Integra Therapy Blog

Physiotherapy without Contact? Using embodiment practices to enhance therapeutic relationship when using online video tools

I’m impressed at the way the COVID-19 virus has taken the global community by storm in unexpected ways across every sector of society. There’s no one who’s been left unaffected by its spread and it continues to transform the way we feel and respond to this new situation.

Many outpatient physiotherapy services have been altered drastically, including my own. The decision to practice ‘physical distancing’ (I prefer it to ‘social distancing’) has meant suspending all face-to-face contact in the clinic and redirecting all of our services online.

The wonderful thing about physiotherapists is we offer a wide range of skills that can be used to continue supporting our clients in this unique moment of separation. Skills such as; assessment, diagnostic and exercise advice and coaching where appropriate, creating a therapeutic alliance that meets the needs of our clients.

I started thinking about the idea of ‘distancing’ and how that could be examined more closely; in what ways does it matter if there’s physical/geographical space between a clinician and client?

What does distance signify for the client (or the therapist)? Does the knowledge of non-contact hold meaning to the client’s expectations of the therapeutic encounter? If it does hold meaning, in what ways might I, as the therapist close the gap?

What follows is an outline of some of those reflections which could be used to think differently about the therapeutic encounter and how that might be applied in practice.

As an aside note, when we think about distance, we may also think about different notions of space which carry different textures and meaning. ‘Distance’ could translate to ‘separation’, which may include ideas around safety, isolation, withdrawal or hiding.

For other’s it may also mean freedom, restoration and safe boundaries. It’s worth remembering each person brings their unique understanding to these ideas and consequently may respond more positively or negatively to it.

As therapist’s we may not necessarily ‘know’ the client’s position on certain ideas, but holding it in mind means you’ll hold for the client the possibility for exploration in the therapeutic encounter. Where appropriate, it’s useful to get to know our client’s story; who they are; what motivates or drives them. Being interested in somebody is part and parcel of building trust and learning to relate to each other’s humanity.

‘Contact’ or more specifically manual therapy, as an effective component of service delivery for certain conditions and has been challenged within the profession in recent years. Historically, massage was the core skill of physiotherapy. Adopting a hands-on or hands-off approach has polarised some quarters of the musculoskeletal world; perhaps emphasised by the different demographics of the private or public spheres within the profession.

Considering our contemporary times, the shear client load and pressures within NHS outpatient departments has meant a drastic reduction of individualised time with clients. Parallel to these evolving changes, there continues to be necessary, ongoing dialogue concerning the evidence-base of our treatment techniques that physiotherapists employ.

Manual therapy and other combined interventions such as education and exercise have been suggested to produce favourable outcomes that justify our efficacy for particular conditions and in different population groups. At the centre of these discourses is whether service delivery remains client-centred and at the same time supported by clinical evidence.

Non-contact also brings to mind the possibilities that touch may be problematic for some clients. Without complete histories, there may be trauma, current or historical abuse, shame from body image or body dysmorphia and/or cultural nuances that restrict the use of touch for particular individuals.

Whether within our individual practice we choose to use touch (manual therapy) or not, the challenge is can we remain connected to our clients in meaningful ways that delivers compassionate and person-centred care? And can we continue to do this when using video tools or telehealth as a model for service delivery?


So what are the conditions that might best achieve this, particularly where face-to-face interactions have been suspended?

From an embodied perspective as a somatic practitioner and physiotherapist, there’re central themes that emerge as core skills that enhance the therapist-client interaction or therapeutic alliance.

 

Therapeutic Presence
This describes the experience of being ‘conscious’ of one’s bodily responses in relationship to another person. In other words, you’re ‘present’ with yourself and able to recognise information coming from different sensing channels (mental activity, sensations from the body, sight, hearing etc.).

Therapeutic presence helps you make more informed decisions about how to respond more compassionately both towards yourself and your client.

There are a number of ways to help achieve this, but it takes practice to feel comfortable. Somatic practitioners have a method to achieve this by means of ‘grounding’ the body using the breath and their skills of awareness.

Grounding increases the opportunity to further attend to inner sensations arising in the body through interoception; a part of the nervous system that functions to inform us how we feel. It gives representations of our internal state, more broadly our emotions and internal physiological state of the body.

