LUIGI STECCO

CARLA STECCO

FASCIAL
MANIPULATION

for Internal Dysfunctions

English Edition by
Julie Ann Day

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including, but not limited to, photocopying, recording, taping, Web distribution,
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without the written permission of the publisher.

ISBN 978-88-299-2328-1

Printed in Italy
2013, by Piccin Nuova Libraria S.p.A. - Padova

CONTENTS

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . .XVII
Basic Principles . . . . . . . . . . . . . . . . . . . . . . . XIX
Fasciae of the voluntary muscles . . . . . . . . . XX
Fasciae of the involuntary muscles . . . . . .XXII

Part I
THE ORGAN-FASCIAL UNIT
Chapter 1
ANATOMY OF THE ORGAN-FASCIAL UNIT . 3
The cavities of the trunk . . . . . . . . . . . . . . . . . 3
The organ-fascial unit . . . . . . . . . . . . . . . . . . . . . . 7
Nomenclature of the o-f unit . . . . . . . . . . . . . . . . . 8
O-f units in the head . . . . . . . . . . . . . . . . . . . . 10
Chapter 2
EVOLUTION OF THE ORGAN-FASCIAL
UNIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Evolution of the parenchyma . . . . . . . . . . . . . . . 11
Formation of the visceral o-f units . . . . . . . . . 14
Formation of the vascular o-f units . . . . . . . . 14
Formation of the glandular o-f units . . . . . . . 16
Evolution of investing fasciae . . . . . . . . . . . . . . . 17
Evolution of the enteric system. . . . . . . . . . . . . . 20

From anatomy to pathology . . . . . . . . . . . . . . 42

Node points . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Chapter 5
LOCAL REFERRED PAIN . . . . . . . . . . . . . . . 45
Deep pain and parietal pain . . . . . . . . . . . . . . 45
From external to internal:
somato-visceral pain . . . . . . . . . . . . . . . . . . . . . . 46
From internal to external:
viscero-somatic pain . . . . . . . . . . . . . . . . . . . . . . 49
Anatomical explanation of viscero-somatic
pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Assessment chart for internal dysfunction . . . . . 53
History taking and Data . . . . . . . . . . . . . . . . . 53
Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
 9HULFDWLRQ . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Chapter 3
PHYSIOLOGY OF THE ORGAN-FASCIAL
UNIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
The courage to change . . . . . . . . . . . . . . . . . . 23
The intramural system and segmental
peristalsis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
The extramural system and organ-fascial unit
peristalsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Chapter 6
THE CERVICAL TENSILE STRUCTURE . 59
Visceral o-f unit in the neck . . . . . . . . . . . . . . . . 62
Fasciae of the vi-cl o-f unit . . . . . . . . . . . . . . 62
Functions of the vi-cl o-f unit . . . . . . . . . . . . 63
Dysfunctions of the vi-cl o-f unit . . . . . . . . . . 64
Vascular o-f unit in the neck . . . . . . . . . . . . . . . . 64
Fasciae of the va-cl o-f unit . . . . . . . . . . . . . . 64
Functions of the va-cl o-f unit . . . . . . . . . . . . 65
Dysfunctions of the va-cl o-f unit . . . . . . . . . 65
Glandular o-f unit in the neck . . . . . . . . . . . . . . . 65
Fasciae of the gl-cl o-f unit . . . . . . . . . . . . . . 65
Functions of the gl-cl o-f unit . . . . . . . . . . . . 66
Dysfunctions of the gl-cl o-f unit . . . . . . . . . . 67
Treatment of the cervical tensile structure . . . . . 67
Clinical case study . . . . . . . . . . . . . . . . . . . . . 70

Chapter 4
TENSILE STRUCTURES . . . . . . . . . . . . . . . . 33
To contain without compressing . . . . . . . . . . 33
Tensile structures . . . . . . . . . . . . . . . . . . . . . . . . 33
Tensile structures in civil engineering . . . . . . 36
Tensile structures and body cavities . . . . . . . . . . 38
Antero-posterior (AP) tensors . . . . . . . . . . . . 38
Latero-lateral (LL) tensors . . . . . . . . . . . . . . . 38
Oblique (OB) tensors . . . . . . . . . . . . . . . . . . . 39
From anatomy to the treatment . . . . . . . . . . . . . . 40

