Dr. Fass, thank you SO much for your detailed reply (and I apologize for taking two months to acknowledge it – I’d checked back a while ago but didn’t see it – I must have gone to the Part 2 comments section!).

This topic fascinates me – I’m now setting about deciphering the postural-structural biomechanics model better. I’m most willing to accept this current understanding of fascia and thixotrophy. As eager as I am to confirm the benefits of manual therapies, I am equally willing to accept criticisms of it, or at least indications of its limitations. I couldn’t consider myself a professional in this field if I weren’t. Yes, the human body is incredibly resilient, and if our fascia could really be affected as quickly or deeply as those who employ mild heat/manual pressure to affect it often claim, then we’d be in trouble! As a CMT I am known to deliver on deep pressure (no client has ever said that I didn’t give enough), and I sometimes wonder why my clients muscles aren’t turned to jello if I gave so much 😉 What Paul Ingraham explains about circulation is intuitively true for me, and I admit that a solid, usually fairly full-body, workout can be just as if not more effective for me than a session of massage therapy: after I exert my body well, a specific soreness in muscle that has been bothering me often fades or disappears – even if I don’t go and “stretch” that muscle (group) which I think is causing or contributing to the ache.

Amongst MTs, language like “muscle releasing”, “lengthening muscle fibers”, “changing muscle fiber direction” (such as with adhesions) is standard, and I’ve always been skeptical about the degree to which cross fiber/longitudinal release techniques, for example, can really affect such shifts. Some clients do seem to “respond” better to certain techniques/touch, and I can often palpate shifts in the quality of tissue (including into deeper muscle layers) after working on it. When I observe greater ROM or a release from a postural deviation, I can quantity my value to a certain extent (even if those improvements are temporary and dependent on the client’s active involvement after this point not to prolong poor habits). But in terms of this response and how individuals differ widely in their responses to manual therapies, would you say that an individual’s power to “let go” is key, and that that process is mostly a neurological phenomenon (whether s/he enters into the parasympathetic state during the treatment), while also factoring in the specific severity and underlying complex causes of the local problem (hypertonicity, adhesions, active trigger points)? So, it *might* be easier to affect tissue through manual therapy and to address pain/tension present for individuals whose pain/tension is resulting from recent or comparatively minor injury/poor posture/ and/or superficial emotional difficulty vs. chronic, long-term or deeper physical or emotional-psychologically challenges? I can see that the individual’s trust in his/her manual therapist and manual therapy itself also plays an important role.

Thank you again for your time!

Hi Miranda, thanks for your question and I’m glad that you enjoyed the post!

There are a few concepts here that I think can be scrutinized. “Thixotropy” itself is a concept that largely doesn’t appear to have relevance on the macro level of tissue that any manual therapy would take place in. I like what my friend Paul Ingraham had to say on the matter (his blog is a wonderful source of evidence-based practice directly relevant to MTs, if you’re not already familiar with it) – http://saveyourself.ca/articles/thixotropy-is-not-therapy.php

The assumption of directly (mechanically) deforming fascia is higly questionable itself, as was concluded in the following (a widely referenced article on the reality of fascial stiffness and its resistance to deformation) – http://www.jaoa.osteopathic.org/content/108/8/379.full. If we can’t mechanically deform fascia, then any influence on the fascia itself – assuming that we have any influence and also that influence is clinically important – cannot occur from direct manipulation, but rather indirect mechanisms through the nervous system. But given the multiple confounders of skin, muscle, joint, nerves, blood vessels, etc all potentially being influenced through our manual approach (and the only definitive influence that can be directly observed, of course, is the skin itself), we cannot confidently determine that any affect that we have on a patient is produced through an assumed interaction with fascia…there are just far too many confounders in that assumption.

We know that contact with the patient very often is beneficial. However, the previously dominant biomedical theory (and postural-structural model in the manual therapies) often lead our reasoning towards a “purely” mechanistic means of explaining these influences, and fascial explanations were one of these attempts. That doesn’t mean that manual therapies suddenly “don’t work,” it just means that we need to adjust these explanations as new information replaces and updates the old. Fascial-based therapies largely falls into this category, IMO.

Cheers,

Robin