This helps increase the awareness of one’s physical body in space; ‘I feel my body supported by the floor/chair’ and ‘I’m aware of the soles of my feet on the ground’, as well as information about how you feel; ‘I feel anxious’ or ‘I feel safe’. This allows more choice about how to respond from a place of authenticity.

This approach is shared with mindfulness-based practices. It utilises our internal sensing skills (interoception) that support the regulation of our emotional responses, offering a broader perspective on our experience helping to foster clearer communication.

 

Active Listening
Most of our communication is through non-verbal communication, in particular through our body language.

Nonverbal phenomena are most important in the structuring and occurrence of interpersonal communication and the movement-to-movement regulation of a particular interaction.

However, not being in the same room as someone potentially reduces the ability to pick-up on body language where we may be less likely to view the entire person on a screen.

Paying more attention to what is being said or ‘active listening’ is a way to ensure we’re most attentive to the client’s needs.

It’s been argued to be an essential part of a set of our clinical reasoning skills.

Repeating or affirming what has been said, helps to clarify the information received and engenders more trust from the client that they’ve been heard. Although this skill in theory should be implicit in all therapeutic interactions, not having to rely so heavily on bodily clues in face-to-face interactions, brings it more into focus as an active skill to use.

Being present in the body as described above, further enhances the capacity to listen carefully to what is being said. It serves to redirect our attention from any thoughts processes that may be trying to construct a reply before the other person has finished speaking. Our response is from a more embodied position, that’s present to the therapist’s experience and present to what the client is actually saying.

 

Tracking
As an extension to both therapeutic presence and active listening, tracking is the dynamic way in which you’re able to follow signals in your own body. It gives moment-by-moment information regarding the interaction.

These include registering in the body both non-verbal and verbal cues that give a more comprehensive meaning to the dialogue. How the therapist responds from this informed place is vital to remain compassionate and as authentic as possible.

Tracking supports the emotional response of the therapist by helping them monitor more closely if for example, there’s material shared in the interaction that has high affect. It allows them to choose how to respond appropriately to better regulate their response.

 

Language
How we use language in interactions with clients must be carefully considered to avoid judgements or projections about them. A projection used here is a psychological term where one ascribes one’s own traits, emotions or positions onto someone else.

An example would be, “you look like you’re sad when you rubbed your cheek”. The other person may be feeling something completely different but hasn’t stated it explicitly as to verify that assumption.

As therapists we have to be cognisant of dominant narratives and certain expectations that influence our ideas regarding models of ideal health which include; particular attributes relating to body size, shape and ability, as well as behaviours and other socioeconomic factors.

These unconscious and conscious biases inform how we process information that informs our thinking and thus the assessments that are made about our clients.

It can’t be assumed as a given that somatic training automatically eliminates these biases or blind spots. This always needs constant reflexive work and active attention. However somatic practice does specifically focuses on bringing conscious language and embodied awareness to the therapeutic relationship that help minimise judgements or projections.

 

Summary
Connecting compassionately with clients, whilst at the same time meeting their needs using novel video technology, can be a daunting task for physiotherapists.

Clients may be experiencing increased levels of anxiety for a variety of reasons. Their dysregulation may include how they navigate the unfamiliar conditions of their physiotherapy interactions that are delivered in this novel form. The therapist too may also be experiencing a degree of dysregulation for similar reasons.

Utilising these specific skills can support any dysregulation clients or the therapist may experience helping to facilitate a greater degree of connection in spite of any physical distancing.

Bringing a somatic perspective can add value to the therapeutic relationship by being more conscious about how the interaction is taking place which remembers the body as central resource to the exchange.

Maintaining the client-centred connection and not just delivering a product/service remotely is perhaps most fundamental to clients, especially those experiencing vulnerability and an unusual disconnection from service providers.

Coronavirus Update: We’re temporarily moving our services online

 

We’re in an unprecedented moment with the Coronavirus pandemic impacting the global community at every level of society.

People are frightened and anxious about how the situation will evolve. There is a lot of uncertainty and misinformation. However it’s an opportunity to reassess our values.

The current health advice is to social distance and self-isolate where necessary and practicable to safe-guard ourselves and others.

Consequently, we at Integra Therapy have suspended face-to-face clinic services and are redirecting services remotely until further notice.

