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Pre-Conference Workshop and RegistrationThu, 17 September 2015
12:30 —

Registration Desk Hours

13:30 — 17:30

The Fascia Research Society Presents: Understanding Research Fundamentals for the Congress and Beyond*

Jerrilyn Cambron, LMT, DC, MPH, PhD Lisa Hodge, PhD Eric Jacobson, PhD, MPH Ruth Werner, BCTMB

Workshop Description
This workshop will prepare participants to engage more completely in the Fascia Research Congress. Beyond the congress, those in attendance will be better able to understand and utilize research results and be more prepared to pursue research in the future, should they so choose. Presenters will share their expertise with basic science and clinical studies while introducing the basic tenets of research. Topics will include research fundamentals such as design, reliability, validity, and how to evaluate research critically. Participants will be introduced to additional resources for expanding their research literacy and ways to engage in partnerships between clinicians and scientists. Time will be allotted for questions from the group. Hide Details
Day 1Fri, 18 September 2015
7:00 — 8:30

Registration

8:30 — 9:00

Welcome and Overview - Tom Findley, MD, PhD opens with Co-Chair Antonio Stecco, MD

9:00 — 10:30

Anatomy Consensus in nomenclature - Carla Stecco, MD Description

The term fascia is actually used with a lot of meanings and to identify very different structures. In the last years a wide discussion about fascial terminology was performed. The major contributions were published in the Journal of Bodywork and Movement Therapies. They report different perspectives about this matter: osteopathic, chiropractic, medical doctor, basic science researchers, and movement practitioners. One year ago a group was created to find a common definition of fascia and to understand what anatomical structures could be included in this definition. After one year of debates and many emails, at this stage it looks like we are as far away from reaching a felt consensus. Two different, main opinions have come to light: one more anatomical, one more functional. The first one restricts the term fascia only to dissectible, fibrous sheaths, the second one includes many elements and points the interest more into the force transmissions, sensory functions and wound regulation of fasciae. The first one permits a clearer communication among the scientific world, the second one could be easily used in the clinical practice to highlight the continuity of the fasciae along the body and their polyhedric function. Hide Details
Innervation of Fascia - Siegfried Mense, MD, PhD Description
Noxious stimulation of fasciae – including the thoracolumbar fascia (TLF) – evokes pain. Recent publications have described a dense innervation of the TLF. Here, the posterior lamina of the rat TLF was studied, which covers the multifidus muscle. The aims were: 1. To give a comprehensive report on the existence of nociceptors in the TLF, and 2. to see if the innervation changes when the fascia is inflamed.  In the quantitative evaluation, the fiber length of fibers and free nerve endings were measured. The fiber types addressed below were identified with antibodies that bind to the characteristic molecules in the axon or membrane of the fibers.
  1. It is generally assumed that endings containing SP are nociceptive. This applies also to most of the CGRP-positive fibers, but some are mechanoreceptive. The great majority of the SP and CGRP fibers were located superficially in the fascia. This finding may be of interest to the therapists who use fascia release or similar techniques. Endings exhibiting the TRPV1 molecule in their membrane were likewise found. This receptor molecule is characteristic of nociceptive fibers. One important function of nociceptors is to induce a neurogenic inflammation around the ending. Such a neurogenic inflammation occurs, when in patients with a slipped disc dorsal roots are compressed. Our data show that a neurogenic inflammation can be induced in the TLF. This is clear functional evidence for the existence of nociceptors in the fascia.
  2. An experimental inflammation of the TLF caused changes in the fascia innervation, but the changes did not occur in all fascia layers alike. In the middle layer – which consists of massive collagen fiber bundles - the fiber density was close to zero for all fiber types. In inflamed fascia, CGRP-positive fibers showed a significant increase in the inner layer. In intact TLF, the nociceptive SP-containing nerve fibers were present exclusively in the outer layer. In inflamed fascia, SP-positive structures were also found in the inner layer. An unexpected finding was that sympathetic fibers did not show an increase, but a significant decrease, in fiber length. The meaning of this decrease is still obscure.
The increase in length of the nociceptive SP-positive fibers may explain the pain of patients with a pathological alteration of the fascia. The increase of the CGRP fibers in the inflamed fascia could also contribute to fascia pain. Collectively, the data support a role of the TLF as a pain source in non-specific low back pain. Hide Details
Sensory Aspects of Fascia - Robert Schleip, PhD, MA Description
Fascial tissues, such as joint capsules, ligaments, intramuscular and visceral connective tissues are frequently innervated by sensory nerves. Looking at their combined quantity, it can be estimated that together they may provide one of our richest sensory organs. It may even be our most important peripheral organ for perceiving our own bodies. This review will cover current knowledge and assumptions about the different receptor types in fascial tissues. What do we know about their distribution, their particular sensitivities as well as about their respective functional and physiological properties? How justified and helpful is the common trifold categorization - into proprioceptive, nociceptive and interoceptive function? How can we understand the role of the many polymodal receptors in fascia, and how can we utilize their dynamic properties in different therapeutic approaches? And finally: what do we know about potential linkages between sympathetic arousal and fascial matrix properties? While being careful not to confuse wishful thinking and plausible speculations with proven facts, this talk will try to give an overview of the current research findings and directions. Hide Details
10:30 — 11:00

