaneous layers and its regional variations will be presented. The relationship with the muscles, vessels and nerves will be discussed, focusing on the possible role of the fasciae in proprioception. This lecture will contribute to clinician’s understanding of the biomechanical behaviour of the fasciae, its role in acute and chronic myofascial pain syndromes, and the real effectiveness of different therapies.
Fascial Imaging Techniques
Imaging techniques such as elastography, and real-time ultrasound, are rapidly evolving, and are becoming increasingly accessible to clinicians. They offer the potential for observing fascial function and movement, during assessment, as well as the ability to observe and record before-and-after images of fascia – in relation to different forms of treatment. Therapists and practitioners need to be aware of which fascial structures can be visualised, allowing a better understanding of fascial function and patho-physiological aspects of fascial dysfunction. Each panelist will present a facet of current imaging methodology, with video examples, and ample time for questions from the audience.
Jay P. Shah, MD
Ultrasound and Microanalytical Techniques Identify Objective Abnormalities in Hard, Painful Myofascial Trigger Points
This lecture summarizes quantitative studies that surveyed the local viscoelastic properties, micro-vasculature, and biochemical milieu of myofascial trigger points (MTrPs). Objective, repeatable and reliable diagnostic tests are needed to develop better evaluation and treatment outcome measures for MTrPs. We found that these palpable, discrete, hyper-irritable nodules can be visualized using ultrasound, and are stiffer than surrounding tissue. Furthermore, active (i.e., pain-producing) MTrPs can be differentiated from latent MTrPs and unaffected muscle. Specifically, active MTrPs demonstrate unique blood flow waveform characteristics, larger surface area and elevated levels of inflammatory mediators, neuropeptides, catecholamines, and cytokines – substances associated with sensitization and persistent pain.
Lunch and Posters
Paper/Oral by Selected Abstract Authors
Art and Science/Research and Practice – Mechanisms to Improve Communication to Promote Translation
There are two purposes to this workshop. First it is to identify the challenges that exist between researchers and clinicians that inhibit the advancement of diagnostic and therapeutic palpation in patient care. The second purpose is to begin a process that will result in better bidirectional translation of observations and research outcomes between clinicians and researchers. The panel consists of two accomplished basic scientists who are actively involved in fascial research and three clinicians who practice different disciplines within manual therapies and who have significantly contributed to the academic and research communities. Audience participation is critical to achieve the purposes of this session and so their clinical perspectives will be encouraged.