Andrea is offering online support via ZOOM or other video link tools where needed.

If you need advice for a new or existing condition, or therapeutic support to manage new symptoms, then get in touch with Andrea;

andrea@integratherapy.co.uk

Or call on 0776 037 6323 to arrange a session.

 

We’re working on providing online content that will help you manage stress, how to keep moving with exercise, advice and more.

Be well and look after yourselves and each other.

Who’s body is it anyway?

Isn’t that an obscure title for a piece? What do I mean by that?

A number of you may have formed an answer to the question; others may think that it’s a trick question; whilst some may wonder why ask the question in the first place, it’s obvious?

For a long time now, I’ve been exploring the boundaries of my own body, working with other bodies in different contexts; clinical practice, healing work, and somatic facilitation. Over time, I not only experience my own body differently, but have understood through scholarly, creative and spiritual readings, that the view of the body hasn’t a universal consensus.

Viewing the body through different lenses, means its representation and meaning shifts. It’s made complicated by theories, history, ideologies, lived experience and the dynamics of power, from the margins to the centre and beyond.

I’ve longed to understand the concept of the body more fully, transcending the biomedical model constraints of what my physiotherapy degree taught me. From its beginnings over a hundred years ago, the profession has somewhat moved on from these rigid models of materialism. It has embraced ‘biopsychosocial models’ particularly in clinical areas that are concerned with longstanding medical conditions and persistent pain. Physiotherapy is also showing positive orientations towards an integrated understanding and consideration of the impact of sociocultural influences on our bodies and health more generally. A welcome step in the right direction, given there’s a large body of research that demonstrates the social determinants of health cannot be ignored.

Our human condition vis-à-vis our body and by inference our health, is in constant demand; from our relationships, interactions, work, the environment and least not ourselves. The conversation around our multifaceted experience and the impact that has on our bodies and thus our wellbeing is well overdue.

I’m nervous having said that. I’m nervous because it’s a big undertaking. There is SO much to think about when one considers our sociocultural legacies, histories and contemporary life. I’m not an historian, sociologist, cultural critic or psychologist, so don’t expect complete analyses. I am however interested to tease out a more relevant and inclusive perspective. My hope is that in these musings I can grapple with ideas, unpick my own thinking, widen my understanding not only of my own experience, but be in a more informed place to meet the needs of people I work with.

I appreciate you staying on to read this.

Andrea

Who’s listening?

Here’s what happened today.

Disclaimer: This is not a post that is attempting to give answers or leave a tidy pile of information as a take home.

I dropped my car to the garage and decided to walk back the scenic route which has more green spaces on the way back home. For those who know Bath, I pass through the Hedgemead Park, a beautiful Victorian park cut along a hillside built in the late 1900’s. It’s hot and I’m sweating. For a moment I suddenly feel a light pulling, maybe enough to say an ache low in my abdomen. Hmm, I wonder? I’m not alarmed, but notice it and wonder what it is, why has it arrived, will it develop into something persistent? You know as you do when some unexplained sensations arrive in your body.

As I enter the park, the canopy of trees offers their shade. I’m welcomed by it as I notice my deep intake of air and long sighing exhale as the dark canopy covers me. After a few steps feeling this welcome coolness, I notice the sensation in my abdomen has largely disappeared. I continue walking and it doesn’t emerge again.

I sat later in Victoria Park and thought about that experience. I wondered about our individual experience, in particular sensations arising in the body. They’re generally thought of as isolated, individualised and self-contained. They belong to me. So here’s a thing, what if these responses were shared in some way, part of a conversation with the world, the environment? What if they were questions being asked or answers being given and how might that change our response to the original sensations?

I thought of Heidegger a 20th century German philosopher who spoke about human interconnectivity as ‘being-in-the-world’, a notion that we are entrenched and in a dynamic exchange with the world around us that shapes us as much as we shape it. And too Thich Nhat Hahn, the Buddhist philosopher and activist who wrote about ‘inter-being’, where we consider all beings, human and non-human having sentience and a responsive capacity in some way.

The notion of interconnectivity is not new. But imagining my experience as not being just ‘mine’ but part of a wider conversation with the world opened up the possibility of thinking differently about how my body expresses itself; that it may not only be something ‘wrong’ or a ‘problem’. This wider perspective was helpful as I wonder how listening and experiencing our bodies in different ways might support how we manage ourselves from day to day.

