How a Mysterious Body Part Called

Fascia Is Challenging Medicine

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Robbie Gonzalez
Filed to: DAILY EXPLAINER7/29/14 3:07pm

Fascia is a web of fibrous tissue that permeates the body, but is it really
the"Cinderella Tissue" that new age therapists, Rolfers, and yoga instructors

suggest? The fascial system is still a medical mystery. But that could soon change,
thanks to an unlikely alliance between researchers and alternative therapists.
Image of myofacial release therapy via Colorado Body and Soul

In October, 2007, more than 100 scientists from around the world convened in
Boston, Massachusetts to discuss the latest research on fascia, an enigmatic,
gauze-like matrix of connective tissue that envelopes the muscles, surrounds the
nerves and swathes the organs in a body-wide-web of fibrous collagen. But the
researchers had some unlikely company. Also in attendance, and outnumbering
researchers 5:1, was a throng of complementary- and alternative-medicine
practitioners with a mutual interest in fascia. United by their fascination with this
medically neglected tissue, the two camps comprised the attendees of the firstever International Fascia Research Congress.
Science's coverage of that first congress indicates that practitioners of
complementary and alternative medicine (aka "CAM") signed up for the meeting
in droves. The researchers, however, had required some convincing. Therapies
defined by the National Institutes of Health as "complementary," "alternative," or
"integrative," are characterized, in large part, by a lack of scientific evidence in
support of their effectiveness. More distasteful, still, to many scientists, is how
readily such therapies expose themselves to untestable spiritual and metaphysical
interpretations. For many researchers, to associate with alternative practitioners
is to not only grant outlandish theories credibility by association, but to risk
sullying one's own scientific reputation.
The scientists who did attend the meeting had been assembled through the
efforts of conference-founder and Executive Director Thomas Findley. An MD
with a PhD in physical medicine and rehabilitation, Findley has studied the
science of rehabilitation for close to forty years. But he is also a longtime
practitioner of"Rolfing." Also known as "Structural Integration," Rolfing is an

alternative form of movement and energy therapy. To quote Ida P. Rolf, the
founder of the practice:
Rolfers make a life study of relating bodies and their fields to the earth and its
gravity field, and we so organize the body that the gravity field can reinforce the
body's energy field. This is our primary concept.

But unlike many alternative therapists, Findley seems to recoil at the mention of
words like "energy field." Among bodyworkers like Rolfers, the standard practice

may be to offer therapies that elude quantification and verification, but this,
Findley says, is problematic. "The point of science is to ask a question in a way
that can be answered either 'yes' or 'no,'" he says, "and a lot of practitioners pose
questions in ways that aren't really answerable in a scientific context." [At left:
The logo for theRolf Institute of Structural Integration, which markets Rolfing.
According to the RISI, Rolfing "works on the web-like network of connective
tissues, called fascia, to release, realign and balance the whole body, potentially
resolving discomfort, reducing compensations and alleviating pain."]
Findley thinks the answers he's looking for could be hiding in fascia. On the
scientific side of things, the field of fascia research has grown considerably in
recent years, though it lacks the coherence of other, more established areas of
physiological investigation. For decades, anatomical dissections and
representations have presented the body as stripped of its fascial tissues, and the
majority of physiology textbooks make little mention of it. "Most scientists," says
Wallace Sampson, alternative medicine skeptic and professor emeritus at
Stanford University, "even those wary of alternative therapies, admit that the
field of fascia research is a field of neglect, and remains sorely underinvestigated."
By uniting alternative therapists with researchers, Findley hopes to spur
discovery. He is fond of telling conferencegoers that when he was in medical
school, glial cells (the predominant cell-type in the central nervous system) had
no function. "We now know [glial cells] have a major function in memory, and do
all sorts of things," he says. "What about fascia?"
"We strip it, do away with it, say it has no function at all," he continues. "Well, I
suspect we're going to find major functions in fascia, just as we find major
functions in glial cells."

