Restoration of Bone's Elastic Response Using Osteopathic Techniques

Restoration of Bone’s Elastic Response Using
Osteopathic Techniques
By
Vicki Keam
Diploma in Osteopathic Manual Practice
London College of Osteopathy and Health Sciences
March 5, 2020
Copyright in this work rests with the author. Please ensure that any reproduction
or re-use is done in accordance with the relevant national copyright legislation.

ii
Table of Contents
Table of Contents............................................................................................................ ii
Introduction ...................................................................................................................1
Chapter 1. Bone Mechanics and Bone Motion .........................................................2
1.1. Bone Architecture..................................................................................................4
1.1.1. Bone Types ...................................................................................................4
1.1.2. Bone Crystals ................................................................................................5
1.2. Bone Motion & Absorption of Energy.....................................................................6
1.2.1. Load Deformation..........................................................................................7
1.2.2. Bone Strengths..............................................................................................8
Chapter 2. Definition of Fascia................................................................................10
Chapter 3. Osteopathic Techniques........................................................................11
3.1. Relevant Techniques...........................................................................................11
3.1.1. Myofascial Release Techniques ..................................................................12
3.1.2. CranioSacral Techniques ............................................................................12
3.2. Irrelevant Techniques ..........................................................................................13
Chapter 4. Conclusion – Treating Bone like Fascia...............................................14
References...................................................................................................................15
Appendix A ..................................................................................................................17
Appendix B..................................................................................................................18

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Introduction
In Dr. Still’s, 1910 book, “Osteopathy Research and Practice”, Dr. Still asked
questions about bones. He pondered if they had purpose beyond erect position
support. He also stated that “the osteopath who succeeds best does so because
he looks to Nature for knowledge…” (1 pp. 23, 42)
For all organs to function properly they need to be restriction free. If there are
restrictions, fixations or adhesions to another structure there will be functional
impairment of the organ. With altered motion and time, significant changes to the
organ and related structures will occur. Through Osteopathy treatments it is
possible to bring about improvement in function by restoring some correct motion.
(2).
Bone is often thought of as hard and immobile and only breaks under extreme
forces. Decades of research reveals differently. This thesis will explore bone
properties and biomechanics. It will ponder increasing biotensegrity and
homeostasis of the whole body by acknowledging bone’s relationship with fascia
and the possibility of restoring the elastic response in bone with Osteopathy
techniques.

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Chapter 1. Bone Mechanics and Bone Motion
Even though bone types differ in their architecture and crystallization, they all have
the ability to move. The architecture, thus the tensegrity of bone, allows it to absorb
and release energy. This ability is lost from repetitive forces over time and the
bone moves into a plastic state. In this state the bone will produce micro-fractures
or internal cracks, therefore changing the gross anatomy tensegrity and
biomechanics and changing the homeostasis of the body.
Researchers have debated whether these micro-fractures aid in the strength of
bone after the elastic state has dispersed. Are micro-fractures in bones a positive
(making the bone harder with remodeling repairs to the micro damage), or a
negative (too many micro-fractures lead to a large fracture), to the structural
integrity of bone. Some have stated because of modern medicine it is unnecessary
to restore the Elastic state in bone, but also not possible. (3)
Dr. Sutherland looked to anatomy and found motion when no one else saw the
possibility. He stated, “When you look at the base of the cranium that ossifies in a
cartilaginous matrix, you reason that if there is mobility between the bones of the
base, there must be mobility between the bones of the vault”. Dr. Sutherland found
a way to restore the lost motion of the vault. He understood that if there is motion
it can be lost from life forces and can be restored by seeing, feeling, thinking, and
knowing fingers. (4 p. 9)
In Graham Scarr’s book “Biotensegrity,
the Structural Basis of Life” he explains
how the atoms that form the amino acid
chains form tensegrity models that give
strength and the ability for motion. He
explores how the even more complex
Quasicrystalline order is formed from