I had to smile to myself at the thought of my abdomen having a good old chat with the shade of the tree!

What ways do you listen to or with your body that are supportive to you?

What is the Integra Method System?

Some of you may know that I’ve been involved in my own independent research now for the last 14 years. It involves the development of a system (aimed at manual therapists and body workers but not exclusive to that population) that perpetually minimises the accumulation of physical stress on the body.

It allows your body to heal and redress functional and structural dysfunctions all through natural processes. It enables you to restore your vitality, reduces overall pain and gives you back the hope that your body will not ‘fail’ due to the physical demands of your work and lifestyle.

Receiving 2nd prize for research poster presentation at British Fascia Symposium 2016

Receiving 2nd prize for research poster presentation at British Fascia Symposium 2016

Over the last 16 years I’ve drawn on the work of fascia-informed manual techniques, contemplative practice, yoga and transpersonal approaches to human wellness to inform this novel piece of research.

Losing your physical capacity to continue working as a therapist? How to reclaim your energy and gain control of your health?

Is manual therapy taking it's toll on you?

Is manual therapy taking it’s toll on you?

I’m cutting straight to the chase here; working as a physiotherapist or manual therapist can be really taxing on our bodies! Let’s face it, we are using our bodies as our main vehicle to deliver our work and for most of us have done it 8 hours a day, five days a week for years. As I’ve discovered and other colleagues I’ve spoken with this is not a sustainable pattern. It’s no wonder by the time we reach our (I say ‘our’ because I’m old!) double-figured years of service we’re completely knackered! Spent out!

(Don’t) Take my breath away! Part I of a three part series on Stress

Recently I’ve had a string of clients who have come to me with issues that don’t normally fit into the musculoskeletal physio’s lexicon of conditions to treat, ranging from panic attacks, insomnia and a vague diagnosis of prostatitis (inflammation of the prostate) and chronic inflammation of the bladder. In all cases, what was common to each of them was the fact that they all experienced an increased amount of stress either from the ‘condition’ itself or the fact that they were so anxious for a diagnosis to explain their symptoms that they over-dosed on information on the internet searching desperately for answers.

In each of these instances I asked them what they thought they needed to help them at this time. And without fail the resounding answer was ‘to reduce my stress.’ So how can a physio help in reducing people’s stress and anxiety levels?

Firstly, I think I should say that this is perhaps not what most people think is in the skill set of a musculoskeletal physiotherapist, but one couldn’t be further from the truth. At its base, physiotherapists traditionally have been trained academically and clinically in a variety of medical disciplines that address a multitude of clinical issues including respiratory care both in the acute and chronic setting. Not only this, we have been groomed to have excellent observational and assessment skills to detect where dysfunction and maladaptive movement patterns occur. In this case, although long departed from the respiratory discipline, my specific interest and training in yoga and contemplative practices that enrich the art of breathing, self-observation and use techniques that foster a more relaxed state, have helped me maintain those skills.

Why stress over the stress?

Firstly we need to appreciate that stress is a normal response of the body. In fact it is a necessary trigger to protect the body and let us know how and what to respond to appropriately. This is what is known as self-regulation and it’s our body’s ability to do this constantly that is crucial for our health and wellbeing. Typically we are familiar with the adage ‘fight or flight’ which is the response that utilises adrenaline (hormone released from the adrenal glands) as an immediate response to perceived danger. So as modern humans, we would either run from the unleased pit bull on Hampstead Heath or stand to face it head-on! It is one branch of the body’s nervous system (autonomic nervous system – ANS, see Fig.1) that works without you consciously making a decision in that process –  which is really useful as it would require having super-human fast reactions and attention to be able to monitor and control all of those incoming signals in order to protect your body!

Fig. 1 Effects of the sympathetic and parasympathetic nervous system on the organs of the body.

Fig. 1 Effects of the sympathetic and parasympathetic nervous system on the organs of the body.

