Fascia, Scars, Adhesions, & Fibromyalgia
This Blogpost is a small collection of various sources I have read on the subject. I hope you find it useful and informative. Current research in fascia science challenges old theories that I was taught in school. I enjoy this part of my profession, the part that challenges me to be a constant student, forever learning....
"The formation of scars and adhesions is a ubiquitous and naturally occurring process that most often, is not pathological. As a profession, manual therapists have long held the belief that local restrictions in tissue movements can result in a more global dysfunction. There is little support for this concept. There are little data available that would suggest validity of applying manual treatment to existing scar tissue. As well, the innervation of fascia is poorly understood, with obvious clinical implications for local pain and presumed pathology."
Read the full article here
"I think "adhesion" is too general a term for precise, clinically meaningful use. Mechanical "adhesions" can occur in various tissues in the body, but failure to differentiate between the types will probably preclude any meaningful conclusions. It probably is a good idea to avoid manual lysis of abdominal adhesions that are secondary to surgery, as there may be a risk of a full thickness tissue tear."
"Upon previous research, I have only found one definition of the word, "adhesion". I have, then, assumed that massage therapists have taken the word and have applied it with other definitions."
"Common complications from abdominal and pelvic surgery include adhesions and chronic pain. Laparoscopic adhesiolysis is sometimes used with the intent of reducing adhesions and related pain. Physical therapy interventions, such as soft tissue mobilization (STM) may be used for this condition, but evidence to support its effectiveness is lacking"
"The outcomes on this patient suggest STM as a conservative treatment option for pain and dysfunction presumed related to intra-abdominal adhesions from abdominal/pelvic surgeries. Higher level of evidence studies, including potential comparison between STM to traditional laparoscopic adhesiolysis are needed to further determine benefits of non-surgical care for this condition."
Abstracts for the upcoming 4th International Fascial Research Congress (September 2015),
"To demonstrate clearly that managing widespread pain must include treatment of the fascia as we are structured determined systems, and to decrease pain is to invite change in the structure through the fascial matrix in order to have a correlating change in the central nervous system. In this way we restore homeostasis in the client."
"The culprit appears to be chronic tension within the fascia responsible for causing micro-injuries (i.e. tears) in those with a “dysfunctional” healing response. Such a response is said to result from insufficient growth hormone release consequent upon inadequate deep sleep.
In summary, Liptan argued that: “Fascial dysfunction and inflammation may lead to widespread pain and central sensitization seen in fibromyalgia.”"
"But over a century later, direct histological evidence to support the related concepts of “fibrositis” and “fascial adhesions” is still lacking."
To date, the search for underlying peripheral musculoskeletal pathology in fibromyalgia has not been fruitful. Yet, a recently published book – Fascial Dysfunction: Manual Therapy Approaches (2014) – is being advertised to manual therapists with this rather astounding claim appearing in the blurb:
Fascial dysfunction is now recognized as one of the main underlying causes of musculoskeletal pain leading to impaired and reduced mobility. [Link: http://www.amazon.com/Fascial-Dysfunction-Manual-Therapy-Approaches/dp/1909141100]
Could Gowers have been right after all? Should we now discard the term fibromyalgia and revert to his “fibrositis” model? It seems a most unlikely possibility but a critical review is urgently needed to once and for all resolve this important question."
RMT/Owner & Director
Maple Ridge Massage Therapy Clinic