Chapter 7
THE THORACIC TENSILE STRUCTURE . 71
Visceral o-f unit in the thorax . . . . . . . . . . . . . . . 74
Fasciae of the vi-th o-f unit . . . . . . . . . . 74
Functions of the vi-th o-f unit . . . . . . . . . . . . 74
Dysfunctions of the vi-th o-f unit. . . . . . . . . . 76
Vascular o-f unit in the thorax . . . . . . . . . . . . . . . 76
Fasciae of the va-th o-f unit . . . . . . . . . . . . . . 76
Functions of the va-th o-f unit . . . . . . . . . . . . 77
Dysfunctions of the va-th o-f unit . . . . . . . . . 78

VI

CONTENTS

Glandular o-f unit in the thorax . . . . . . . . . . . . . . 78

Fasciae of the gl-th o-f unit . . . . . . . . . . . . . . 78
Functions of the gl-th o-f unit . . . . . . . . . . . . 80
Dysfunctions of the gl-th o-f unit . . . . . . . . . 80
Treatment of the thoracic tensile structure . . . . . 80
Clinical case study . . . . . . . . . . . . . . . . . . . . . 83
Chapter 8
THE LUMBAR TENSILE STRUCTURE . . . 85
Visceral o-f unit in the lumbar region . . . . . . . . . 88
Fasciae of the vi-lu o-f unit . . . . . . . . . . . . . . 88
Functions of the vi-lu o-f unit . . . . . . . . . . . . 88
Dysfunctions of the vi-lu o-f unit. . . . . . . . . . 89
Vascular o-f unit in the lumbar region. . . . . . . . . 90
Fasciae of the va-lu o-f unit . . . . . . . . . . . . . . 90
Functions of the va-lu o-f unit . . . . . . . . . . . . 91
Dysfunctions of the va-lu o-f unit . . . . . . . . . 92
Glandular o-f unit in the lumbar region . . . . . . . 92
Fasciae of the gl-lu o-f unit . . . . . . . . . . . . . . 92
Functions of the gl-lu o-f unit . . . . . . . . . . . . 93
Dysfunctions of the gl-lu o-f unit. . . . . . . . . . 93
Treatment of the lumbar tensile structure . . . . . . 94
Clinical case study . . . . . . . . . . . . . . . . . . . . . 96
Chapter 9
THE PELVIC TENSILE STRUCTURE . . . . 97
Visceral o-f unit in the pelvis . . . . . . . . . . . . . . 100
Fasciae of the vi-pv o-f.unit . . . . . . . . . . . . . 100
Functions of the vi-pv o-f unit . . . . . . . . . . . 101
Dysfunctions of the vi-pv o-f unit . . . . . . . . 102
Vascular o-f unit in the pelvis . . . . . . . . . . . . . . 103
Fasciae of the va-pv o-f unit . . . . . . . . . . . . 103
Functions of the va-pv o-f unit. . . . . . . . . . . 103
Dysfunctions of the va-pv o-f unit . . . . . . . . 104
Glandular o-f unit in the pelvis . . . . . . . . . . . . . 104
Fasciae of the gl-pv o-f unit . . . . . . . . . . . . . 104
Functions of the gl-pv o-f unit . . . . . . . . . . . 106
Dysfunctions of the gl-lu o-f unit. . . . . . . . . 106
Treatment of the pelvic tensile structure . . . . . . 107
Clinical case study . . . . . . . . . . . . . . . . . . . . 109
Chapter 10
THE CEPHALIC TENSILE STRUCTURE . . 111
The o-f unit for sight . . . . . . . . . . . . . . . . . . . . . 114
Fasciae of the o-f unit for sight . . . . . . . . . . 114
Functions of the o-f unit for sight . . . . . . . . 114
Dysfunctions of the o-f unit for sight . . . . . . 115
The o-f unit of stereopsis. . . . . . . . . . . . . . . . . . 115
Fasciae of the o-f unit of stereopsis . . . . . . . 115
Functions of the o-f unit of stereopsis . . . . . 115
Dysfunctions of the o-f unit of stereopsis . . 115
The o-f unit for hearing . . . . . . . . . . . . . . . . . . . 116
Fasciae of the o-f unit for hearing . . . . . . . . 116
Functions of the o-f unit for hearing . . . . . . 117
Dysfunctions of the o-f unit for hearing. . . . 117
The o-f unit of statokinetics . . . . . . . . . . . . . . . 117