The branch of the ANS, the sympathetic nervous system controls our stress response through the organs and tissues around the body. When your system is under psychological or physical stress the sympathetic system becomes dominant in order to release energy to the tissues so you can respond appropriately to protect yourself from the perceived threat or uncertainty. Even in relatively normal stable conditions, the sympathetic system is more dominant and maintains a low level of physiological arousal (Thayer & Brosschot, 2005). On the flip side when the body needs to return to a more restful state it utilises the other aspect of the ANS, the parasympathetic nervous system which inhibits the stress response migrating the system to a more ‘rest and digest’ state (Fig. 1). The parasympathetic system has the opposite effect to an adrenaline rush in a stressful situation and this is what we want to promote when we target stress or anxiety.

What can be done to reduce stress in this setting?

One of the simplest and most accessible ways one can reduce ones stress response is by using the breath. There are of course many other ways at our disposal to reduce stress; activities that we enjoy engaging in, exercise, listening to or playing music or an instrument, walking in the countryside, reading etc. However the breath is one of the most potent influencers on the brains output to all the other physiological systems in the body. Extremely sensitive chemoreceptors (chemical receptors) in the brain detect changes in the mixture of gases dissolved in the blood and respond by sending signals via the ANS to either increase or decrease the heart and respiratory rate and accordingly, as well as effecting other systems of the body such as the endocrine system. In another blog in this three part series we will examine the effect of breathing on the fascial or connective tissue system. By working with the breath you have a very powerful means of controlling how you psychologically and physically respond to a given situation.

Here is what to do – Simple exercises you can do to help with stress and anxiety

It’s useful to be able to spot if you think you are anxious or under undue stress which we won’t go into here but this will be part of this three part series on stress. However, even if you don’t think you are, these are excellent techniques that you can use if you need ‘down time’ or want to just ‘relax and take time out’.

All you need is 10 minutes, a quiet comfortable space and YOU!

Step 1 – Noticing

Find quiet, comfortable, warm environment away from any distractions like the TV, small children and make sure your mobile devices are switched to ‘silent’ or off. You can dim the lights around you to reduce the light hitting the back of your eyes, encouraging a less aroused state. Find a lying position on your back, either on a yoga mat or equivalent or on a firm bed. Have your knees bent so your feet are flat on the floor (you can place a pillow under your knees to ease any pressure on your lower spine) or straight out in front of you. Place one hand over your chest and the other between your navel and imagined or actual bra line.

  • Now take a moment to notice all the contact areas of your body on the surface that supports you. Each side or body part may feel different from each other and this is quite normal. The idea here is not to make a story about ‘why’ it is as you find it, but rather taking in and openly accepting things as they present themselves.
  • Also notice the movement of both your hands as you breathe in and out. Do they move in the same way at the same time? Are you breathing in one area more than another? Often people don’t feel that they are breathing ‘properly’ and it could be that you feel hardly any movement in your chest or they don’t breath fully into the lungs and are only expanding the top of the chest with shallow breathing.
  • You should notice that as you breathe in, the chest and stomach move up and outwards, the hand over your belly will move first only a fraction of a second before the other hand on the chest moves. And as you exhale both your chest and stomach should gently fall back towards the spine.
  • Notice as you breath the sensations around the back, sides and top of the rib cage by your collar bones, can you feel these areas move too?

Repeat this a few times to familiarise yourself with the motion of normal relaxed breathing and discover what is true for you.

Step 2 – Taking a deeper breath

  • Now take a full breath in and exhale out. Repeat this a few times to familiarise yourself with this movement, remembering to keep as relaxed as you can; through your shoulders and arms, in particular around your head and neck. This shouldn’t be hard work.
  • Notice what happens to the movement of your belly-hand and your chest-hand. Do they move in the same way? Can you feel now more of the back, sides and top of your chest? Using your imagination as you inhale, can you begin to fill the base of the lungs, then the middle of the chest and then right up into the apex of the lung as your collar bones broaden? This is known as a ‘yogic’ or ‘three-part’ breath that enables you to use the full capacity of the lungs.
  • Notice if you feel you are not breathing into a particular area of the lung, for example into the base of the lungs. Can you direct your attention to that area visualising the air travelling there and actively inviting the breath to go there? What does that feel like?

Repeat this 10 times and return to relaxed breathing. How does the body feel now?

Step 3 – Controlled inhalation and exhalation

If you are comfortable with Steps 1 & 2 then you can progress to this stage.