Break

11:00 — 12:30

Functional Anatomy - Can Yücesoy, PhD Description

Muscle is the motor for movement and different muscles are typically considered as distinct anatomical entities. Fascia is an organ of support and although it is very difficult to divide it into subunits and to describe each separately, one understandable ambition is to do so. However, function wise, such anatomical distinctions and the defined roles of these units are likely to be quite insufficient for an adequate understanding of joint movement and stability. First, inside the muscle, highly organized fascial structures exist and are interconnected. However, they are also interconnected with the contractile apparatus in a way that they can influence locally the force balance determining the length of the sarcomeres. Therefore, intramuscular fasciae not only support the contractile apparatus, but can also manipulate its functional output determining the muscle’s contribution to joint moment and movement. Second, intramuscular fasciae and other fascial structures outside the muscle are interconnected. Consequently, these fasciae are not only supporters of systems that are necessary for the physiological state of the muscles (e.g., circulation and innervation) or of different components of the musculoskeletal system within the limb, but can also further manipulate the above mentioned mechanism and hence the functional output. This lecture will elaborate on this mechanism. Disease, treatment and exercise can cause changes to the musculature but also to the fasciae, and affect the function through their mutual interaction. Examples to this issue from spasticity, surgery, botulinum toxin type–A injections, kinesio taping and therapeutic mechanical loading will be addressed. Hide Details
Fascia and Pain - Andreas Schilder, MSc Description
The thoracolumbar fascia plays an increasing role in clinical research and has been suggested as an important structure in conditions of non-specific low back pain. The existence of nociceptive fibers within the fascia suggests its contribution to the development and/or persistency of pain. In human experimental studies, chemical and electrical stimulation of the fascia evoked pain. Of note, there is marked difference in pain response after injections of algesic agents into the fascia and the deep part of the muscle of healthy volunteers where the fascia induced more pain compared with muscle belly injections. Painful stimulation of deep tissue led to distinct differences in pain quality and distribution where fascia pain was described as affective, highly radiating pain. Furthermore, findings show that the spinal inputs originating from the fascia are able to induce segmental long-lasting changes in pain sensitivity making it a prime candidate to contribute to nonspecific subacute/chronic low back pain. This talk will address the different pain behavior of connective tissue and other deep tissues and highlights the importance of the fascia in clinical pain conditions such as non-specific low back pain. Hide Details
Effects of scar tissue on force transmission - Peter Huijing, PhD Description
In human patients affected by spastic paresis tendon transfer surgery is performed to alleviate effects of extreme positions of the joint crossed by the spastic muscle. The surgeon evaluates the effect of the operation by considering the position of the joint after recovery ( e.g. can the hand be held in midposition ?) However, as additional invasive interventions are not desired after recovery of human patients, little is known regarding details of effects of this type of surgery and those of the process of recovery on muscular properties, epimuscular myofascial force transmission as well as processes of adaptation taking place within the transferred muscle and tendon and their tissue surroundings. This lecture will focus on such information obtained in healthy experimental animal experiments, after having recovered from tendon transfer surgery of m. flexor carpi ulnaris to a dorsal flexion insertion site. Enhanced understanding of such functional effects are of importance, not only for the field of surgery, but also for many other clinical and fundamental disciplines. Hide Details
12:30 — 14:00

Lunch and Posters/Exhibitors

14:30 — 16:00

Concurrent Abstract Presentations

16:00 — 16:30

Break

16:30 — 17:30

Concurrent Abstract Presentations

17:30 — 18:00

Break

18:00 — 19:30

Welcome Reception

19:30 — 21:00

In Search Of Our Interior Architectures - Jean Claude Guimberteau, MD Description

