Facia and manual therapy

1. Fascia
Hidden secrets in
Manual Therapy
Dr. Satyen Bhattacharyya
Associate Professor: BIMLS, Bardhaman
Chief Physio: Fit O Fine
Director: Well O Fit Healthcare PVT. LTD.
www.fitofine.in

2. What is Fascia?
Fascia is the complex network of connective
tissues located under the skin. It wraps
around every nerve, bone and the muscle in
the body; and all the structures of the body
are surrounded, protected and supported by
fascia.

3. Peeling the Skin of Chicken
Breaking the Fascia of a Cadaver
Shepenous vein inside
the Superficial Fascia of
Leg
Para Umbilical vein inside
the superficial Fascia
Lateral ankle area to
show superficial
peroneal nerve
some
examples…

4. Fascia is considered as all collagenous soft connective tissues.
These connective tissues consist of cells embedded in an extracellular matrix (ECM).
ECM
Fibers Ground
substance

5. Connective
tissue
Resident
cell
Immigrant
cell
• Fibroblast (secrets the fiber &
ground substance of the ECM. &
collagen)
• Adipocytes (stores fat)
• Mast (trigger inflammation)
• Macrophages (ingests & removes
foreign material or damaged cells)
• Lymphocytes
• Monocytes
• Neutrophils
(all involve in immune defense &
inflammation)

6. • In ordinary connective tissues, the ground
substance consist of mainly water that plays
major role in communicating between tissues
through diffusion. Water is stabilized by a
complex of glycosaminiglycans (GAGs),
proteoglycans and glycoproteins, that is only
a small fraction of the weight of the ground
substance.
• The extracellular fibers of connective tissues
are classified further to collagen fibers,
elastic fibers and reticular fibers.
• With the recent discovery of interstitium
(march 2008), defined as a network of fluid-
filled spaces in tissue in connective tissues in
connective tissues all over the body, the
newly discovered organ is part of this fascial
system.

7. New organ
• After discovering mesentery as a
single organ in the digestive
system in 2012, a new organ
called as interstituem was
discovered in 2018

8. Layers of
Fascia
Superficial Fascia
Deep Fascia
Intermuscular Fascia
Visceral Fascia

9. Superficial
Fascia
• Formed of interwoven
collagen fibers, loosely
packed and mixed with
abundant elastic fibers.
Functionally it may play
role in the integrity of the
skin and support for
subcutaneous structure
(veins) ensuring their
patency.

10. Deep Fascia
• Fibrous membrane forming
an intricate network
envelops and separates
muscles, forms sheaths for
nerves and vessels,
strengthens ligaments
around joints, and binds all
structures together into a
firm compact mass

11. Intermuscular Fascia
• Also known as subartorial fascia,
dividing the muscle groups into
septa (walls) enclosing specific
muscle and nerves

12. Visceral Fascia
• Also known as subserous fascia, suspends the organs within
their cavities and wraps them in layers of connective tissue
membranes

13. Fascial Lines and Manual Therapy
Superficial
front line (SFL)
Superficial
back line (SBL)
Lateral lines (2
sides)
Spiral lines
(functional
lines 2)
Arm lines (4)
Deep front
line

14. Superficial
front line
• Runs from the top of the toes
up the front of the leg and up
the torso to the top of the
sternum, and passes along the
side of the neck to the back of
the skull
• Primary function: to maintain
posture
Saggital plane direction force for manual therapy

15. Superficial back line
• Runs from the underside of the foot up the
back of the leg to the sacrum, and up the
back to the skull, and over the skull to the
forehead
• Primary function: to maintain erect posture
Saggital plane direction force for manual therapy

16. Lateral line 2 sides
• Runs from the underside of the foot up the side
of the leg and trunk, under the shoulder
complex to the side of the neck and skull
• Primary function: to maintain stability during
lateral and rotational movement. Support other
lines
Lateral component

17. Spiral line
• Runs from the side of the skull
across the neck to the opposite
shoulder and ribs, and back
across the belly to the front of
the hip, the outside of the knee,
the inside of the ankle, and
under the arch of the foot and
back up the leg and back to the
skull.
• Primary function: to create
control rotation of the body
• Rotational component
• Visceral mobilization

18. • A dissection of the superficial
pectoral fascia in the sternal
area. Notice how one leg of the
evident 'X' across the sternum,
from upper right to lower left in
the picture, is more prevalent
than the other, almost certainly
as a result of use patterns.
Anatomy Train
2nd edition
Page no 23
Spiral Line Cross Section

19. Functional line (2 sides)
• The functional lines extend the arm lines
across the surface of the trunk to the
lateral pelvis and leg, or up from the leg
and pelvis across the ribcage to the
opposite shoulder and arm.
• One of those lines runs in the front of
the body another in the back, therefore
the right and left line forming an X
across the torso.
• Functional lines rarely contribute to
posture but help in co ordination
movement.
Use for core muscle
Lower cross syndrome

20. Arm line (4 sides)
• It connect seamlessly into the
other main lines. Their
functionality could be
summarized as bringing things
towards us, pushing things
away.
• Deep front arm line
• Superficial front arm line
• Deep back arm line
• Superficial back arm line
Local pathology
Peripheral mobilization

21. Deep front line
• A core line that begins deep
on the sole of the foot and
runs up the inside of the leg
to the front of the hip joint
and across the pelvis to the
front of the spine and on up
through the thoracic cavity to
the jaw and the bottom of the
skull.
Integrity
stability

22. Manual approach
MOBILITY
1
STABILITY
2
STRENGTH
3
MOVEMENT
PATTERN
4

23. Inflammation or
trauma
Ground
substance
viscocity
Tensegrity
affected
ECM repsonce
Collagen cross
linking
Movement
dysfunction

24. Assessing movements
Movement
screen
Performance
Range of
motion
Soft tissue
palpation
Neurological
(muscle
testing)

25. Kinetic chain
• The interrelated groups of body segments,
connecting joints, and muscle working
together to perform movements and the
portion of the spine to which they connect.

26. How it affects?
Hip tight
Core sloppy
Thoracic spine tight
Ankle tight
Low back/knees sloppy
Lumbo pelvic hip complex/core tight

27. Range of
motion
Identify and differentiate
active and passive ROM

28. Dynamic movement test/functional movement screening
• Identify muscle
asymmetries, tightness,
weakness and risk of
injuries examining hips,
core, shoulders, knee,
ankles & spine

29. Strength/muscle
test

30. Treatment • Proper hydration
• Enough sleep
• Proper nutrition
• Movement
• Stretching
• IASTM
• YOGA
• MFR
• MET
• Dry Needling
• Kinesio Taping
• Active Release Technique
• Nerve mobilization
• Rolfing (structural
integrity)

31. Thank You
Movement is the only solution
Photo courtesy: Dr.Argha Sadhu
Refrence:
• Anatomy Train 2nd edition
• Grays Anatomy
• https://www.slideshare.net/deepakkumar4055/fascia-56317848?from_search=0
• https://www.slideshare.net/allanray/fascia-and-movement-in-yoga?from_search=19
• https://en.wikipedia.org/wiki/Fascia