Fasciae of the o-f unit of statokinetics . . . . . 117

Functions of the o-f unit of statokinetics . . . 117
Dysfunctions of the o-f unit ofstatokinetics . 117
The o-f unit for olfaction . . . . . . . . . . . . . . . . . . 117
Fasciae of the o-f unit for olfaction . . . . . . . 117
Functions of the o-f unit for olfaction . . . . . 118
Dysfunctions of the o-f unit for olfaction . . 118
The o-f unit for taste . . . . . . . . . . . . . . . . . . . . . 119
Fasciae of the o-f unit for taste. . . . . . . . . . . 119
Functions of the o-f unit for taste . . . . . . . . . 119
Dysfunctions of the o-f unit for taste . . . . . . 119
Treatment of the cephalic tensile structure . . . . 119
Clinical case study . . . . . . . . . . . . . . . . . . . . 121
Fascial Manipulation for Internal Dysfunctions:
indications for segmental dysfunctions . . . . 122
Part II
THE APPARATUS-FASCIAL SEQUENCES
Chapter 11
ANATOMY OF THE APPARATUS-FASCIAL
SEQUENCES . . . . . . . . . . . . . . . . . . . . . . . 125
Sequences and tensors . . . . . . . . . . . . . . . . . 125
The apparatus-fascial sequences . . . . . . . . . 128
Visceral sequence . . . . . . . . . . . . . . . . . . . . . . . 128
Vascular sequence . . . . . . . . . . . . . . . . . . . . . . . 130
Glandular sequence . . . . . . . . . . . . . . . . . . . . . . 131
Receptor sequence . . . . . . . . . . . . . . . . . . . . . . 134
Chapter 12
EVOLUTION OF THE APPARATUS-FASCIAL
SEQUENCES . . . . . . . . . . . . . . . . . . . . . . . 137
Apparatus-fascial sequences and nerves
from CNS . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Evolution of the three internal
fascial sequences . . . . . . . . . . . . . . . . . . . . . . . . 140
Evolution of the septum transversum . . . . . 141
Evolution of the three autonomic systems . . . . 143
Parasympathetic system . . . . . . . . . . . . . . . . 144
Orthosympathetic system. . . . . . . . . . . . . . . 144
Adenosympathetic system . . . . . . . . . . . . . . 145
Chapter 13
CATENARIES AND DISTAL TENSORS . . 149
Physiology of the internal fascial sequences . . 149
The catenary . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Catenaries and tensile structures of the trunk . . 153
Catenaries and distal tensors . . . . . . . . . . . . . . . 155
Semiconductors and Piezoelectricity . . . . . . 157
The assessment chart for the apparatus . . . . . . . 158
Chapter 14
DISTAL REFERRED PAIN . . . . . . . . . . . . . . 161
From segmental to multisegmental pain . . . 161

VII

CONTENTS

Four pathways of distal referred pain . . . . . 164

External compensations . . . . . . . . . . . . . . . . . . 164
Somato-somatic referred pain . . . . . . . . . . . 164
Somato-visceral referred pain . . . . . . . . . . . 165
Internal compensations . . . . . . . . . . . . . . . . . . . 166
Viscero-visceral referred pain . . . . . . . . . . . 166
Viscero-somatic referred pain . . . . . . . . . . . 168
A parallel with acupuncture . . . . . . . . . . . . . . . 169
Names of the meridians and internal organs 170
The three energy subcircuits . . . . . . . . . . . . 170
Points on the trunk and distal points . . . . . . 171
Acupuncture and auriculotherapy . . . . . . . . 172
Chapter 15
THE VISCERAL SEQUENCE . . . . . . . . . . . 175
Anatomy of the visceral sequence . . . . . . . . 175
Respiratory Apparatus (ARE) . . . . . . . . . . . . . . 178
Functions of the respiratory apparatus . . . . . 178
Dysfunctions of the respiratory apparatus . . 178
Digestive Apparatus (ADI) . . . . . . . . . . . . . . . . 179
Functions of the digestive apparatus . . . . . . 181
Dysfunctions of the digestive apparatus . . . 182
Treatment of the visceral sequence . . . . . . . . . . 183
History taking and Data . . . . . . . . . . . . . . . . 183
Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . 184
 3DOSDWLRQYHULFDWLRQ . . . . . . . . . . . . . . . . . . 184
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Clinical case study . . . . . . . . . . . . . . . . . . . . 186
Chapter 16
THE VASCULAR SEQUENCE . . . . . . . . . . 187
Anatomy of the vascular sequence . . . . . . . 187
Circulatory apparatus (ACI) . . . . . . . . . . . . . . . 190
Functions of the circulatory apparatus . . . . . 190
Dysfunctions of the circulatory apparatus . . 192
Urinary Apparatus (AUN). . . . . . . . . . . . . . . . . 193
Functions of the urinary apparatus. . . . . . . . 193
Dysfunctions of the urinary apparatus . . . . . 195
Treatment of the vascular sequence . . . . . . . . . 196
History taking and Data . . . . . . . . . . . . . . . . 196
Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . 196
 3DOSDWLRQ9HULFDWLRQ . . . . . . . . . . . . . . . . . . 196
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Clinical case study . . . . . . . . . . . . . . . . . . . . 198
Chapter 17
THE GLANDULAR SEQUENCE . . . . . . . . 199
Anatomy of the glandular sequence. . . . . . . 199
Endocrine Apparatus (AEN) . . . . . . . . . . . . . . . 202
Functions of the endocrine apparatus . . . . . 202
Dysfunctions of the endocrine apparatus . . . 203
Haematopoietic Apparatus (AHE) . . . . . . . . . . 205
Functions of the haematopoietic apparatus . 206
Dysfunctions of the haematopoietic
apparatus . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Treatment of the glandular sequence . . . . . . . . 209

