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FasciaFascia isis AliveAliveActiveActive ContractilityContractility and and SensorySensory InnervationInnervation

of Human of Human MuscularMuscular ConnectiveConnective TissuesTissues

Robert Schleip PhDFascia Research Project, Applied Physiology, University of Ulm, Germany

www.fasciaresearch.de

1. 1. FasciaFascia as a as a tensionaltensional networknetwork

2. 2. FasciaFascia as a as a sensorysensory organorgan

3. Fascial 3. Fascial tonicitytonicity

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Fascial Fascial tissuestissues

Superficial & deep fascia

Perimysium & septi

Epimysium & aponeuroses

Endomysium

Huijing & Baan 2003

Lateral myo-fascial force transmission

Peter Huijing

Vrije Universiteit, Amsterdam

T. Myers: Anatomy Trains

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Vleeming A, 1995 Barker P. 2006

Tensegrity Architecture

www.intensiondesigns.com

Fukunaga 2003

Elastic recoil function of fascial elements

Classical model:

muscle fibers shorten

New findings:muscle fibers don‘t shorten;

usage of fascial recoil

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Using muscles for adjusting the ideal prestiffness (and resonsance frequency) for

maximum energy storage of fascia

1. 1. FasciaFascia as a as a tensionaltensional networknetwork

2. 2. FasciaFascia as a as a sensorysensory organorgan

3. Fascial 3. Fascial tonicitytonicity

Fascial mechanonreceptors

Already postulatedin 1899 by A.T. Still

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• Localisation • Sensitivity • Effects

Overview at www.fasciaresearch.com

• Stilwell 1957• Sakada 1974 • Vshivtseva 1988• Yahia 1992• Stecco 2006

Presence of intrafascialmechanoreceptors

Golgi Paccini Ruffini Interstitial Sisters

Simplification:

The three Italian brothers and their little sisters

Golgi Paccini Ruffini Interstitial Sisters

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GOLGIReceptors

• Respond to stimulation with a

decrease in muscular tonus

Passive stretching does not excite GTOsJami L 1992 Golgi tendon organs in mammalian skeletal muscle:

functional properties and central actions. Physiol Rev 73(3): 623-666

E. Lederman: Foundations of Manual Therapy

• Myotendinous junctions & attachment areas ofaponeuroses

• Ligaments of peripheral joints

• Joint capsules

GOLGIReceptors

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GOLGIReceptors

Therapeutic stimulation:

Slow, deep stretching

close to the attachments

maybe combined with AMPs (active movement participationsof client during manipulation)

Golgi Paccini Ruffini Interstitial Sisters

PACINIReceptors

Sensitive only to

rapid pressure changes

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PACINIReceptors

• Deep capsular layers

• Spinal ligaments

• Myotendinous junctions

• Proprioceptive feedback for movementcoordination

• Stimulation by practitioner tends toincrease local proprioceptive attentionand self-regulation

PACINIReceptors

• high velocity adjustments

• sudden pressure release techniques

• vibratory tools

• rocking, shaking, rhythmic joint compression

PACINIReceptors

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Golgi Paccini Ruffini Interstitial Sisters

RUFFINIReceptors

Specially responsive to:

tangential forces (shear)

Stimulation results in:

an inhibition of overall sympathetic activity

RUFFINIReceptors

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• Ligaments of the peripheral joints

• Dura mater

• outer capsular layers

RUFFINIReceptors

Slow melting pressure

with lateral shearing.

RUFFINIReceptors

Golgi Paccini Ruffini Interstitial Sisters

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Composition of a motor nerve

INTERSTITIALReceptors(Type III & IV)

50%: high threshhold

Other 50% are responsive even to very subtle stimulation.

INTERSTITIALReceptors(Type III & IV)

Most abundant receptor

Found almost everywhere, even inside bones.

Highest density in periosteum

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INTERSTITIALReceptors(Type III & IV)

Strong stimulation can increase vasodilation and plasma extrusion

Also used for interoception (plus proprioception?). Can function as mechanoreceptors and/or nociceptors.

Receptor sensitivity is frequently modulated byneurotransmitters .

INTERSTITIALReceptors(Type III & IV)

Work on periosteum, interosseous membranes, and other fasciae connected with bones.

Intention of re-sensitizing interstitial mechano-receptors.

Look for autonomic reactionswidening of breath & eyes, but not yet any withdrawal responses.

Golgi Paccini Ruffini Interstitial Sisters

Schleip 2008

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1. 1. FasciaFascia as a as a tensionaltensional networknetwork

2. 2. FasciaFascia as a as a sensorysensory organorgan

3. Fascial 3. Fascial tonicitytonicity

Bunker & Anthony 1995Frozen shoulder

Hasegawa et al. 1990M. Ledderhose

Kloen 1999M. Dupuytren

Knuckle padsNodular fascitisDesmoid type fibromatosisHypertrophic scar

Club footPeyronie‘s disease

IntroductionIntroduction

Pathological fascial contractures→ facilitated by myofibroblasts

Adapted from Tomasek et al. 2002

Myofibroblast development

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32 humans (25M, 7F, 17-91yrs, Ø47±23yrs)

ImmunohistochemistryMonoclonal antibody

against α-SM-actin

Digital quantificationppm of surface portion

L2L4

F.lata

F.plant.

SS-lig.

Histological examination

HistochemistryHistochemistry

100 µmPlantar fascia. Male 57 yrs.

DensityDensity of myofibroblasts in human of myofibroblasts in human fasciafascia

IH for α-SM-actin (15 photos per sample. Monte Carlo method for choice of locations)

Digital quantification of stained areas. 565 ppm

Typical lumbar fascia

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100 µmL2 lumbar fascia. Male 19 yrs. Lumbar fascia., male 19 yrs

•Frozen lumbars?

•Signs of injured lumbar fascia?

High density of contractile cellsin perimysium

Tonic

Phasic

Pharmacologicalstimulation

Adrenaline

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Control tissue

Mepyramine

Hypothesis: general joint mobility related to MFB density

Remvig L, Schleip R (unpublished)

Dupuytren contracture Systemic hypermobilityAverage

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THANK YOU

www.fasciaresearch.com

Werner Klingler MD Adjo Zorn PhD Stefanie Rankl Anne Klein