Growing Acceptance

It's been almost seven years since the first Fascia Research Congress, and both
Findley and his conference have celebrated their fair share of
accomplishments.World-renowned biomechanics researcher Peter Huijing, who
was reluctant to attend the first FRC for fear that it would damage his reputation,
has become one of the biggest headliners at subsequent meetings. He volunteered
to help organize the second FRC in 2009. He even convinced his home institution
Vrije Universiteit Amsterdam to host it.
In 2007, Wallace Sampson, the alternative medicine skeptic, roundly criticized
the Fascia Research Congress, calling it "A Meeting of Incompatibles." You have
to do the basic science and build from there, he insisted at the time. "You can't
force the clinical side." In 2014, Sampson applauds Findley. "Findley may be in a
position to point out, better than anyone else, in any other field, the reasons for
the conflict between alternative medicine and basic science," he told me.
And yet, fascia's "major functions" have yet to reveal themselves. To date, there
have been no home runs establishing a clear, causal link between fascia's
molecular, cellular, or biomechanical properties and the effective treatment of
pain, injury, or disease at least to the satisfaction of the broader scientific
community. Findley continues to reference discoveries that have yet to be made.
His e-mail signature is a quote, attributed to Albert Einstein.
"For an idea that does not first seem insane," it reads, "there is no hope."
But how insane is Findley's idea, really? Does it not make intuitive sense that a
tissue found throughout the body would harbor some form of medical or
therapeutic significance?
Sure, says John Hutchinson, professor of evolutionary biomechanics at
University of London's Royal Veterinary College, but intuition can be dangerous
when it comes to research. "There's a lot about it we don't understand," he says,

noting that it remains an understudied tissue, "but when you point to something
as complex as fascia, it's easy to use the fact that it's understudied in a way that's
convenient to your argument."
Robert Schleip a longtime Rolfer turned researcher, and director of Ulm
University's Fascia Research Group has expressed similar frustrations over
what he calls "the current trend among bodyworkers of attributing anything
wonderful or astonishing to the properties of fascia":
[Our research group] has been receiving an almost exponentially increasing
number of inquiries from enthusiastic healers (and martial art teachers)
worldwide who wish that we would sanctify their claims that fascial contraction
provides the explanation for their observed miracle powers. While I do tend to
believe that the fascial net plays much larger roles in human functioning than
previously assumed in orthopedic medicine, I am afraid that such over-zealous
claims and projections are undermining the seriousness of the investigation.
In a presentation delivered at the 2012 International Fascia Research Congress (a
video of which appears below), Schleip expanded on this point in a talk about
how his experience as a scientist has informed his personal Rolfing practice:
"We have been teaching for several decades that with the rolfing strokes we are
changing a gel-to-sol transition int he ground substance, or that we are also
loosening cross-links within the collagen fibers," says Schleip, in reference to
common phrases employed by Rolfers to explain their work to their patients.
"But, if you meet us teachers late night at the bar, we don't know shit about it and
we agree to that."
To quote Eric Jacobson a lecturer on Global Health and Social Medicine at
Harvard Medical School with longstanding ties to the Rolf Institute of Structural
Integration, the Ida P. Rolf Research Foundation, and the Fascia Research

Congress the current state of fascia science is such that one must always bear in
mind "the difference between what we know about fascia and what we're
hypothesizing its significance might be."

What Does Medical Science Know About Fascia?

Scientific investigations of fascia have grown considerably in recent years, as
evidenced by a continuous rise in its MEDLINE references since the 1960s.
Suffice to say, there is more research to summarize than there is space to do so.
Science writer Paul Ingraham sums up a great deal of this work in his
article "Does Fascia Matter?"
Robert Schleip sent me six scientific articles that he regards as "home runs" for
the field of clinical fascia research (see references below). I showed the studies to
Hutchinson and to Silvia Blemker, a biomedical engineer at the University of
Virginia.
Blemker says the the clinical studies Schleip references "all provide evidence to
support the role of fascia in health and disease, but... they are small bits and
pieces of the puzzle and in many ways do not fit within the community's
conceptual models of disease processes." In this light, she continues, "it is
understandable that these studies get push-back from the [larger scientific
community.]"

Neither of the rodent studies seemed particularly momentous to Hutchinson.