History taking and Data . . . . . . . . . . . . . . . . 210
Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . 210
 3DOSDWLRQYHULFDWLRQ . . . . . . . . . . . . . . . . . . 210
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Clinical case study . . . . . . . . . . . . . . . . . . . . 212
Chapter 18
THE RECEPTOR SEQUENCE . . . . . . . . . . 213
Anatomy of the receptor sequence. . . . . . . . 213
Photoreceptor apparatus (APR) . . . . . . . . . . . . 216
Functions of the photoreceptor apparatus . . 216
Dysfunctions of the photoreceptor apparatus. . 217
Mechanoreceptor apparatus (AMR) . . . . . . . . . 217
Functions of the mechanoreceptor
apparatus . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Dysfunctions of the mechanoreceptor
apparatus . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Chemoreceptor apparatus (ACR) . . . . . . . . . . . 219
Functions of the chemoreceptor apparatus . . 219
Dysfunctions of the chemoreceptor
apparatus . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Treatment of the receptor sequence . . . . . . . . . 220
History taking and Data . . . . . . . . . . . . . . . . 220
Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . 220
 3DOSDWLRQYHULFDWLRQ . . . . . . . . . . . . . . . . . . 220
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Synergies of the receptor sequence . . . . . . . 223
Clinical case study . . . . . . . . . . . . . . . . . . . . 223
Fascial Manipulation for Internal Dysfunctions:
indications for global dysfunctions . . . . . . . 225
Part III
THE SYSTEMS
Chapter 19
ANATOMY OF THE SYSTEMS . . . . . . . . . 229
 6\VWHPVDQGVXSHUFLDOIDVFLD . . . . . . . . . . . 229
Reactions of the systems to stress . . . . . . . . . . . 234
Stress and the ANS . . . . . . . . . . . . . . . . . . . . . . 235
Stress and the Orthosympathetic system . . . 235
Stress and the Parasympathetic system . . . . 236
Stress and the Adenosympathetic system . . 236
Systemic and multisystemic pathologies . . . 237
Chapter 20
EVOLUTION OF THE SYSTEMS . . . . . . . . 239
External and internal components
of systems . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Evolution of the lymphatic-immune system . . . 242
Evolution of the cutaneous-thermoregulatory
system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
Evolution of the adipose-metabolic system . . . 243
Evolution of autonomic ganglia . . . . . . . . . . . . 243

