Integra Therapy Blog

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.

Fourth Fascia Research Congress Washington D.C.

18th - 20th September 2015

18th – 20th September 2015

Integra Therapy is very pleased to be taking part in this year’s Fourth International Fascia Research Congress in Washington D.C. I will be going to present new research in fascial dynamics which considers the ‘live’ aspect of fascia by examining how it may behave in the ‘living’ human subject, in other words in vivo. The majority of connective tissue research in the scientific realm largely concentrates its concerns with the detail of biology, biomechanics and physiology from an objective viewpoint. Aside from the work of Jean-Claude Guimberteau [1] these studies although useful, are limited in that they rarely capture fascial dynamics in live human subjects. It is well known in the biological sciences that what occurs in vitro does not necessarily translate to how results behave in vivo within living biological examples. In many instances science makes a great leap of faith to extrapolate those findings to living subjects. The question remains how does fascia behave in vivo in the living subject?

Additionally, investigating living tissue and in particular fascial dynamics in humans is problematic not only due to ethical considerations, but in essence fascia ‘is’ our physical body in its totality. It is our bodies which we inhabit that enables us to perceive and be and think in the world. Therefore our fasica is part of our experience both ‘subjectively’ and ‘objectively’ if you will. And it is the lived experience or phenomenology of our experience in our bodies relating to fascia research, that I believe is in need of redress.

This is the thrust of the research that I have undertaken on myself as a self-study over 13 years. It describes a methodology I have called the Integra Method which allows an individual to develop a heightened somatic awareness of their body/fascial system that may describe a perpetual neurobiological response [2] so that the body is experienced as freeing itself of tension in real-time, all the time. These observations have lead me to understand that this ongoing change in the body is ‘autogenic’ (self-generating) and outside of volitional control. As a result of this process, there have been anatomical structural and functional changes that preferentially optimise function to my body which have been captured through photographic and video evidence (see example images of my feet below). In addition, the first-person narrative and heuristic aspects of the process were captured in a reflexive diary to explore how lived experience relates to an ongoing changes in the physical body. This forms part of a second phase to the research in which the data has yet to be processed.

PS Feet3 04.06FeetThis research raises questions around – What more can we understand about the way the human body organises itself in relation to dysfuntion and health and what are the conditions for that if any? Does the body have an innate capacity to change its own structure without external traditional methods of training or practices? Does fascia behave autogenically and can that be sensed as a felt experience?  How can a more relational way of looking at fascia with a first-person perspective benefit perceived wellbeing and health? Can this methodology provide insights into an individuals own structural and functional limitations to help provide them with their own solutions towards health?

I have a lot of questions with not necessarily any definitive answers, but I do have an experience with this research approach that is compelling and I believe valuable. If this opens up a conversation in you the reader and those attending the conference who are interested in any aspect of this work, then do get InTouch with me as I’ll be very interested in your thoughts.
[1] Guimberteau, J. C. (2005) The sliding mechanics of subcutaneous structures in man Illustration of the functional unit: the microvacuoles. Studies of the Academie Nationale de Chirurgie, 4, 35-42.
[2] Schleip, R. (2003) Fascial Plasticity- A new neurobiological explanation: Part 1. Journal of Bodywork and Movement Therapies, 7. pp. 11-19.

Stepping out of the box! Different ways to explore your wellbeing.

I’m always struck at the complexity and nuance of working in different ways with the body and what it can reveal- it excites my interest no end!

We can really enhance our wellbeing by being more present to ‘all’ our experience, from the obvious, ‘this hurts, I’m hungry or I want to feel the burn!’ to the more implicit, ‘gut feeling’ or intuitive felt sense. It hopefully enables us to make choices that ‘fit’ what is right for us to do at that moment, based not only on what we think, but also how we really feel.

That’s what some of my clients say when they faced with difficult challenges of dealing with chronic pain and injuries, where sometimes they sabotage what they really need, such as rest, ‘time out’ and maybe time for reflection and acceptance of their situation, by attempting to sustain the daily quotidian.

Perhaps it can offer us more clarity, more choice and a more authentic way of being.

Here’s a glimpse of my own journey exploring these very ideas. Please click to read more.

Contact Integra Therapy