  • This time remembering to keep as relaxed through the body as possible, inhale for a count of four counts, then notice a slight natural pause at the top of the in-breathe and then exhale for a count of six, again noticing the slight pause at the end of the out-breath. Repeat this cycle 5 times and then return to normal relaxed breathing. How does the body feel after that sequence?
  • If you’re comfortable you can repeat this set 2 or 3 times in total and/or extending the inhalation to five counts and exhaling for seven, resting to observe how the body is after each set.

Extending the exhalation is the key here as it serves to increase parasympathetic output and reduces the general tone of the tissue (i.e. you encourage a more relaxed response in the body). It also ensures naturally that you are ready to begin inviting another breath in to begin the cycle again. Many people who suffer with anxiety feel they are not getting enough air in and this increases their stress, where they begin to over-breath which in turn compounds their sense of panic. If you consciously exhale for a bit longer, the natural reflex of the diaphragm will take over and air will naturally rush in without any effort, reducing the perceived increased effort of breathing.

It’s comforting to know that by employing your breath in a more conscious way acts as a potent regulator of how you think, feel and thus behave. It’s free; it’s always there when you need it and wants to help you live a life less stressful. Go on; why not give it a go?

Next time in part II of this three part series we’ll be looking at how you might identify the signs stress and anxiety.

References

Thayer, J. F., & Brosschot, J. F. (2005) Psychosomatics and psychopathology: looking up and down from the brain. Pyschoneuroendocrinology, 30, 1050 – 1058.

Reflections on the Fourth International Fascia Research Congress

Well what a show! It’s been a slow walk back home from the Fourth Fascia Research Congress in Washington DC but what a show! This congress may have been the best attended yet, with over 800 delegates attending over the 3 days, it was a hub of busying clinicians, scientists, movement practitioners and researchers all hustling together in a buzz of intellectual and practice-lead conversations.

Main hall at Fourth Fascia Research Congress

Main hall at Fourth Fascia Research Congress

It was stimulating space, maybe at times overwhelming; packed with squeals of laughter from reunited friends meeting and greeting again since the last FRC, new faces connecting and slowly finding common ground and that seeker searching for solace in the silence found away from the intensity of the crowds. An artificial space made real by the people coming into it and contributing to its development and growth.

Map showing all the countries where the delegation came from

Map showing all the countries where the delegation came from

Notwithstanding this trip was made more special because of my added bonus road trip that extended through to Boston, coastal Maine and Quebec. Amongst the elusive moose, expansive early autumnal hues across the wild terrain and quaint, elegant but shabby crumbling jetties and small coastal villages of Massachusetts, fresh local lobster- my head and heart have returned full… but that’s another story for another day!

My overall impression was that this was a magnificent attempt to bring together an event that’s multidisciplinary in its efforts to carve out a more informed body of information about fascia and its related topics. Hands-down, this really is the work of genius of those founding members, whilst equally acknowledging it’s not an easy job to contain and promote diverse perspectives from different discourses that have a part to play in fascia research. Part of this difficult challenge was the ongoing debate on nomenclature, which the working committee (after meeting before the congress) came up with a largely unified definition of fascia, which has been at least 4 years in debate. But amazingly this year a consensus has been reached with an additional sub-group committee formed to refine, add and develop further alternative definitions as they emerge from practitioner, researcher, and clinician’s experiences. This is great news as it means not only can fascia be communicated more effectively amongst those in fascia-cognisant therapies and disciplines, but also to wider scientific circles. And this latter point bears out with the timely invitation for the fascia research group to contribute to the next edition of the Terminologia Anatomica, a renowned anatomical textbook equivalent to Gray’s anatomy (for the Anglophones amongst us) which is fantastic progress in marking a tangible connection to the wider scientific community.

Let’s be honest any large conference can have its lows moments; where sometimes you find yourself restless and unsettled, moving from one talk to another in the parallel seminar sessions or your brain is too full to begin to untangle yet ‘more’ technical science speak! However for me there were more delightful highs than the lows where I found particular inspiration and that spoke to my intellect or challenged my ideas and practice. Here’s a taste some of the more noteable moments:

BIG – The Biotensegrity Summit hosted the first meeting of its kind, a group gathering with the aim to bring together the collected works of Stephen Levine, who’s early work on biotensegrity set the scene for clinicians and-the-like to begin thinking about human examples as systems, which challenged the traditional objective and compartmentalised paradigm that has dominated modern biological medicine. Dr Levin’s engaging and enlivened presentation for the first half was well received by a captive audience of around 100 attendees.