FOREWORDS:  This conference  is the culmination of 20 years of intratissular endoscopic research carried out during more than 1000 surgical procedures.  I will have time to show some of the images I have obtained during my exploration of living tissue, to explain them, and to discuss the world under the skin that is far from simple. Intratissular endoscopy provides a different view of the microanatomical structures and the architecture of living tissue, revealing how the fibrillar network extends throughout the entire body. I will have time to share the beauty of the images and to slowly address fundamental questions about tissue continuity inside the body. It is important to understand that the fibrillar network is one of total tissue continuity. This enables us to visualise our body as a ‘global’ structure with a specific, three-dimensional architecture made up of elements that, while fragile, have a stubborn capacity for adaptation. This suggests that there is an architectural system for all living organisms, whose role is far more important than simply connecting things, but on the contrary is actually constitutive. We can then discuss the continuity of living matter and its global character, and question the mechanistic view of a body assembled from spare parts. Unicity or multiparity? With enough time, we can share  the difficulty involved in moving away from the tranquil certainty of rationality to enter a world of fractals and apparent chaos. In so doing we move away from the rationality of Newtonian physics to approach the shores of Quantum Physics. We will discover that this apparently chaotic fibrillar disorder, together with tissue continuity, ensures the efficiency of the living organism. Finally, with time, we can begin to appreciate that although Nature is a symphony of fragility and complexity, it is gradually becoming more comprehensible. Inevitably, observations using ever more effective optical procedures, as well as other new techniques, will bring about further changes in our perception of the world of living matter and challenge conventional beliefs. Part 1. 45 minutes - Anatomical observations. The simple act of  lifting the skin, watching it stretch and then return to its original position when we let go, immediatly recovering its original shape and texture,  is certainly very banal but many questions arise when you think of all the elements involved in this process. Observation of living matter with an intratissular endoscope allows us to contemplate the world beneath the skin from a different angle, and to  provide an explanation for flexibility and elasticity, for which there has been no satisfactory physiological explanation until now. The same applies when you consider flexion and extension of the fingers and think of all the structures  involved in enabling the progression of the flexor tendons in the the palm with no visible external changes at the surface of the skin. For decades , scientific explanations have been  limited to the notion of the concept of elasticity or the existence of loose connective tissue , stratified , hierarchical layers with a virtual space between them. These biomechanical theories are all very vague. These concepts, based on observations from the last century, have never been debated and are considered as acquired truths. For over 50 years, scientific research has been carried out almost exclusively at the microscopic and macroscopic levels. The intermediary mesoscopic level has been ignored. The classical doctrine is: connective tissue  is connective , provides the link between the vital organs and, as it seems to be mobile, ensures mobility  and elasticity. Furthermore, this connective tissue is not considered as 'noble' and is neglected by surgeons and anatomists because it is very fragile. It is difficult to dissect  because  it is not dense enough . Surgical dissections in these areas, such as separation or undermining are easier. For example , very often with his index finger , the surgeon, collapses these structures - with no regard for them - in order to gain access to the bony structures. What we call surgical  planes are in fact created by the surgeon's scissors and undermining,  but in reality, they have no physical existence. These surgical planes do not exist in living tissue. In fact, careful observation reveals that connections are present within a real connective tissue and histological continuity, with no clear separation between the skin and the subcutaneous tissue, vessels , fascia and muscle. Tissue continuity is total. During all those hours of surgical observation using a contact endoscope to film high resolution video sequences of the connective tissue and sliding systems, I came to realise that this much neglected connective tissue is essential, and perhaps even plays a structural role in the body. It is not a 'secondary'  tissue, simply filling gaps between organs, with no essential function -  a simple inert packing tissue as is traditionally thought. I have studied this tissue organization carefully for 15 years, searching  to understand how it is structured. I discovered a world of fibers and fibrils of different diameters, shapes and forms - ropes, cables, shrouds, veils, and sails. I have called  this fibrillar framework  the Multimicrovacuolar Collagenic Absorption System (M.V.C.A.S.) because it allows simultaneous sliding and force diffusion without damage to the fibers. This system is of chaotic and irregular organization, operating in a way that is far removed from traditional mechanical analysis. Intratissular endoscopic technology reveals a world under the skin that is not arranged in a regular and orderly manner as everybody would  like to think . This interior  architecture is composed of  a myriad of collagen fibrils , organised in an  irregular and  fractal manner  and woven in the three dimensions of space. From a  biomechanical point of view, this network has interconnections whose behavior is non-linear and allows optimum adaptation to mechanical stress. Each intertwining of this system forms a small volume - a functional unit, the microvacuole, whose shape is  fractal irregular and polyhedral. These  microvacuoles in the MVCAS are  filled with glycoaminoglycans. They act as a system of absorption with varying pressure but a stable volume. They are found throughout the human body. This system has its own dynamic behaviour consisting of very specific movements between fibrils - stretching , division, sliding of one fiber along another fiber - to create an extensible and mobile interior architecture in 3 dimensions. The dynamic behaviour of this  multimicrovacuolar system – made possible by varying degrees of preconstraint and the fusion-fission division of the molecular system of the fibrils  - enables all the potentialities of movement within the body, combining mobility , speed , interdependence and adaptability. This  fibrillar organization is found everywhere in the body and in each specific type of tissue. It appears to be an ideal intertwining of fibers, fibrils and micro fibrils with microvacuolar spaces which are inhabited by cells to varying degrees. It provides us with a structural rationalism. The sliding tissue - in fact the connective tissue - seems to provide the global structuring framework of the body. The connective tissue is therefore not only 'connective'. It is also the constitutive tissue. A more holistic view is therefore required. Thus, a true new structural ontology can be developed using this basic functional unit - the microvacuole – which can be considerd as an intrafibrillar microvolume  responsible for shape, form and dynamic behaviour. However,  this basic volume is not a fixed entity. It is not virtual, but transitional, and may change, disappear and reappear. Individual fibrillar behaviour is part of a global, non-linear, but coherent ballet within living tissue. This fibrillar continuum from the  surface of the skin to the cell – with areas of densification adapted to functional demand - could therefore be defined as the global fascial network of the body, linking everything from  head to toe, and from the surface of the skin to the deepest areas in the body. The fact that this can be observed in all living structures, and on many levels gives rise to a fundamental question: Does this fibrillar  architecture provide a structuring framework for life? It is this concept of intracorporeal tissue continuity, and not that of spare parts attached to each other, which must be retained. Part 2. 45 Minutes - Reflections The concept of the microvacuole is fascinating because it helps to explain how the intracorporeal space is filled. It helps us to understand how water spreads within the body, thanks to the microvacuolar volumes . Moreover, it provides an explanation of the resistance of the intracorporeal tension to  gravity. The architectural framework of living matter is composed of fibers and fibrils . It is the result of microvolumes formed by the intersection of fibrils in all three dimensions. These microvolumes are inhabited by cells to a greater orlesser extent. In some areas they only contain glycoaminoglycans. Their function within the global architectural framework of the body is highly specialised and varies depending on which part of the body they are found. However, all these fibrillar and microvacuolar elements, even when their distribution seems chaotic , are not arranged haphazardly. They always occupy space optimally. The polyhedral and irregular shape of microvacuoles and cells facilitates this spatial arrangement and the basic physical laws are the major actors. However, once again, deterministic chaos reappears. The organization of the fibrillar framework is irregular and fractal, with unpredictable mobility, but within a dynamic context  that is not meaningless. The introduction of  irregularity , chaos and unpredictibility, can be considered as intellectual violence  when we know that it affects living matter. Must we therefore conceal chaos and efficiency? The acceptance of the microvacuolar concept also helps to define the state of  living matter matter in pathological circumstances such as edema , inflammation , obesity , growth and aging. It also helps to understand the healing response and opens new avenues for improving our techniques in optimizing the flexibility of  scar tissue and limiting adhesions. These observations encourage a global vision of the body, and the interconnections between the structures within the fibrillar architecture, from the cell to the surface of the skin. But this new scientific approach requires us to discuss and debate certain fundamental theories and underlying assumptions underpinning current anatomical knowledge. Firstly, we have to accept that Cartesian order, rationalism and positivism are  not the only theories that can explain efficiency. Pseudo-chaotic dynamic behaviour that could be defined in physics as a non - linear, but non - hazardous, behavior, is found throughout the body.  There are some differences depending on the  functional role of the fibrillar network in different areas of the body. This endoscopic exploration of living tissue, without minimizing the essential role of the cell, allows us to assign a key role to the fibrillar extracellular medium in which the cells are irregularly embedded. But at the moment , the perception of living matter is almost exclusively focused on the cell. The extracellular environment has been abandoned. However, the cell can not explain the global shape of the body because it is not found everywhere, while the fibrillar architecture is  everywhere. The cell needs a supporting framework. This structural environment is provided by the fibrillar architecture, which  exists in three-dimensions and across all scales. This must be taken into account. In conclusion, the connective tissue that is found throughout the body,  from the bones to the skin, tendons and nerves, plays an essential structural role , but is also responsible for the mobility and flexibility of living tissue. The concept of form, the distribution of water in the body, and disease states can also be explained. This could actually be the constitutive tissue, in which cells develop specific activities, rather than mere 'connective' tissue. It would be a significant paradigm shift. The endoscopic exploration of living tissue, which is in its infancy,  will lead to new discoveries and challenge old dogmas, thanks to new technical improvements. Hide Details
Day 2Sat, 19 September 2015
8:00 — 9:00

