This past year, I had the pleasure of studying with Fascial Manipulation with Antonio Stecco, MD and Warren Hammer, DC. This method is different in many ways, but much of what interested me was the use of a movement assessment to determine where to direct the manual therapy. Follow up re-assessment after manual therapy allows demonstration of within treatment improvement, which has been shown to predict better clinical outcomes. The Assess-Correct-Reassess theme is prominent in the Modern Rehab Renaissance as well with the intervention there being corrective exercise rather than manual therapy. Pairing these 2 methods is golden, allowing for between treatment improvement, happier patients/clients, reduced health care costs and better karma! To paraphrase Craig Liebenson, DC, “Manual therapy helps with pain and mobility but doesn’t myelinate. Only exercise myelinates a sustainable motor program.” So…astute clinicians, bodyworkers and trainers with manual skills can have a 4 step bombproof intervention improve outcomes and apply this ENTIRE cutting edge approach as follows:
- Assess movement patterns (Stecco movement verification screen, FMS, Mag 7, Janda KMPs)
- Apply manual therapy
- Re-Assess for improvement in pain, movement quality
- Assign appropriate home rehab exercise to myelinate the motor pathway (Home tutorials available to members at MyRehabExercise.com)
I want to thank Warren Hammer for graciously offering this reprint of an introductory article regarding Stecco Method which appeared in Dynamic Chiropractic in January 29, 2010. Keep your eye out at the links below for upcoming seminars for Fascial Manipulation. Also find a promotional video I put together for Warren and Antonio below.
(This reprint with author’s permission)
By Warren Hammer, MS, DC, DABCO
____________________________________________________________This past November I was privileged to speak on Graston Technique® at the 2nd Fascia Research Conference held in Amsterdam. There is much to report about the new material that was presented at the conference and I will do so in future articles. I became especially interested at the final day of the 6 day conference when I attended a workshop entitled “The Fascial Manipulation© Technique and its Biomechanical Model – a guide to the human fascial system”. The course was presented by Carla Stecco, Orthopedic Surgeon, MD, assistant professor of human anatomy and movement sciences, University of Padova, Italy, and Julie Ann Day, physiotherapist also from Padova , Italy. Fascial Manipulation© is a soft tissue technique developed by Luigi Stecco, PT who over the past 30 years has continually updated his fascial method of treatment. As a fellow ‘fascist’ Luigi and I have communicated over the years and he sent me a copy of his last two books that were translated into English[i],[ii]. I highly recommend his texts to anyone interested in soft tissue treatment. He has written 5 previous texts in Italian. Another new edition will be out next year. His daughter Carla and his son Antonio, also an MD, have been involved in writing many peer reviewed papers relating to the fascia based on their dissections of fresh cadavers. Much of the information derived from the dissections has verified the fascial treatment points that Luigi Stecco has mapped out over the human body that has effectively solved many patient complaints. He noticed that many of these points often were similar to acupuncture points or Travell’s trigger points. A recent paper on Fascial Manipulation© written in the Journal of Bodywork and Movement Therapies[iii] demonstrated the effectiveness of this method on 28 subjects with chronic posterior brachial pain. The paper explains how fascial anatomy provides a biomechanical explanation for why certain fascial treatment locations are more effective than for example any point that happens to be tender. It is found that most of the treatment points are at a distance from the area where the subject experiences pain. The anatomical studies3 demonstrate a myofascial continuity for example in the entire posterior upper extremity provided by muscular insertions onto the fascia. The authors hypothesized ‘that these muscular insertions allow the fascia to perceive stretch produced by a muscle and that this tension can be transmitted at a distance, both in a distal and a proximal direction’. This explanation redefines locations of referred pain that until now have been unexplainable[iv]. At the Fascial Manipulation© workshop it was explained that muscle spindles are embedded in the endomyceum and are in parallel with muscle fibers and if fascia is too rigid it may alter the stretch of the muscle spindle and adversely affect its normal firing. Fascial restrictions may also create an adverse effect on the free nerve endings which also function as mechanoreceptors resulting in changes in tissue viscosity[v] especially when the restricted fascia is over-stretched. Densified fascia could alter afferent signals resulting in muscle incoordination along the myokinetic chain, causing abnormal biomechanics, eventual abnormal muscle compensation and pain. Maintenance of normal fascial physiological elasticity becomes essential for proper neurological function. This is only a partial explanation of the effect of restrictive myofascial tissue and its adverse effects. I was privileged to observe Luigi treating some of his patients. After a thorough case history he performs a fascial functional examination to determine which myofascial unit or sequence is involved. He then determines by palpation the points that he considers causative and may treat one to several points along one or more myofascial units. The patient is often unaware of these tender points. These points are treated with a compression friction type massage for up to about 2 minutes more or less. The patient is asked to designate the pain as a ‘10’ and treatment is continued until the pain reaches about a ‘5’. Luigi seldom treats a patient more than one visit. Most of the patients treated were last seen within a span of 3 to 10 years ago for all types of musculoskeletal and visceral complaints. The technique has been taught in Europe and around the world for the past 15 years. Recently, Antonio Stecco, MD and Warren Hammer, DC have introduced the method into the U.S. More information can be found at www.fascialmanipulationworkshops.com .
[i] Stecco L., 2004. Fascial Manipulation for Musculoskeletal Pain. Piccin, Padova, Italy.
[ii] Stecco L, Stecco C.,2009. Fascial Manipulation Practical Part. Piccin, Padova, Italy.
[iii] Day JA, Stecco C, Stecco A. Application of fascial manipulation technique in chronic shoulder pain-anatomical basis and clinical implications J Bodywork & Movement Therapies 2009, 13:128-135.
[iv] Baldry P, Myofascial Pain and Fibromyalgia Syndromes, New York, Churchill Livingstone 2001.
[v] Schleip R 2003 Fascial plasticity-a new neurobiological explanation. J Bodywork Movement Therapies 7(1):11-19.