From the paper:
A Pilot Study: Application of Fascial Manipulation© technique in chronic shoulder pain - Anatomical basis and clinical implications. By Day JA, Stecco C, Stecco A (JBMT, 2009)
Classical anatomy still relegates muscular fascia to a role of contention. Nonetheless, different hypotheses concerning the function of this resilient tissue have led to the formulation of numerous soft tissue techniques for the treatment of musculoskeletal pain. This paper presents a pilot study concerning the application of one such manual technique, Fascial Manipulation©, in 28 subjects suffering from chronic posterior brachial pain. This method involves a deep kneading of muscular fascia at specific points, termed Centres of Coordination and Centres of Fusion, along myofascial sequences, diagonals, and spirals. Visual analogue scale (Vas) measurement of pain administered prior to the first session, and after the third session was compared with a follow-up evaluation at three months. Results suggest that the application of Fascial Manipulation© technique may be effective in reducing pain in chronic shoulder dysfunctions. The anatomical substratum of the myofascial continuity has been documented by dissections and the biomechanical model is discussed.
The biomechanical model of the Fascial Manipulation© technique
The myofascial system is a three-dimensional continuum so, like others, (Busquet L 1995; Godelieve Denys-S 1996; Myers T 2001) the manual therapy technique known as Fascial Manipulation©, presents a biomechanical model to decipher the role of fascia in musculoskeletal disorders. The body is divided into fourteen segments: head, neck, thorax, lumbar, pelvis, scapula, humerus, elbow, carpus, digits, hip, knee, ankle, and foot. Each body segment is divided into six myofascial units (mf units) consisting of monoarticular and biarticular unidirectional muscle fibres, their deep fascia and the articulation that they move in one direction on one plane. A new functional classification is applied to body movements to facilitate analysis of motor variations. All movements are considered in terms of directions on spatial planes and are defined as follows: antemotion (AN), retromotion (RE), lateromotion (LA), mediomotion (ME), intrarotation (IR) and extrarotation (ER). Within each mf unit, in a precise location of the deep muscular fascia a specific point, termed Centre of Coordination (cc) is identified. Each cc is located in the point of convergence of the vectorial, muscular forces that act on the body segment during a precise movement. Biarticular muscles link unidirectional mf units to form mf sequences. One sequence is considered to monitor movement of several segments in one direction on the three planes. Sequences on the same spatial plane (sagittal, frontal, or horizontal) are reciprocal antagonists, considered to be involved in the alignment of the trunk or limbs. Other points, termed Centres of Fusion (cf), located on the intermuscular septa, retinacula, and ligaments, monitor movements in intermediate directions between two planes and three-dimensional movements. Cf can interact either along mf diagonals or in mf spirals, according to the executed movement. Musculoskeletal dysfunction is considered to occur when muscular fascia no longer slides, stretches, and adapts correctly and fibrosis localises in the intersecting points of tension, known as cc and cf. Subsequent adaptive fibroses can develop as a consequence of unremitting non-physiological tension in a fascial segment.