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the procollagen chains and how they contribute to the biotensegrity of the whole
body. (5 pp. 61-71)
The complex manner in which procollagen becomes tropocollagen (type 1
collagen, the primary organic material), gives integrity to the tensegrity module of
a fibril. Its left-handed helix of procollagen is comprised of three polypeptide chains
that are twisted around each other like a spring. Proposed by Hodge and co-
workers, tropocollagen molecules are arranged in parallel lines, with holes
between the head of one molecule and the tail of the molecule in front of it in the
same line. Each of these holes are about 26.5 Nm long. These then pack together
in a staggered array to form micro fibrils, fibrils, and fascicles within the
extracellular matrix (ECM). (5 pp. 61-71) (6 pp. 3-61) (7)
The organization of the Extra Cellular Matrix (ECM), and vascularization can be
highly variable, even within a single section of bone. Bone matrix is a two-phase
system with a high surface area with porous structures in which the mineral phase
provides the stiffness and the collagen fibers provide the ductility and ability to
absorb energy (toughness). Alterations of collagen properties can therefore affect
the mechanical properties of bone and increase fracture susceptibility. Several
studies suggest that part of the large variation in bone strength may be related to
differences in the quality of the collagenous matrix, including the nature and extent
of its posttranslational modifications. (7) (8 pp. 13-28) (9 pp. 69-80)
Many researchers have analyzed and studied bone formation over the years using
Wolff’s law (Appendix A) from different perspectives including computer analysis
and graphic reconstruction. R. Huiskes studied the architecture of the organic bone
and the stress transfer through a structure with external forces concluding that the
results depend on its geometry. For example, the trabecular architecture gives it
the ability to absorb the load pressures from forces and the elastic properties of its
organic material allows for recoil from the forces. This further indicates that a
healthy bone could return to an elastic state from a plastic state. (10) (6 pp. 3-
61)

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1.1. Bone Architecture
1.1.1. Bone Types
The architecture of different bone types reveals further explanation as to how the
crystals are arranged and the absorption of forces on the stress strain curve.
Ermanno Bonucci states, “Bone types differ not only in their micro-architecture, but
also in the structure and composition of their organic matrix and in their degree of
calcification”. (11)
Woven-fibered bone matrix consists of highly irregular structures of varying sizes.
The lack of regularity is reflection of the rapid rate at which woven-fibered bone,
the most rapidly deposited bone tissue type, is laid down. Woven bone forms the
primary bone during fetal life and in the newborn. (8 pp. 13-28) (10) (12)
Parallel-fibered bone consists of bundles of individual collagen fibers running
parallel to each other. This arrangement provides the bundles with a degree of
resilience as well as enhancing their tensile strength and is often found in the
compact bone of the primary inner and outer circumferential systems. Non-
Collagenous proteins are lower than that in woven bone. (11) (12)
Lamellar bone is also known as
osteonic bone, or mature bone
because it replaces most of the
primary bone during bone
remodeling. (8 pp. 13-28) (11)

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Osteon structure depends on the
way the collagen fibrils are arranged
around the Haversian canals. When
they are examined under a
microscope, three main types of
osteons can be detected.
Completely anisotropic osteons
have most of their collagen fibrils
running transversally. Completely
isotropic osteons have most of the collagen fibrils longitudinally oriented. Osteons
are the most frequent, that have collagen fibrils that are coarse in the one lamella
and are perpendicular to the neighboring lamellae. The energy absorption ability
of osteons depends on the lamellar formation. There are two types of lamella. One
is Collagen-rich and dense and the other is collagen-poor and loose. Both have
an interwoven arrangement of their fibers that have bundles that run in one
direction and bundles that overlap obliquely. From a mechanical point of view,
lamellar bone has a high density that can resist mainly tensile strains making it the
stoutest and most specialized skeletal tissue. This tissue also makes up the
trabeculae. (8 pp. 13-28) (12)
1.1.2. Bone Crystals
Collagen and crystals co-exist in the proportions necessary to impart maximum
strength to skeletal segments. The layout of the collagen fibril determines the
layout of the plate like mineral crystals, forcing the crystals to be discrete and
discontinuous at regular intervals that correspond to the holes’ space. The mineral
crystals grow with a specific crystalline orientation. The C-axes of the crystals are
roughly parallel to the long axes of the collagen fibrils. The average lengths and
widths of the plates are 50 Nm x 25 Nm. Crystal thickness is 2 Nm – 3 Nm. It is
believed that bone crystals have elastic behavior in multiple directions, thus it
seems that the anisotropy strength that bone matrix has creates the elongated
shape of the crystals. Elasticity and toughness are roughly a 2:1 ratio. Jae-Young