Dr Stephen Levine addressing the delegation at BIG

Dr Stephen Levine addressing the delegation at BIG

He reminded us of the principles of biotensegrity in human function which follow the laws of non-linear dynamics, meaning the biological material that we are made of behaves dynamically like other ‘soft materials’ such as silly putty, colloids, foam, emulsions etc. When you stress them they will move and deform fairly easily, but will stiffen quickly and become stronger with the increasing force applied. This means our cells and tissues are constantly changing their shape to establish spatial stability in the form of isocohedrens (the most stable 3-dimensional emergent shape occurring in nature). The important thing to remember is these ever changing isocohedral structures oscillate and these oscillations are key to carrying mechanical information instantaneously throughout the system, which is faster than neural stimuli in the nervous system. We as humans are believed to be complex, tensegrity structures that are constantly conveying instantaneous information from the external environment to the internal cell nucleus to govern overall health of the body.

IMG_0277 (Edited)

Graham Scarr tensegrity model building

A panel presentation followed which brought together a multidisciplinary line-up of practitioners, clinicians, scientists, researchers who spoke of how they are using/applying biotensegrity principles particularly in their work. What was interesting here was for me was discovering people who have made important contributions to their particular area of expertise; namely Dr Mike Turvey’s work on systems of perception of the body and Professor of Medicine and epidemiology Alfonse Masi’s work on clinical epidemiology and the mechanisms of disease, which provided a great opportunity to meet and talk with them. The second half of the meeting was organised around small break-out stations which I ascertained each had a theme to it, whether it be movement disciplines, biomechanics, science or model-making. Here you could speak directly with the various table facilitators in more depth.

Myself pictured with Stephen Levine holding tensegrity model at the BIG Summit.

Myself pictured with Stephen Levine holding tensegrity model at the BIG Summit.

Although initially feeling somewhat disoriented as we the delegates weren’t sure what to do and where to go, this dis-ease soon dissolved as I found myself cruising around each table grabbing onto and listening-in on conversations managing to find plenty of discussions to engage with, which in the end proved to be a rich, practical space to dialogue and share ideas.

Dr Mense’s (Professor of anatomy and cell biology with an interest in pain) stated some important conclusions from his research groups’ studies on the thoracolumbar fascia (TLF). They findings suggest that fascia is the most pain sensitive structure in the lower back, where the inner layer of superficial fascial is has the highest degree of innervation with noiceptive (unpleasant stimuli) nerve endings. Interestingly high chemical intensity stimulation of the TLF produces tonic pain and widespread network patterns more than stimulation of muscle units alone, meaning that under certain conditions fascia over the muscles themselves, may be a better indicator as to the source of wide spread pain in low back symptomology. This has implications for understanding the mechanisms and presentation of the acute/sub-acute/chronic persistence and development of non-specific low back pain and where fascia might be the key structure with which to target treatment approaches.

Robert Schleip discusses the role of fascia as a body-wide sensory network; It has a wide influence on the body’s control of function and regulation. There are over 10, 000 nerve endings per limb which terminate in the fascia. Most of these are made up of are sensory nerves that provide information at to proprioception (spatial awareness) and interoception (sense of the physiological condition of the body) and sympathetic nerves that provide a link to the autonomic nervous system (affecting plasma’s ability to leak out and blood capillary dilation). Sympathetic nerves in fascia may have an effect on nutrition and hormonal changes. Proprioceptive stimulus strongly inhibits myofascial noiceception (unpleasant stimuli) via wide-dynamic neurons (so giving mechanical inputs to the tissue can override pain signals interpreted by the brain). This all points to the fact that fascia’s influence is wide and far reaching across various systems through mechanical stimuli,  more than was previously given credit.

Andry Vleeming’s always an elegant speaker to listen to. In summary his message and research are compelling, he states, “The stability of the spine depends on the interplay between the deep spinal and abdominal muscles through their interrelated myofascial components”. Vleeming and Paul Hodges work are a must for those interested in these relationships particularly for LBP, functional fitness and sports related disciplines.