VIII

CONTENTS

Chapter 21
THE QUADRANTS OF THE SUPERFICIAL
FASCIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
 7KHVXSHUFLDOIDVFLD . . . . . . . . . . . . . . . . . . 249
The quadrants . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Transverse retinacula of the
 VXSHUFLDOIDVFLD . . . . . . . . . . . . . . . . . . . . . 252
Longitudinal retinacula of the
 VXSHUFLDOIDVFLD . . . . . . . . . . . . . . . . . . . . . 254
 7KHTXDGUDQWVRIWKHVXSHUFLDOIDVFLD . . . . 255
The Assessment Chart for the systems . . . . . . . 257
Compilation of the Assessment Chart
for the systems . . . . . . . . . . . . . . . . . . . . . . . 259
History taking and Data . . . . . . . . . . . . . . . . 259
Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . 260
 3DOSDWLRQYHULFDWLRQ . . . . . . . . . . . . . . . . . . 260
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Chapter 22
THE LYMPHATIC-IMMUNE SYSTEM. . . 261
The lymphatic-immune system (SLI)
and stress . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
The lymphatic system . . . . . . . . . . . . . . . . . . . . 264
Functions of the lymphatic system . . . . . . . 264
Dysfunctions of the lymphatic system . . . . . 264
The immune system . . . . . . . . . . . . . . . . . . . . . 265
Functions of the immune system . . . . . . . . . 266
Dysfunctions of the immune system . . . . . . 267
Treatment of the SLI . . . . . . . . . . . . . . . . . . . . . 267
Manipulation of the Immune System. . . . . . 268
Mobilisation of the lymphatic system . . . . . 270
Clinical case study . . . . . . . . . . . . . . . . . . . . 271
Chapter 23
THE ADIPOSE-METABOLIC SYSTEM . . 273
The adipose-metabolic system (SAM)
and stress . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
The adipose system . . . . . . . . . . . . . . . . . . . . . . 276
Functions of the adipose system . . . . . . . . . 276
Dysfunctions of the adipose system. . . . . . . 276
The metabolic system . . . . . . . . . . . . . . . . . . . . 278
Functions of the metabolic system. . . . . . . . 278
Dysfunctions of the adipose system. . . . . . . 279
Treatment of the SAM . . . . . . . . . . . . . . . . . . . 279
History taking and Data . . . . . . . . . . . . . . . . 279
Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . 280
 3DOSDWLRQYHULFDWLRQ . . . . . . . . . . . . . . . . . . 280
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Clinical case study . . . . . . . . . . . . . . . . . . . . 282
Chapter 24
THE CUTANEOUS-THERMOREGULATORY
SYSTEM . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
The cutaneous- thermoregulatory system (SCT)
and stress . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

The cutaneous system and the

peripheral nervous system (PNS) . . . . . . . . 286
Functions of the cutaneous system . . . . . . . 286
Dysfunctions of the cutaneous system . . . . . 288
The thermoregulatory system . . . . . . . . . . . . . . 289
Functions of the thermoregulatory system. . 289
Dysfunctions of the thermoregulatory system . 289
Treatment of the SCT and PNS. . . . . . . . . . . . . 290
Clinical case study . . . . . . . . . . . . . . . . . . . . 297
Chapter 25
NEURO-PSYCHOGENIC SYSTEM . . . . . . 299
Reactions of the nervous and psychogenic
systems to stress . . . . . . . . . . . . . . . . . . . . . . 299
The central nervous system (CNS) . . . . . . . . . . 302
Functions of the central nervous system . . . 302
Dysfunctions of the central nervous system 302
Treatment of the CNS . . . . . . . . . . . . . . . . . . . . . . . 303
History taking and Data . . . . . . . . . . . . . . . . 303
Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . 303
 9HULFDWLRQ . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
The psychogenic system . . . . . . . . . . . . . . . . . . 305
Functions of the psychogenic system . . . . . 306
Dysfunctions of the psychogenic system . . . 307
Treatment of the SPS . . . . . . . . . . . . . . . . . . . . 308
History taking and Data . . . . . . . . . . . . . . . . 308
Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . 308
 3DOSDWLRQYHULFDWLRQ . . . . . . . . . . . . . . . . . . 308
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Clinical case studies . . . . . . . . . . . . . . . . . . . 311
Fascial Manipulation for Internal Dysfunctions:
indications for systemic dysfunctions . . . . . 312
Chapter 26
SYNOPTIC TABLES . . . . . . . . . . . . . . . . . . . 313
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

ACKNOWLEDGEMENTS

A number of the anatomical images in this book

are by my daughter Carla, an orthopaedic surgeon
and assistant professor of anatomy at the University
of Padova. These photographs have been taken both
in the anatomy department of the Padova University,
as well as at the Ren Descartes University in Paris.
My son Antonio, a medical doctor specialised in
Physical Medicine and Rehabilitation at the University of Padova, has taken some of the anatomical
photographs. These photographs were taken at the
University of New York in collaboration with Dr.
Sushama Rich, Chair of Anatomy at the Touro College of Osteopathic Medicine.
I would like to thank Dr. M. Piccin for allow-

ing me to use some illustrations from Istituzioni di

Anatomia delluomo by Chiarugi G. and Bucciante
L., as well as from Anatomia Umana by Esposito
V. et al.
Prof. W. Hammer, who introduced Fascial Manipulation into the United States, has also given me
permission to use some photographs from his book
Functional Soft-Tissue Examination and Treatment by Manual Methods.
The concepts involved in tensile structures, catHQDULHV DQG WHQVRUV KDYH EHHQ FODULHG WKDQNV WR
consultations with Giuseppe Costa, who is an engineer.
LUIGI STECCO

With special thanks to Lawrence Steinbeck and Rodney Jackon for their
English language assistance throughout and to Rena Margulis for her helpful
advice about English acupuncture terminology and more.