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Rho (et. al) discuss that the underlining importance of the shape, geometry and
material properties of the crystals, determines the behavior of whole bone. (6 pp.
3-61) (13)
Seashells also have a discontinuous arrangement of their minerals that allows for
the absorption of energy from forces to ensure protection to their living organism.
The whole architecture of bone is designed to stop micro-fractures because of the
discontinuity of the components. When it is no longer able to stop the propagation
of these cracks, a catastrophic fracture occurs. (14) (15)
1.2. Bone Motion & Absorption of Energy
During daily living there are forces applied to the bones. For example, when a body
is in motion (the gait cycles) these impacts are from loads such as gravity, muscle
pull, resistance, external forces, and body mass. The architectural design of bone
matrix allows for the absorption and release of the energy. These forces also
determine bone formation, regeneration and degradation. Bone strength and
hardness determines the amount of the displacement and the changes in the bone
that take place during the loading, also known as strains or stresses on the bones.
(10) (16)
Stress and strain provide insight into mechanical behavior of material properties in
bone when deforming under forces. Stress is measured load per unit of area
(Newton’s per square meter) and strain is measured linear of shear deformation (a
percentage of change). When bones are under strain, they exhibit two distinct
characteristics as either elastic or plastic regions on the stress-strain curve
(Young’s Modulus). The elastic region is when the bone can absorb the energy
from the forces and return applied stress, whereas the plastic region is when bone
cannot absorb the forces and the material move beyond its point of resilience,
consequently generating microfractures. Once a bone has a micro fracture it
changes the whole bone’s ability to absorb energy, changing the stress-strain
curve in the amount of forces it can withhold. (16)

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1.2.1. Load Deformation
The load deformation curve is present in a healthy bone and is determined by the
external force imposed in relation to the constant load force. Bone is anisotropic
material; therefore, the direction of the force will determine the load deformation
curve. This deformation is desirable as it implies that the bone is not in a plastic
state. (10)
The angles in which forces are applied on a normal femur received during a
walking gait cycle on flat terrain are perpendicular compression and torque. The
diaphysis of the femur receives mostly perpendicular forces while the femoral head
receives mostly oblique forces due to the structure, muscles and the collagen
architecture within the bone. Load deformation is related to the viscoelastic of the
bone and this is how the organic material reacts to the forces as they are applied
to the bone. The speed and amount of time that the forces are applied contribute
to the reaction that the bone has during loading. If the bone is healthy and can
correctly absorb these forces, the load deformation is approximately 3%. Therefore
the bone is not fractured and when the load is removed, the energy is released
and the bone goes back to the original format or extent (Youngs Modulus). Bones
that have low elasticity that withstand loads and absorb the energy from them
without breaking are considered to be strong and have a hardness to them. Bones
with high elasticity cannot withstand loads or absorb the energy are therefore
considered weak or fragile.
When bone tissue does not retake the original extent and is permanently stuck it
is known as the plastic response. The frequency at which bone receives these
forces plays greatly into the placidity deformation of bone. If a bone receives a
large volume of forces too often and too fast without recovery time, the deformation
curve has no time to recover and stays in a placid state. The recovery time in which
bones need vary on the strain enforced upon them. Approximately 20 to 40 loading
cycles at physiological threshold showed reduced mechanosensitivity. For

