Three-Dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy

Spennende studie som viser at tykkere bindevevsområder som fascia latae og plantar fascia ikke kan deformeres i strukturell integrering, men mykere bindevev som f.eks. rundt nesen kan det. Den forteller at det kreves enormt med strykk og strekk for å skape endringer i bindevev, så den releasen for opplever i strukturell integrering er sannsynligvis heller endringer i «twisting or extension forces» i vevet. Bindevevet blir ikke lengre eller deformert på noen som helst måte, det blir mer fleksibelt.

The palpable sensations of tissue release that are often reported by osteopathic physicians and other manual therapists cannot be due to deformations produced in the firm tissues of plantar fascia and fascia lata. However, palpable tissue release could result from deformation in softer tissues, such as superficial nasal fascia.

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Rolfing, which is also referred to as structural integration in osteopathic medicine, is a manual technique in which the practitioner is trained to observe both obvious movement of the skeleton and more subtle motion evidenced by slight muscle contraction visible through the overlying skin.1,22 Rolfers are not trained in diagnosis and treatment of specific conditions—as are osteopathic physicians—but rather in therapies to improve posture and general ease of function.1,22

The therapist manipulated the nasal fascia of the subject with two fingers oriented caudally at a 30-degree angle to the surface of the skin just superior to the cartilaginous structure of the nose. Both normal and tangential pressure were applied with the rolfing technique (ie, structural integration).1

We used available in vitro data for dense fasciae7,11 to evaluate the magnitude of forces required to produce specific deformations in these fasciae. We concluded that the magnitude of these evaluated forces is outside the physiologic range of manual therapy. This conclusion is supported by the findings of Sucher et al6 that in vitro manipulation of the carpal tunnel area on human cadavers leads to plastic deformation only if the manipulation is extremely forceful or lasts for several hours.

Ward25 describes manual techniques central to osteopathic medicine (integrated neuromusculoskeletal release, myofascial release) that are designed to stretch and reflexively release restrictions in soft tissue. These techniques incorporate fascial compression, shear, traction, and twist. Our results indicate that compression and shear alone, within the normal physiologic range, cannot directly deform the dense tissue of fascia lata and plantar fascia, but these forces can impact softer tissue, such as superficial nasal fascia.

Our calculations reveal that the dense tissues of plantar fascia and fascia lata require very large forces—far outside the human physiologic range—to produce even 1% compression and 1% shear. However, softer tissues, such as superficial nasal fascia, deform under strong forces that may be at the upper bounds of physiologic limits. Although some manual therapists3,4 anecdotally report palpable tissue release in dense fasciae, such observations are probably not caused by deformations produced by compression or shear. Rather, these palpable effects are more likely the result of reflexive changes in the tissue—or changes in twisting or extension forces in the tissue.25

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