ABBREVIATIONS

ACI
ACR
ADI
AEN
AF
AFR
AHE
AMR
an
an-la
an-la- q
an-me
an-me-q
AP
ARE
AUN
BL
ca
cp
cu
CNS
CV
cx
di
FMID
GB
ge
gl-cl
gl-lu
gl-pv
gl-th
GV
HT
hu
KI
la
LI
LL

Apparatus, circulatory
App., chemoreceptor (taste-smell)
Apparatus, digestive
Apparatus, endocrinal
Apparatus-fascial (sequence)
Apparatus, photoreceptor (sight)
Apparatus, haematopoietic
Apparatus, mechanoreceptor (hearing)
Ante, anterior part
Diagonal or ante-latero tensor
Ante-latero quadrant - cubitus, carpus, ...
Diagonal or ante-medio tensor
Ante-medio quadrant
Antero-posterior tensors
Apparatus, respiratory
Apparatus, urinary
Bladder Meridian
Carpus, wrist
Caput, head
Cubitus, elbow
Central Nervous System
Conception Vessel, extraordinary meridian
Coxa, thigh
'LJLWQJHU
Fascial Manipulation for Internal Dysfunctions
Gall Bladder Meridian
Genu, knee
Glandular o-f unit in the neck (collum)
Glandular o-f unit in the lumbi
Glandular o-f unit in the pelvis
Glandular o-f unit in the thorax
Governor Vessel, extraordinary meridian
Heart Meridian
Humerus, glenohumeral joint
Kidney Meridian
Latero, lateral part
Large Intestine Meridian
Latero lateral tensors

LR
LU
me
mf
OB
of
PC
pe
PNS
re-la-q
re-la-Q
re
re-la
re-me
SAM
sc
SCT
SI
SLI
SPS
SP
ST
ta
TCL
TCP
TLU
TPV
TTH
o-f unit
va-cl
va-lu
va-pv
va-th
vi-cl
vi-lu
vi-pv
vi-th

Liver Meridian
Lung Meridian
Medio, medial part
Myofascial
Tensors of oblique tensile structure
Organ fascial (unit)
Pericardium Meridian
Pes, forefoot
Peripheral Nervous System
retro-latero quadrant (with mobilization)
retro-latero Quadrant (with pinching)
Retro, posterior
Diagonal or retro-latero tensor
Diagonal or retro-medio tensor
System, adipose metabolic
Scapula, shoulder girdle
System, cutaneous thermoregulatory
Small Intestine Meridian
System, lymphatic - immune
System, psychogenic
Spleen Meridian
Stomach Meridian
Talus, ankle
Tensile structure, cervical
Tensile structure, cephalic
Tensile structure, lumbar
Tensile structure, pelvis
Tensile structure, thorax
organ-fascial unit
Vascular o-f unit in the collum (neck)
Vascular o-f unit in the lumbi
Vascular o-f unit in the pelvis
Vascular o-f unit in the thorax
Visceral o-f unit in the collum
Visceral o-f unit in the lumbi
Visceral o-f unit in the pelvis
Visceral o-f unit in the thorax