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resensitization to occur unloaded rest periods of 15 seconds to 4 hours is required.
(16)
Without these rest periods the bone’s chances of microfractures, large fractures
and abnormalities within the organic matrix are increased. Bones are the gross
body’s struts therefore will also lead to changes in the tensegrity of the whole body.
(5) (16)
1.2.2. Bone Strengths
When forces are applied to the bone the results that occur varies. What determines
the outcome is the direction in which the forces were applied in relation to the
speed and the amount of pressure inflicted.
A compressive stress and distension is when the bone shortens and extends.
Bone’s maximum stress is a plane perpendicular to the compressive strength. As
Egan shares, “the stresses and distensions produced by the compressive
strengths and other strengths are responsible for facilitating the deposition of the
bone material”. (Egan, 1987) (17 pp. 61-85)
When the bone is pulled by forces this in known as tensile strength and causes the
bone to elongate. These strengths influence the formation of bone. The tibial
tuberosity is an example of this as the Patellar ligament repeatedly causes stress
and therefore determines the formation of the tuberosity.
The bending strengths of bones is important for when traveling across rough
terrain or playing sports with fast twists and turns to the upper body. The spinal
vertebrae must be able to obliquely absorb the energy of gross anatomy side
bends and turns as one changes direction. The result of bending strength is a bow
in the bone causing tensive stress to the convex side and compressive stress to
the concave side.

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Shear strength is the resistance from a force that is applied from the opposite axis
of the bone, creating an angular distortion. Whereas torsional strength is the
resistance from the twisting or wrenching of forces against the bone’s long axis,
creating distortion.
All of these strengths and forces come together when walking and the body is
absorbing 3 to 7 times the body weight. During standing, 1/3 of the body weight is
taken on by the hip joint. Bankoff explains how the compressive strengths on the
lower portion of the femoral neck and a large traction strength on the upper portion
of femoral neck happens as the body pushes down the femoral head, causing the
femoral neck to bend. The constricted muscles of the hip absorb a large amount
of body weight, contributing to the compressive load on the upper femoral neck
that reduces the tensile strength. The injuries incurred when the muscles and the
bone’s ability to absorb energy fail, are stress fractures. (17 pp. 61-85)

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Chapter 2. Definition of Fascia
The basics of the bone’s organic matrix is fascia. Dr Still wrote extensively in
“Philosophy of Osteopathy” about fascia. He wrote about the importance of
understanding fascia, the origins of it being in the womb and that disease lies within
it. Dr. Still felt it is all encompassing and a completeness and universality in all
parts. Osteopath B. Borodioni redefined what bone is in his paper “Bone Tissue is
an integral Part of the Fascial System” and included it in the fascial continuum.
(appendix B) (18)
If a therapist lines up the fascia properly the body’s natural inherent (intrinsic) force
is engaged and the body seeks homeostasis. These inherent forces are the
rhythmic activity in all tissues that works to improve the hydrodynamics and
bioenergetic factors around restricted tissues and articulations. (19 pp. 698-699)
(4 pp. 191-216)
If bone falls into the definition of fascia (appendix B), then why not treat it like fascia
and restore the elastic response and allow the inherent forces to improve the
homeostasis so that it can absorb forces from life and reduce microfractures to
increase health and biotensegrity.

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Chapter 3. Osteopathic Techniques
Osteopathic philosophy is about viewing the body as a whole functioning unit,
encouraging it to induce the self-regulatory mechanisms that are self-healing in
nature. Understanding structure and function are interrelated at all levels and an
appropriate treatment is based on these principles. By viewing bone as an organ
that has multiple functions, we can think of bone differently and treat it like an organ
that is in need of mobilization. The static state affects the health of bone by
producing micro fractures therefore altering health. When myofascia ends up in an
altered state there are numerous techniques that can be used to increase the
health and function of it. (20 pp. 1097-1098)
Osteopathic treatments manually guide or induce the body’s inherent forces. By
correcting the somatic and visceral disorders that are present we enhance
homeostasis. Techniques are either direct or indirect. Direct techniques are when
the restrictive barrier is engaged, and a final activating force is applied to correct
dysfunction. Indirect techniques disengage the restrictive barrier and the
dysfunctional body part is moved away from the restriction until the tissue tension
is equal in one or all planes and directions. (19 pp. 1097-1098)
3.1. Relevant Techniques
Dr. Still and Dr. Sutherland taught how important understanding applied anatomy
was to their students and that the key to evolving Osteopathic techniques was
based on this understanding of nature. Bone to the untrained hands is hard and
moves with muscle contraction only but understanding that healthy bone can
absorb and release energy from forces is the key to finding the technique which
can restore elastic response in bone. Osteopathic therapists have trained hands
to feel, see, think, and know what fascia is doing. Dr. Sutherland explained
osteopathic techniques are intelligent application of the tactile sense and the
proprioceptive sense to the search for the correct problem in the patient’s body.