How to Prepare an Abstract for FRC 2018 - Tom Findley, MD, PhD Pre-registration required by email. Contact info@fasciacongress.org to register. Description

Dr. Findley will be offering an abstract writing workshop for all who are interested. The purpose of the workshop is to assist people in learning how to prepare an abstract for Fascia Research Congress 2018. Bring your own breakfast and coffee. Hide Details
9:00 — 10:30

The Functional Coupling of the Deep Abdominals and Para Spinal Muscles - Andry Vleeming, PhD Description

The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia Abstract The thoracolumbar fascia (TLF) consists of aponeurotic and fascial layers that interweave the paraspinal and abdominal muscles into a complex matrix stabilizing the lumbosacral spine. To better understand low back pain, it is essential to appreciate how these muscles cooperate to influence lumbopelvic stability. This study tested the following hypotheses: (i) pressure within the TLF’s paraspinal muscular compartment (PMC) alters load transfer between the TLF’s posterior and middle layers (PLF and MLF); and (ii) with increased tension of the common tendon of the transversus abdominis (CTrA) and internal oblique muscles and incrementaln PMC pressure, fascial tension is primarily transferred to the PLF. This study reveals a co-dependent mechanism involving balanced tension between deep abdominal and lumbar spinal muscles, which are linked through the aponeurotic components of the TLF. This implies the existence of a point of equal tension between the paraspinal muscles and the transversus abdominis and internal oblique muscles, acting through the CTrA. Hide Details
Fascia Sliding - Jean Claude Guimberteau, MD Description
The mobility of our body structures is so intrinsic and natural to us that we tend to take it for granted. The very fact of being able to pinch your skin and lift it, then let it go and see it return to its initial shape and texture in just a few seconds may seem banal enough until you begin to think of all the elements involved. The same is true when you bend your fingers and think of the movement of the flexor tendon across the palm without external translation. For decades, scientists thought that the skin was simply an elastic structure with loose connective tissue and a more or less virtual space. However, in biomechanical terms, this explanation is very vague. These old concepts developed more than 50 years ago have evolved thanks to the impact of research at the microscopic level, and the global, mesospheric concept has been abandoned. And yet, surgical dissection in vivo demonstrates that there are only tissue connections, simply a histological continuum without any clear separation between skin and hypodermis, the vessels, the aponeurosis and the muscles. In fact, visible everywhere are structures which ensure a gliding movement between the aponeurosis, the fat structures and the dermis. As they studied this system of gliding between the various organs, in particular at the level of the tendons, the authors noted the existence of a type of system composed of cables and veil-like structures that they term the Multimicrovacuolar Collagen  Absorption System (MVCAS). This system looks totally chaotic in organization and seems to function in a manner far removed from traditional mechanical structures. The functional unity of this sliding system is dependent upon a polyhedral three-dimensional crisscrossing in space of the microvacuoles, whose collagen envelope is type 1 or type 4 and whose content is made up of proteoglycoaminoglycans. The dynamic of this multimicrovacuolar system allows all of the subtle movements that occur within the body, thanks to its pre-stressed nature and the molecular fusion-scission-dilacerations that it is capable of. All the fibrils participate in the local tissue response to the traction. The tissue responds in various ways. The microvacuoles change shape in response to the constraint and their volumes are compressed. The fibrils stiffen  as strain is put on their collagen structure. This explains the increase in resistance that is felt as the traction is increased and suggests a correlation between the increased density of the fibrils and the resistance felt by the operator. All the constituent components turn and orientate themselves in the direction of the applied force. The alignment of the fibrils always occurs in the direction of the applied force, and is accomplished without damage or rupture of the fibrils. This ensures that the resulting movement occurs in the direction of the applied force. However, some fibres move more than others. They do not all react with the same intensity. We do not see a global linear shift of fibres. Tissue continuity is maintained at all times. The force is transmitted, diffused and absorbed by the system. We must not forget that this fibrillar architecture is designed to allow maximum mobility without influencing the surrounding tissues. The fibres must therefore be able to absorb energy because they have to deal with the constraint without breaking or rupturing. The physiological limits of the elasticity of the fibrils must be respected. Rupture of the tissue must not occur under normal physiological conditions as this would lead to the destruction of vessels and nerves and the subsequent interruption of information and energy supplies. Hide Details
Hyaluronan- Preeti Raghavan, MD Description