FOREWORD

I was more than happy to write this foreword to

Fascial Manipulation for Internal Dysfunctions by
Luigi Stecco, because I have always encouraged
manual therapies dealing with internal dysfunctions. My enthusiasm derives from the extraordinary results I obtain using Visceral Manipulation,
the method I have developed from my experiences
as an osteopath. In recent years, many scholars have
shifted their attention from the organs to their surURXQGLQJIDVFLDHEXWWKLVLVWKHUVWERRNWRSURYLGH
a overview of all the internal fasciae. Furthermore,
LWSURSRVHVDELRPHFKDQLFDOPRGHOWKDWGHQHVWKH
VSHFLFUHODWLRQVEHWZHHQRUJDQVIDVFLDHDQGPXVFXORVNHOHWDO V\VWHP DQG LV VXSSRUWHG E\ EHDXWLIXO
images of dissection that help to comprehend these
relations.
7KLV ERRN H[DPLQHV DOO IDFHWV RI WKH IDVFLD
showing how this is the only tissue of the human
ERG\WKDWPRGLHVLWVFRQVLVWHQF\ZKHQXQGHUVWUHVV
(plasticity), yet it is capable of regaining its elasticity when subjected to manipulation (malleability)
I particularly appreciate the concept of the tensile structures that explains perfectly how different
WUXQNFDYLWLHVFDQLQWHUDFWZLWKWKHLQWHUQDORUJDQV
,QIDFWWKHIDVFLDHRIWKHWUXQNDUHDUUDQJHGDFFRUGing to the principles of tensile structures, allowing
IRUDPSOHWUXQNPRYHPHQWVZLWKRXWLQWHUIHULQJZLWK
internal organ function. This concept effectively
shifts the therapists attention from the organ itself
to its container, and treatment can then focus on
recreating a suitable environment within which the
organs can move according to their physiological
rhythms.
,QRXUERRNVZHKDYHDOZD\VVXVWDLQHGWKHLPportance of the mobility and motility of the interQDORUJDQV1RZWKLVERRNE\6WHFFRPDLQWDLQVWKH
guiding principles of the fasciae, but it extends it
further to the apparatus and systems.
Initially, the reader may be somewhat disconcerted by the numerous different manual ap-

proaches that are proposed. However, once these

approaches have been studied it will be comprehensible that they are all useful for the treatment of
the clinical variations that any single patient may
present.
Based on these considerations, one can understand that this manual by Stecco represents a useful guide for all therapists interested in treating internal dysfunctions without the use of medications
VXFKDVDQWDFLGVSDLQNLOOHUVDQWLVSDVPRGLFVHWF
ZKLFKFDQRIWHQPDVNWKHVLJQVDQGV\PSWRPVH[pressed by the human body.
/DVW , ZRXOG OLNH WR XQGHUOLQH WKH FODULW\ ZLWK
which Stecco has described the autonomic system
DQG LWV DIOLDWLRQV ZLWK WKH LQWHUQDO IDVFLDH 6HHQ
in this light, the autonomic system no longer represents an incomprehensible chaos. Moreover, it
becomes a sort of peripheral brain, regulating the
IXQFWLRQVRIWKHGLIIHUHQWRUJDQVSHUIHFWO\WKDQNVWR
its interactions with the visceral fasciae.
I sincerely hope that therapists, medical doctors,
RVWHRSDWKVFKLURSUDFWRUVDQGUHVHDUFKHUVZLOOWDNH
WKHSURSRVDOVSUHVHQWHGLQWKLVERRNLQWRFRQVLGHUation, both in order to realise the potential our hands
possess to cure many internal dysfunctions, as well
as to ascertain the validity of these ideas.
Fascial Manipulation for Internal Dysfunctions
certainly provides a simple but effective biomechanical model for guiding the therapists hand in
unravelling the chaos of fascial anatomy. To quote
the Fascial Manipulation motto: manus sapiens poWHQVHVWDNQRZOHGJHDEOHKDQGLVSRWHQW

JP BARRAL
Diploma in Osteopathic Medicine European School
of Osteopathy, Maidstone, England.
and Faculty of Medicine, Paris du Nord
(Department of Osteopathy and Manual Medicine).

To my wife Lena, for all her support

INTRODUCTION

This book presents a series of treatment approaches for numerous dysfunctions of the internal
apparatus and systems. An apparatus is formed
by individual organs that collaborate together for a
single function. A system is the union of parts that
are organised in a similar manner and which extend
throughout the entire body.
9DULRXV RVWHRSDWKLF WHFKQLTXHV UVW DQG IRUHmost Visceral Manipulation by Barral1, describe
VSHFLF PDQXDO DSSURDFKHV WR KHOS SDWLHQWV ZLWK
internal dysfunctions.
Acupuncture is also applied to all of the problems examined in this text.
Nevertheless, the scope of this book is not to duplicate other work but to link internal dysfunctions
WRGHQVLFDWLRQVLQWKHVXSHUFLDOGHHSYLVFHUDO
vascular and glandular fasciae.
The treatment approaches presented here utilise
the same points as those used in treatments of deep
fascia but the manual techniques are different, as are
the combinations of points.
Fascial Manipulation (FM) for the musculoskeletal system acts on the muscular fascia and
the somatic (voluntary) nervous system via muscle
spindles. Fascial Manipulation for Internal Dysfunctions (FMID) aims to restore function within
the autonomic (involuntary) nervous system.
For dysfunctions within the components of the
musculoskeletal system (joints, muscles, ligaments,
etc.), strategies suitable for rebalancing the myofascial (MF) unit, the MF sequence, or the MF spiral
are employed.
)RUG\VIXQFWLRQVZLWKLQWKHERG\VLQWHUQDOFRPSRnents, strategies to either rebalance tensile structures
that contains organ-fascial units (o-f units) or to restore
XLGLW\ZLWKLQTXDGUDQWVRIWKHVXSHUFLDOIDVFLDFRQnected to the systems (see p. 316) are applied.
FMID acts on both internal organ dysfunctions
and dysfunctions of vessels, glands and systems.
)RU WKLV UHDVRQ WKH WHUP LQWHUQDO G\VIXQFWLRQV
1