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T. Liem stated that a dialog directly with the tissue, engages the forces at work and
the body as a whole. It is the tissue that tells us what it needs and what we should
do. (4 pp. 191-216) (21 pp. 1-23)
3.1.1. Myofascial Release Techniques
Myofascial release techniques release fascia using both direct and indirect
approaches. They reduce adhesions, restore tensegrity, increase sliding mobility
of the layers of fascia, and increase neural functions in both acute and chronic
conditions. The results of myofascial release in the body’s general life is reduced
pain and increased gross mobility therefore enhancing one’s quality of life.
A myofascial release technique may involve the application of a low load, long
duration stretch along the lines of maximal fascial restriction. Others are achieved
with a very light touch in the direction of ease which is the path of least resistance,
allowing the fascia to trigger its inherent (intrinsic) forces. (19 pp. 1097-1098) (22)
Fascial unwinding in an example of an indirect manual technique involving
constant feedback to the practitioner who is passively moving a patient’s body in
response to the sensation of movement.
3.1.2. CranioSacral Techniques
CranioSacral has both direct and indirect techniques that increase the intricate
motion of the cranial bones in relation to the primary respiratory mechanism with
light pressure to engage the inherent forces. According to Sutherland’s model, all
the joints in the body are balanced ligamentous articular mechanisms that provide
proprioceptive information which guides the muscle response for positioning the
joint. The balanced ligament tension release uses this proprioceptive information
to disengage the joint and seek to increase motion.

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The Ed Stiles cranial technique is about blending your hands with the tissue, taking
the bone where it wants to go in a multi-dimension side of ease and then allowing
the fascial inherent forces to unwind the tissue. (23)
3.2. Irrelevant Techniques
Joint techniques vary from direct to indirect approach. They involve finding the
dynamic balance point of a joint, engaging the joint until the feather light edge or
thrusting through a barrier resulting in an increased range of motion. As we are
discussing bones elastic response, we are not addressing joints’ range of motion.
Therefore, the high velocity/low amplitude techniques (HVLA) that moves a
restricted joint through its dysfunctional barrier or muscle energy techniques that
can form a diagnosis and also treat the patient’s muscles to increase the mobility
of joints are not relevant or appropriate for releasing fascia which is the basics of
organic bone matrix. (19)

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Chapter 4. Conclusion – Treating Bone like Fascia
An osteopath’s trained hands have the ability to know what fascia is doing,
therefore they can listen to the organic bone tissue as it reveals what it needs and
how it should be treated.
With the craniosacral techniques available, we are able to treat bone like fascia.
Restoring the elastic response of bone allows the organic bone matrix and crystals
to realign. During the treatment, the inherent forces will be stimulated removing
microfractures thus increasing biotensegrity to enhance homeostasis.

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References
1. Still, Andrew T. Osteopathy, Research and Practice. London England : Forgotten
Books, 1910.
2. Barrel, J.P. Visceral Manipulation . s.l. : Eastland Press, 2005.
3. The Contribution of Trabecular Architecture to Cancellous Bone Quality. Dempster,
David W. 2000, Journal of Bone and Mineral Research, Vol. 15.
4. Sutherland, W.G. Teachings in the Science of Osteopathy. s.l. : Sutherland Cranial
Teaching Foundation Inc., 1990. pp. 191-216.
5. Scarr, G. Biotensegrity - The Structural Basis of Life. s.l. : Handspring Puplishing,
2018, pp. 61-71.
6. Shipman, P., Walker, A. and Bichell, D. The Human Skeleton. 1985. s.l. : {resident
and Fellow of Harvard College, 1985, pp. 3-61.
7. Viguet-Carrin, et. all. The Role of Collagen in Bone Strength. s.l. : International
Osteoporosis Foundation and National Osteoporosis Foundation, 2006.
8. Huttenlocker, Adam K., et all. Bone Histology of Fossil Tetrapods. s.l. : University of
California Press, 2013, pp. 13-28.
9. Martino, Alberto Di, et. all. Electrospun Scaffolds for Bone Tissue Engineering. s.l. :
Musculoskelet Surg., 2011, Vols. 95:69-80, pp. 95: 69-80.
10. Huiskes, R. If Bone is the Answer, Then What is the Question? The Netherlands :
University of Nijmegen, Orthopedic Research Laboratory, 1999.
11. Bonucci, E. Bone Mineralization. s.l. : Department of Experimental Medicine, La
Sapienza University of Rome, 2012, Vol. Policlinico Umberto 1.
12. The Microscopic Determinants of Bone Mechanical Properties. Marotti, G. et all,.
Modena, Italy : Department of Morphological and Medical=Legal Sciences Section of
Human Anatomy, 1994, Italian Journal of Mineral and Electrolyte Metabolism, University
of Modena.