"Even considered together and taken rather credulously in terms of the details of
the science, these two rat studies seem incremental to me." As part of a sustained

research effort, Hutchinson says it's possible these studies might eventually
dovetail with others and lead to some improvements in care. "Possibly," he
hedges, "or not."
Hutchinson's language echoes that of Rolfing-researcher Eric Jacobson, who had
the following to say at a recent presentation on the therapeutic implications of
the lumbar fascia a collagenous sheet that spans and connects to various bones
and regions of the back:
The hypothesis now is that maybe chronic low back pain has something to do
with a dysfunction in that fascia. [That] it's at least part of the story, maybe.
Both Hutchinson and Blemker had good things to say about Huijing's work, but
they agree that it raises more questions than it answers.
Scientists know, for example, that fascia surrounds, separates and connects
muscles throughout the body. According to Blemker, Huijing and his colleagues
have developed a long line of research demonstrating fascia's ubiquity in the body
enables it to transmit some degree of force within and between muscles, but "this
line of thinking has yet to adopted by the mainstream biomechanics community
because it does not yet fit within our conceptual model of musculoskeletal
function."
"There's no question Huijing's work is fascinating," adds Hutchinson, "and there
are aspects about myofascial force transmission that may be right. We just don't
know how right, and how generalizable it would be, yet."
At least in the eyes of Hutchinson and Blemker, these are not "home runs." Are
they interesting? Yes. Deserving of further investigation? Absolutely. But the
therapeutic benefits of fascial manipulation remain too poorly understood to
inform therapeutic interventions.

"Once you say something is not well known," Hutchinson says, "then as far as
science is concerned, as far as evidence-based medicine is concerned, that's
where you stop. You don't elevate it to some other level of significance."
Ingraham, for his part, draws a similar conclusion:
Fascia is biologically interesting! All biology is. But clinical relevance is the
central question of this article: if fascia science cannot actually improve
treatment, then it makes no sense to be fascinated by it in a therapeutic context.

The New Age Tradition vs. Science

Where do new age ideas about fascia originate? To hear Findley tell it, therapies
exist that have targeted fascia for thousands of years. But his personal views on
fascia, and the ethos of the Fascia Research Congress as a whole, have been
informed in large part by the writings of Andrew Taylor Still, the 19th Century
founder of osteopathic medicine. Writes Findley, in an essay titled "The Fascia
Research Congress from the 100 year perspective of Andrew Taylor Still":
I was fortunate in 1988 to inherit the library of more than 100 journal articles
which included the writings on fascia by AT Still. I knew there was important
information there, but did not examine them closely until an Osteopathic student
was doing a research rotation with me in 2012. The first three fascia congresses
thus evolved from 2007 to 2012 without the benefit of guidance from Dr Still, but
remarkably cover most of the concepts he proposed in his writings.

The essay reveals how much Findley's work is influenced by Still's osteopathic
philosophy, which he summarizes in four points:
1. The human body functions as a total biologic unit
2. The body possesses self-healing and self-regulatory mechanisms
3. Structure and function are interrelated, and
4. Abnormal pressure in one part of the body produces abnormal pressures and
strains upon other parts of the body.
Sampson says Findley's references to Still (pictured above, photo via LOC), and
other anatomical concepts that developed in the 1800s, reflect an anachronistic
approach to science.
"Still and his contemporaries had concepts that they described in terms of
wholeness, proper function, and the like," says Sampson. These are words that
accommodate innumerable little reactions, associations and constructions of the
human body, and of life in general. The problem, says Sampson, is that when we
talk about "wholeness," "proper function," "total function," "intact function" and
so forth, we do so with words "whose definitions we understand, but whose
underlying meanings we do not."