Dr Micheal Kjaer spoke on tendinopathies and convincingly posited that the disruption to the substance of a tendon is most likely to occur in the inter-fascial spaces, where there will be inflammation and matrix remodelling and not in the tendon substance true. But the research remains unclear as to the mechanisms of tendinopathy, which surprises me as tendinopathy is arguably the most prevalent issue encountered in musculoskeletal/sports medicine. The best of what the research offers currently for tendinopathy treatments are eccentric/concentric training, slow contractions with high loads. We’ll just keep taking the medicine and hope that further research in fascia may shed more light on this topical area.

Jean-Claude Guimberteau’s seminar and presentations always captivate, not only for his sumptuous ‘Francophonic’ tones, but also his dazzlingly work as a surgeon displayed through a myriad of live endoscopic images taken of the fascia under high resolution. His message is refreshing to hear as he purports that the client’s response is unique, diverse and their behaviour ‘non-linear’, with movement occurring in a quantum, unpredictable manner. He eloquently demonstrates this point with live images from his work showing how the fascia continually forms and reforms, 3-dimensionally. In other words if the tissue is changing unpredictably, then one should understand when our clinical outcomes are not as we expect and this should remain at forefront of any clinicians mind as a naturally occuring observation. He also suggests manual therapists might consider applying their techniques in 3-dimensional way. Although it’s not clear what this might look like, one can see what Guimberteau’s driving at and something that I believe the Integra Method approach to fascial body work invokes, in order to augment how the connective inherently organises itself.

The poster session that I took part in was an exciting moment. Despite the room being cold and the spatial arrangement leaving it feeling slightly like a concentration camp when empty, the experience was completely absorbing as we engaged in each other’s research.

Speaking with delegates at the poster session

Speaking with delegates at the poster session

My research spoke of a phenomenological approach to fascia research and the observations that this approach revealed (see here). People were very encouraging of these ideas which seemed to resonate in some ways to their own clinical experiences and thoughts that lead to thought provoking discussions. There is a lot to be gained from being able to distil and communicate your work into its essence and no mean feat too. But an invaluable if not challenging situation to rise to. I thoroughly enjoyed it as the buzz was tremendous and encourages me to continue this work which I’ll keep you up to date on this site as it develops.

The icing on the cake for me was the eloquent and passionate post-conference workshop by Dr Jaap van der Wal, physician, philosopher and embryologist. His spoke into our hearts and minds like a preacher to the prodigal boy on a Sunday morning service.

Dr Jaap van der Wal

Dr Jaap van der Wal

He approached the topic of embryology with a complete paradigm shift in traditional thinking of embryological development. His philosophical weaving with the embryological anatomy created a model which encompassed a more embodied view of fascia, not only with its relation to the mesodermal layer from which it is formed, but also offered some sense and meaning to our human existence. Certainly one thought leader that I will be following closely in the future as his contribution to fascia research is fresh, provocative and relevant to our human concerns.

There were some moments outside of the academic presentations that are noteworthy. Tom Findley’s presentation received a standing ovation, for reasons that I suspect are to do with his courage that he’s showing in his outward fight with prostate cancer.

With Tom Findley

With Tom Findley

Also in recognition of and to pay due respect for his tireless work in bringing fascia research to an international forum and continues to support generously with his time and mentoring. Stephen Levin accepted the James Oschman life-time achievement award in recognition of his work on biotensegrity. Notwithstanding some of the new relationships and interests that were formed by impromptu micro-meetings between other researchers and clinicians.

Large events such as these can be overwhelming at times, but FRC4 proved to be a rich testament of meeting new/like-minded folk genuinely interested to discover areas of their work that connect to fascial-related themes. It created strong networks for me, encouraging to hear other people’s work that chime with my own, people that I didn’t know existed and people doing innovative research which was inspiring to move among such noteworthy people.

What does the future hold for fascia research? I see it as bright and rich. It’s the only place that attempts to have open discourse in the many specialisms that have a concern with the human body and how it functions (scientist, clinician, movement specialist, researcher). For me it still feels that there was more that can be done in the practical application of the science: how do we experience, interpret and understand these ideas in our own and in our client’s bodies? Always optimistic to bridge the gap between our experience and our understanding of how the science might connect what we have yet to fully know and hope to yet discover.


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