Objectives or outcomes:

  • Comprehensive discussion of the pathophysiology of connective tissue within and around muscles and its contribution to the evolution of spasticity and hypertonia after CNS injury.
  • Rationale for emerging therapies that restore normal connective tissue architecture and tissue gliding mechanisms.
  • Modality to assess spastic patients for hyaluronidase injection.
  • Design an appropriate treatment algorithm.
Description: Histolopathological studies have demonstrated a generalized increase in extracellular connective tissue in spastic muscles. It is known that increased connective tissue in an immobilized and contracted muscle reduces its compliance and could reduce the threshold for stimulation of spindle receptors in the muscle. Various authors have investigated how increased stretch-induced stimulation of spindles in muscles with stiffer connective tissue can contribute to spasticity. In this review we compile evidence for the idea that the primary injury to the central nervous system that leads to muscle paresis also triggers changes in the viscosity of the extracellular matrix due to abnormal turnover of hyaluronic acid. Hyaluronic acid is a complex molecule that exhibits non-Newtonian behavior at higher concentrations leading to altered viscosity which begins a vicious circle that exacerbates spasticity through reduced tissue compliance, potentiation of reflex mechanisms and fibrosis, contributing to abnormal limb posturing, pain symptoms, and decrease in activities of daily living. The rationale for emerging treatments to break this vicious circle is discussed with the presentation of case studies and guidelines. Hide Details
10:30 — 11:00

Break

11:00 — 12:30

Extracellular Matrix - Boris Hinz, PhD Description

Tissues lose their integrity upon injury. To rapidly restore mechanical stability, a variety of different cell types are activated into myofibroblasts whose main function is to secrete and contract extracellular matrix (ECM). Rapid repair often comes at the cost of tissue contracture due to the inability of the myofibroblast to truly regenerate tissue. When contracture and ECM remodeling become progressive and manifest as organ fibrosis, stiff scar tissue obstructs and ultimately destroys organ function. In addition to being a consequence of myofibroblast activities, the mechanical properties of scarred fibrotic organs promote myofibroblast contraction and differentiation. Dr. Hinz will give an overview on how ECM mechanics control development of myofibroblasts and fibrosis with examples from our recent research. Hide Details
Sports Medicine - Michael Kjaer, MD, DMSc Embryology and Genetics of Fascia - Mark Schuenke, PhD

13:00 — 14:30

Lunch and Posters/Exhibitors

13:30 — 14:30

Funding Opportunities & NCCIH Research Priorities - Partap S. Khalsa, DC, PhD, DABCO and Lanay M. Mudd, PhD, FACSM Free and open to the public Description

This session will include a brief presentation on NIH funding opportunities with particular emphasis on research priorities within the National Center for Complementary and Integrative Health (NCCIH), followed by an interactive Q&A session. Dr. Mudd will provide an overview of NCCIH, discuss it's mission and strategic plan, and describe potential funding mechanisms for research involving manual therapies. Dr.'s Mudd and Khalsa will then open up the floor to questions from the audience to provide meaningful feedback for those considering applying to NIH to fund their research. Hide Details
13:30 — 14:30

FRC/FRS Interest Group Description

The FRC and FRS will host an interest group during the box lunch session on Saturday. Both organizations are expanding, and we would like to hear your interests for future direction and focus. Please bring your lunch and join us. Hide Details
14:30 — 16:00

