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Based on this functional classification, a systematic objective examination together with an analysis of three-dimensional movements of the implicated segments can pinpoint dysfunctional cc or cf. Comparative palpation then determines the selection of points requiring treatment in each individual case. The manual technique itself consists in creating localised heat by friction by using the elbow, knuckle, or fingertips on the abovementioned points. The mechanical and chemical stress effects on connective tissue are well known and a local rise in temperature could affect the ground substance of the deep fascia in these specific points. Tensional adaptation can then propagate along an entire mf sequence, diagonal, or spiral, re-establishing a physiological balance. A fundamental element of this method lies in the fact that the myofascial sequence is not only a functional concept but has an anatomical substratum of fascial continuity and muscular expansions onto the fascia itself.

From the paper:

Treating patellar tendinopathy with Fascial Manipulation: a pilot study.

By Pedrelli A, Stecco C, Day JA (JBMT, 2009)


According to Fascial Manipulation theory, patellar tendon pain is often due to uncoordinated quadriceps contraction caused by anomalous fascial tension in the thigh. Therefore, the focus of treatment is not the patellar tendon itself, but involves localizing the cause of this incoordination, considered to be within the muscular fascia of the thigh region. Eighteen patients suffering from patellar tendon pain were treated with the Fascial Manipulation technique. Pain was assessed (in VAS) before (VAS 67.8/100) and after (VAS 26.5/100) treatment, plus a follow-up evaluation at 1 month (VAS 17.2/100). Results showed a substantial decrease in pain immediately after treatment (P<0.0001) and remained unchanged or improved in the short term. The results show that the patellar tendon may be only the zone of perceived pain and that interesting results can be obtained by treating the muscular fascia of the quadriceps muscle, whose alteration may cause motor incoordination and subsequent pathology.

... In Fascial Manipulation, a map of over one hundred fascial points exists, that, when treated appropriately, are believed to restore tensional balance. In order to select the points to be treated the fascial system is first divided into basic elements, or Myofascial Units. Each Myofascial Unit (MFU) includes all of the motor units responsible for moving a joint in a specific direction and the overlying muscular fascia. Hence, movements of single body segments are considered to be governed by 6 MFUs, responsible for movements in the three spatial planes (Sagittal, Frontal, Horizontal). All the forces generated by a MFU are considered to converge in one point, called the Centre of Coordination (CC); each CC has a precise anatomical location within the muscular fascia. If the fascia in this specific area is altered, or “densified”, then the entire MFU contracts in an anomalous manner resulting in non- physiological movement of the corresponding joint, which can be a cause of joint pain. According to the Fascial Manipulation model, the area where the patient perceives pain is called the Centre of Perception (CP), thus, for each MFU one CP is described. In patellar tendinopathy, the MFU of extension of the knee, called MFU of antemotion genu (AN-GE), is the more frequently implicated. It is formed by the knee joint, the monoarticular muscular fibres of vastus medialis, intermedius and lateralis, the biarticular muscular fibres of rectus femoris and the relative muscular fascia. The patella and the anterior region of the knee are considered as the CP of this MFU, while the CC is situated over the vastus intermedius muscle, halfway on the thigh (Fig 1, Fig 2). The location of this CC overlaps with the acupuncture point ST32 (Bossy, 1980), and with one of the trigger points of the quadriceps group, as described by Travell (Travell & Simons, 1999)... In the Fascial Manipulation model, the CC is considered a point of vectorial convergence for muscular forces or the point of the muscular fascia where altered myofascial traction concentrates. Thus, for each segment, we can identify six CCs, one for each direction on the three planes of movement. A pathological CC can be pinpointed by a specific clinical exam (movement tests), and not only by palpation, which differs somewhat from the procedure for trigger point identification. Hence, a CC could be considered as a type of “key trigger point”...

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