Our experience has convinced us that it is possible to

improve the function of an organ through manipulation, reestablishing, to a certain degree, its characteristic movement
(Barral J.P., 1988).

KDV EHHQ XVHG UDWKHU WKDQ YLVFHUDO G\VIXQFWLRQV

which would have been too limiting.
FMID does not act directly on the fascia of the
RUJDQVEXWRQWKHIDVFLDRIWKHLUFRQWDLQHUQDPHO\
the trunk wall. Similarly, acupuncture treats numerous internal dysfunctions by inserting needles into
WKH VXSHUFLDO DQG GHHS IDVFLDH RI WKH WUXQN ZDOO
but not into the fascia of an internal organ.
This text is divided into three parts.
In the UVWSDUW, single organs and their connections with their surrounding fasciae are discussed.
Together these structures form o-f units. Intramural and extramural autonomic ganglia of the enteric
system are inserted within the o-fXQLWVIDVFLDH2Ugan peristalsis can be restored by acting on the tensile structures (see Ch. 4) forming the four segments
(neck, thorax, lumbar, and pelvis) of the trunk wall.
In the VHFRQG SDUW, the apparatus are studied.
Fascial sequences connect the organs of a single apparatus together. Extensive autonomic nerve plexuses are arranged along these apparatus-fascial sequences. The treatment of apparatus focuses on the
forces that invest the entire trunk wall (catenaries
and distal tensors; see Ch.13).
In the WKLUG SDUW, the systems are analysed.
Examples of systems are the nervous system, the
immune system, the thermoregulatory system and
the metabolic system. Systems are composed of internal and external components that are connected
WR WKH VXSHUFLDO IDVFLD 3UHYHUWHEUDO DQG SDUDYHUtebral autonomic ganglia modulate the activity of
the internal organs in response to variations in the
external environment. Treatment of the systems foFXVHVRQTXDGUDQWVRIWKHVXSHUFLDOIDVFLD7KHVH
TXDGUDQWV FDQ DFW DV SHULSKHUDO UHFHSWRUV IRU WKH
internal autonomic ganglia.
7KH)0PRWWRLV0DQXVVDSLHQVSRWHQVHVW$
knowledgeable hand is powerful). The more a therDSLVWV KDQG LV VXSSRUWHG E\ VFLHQWLF NQRZOHGJH
the more effective it will be.
$WKHUDSLVWVKDQGZLOORQO\EHDEOHWRWUHDWLQWHUnal dysfunctions appropriately after comprehending
the importance of the fasciae in the physiology of
organ-fascial units, apparatus, and systems.

XVIII

INTRODUCTION

Naturally, the manual approach itself is also important. Results can only be obtained if one treats:
GHQVLFDWLRQVZLWKVHQVLWLYLW\DQGQRWZLWKYLRlence
DOWHUHGRUGHQVLHGSRLQWVXQWLOWKH\UHVROYH
WKH FRUUHFW IDVFLDH IRU WKH SUREOHP VXSHUFLDO
or deep)
the correct combination of points (rather than
following standard protocols).
Treatment of the organ-fascial units is fairly
straightforward, because the pain or dysfunction is
localised in the same body segment that contains the
dysfunctional organ or organs.

Global treatment of the apparatus-fascial seTXHQFHV LV PRUH GLIFXOW EHFDXVH UHIHUUHG SDLQ LV
often localised in areas at a distance from the origin
of the problem.
In the treatment of the systems, the visible state
RIWKHVXSHUFLDOIDVFLDSURYLGHVXVHIXOLQIRUPDWLRQ
and the actual manual approach varies accordingly.
Fascial Manipulation is not effective when anatomical damage is advanced. However, it can yield
good results when it is applied to dysfunctional fasciae that are decompensating an organ, an apparatus
or a system.

Logo of the Fascial Manipulation method