Concurrent Parallel Sessions

    1. Veterinary Aspects - Vibeke Sødring Elbrønd, PhD and Rikke Mark Schultz, DVM
Session Description
Compared to the bipedal human, the quadrupedal domestic animals have quite a different posture, balance, weight distribution, functionality and coordination, which act differently on the fascial system. Challenges in the daily veterinary work involve diagnostics and treatment of fascial interactions. Several of these are defined and accepted, for decades, as parts of biomechanical models. These veterinary biomechanical  models comprise e.g. the bow and string theory developed by Slijper in 1946, the stomatognatic system, the passive/ mechanical stay apparatus, and the hoof mechanism. The two latter applies for ungulates only. In the veterinary world speaking of fascia automatically directs the focus towards the locomotion system. Limited body regions e.g. the back, the neck and especially the distal part of the limbs have been brought into focus and fascial structures such as tendons, ligaments and synovial sheets have been highlighted. The equine research has gained from a large attention to the extremities in order to understand and treat the structures here because pathology in this region is the most commonly recognized problem in sports horses. Studies have mainly focused on limited tasks e.g. the superficial flexor tendon and often only on the tendon itself and not even on the muscle with/to which it is connected. Studies of how the research and the biomechanical models can be integrated into a full/whole body functional fascia model have, up to now, been limited. In this session parts of the equine fascia system will be presented and related to the generally accepted veterinary biomechanical models. Additionally recently published studies of the full/whole body equine myofascial kinetic lines, results of specific equine dissections, provisional and detailed histological descriptions of the equine fascia as well as bioimpedance studies of the effect of manual and mechanical fascia manipulations will be presented and discussed. The studies were performed at University of Copenhagen, Vet. Faculty in collaboration with internal and external veterinary colleges R.M.Schultz, (DVM), T. Due, (DVM), A.P. Harrison, (Ass. Prof.,Ph. D. Scient), M. J. Krasnodebska, (master student of animal science). More detailed studies of fascia morphology, topography and integrity in conjunction with the already present and accepted models will improve the overview of the full/whole body fascia system in animals. These can lead to better diagnostics and thereby treatment of patients with both somatic and visceral problems. Hide Description
    1. Clinical Studies - Leon Chaitow, ND, DOCésar Fernández de las Peñas, PT, PhDEric Jacobson, PhD, MPH THIS SESSION IS FULL
Session Description
1. Leon Chaitow - What evidence of efficacy can we gather from clinical studies relative to fascia-focused modalities? 2. Cesar Fernandez de las Penas - Efficacy of various fascia related therapeutic interventions in relation to the extremities. 3. Eric Jacobson will present on his recent study involving Structural Integration and nonspecific chronic low back pain. 4. Cesar Fernandez de las Penas will present on his recent study that compared myofascial release versus surgery, in treatment of carpal tunnel syndrome. Hide Description
    1. Surgery and Fasciatherapy - Thomas Hausner, MD and Jean Claude Guimberteau, MD
Session Description
Two different professions at the service of human living matter. These two non-allopathic therapeutic methods, often considered to be in opposition to each other, are in fact underpinned by the same uncertainty of action because they both come into direct contact with living matter without the intermediary of drugs. Surgery, through direct observation and the recording of images is currently the scientific approach most able to explain what fasciatherapists feel when they are working with living tissue. Films of living tissue help to provide an explanation for sensations which manual therapists find difficult to describe.  Visual images of  the mobilization of  living tissue and of specific techniques such as stretching and petrissage of the soft tissues are a precious aid in the search for a biomechanical explanation for the action of these techniques. The effect of  the techniques on groups of cells is clearly visible and this indicates areas where further research is needed to investigate changes in cell protein production which might result from the dynamic constraint imposed on the tissues by manual therapy. Fasciatherapy introduces the surgeon to a method of treatment that is at first disconcerting, but gradually becomes more understandable through the visual evidence of  the effects of these techniques on living tissue. The non-linear organization of living tissue and the observation that it appears to obey laws which have more in common with Quantum than Newtonian physics permits us to attempt a  broader explanation of its behaviour, and to move away from the tutelage of dogmatic rationalism. Evidence Based Medicine, which relies on research findings to influence decision making in patient care must now accept the evidence of the apparent chaotic organization and random character (behaviour?) of the microanatomy of living matter. Hide Description
    1. Research Studies/Animal StudiesPaul Standley, PhD and James Bishop
Session Description
In this session Dr. Standley will review how various manual treatments are modeled in vitro using bioengineered human tissues resembling fascia and tendons. In particular, proof of concept data will highlight optimal dosing of manual treatments by exploring tissue strain directions, frequencies, magnitudes and durations. Various effects of strained fibroblasts will be explained including those related to wound healing as well as myoblast-to-myotube differentiation, a key process in muscle repair and regeneration. This session will offer a translational perspective on current basic research relevant to manual and movement-based therapies. Hide Description
    1. Philosophical Aspects - Jaap van der Wal, MD, PhD
Session Description
New concepts about function and architecture of fascia have come up. Questions like Is the Muscular, Connective Tissue, Skeletal System (MCS) a Tensegrity System?, reveal the need for a new framework of definitions and notions that might replace the outdated anatomical analytical approach of the fascia in which it is dissipated into various separate elements (of the so-called musculoskeletal system, of the visceral organization, of the general body fascia and so on). There is a need for an overall concept of the fascia as organ or system. Moreover there is the quote by AT Still mentioning the fascia as the domain “where soul is dwelling”. In this lecture a reevaluation of the concept of fascia will be tried, based upon a phenomenological approach. Departing from a functional approach of the embryonic germ layers and the meso(-derm) in particular the fascia will be introduced as The Inner Tissue or The Organ of Innerness. A more organic or holistic concept on fascia as the matrix organ will be presented. Hide Description
16:00 — 16:30

Break

16:30 — 17:30

Posters / Exhibitors

18:00 — 20:00

Awards Banquet*

Day 3Sun, 20 September 2015
9:00 — 10:30

Observation, assessment & evaluation of fascial dysfunction

Description

Julie Ann Day - The functional assessment of fascial dysfunction based on Fascial Manipulation® methodology As knowledge concerning the human fascial system evolves, clinicians are encouraged to adopt models for the interpretation of fascial dysfunction that incorporate evidence-based information.

The Fascial Manipulation® (FM) method for musculoskeletal and internal fasciae dysfunction is based on a theoretical model for the human fascial system. Developed through systematic clinical observation and fascial anatomy studies, this model is subject to on-going investigation and modification via cadaver dissections, histological, biomechanical and clinical studies. Clinicians refer to this model throughout the assessment procedure and the application of the FM method.

Using short videos and references to available evidence, this presentation will outline the FM assessment procedure, which includes history taking, the formulation of a hypothesis regarding dysfunction and possible compensatory mechanisms, movement and palpatory tests and post-treatment outcome evaluation.

