By Jackie Shakar, DPT, MS, OCS, LAT
Graston Technique® Clinical Advisor
In my role as Graston Technique® Clinical Advisor, I lead a group of 45+ instructors who play an integral role in teaching our M1-Basic and M2-Advanced courses. Our trainings include the latest on fascia research because we strive to be evidence based.
In this post, I want to discuss the fascial system in terms of the facts and fiction that current and past literature has taught us. Studying and learning about this “fascia-nating” system has guided my clinical practice in a most effective way. Here are my thoughts with a few appropriate resources:
FICTION: The human fascial system consists of inert connective tissue. Movement is solely the responsibility of our muscles.
FACT: Fascia is not the inert connective tissue that we once thought that it was. Also, every fiber of every muscle is both covered and “connected” by fascia. Fascia truly is the connector of all systems as all structures, regardless of which physiological system they belong to, is covered, lined and linked by fascia! When I was in PT school, we removed the investing fascia during dissection. What a shame, as by doing this, we completely changed the functionality of the human myofascial movement system. In addition, fascia has been proven to have contractile tissue properties. Read more about the contractile tissue properties of fascia.
Given the fact that fascia has contractile tissue properties, the groundwork has been laid to incorporate dynamic movement into our soft issue manual therapies. During our Module 2 course, we cover dynamic myofascial techniques utilizing the Graston Technique® instruments that take into accountthatthehuman myofascial movementsystem is dynamic and responds best to therapies that are not exclusively static in their applications.
FICTION: Fascia does not influence human movement.
FACT: Fascia (especially deep fascia) has also been proven to be rich with mechanoreceptors and proprioceptors. In fact, some regard the fascial system as being the largest proprioceptive organ in the human body. For the evidence that substantiates the role that fascia plays in influencing movement both in function and dysfunction from a mechanoreceptive/proprioceptive point of view, read this. If you are interested in learning techniques utilizing Graston Technique® instruments that dramatically influence human movement, then our Module 2 course is for you! In my clinical practice as a physical therapist, I often see significant improvements in movement quantity and quality after just several minutes of a dynamic GT application. This immediate improvement has to be due to the positive changes in the sensory input that in turn greatly enhance motor output via the proprioceptive system.
FICTION: Manual therapy techniques such as MFR, IASTM and stretching are effective in “releasing” and lengthening fascia and scar tissue.
FACT: If you are interested in reviewing the current literature regarding the physiological mechanisms behind manual therapy and its effectiveness, read here. What this evidence is proposing is that soft tissue cannot be “released,” physically lengthened and/or permanently changed during a manual therapy session as the forces necessary to accomplish this are simply not great enough. I am not saying that manual therapy does not work. What I am proposing is that the effectiveness of manual therapies like the Graston Technique® are due to neurophysiological vs. purely mechanical mechanisms. We discuss the neurophysiological mechanisms behind the effectiveness of the Graston Technique® in light of the current evidence in our Module 2 course as well.
Incorporating the emerging evidence regarding the neuromyofascial system has changed my clinical practice as a physical therapist in a most positive way. After completing M1, I encourage you to take M2 training next. I am confident that you will not be disappointed as you take your GT skills to the next level.
Side Note: I want to congratulate Dr. Terry Loghmani from Indiana University. Her myofascial studies were referenced in the first chapter of Dr. Carla Stecco’s much awaited book, Functional Atlas of the Human Fascial System. Stecco does not mention GT specifically, but anyone who reads the citation will know that it applies to Loghmani’s work with GT instruments. Congratulations, Terry!
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