The Future of Fascia Research

Sampson comments on the limitations of language are especially timely, in light
of an ongoing debate within the field of fascia research. A recent issue of
the Journal of Bodywork and Movement devoted no fewer than six editorials to
the lack of agreement over what should or should not be referred to as "fascia."
To hear contributor Paolo Tozzi tell it, "there is no area of anatomical science

stigmatized by a larger divergent terminology as the one regarding fascia-related

connective tissue."
The issue of nomenclature was first brought to the table in an editorial by
University of Padova anatomist Carla Stecco, first author of one of the "home
run" studies sent to me by Schleip. She summarizes the problem with fascia
nomenclature as follows:
Fascia is often described as an ubiquitous tissue that permeates the human body,
organized as a three-dimensional network that surrounds, supports, suspends,
protects, connects and divides muscular, skeletal and visceral components of the
body. If we agree with this wide definition [Ed. Note: There are definitions still
more expansive than this one. See this popular definition, which classifies even
cartilage and bone as fascia.], then fasciae could include every connective tissue,
loose or dense, regular and irregular, with so many functions that would be
impossible to study and understand from a scientific point of view.
Responses from Stecco's fellow contributors on the matter range
from supportive:
"...inconsistent usage of anatomical terms makes it difficult to compare results
across research studies and to draw generalized conclusions. This is a serious
problem that will slow progress if not addressed. "
- University of Vermont neuroendocrinologist Helene Langevin (another
researcher cited by Schleip)
To, at times, borderline dismissive:
In the absence of another word, 'fascia' has a popular meaning that is in such
widespread use that we should 'go with it' for our communication with the world
of the public and large groups of practitioners.

-Tom Myers, author of Anatomy Trains, a popular guide to myofascial therapy

for manual and movement therapists
The most telling editorial of all, however, may be the one penned by Leon
Chaitow, the journal's Editor in Chief, titled "Can We Describe What We Do?", in
which he notes:
It seems... that detail of a single manual method might need to incorporate a
dozen or more descriptors. And since, in many manual treatment settings a range
of methods are involved in a single session precise replication, based on such
descriptions, would at times be extremely difficult, if not impossible, to realise.
The upshot? No. Bodyworkers, including those who purport to target fascia in a
therapeutic fashion, cannot describe what they do. At least not currently. " This
might not be an impossible task, but it would certainly require focused attention
from many for a considerable time," concludes Chaitow (who, it bears
mentioning, sits on the Board of Directors of the Ida P. Rolf Research
Foundation, as well as its Science Advisory Council). "Are we prepared for such a
task?"
Sampson says Chaitow, Schleip, Findley, and anyone else who straddles the
divide between researcher and alternative practioner must be, if they are to
elevate the field of therapeutic fascial manipulation to a new plane of biomedical
legitimacy.
"I applaud them," says Sampson, noting that he took away more from the First
International Fascia Research Congress than he had anticipated. "I spent
considerable time reviewing the research that was presented, and learned a lot
from it." But demonstrating the therapeutic benefits of fascial manipulation,
which he concedes is "an interesting concept," cannot be accomplished through
language and thought alone. It has to be through mathematics, and statistics,

observation, repeated observation and validation. It must be based in

reproducibility, "not feedback into your fingers."
Sampson says that attempting to unite traditional and alternative medicines an
undertaking he initially condemned has put Findley in a unique position to
explore the divide in alternative medicine. "Dr. Findley strikes me as a
reasonable, sensible person" he says "one who could keep the organization on
track," even as "attempts to find connections to function and therapy fail." Such
an endeavor, he says "could lead one to see the futility of extending connections
too far beyond reasonable probability."
"Tell doctor Findley and his crew that 'it's tough,'" Sampson says. "And i don't
mean 'tough titties.' I mean to say that it is very hard."
"That's life," he says. "That's science. We do the best we can."

References
Papers that Robert Schleip recommends on fascia:
1.

Huijing "Epimuscular myofascial force transmission: a historical review

and implications for new research"

2.

Tesarz et al. "Sensory innervation of the thoracolumbar fascia in rats and

humans. Neuroscience."

3.

Langevin et al. "Reduced thoracolumbar fascia shear strain in human

chronic low back pain"

4.

Schilder et al. "Sensory findings after stimulation of the thoracolumbar

fascia with hypertnoic saline suggest its contribution to low back pain"

5.

Corey et al. "Stretching of the back improves gait, mechanical sensitivity

and connective tissue inflammation in a rodent model"

6.

Stecco et al. "Ultrasonography in myofascial neck pain: randomized

clinical trial for diagnosis and follow-up"