César Fernández - Manual assessment of fascial tissue for application of myofascial release Myofascial Release methods focus on addressing fascial dysfunction, which presupposes that fascial dysfunction can be assessed clinically. The question arises as to whether it is possible to differentiate fascial dysfunction from - for example - muscular or neural problems? How accurate and reliable is manual assessment of fascia?

This presentation offers clinical and evidence-informed data regarding manual assessment in relation to ultrasound imaging and cadaver correlations, in the context of myofascial release (induction) methodology. Hide Description
Therapeutic Mechanisms - Leon Chaitow, ND, DO and Geoffrey Bove, DC, PhD Description
Outcome studies offer us evidence of the clinical usefulness of particular fascia-directed modalities. Evidence will be presented based on evaluation of available evidence relating to mechanisms associated with those modalities where such efficacy is strongly suggested, including compression, torsion, shear-force, vibration, and isometric/isotonic stretching. Human, animal and in vitro studies suggest that mechanisms include a variety of processes, possibly involving fluid-dynamics, neurophysiological, biomechanical, biochemical and other effects. Evidence relating to the influence of dosage (degree of load, frequency etc) in respect of particular fascia-related modalities, will also be presented. It is suggested that detailing what is not yet known in relation to therapeutic mechanisms is potentially as important as what is known. Is it all about the interfaces? Updates from the lab. The specific pathophysiological processes leading to pain and dysfunction remain elusive, as do effects of many manual therapy treatments.  Fibrosis formed within and between structures has been associated with pain and dysfunction. Our recent findings demonstrate preventive effects of manual therapies on the fibrosis associated with repetitive motion disorders and post-operative adhesions.  Using these and other findings as support, a hypothesis will be presented that fibrosis between structures may be a key pathophysiological process in these and other disorders, rather than pathology in any specific structure. Hide Description
10:30 — 11:00

Break

11:00 — 12:00

Imaging & Measurement Technologies - Antonio Stecco, MDSiddhartha Sikdar, PhD

12:30 — 13:30

Lunch and Posters/Exhibitors

13:30 — 14:00

Future Directions in Fascia Research - Tom Findley, MD, PhD Description

As a physiatrist I treat many disorders of the musculoskeletal system. As a scientist I strive to understand their pathophysiology to develop focused treatments and prophylactic regimens. Fascia, part of the connective tissues that permeate the human body, may be the unifying structure and concept that is essential to elucidate the mechanisms of these dysfunctions. Scientifically challenging and clinically rewarding areas of future fascia research will be explored from my joint clinical and scientific perspective, with particular emphasis on the links between fascia and cancer proposed more than 100 years ago and now the topic of a special meeting at Harvard in November 2015.
  1. Kwong, E. H., & Findley, T. W. (2014). Fascia-Current knowledge and future directions in physiatry: Narrative review. Journal of rehabilitation research and development, 51(6), 875-884.
  2. Findley TW. Shalwala M. (2013). Fascia Research Congress Evidence from the 100 year perspective of Andrew Taylor Still. J Bodyw Mov Ther 17(3):356-64, 2013 Jul.
  3. Chaudhry, H., Bukiet, B., Ji, Z., Stecco, A., & Findley, T. W. (2014). Deformations Experienced in the Human Skin, Adipose Tissue, and Fascia in Osteopathic Manipulative Medicine. JAOA: Journal of the American Osteopathic Association, 114(10), 780-787.
  4. Findley, T., Chaudhry, H., & Dhar, S. (2014). Transmission of muscle force to fascia during exercise. J Bodyw  Mov Ther. In press
Hide Description
14:00 — 14:30
14:30 — 15:00

Break

15:00 — 17:30

Post Conference Parallel Presentations*

    1. Manual Therapies - Leon Chaitow, ND, DO and César Fernández de las Peñas, PT, PhD
Description
Detailed demonstration of methods of major fascia-directed manual approaches, with interactive discussion.

Including:

      • Myofascial Release/Induction variations,
      • Muscle Energy Techniques and eccentric and pulsed variations,
      • Neuromuscular Techniques,
      • Positional Release methods,
      • Connective tissue manipulation, and others, time permitting.

The workshop will include Video + Practical Demonstrations of:

      • Fascial treatment of Myofascial scars - Raul Martinez Rodrigues, DO PT
      • Fascial Manipulation® - Julie Ann Day, PT
      • Fascial treatment for nerve tissues - Cesar de las Penas, PhD PT DO
      • Muscle Energy Technique (isolytic and slow eccentric variations) - Leon Chaitow, DO
      • Myofascial release (Induction) - Andrjez Pilat, PhD
      • Structural Integration version of MFR - Tom Myers, LMT
      • Counterstrain positional release - Leon Chaitow, DO
      • Q&A - all presenters
Hide Description
    1. Tool Assisted Therapies - Roptrotherapy: Andre Farasyn, PhD, PT, DO and Instrument Assisted Soft Tissue Mobilization (IASTM): Warren Hammer, DC, MS, DABCO
Description
Both doctors will discuss the rationale behind the use of these instruments, including the differentiation between fascial densification and scar tissue/fibrosis. They will demonstrate the use of specific instrument soft tissue methods for a variety of soft tissue injuries. This will include nonspecific low back pain, tension headaches and extremity lesions, including iliotibial band syndrome, rotator cuff, Achilles tendinosis and generally any myofascial condition that responds to this specialized type of mechanical load. Hide Description
    1. Visceral ManipulationPeter Schwind, PhD, MA and Carla Stecco, MD
Description
During the workshop a new way to organize the inner fasciae will be presented, based on the results of several anatomical dissections. In addition, their relationship with the muscular fasciae will be investigated, to understand how the various manual techniques can affect the function of an organ. Furthermore, the internal fasciae’s anatomy is always seen in correlation with the physiology, and in particular the close relationship with intra and extramural ganglia and plexus is emphasized. This new integrated vision between internal fasciae and autonomic nervous system allows us to better comprehend the internal fasciae’s function and it provides a key of interpretation to see how to approach them from a therapeutic point of view. During the practical part of our workshop Peter Schwind will demonstrate techniques of visceral manipulation, based on the concepts of Jean-Pierre Barral D.O. (UK). Special emphasis will be given to various modalities of treating the kidneys within the context of the fascia of the psoas and the supporting fat of the kidneys and the arterial supply of the organ. Then, Carla Stecco also will demonstrate the Fascial Manipulation approach for the same problem. In this way the participants can appreciate the analogies and the differences between the two techniques. Hide Description
    1. Fascia in Sports and Movement Therapies - Robert Schleip, PhD, MAPaul Grilley, PhD, MAStephen Gangemi, DCKlaus EderBernie Clark
Description
How do sports, exercise and daily movements influence the remodeling of fascial tissues? How can movement related overload syndromes be best treated and prevented? What scientific evidence as well as practical innovations are most relevant in the fields of yoga therapy, foam rolling, athletic performance, stretching and sports rehab?

Several informative presentations, mixed with brief practical instructions, will open this intriguing new field of inquiry, with space for audience participation and discussion in order to foster networking, curious questioning, and new creative ideas among all involved:

      • Stephen Gangemi: Natural Movement: Moving our bodies the way they're designed to move
      • Paul Grilley: Yoga, fascia and meridians
      • Bernie Clark:  What stops me? The role of connective tissue and human variation on range of motion
      • Robert Schleip: Principles of a fascia oriented training approach
      • Klaus Eder: Fascia oriented support for world champion soccer players
Hide Description
    1. Ultrasonography and Ultrasound Elastography - Jouko Heiskanen, MD, Pt and Wolfgang Bauermeister, MD, PhD
Description

A. Jouko Heiskanen, MD, Pt In this dynamic ultrasonography workshop we visualize the structures of fascias, movements of its layers in relations to muscles as they occur in real time.  This sonopalpation workshop has three goals:

      • theoretic base: how valid and reliable is ultrasound as an assessment tool in fascial evaluation?
      • practice: an objective assessment for normal myofascial anatomy, its thickness, consistency, as well as facial connections to bones, tendons and ligaments and
      • applying: dynamic, functionally applied sonopalpation for structures and movement patterns of myofascial system.

Diagnostic ultrasound has been used by radiologists within radiology departments as a diagnostic tool for decades. Musculoskeletal therapists have used ultrasound imaging (ultrasonography, sonopalpation) as a part of muscle assessment and “biofeedback” in therapeutic exercise and in facilitation of patient’s optimal motor learning. This dynamic ultrasonography workshop applies a review to:

      • free fascia: in lying, sitting and standing, breathing, relaxation (transmitting force and load),
      • active fascia: effects of local/global muscles, inhibition, kinetic chain, fascial lines, standing/walking
      • modified fascia: light/heavy pressure, stretching, taping, massage
      • education: technique portion how to use ultrasound in teaching
The clinical aspect of this workshop is to visualize the continuous interplay of articular, myofascial, neural, visceral systems in healthy body for manual therapists, masseurs, doctors, athletes and scientists Combined with manual palpation it creates a more realistic conception of the fascial system. This ultrasonography could be a new way to improve teaching results in functional anatomy in various professions. Characteristics of adhesion and other pathologies are important but not the main focus in this instruction. In this workshop we work in small groups so that everyone act as an ultrasound researcher and will be investigated by the colleagues.

B. Wolfgang Bauermeister, MD, PhD - Ultrasound Elastography: Anatomy Trains Assessment of the elastic properties of fascia and muscle related to myofascial trigger points Myofascial Pain caused by trigger points in the fascia and the muscles is mostly not considered because it is difficult to objectively prove the existence of myofascial trigger points (mTrPs). Their related patterns like the Anatomy Trains as perceived by Thomas Myers in the late 1990’s are based on structural connections. Stiffness of fascia and muscle can be palpated and measured to a certain extent, but it cannot be visualized by conventional means like MRI or conventional ultrasound. Ultrasound Elastography has emerged as a tool not only in research but in everyday practice too for the imaging of the Anatomy Trains and the underlying pathophysiology such as mTrPs and fibrosis.

      • Current research: Theory, Shear wave, vibrational and compression Elastography, Shockwave therapy and their effect on fascia and muscle
      • Practical application: Clinical Elastography for imaging the different parts of the Anatomy Trains detecting mTrPs in the fascia and muscle
      • Findings: Putting the results together, relating them to muscle imbalance and pain threshold measurements
      • Treatment effects: Elastography shows the immediate effects of any therapeutic intervention. The effects of manual techniques, percussion massage and Frequeny Specific Microcurrent will be demonstrated.
The participants will learn to perform the Elastography exam, to interpret the findings and incorporate them into a therapeutic strategy. Hide Description
Post Conference WorkshopsMon, 21 September 2015
* Not included in conference registration fee

Please note that while speakers and topics were confirmed at the time of publishing, circumstances beyond the control of the organizers may necessitate substitutions, alterations or cancellations of the speakers and/or topics. As such, the Fourth International Fascia Research Congress reserves the right to alter or modify the advertised speakers and/or topics if necessary without any liability to you whatsoever. Any substitutions or alterations will be updated on our web page as soon as possible.