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13. Rho, Jae-Young et. all. Mechanical Properties and the Heirarchical Structure of
Bone. Shrivenham : Medical Engineering and Physics - Department of Materials and
Medical Sciences, 1997.
14. Multiscale Mechanics and Optimizatino of Gastropod Shells. Yourdkhani, M., et. all.
s.l. : Elsevier Lim / Science Press, 2011, Journal of Bionic Engineering.
15. Contribution of Collagen and Mineral to the Elastic-Plastic Properties of Bone.
Bursein, A. Ph.D., et. all. No. 7, 1975, The Journal of Bone and Joint Surgery, Vol. 57A.
16. Mechanical Basis of Bone Strength; Influence of Bone Material, Bone Structure, and
Muscle Action. Hart, N.H et. all. 2017, Journal of Musculoskeletal.
17. Bankoff, Antonia Balla Pria. Human Musculoskeletal Biomechanics; Biomechanical
Characteristics of the Bone. [ed.] Dr. Tarun Goswami. s.l. : In Tech., 2012. pp. 61-85.
18. Sill, A. Philosophy of Osteopathy. 2015. ISBN 13:978-1517173678.
19. Chila, Anthony G., [ed.]. Foundations of Osteopathic Medicine. 3rd. s.l. : Lippincott
Williams & Wilkins, a Wolters Kluwer Business, 2011. pp. 1097-1098.
20. Chila, Anthony G., [ed.]. Foundations of Osteopathic Medicine. 3rd. s.l. : Lippincott
Williams and Wilkins, a Wolters Kluwer Business, 2011. pp. 698-699.
21. Liem, T. Cranial Osteopathy Principles & Practice. s.l. : Elsevier Churchill Livingston,
2004. pp. 1-23.
22. Selected Fascial Aspects of Osteopathic Practice. Tozzi, P. 2012, Journal of
Bodywork and Movement Therapies.
23. Stiles, E. www.omtsos.com/videos. [Online]
24. Sutherland and Sutherland, W.G. Teachings in the Science of Osteopathy. Reprint
. s.l. : Sutherland Cranial Teaching Foundation Inc., 1990.

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Appendix A
Wolff’s Law
Wolff law of bone transformation states; every change in the function of a bone is
followed by certain definite changes in internal architecture and external
conformation in accordance with mathematical laws. Function dictates structure.
Every change in the form and the function of a bone is followed by certain changes
in its internal architecture and secondary alterations in its external conformation.
Structure dictates function.
Chila, Anthony G. (Executive Editor) (2011) Foundations of Osteopathic Medicine
3rd edition, Lippincott Williams &Wilkins, a Wolters Kluwer Business. Pages 701 –
704.

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Appendix B
Bruno Bordoni’s Definition of Fascia:
The fascia is any tissue that contains features capable of responding to mechanical
stimuli. The fascial continuum is the result of the evolution of the perfect synergy
among different tissues, capable of supporting, dividing, penetrating and
connecting all the districts of the body, from the epidermis to the bone, involving
all the functions and organic structures. The continuum constantly transmits and
receives mechano-metabolic information that can influence the shape and function
of the entire body. These afferent/efferent impulses come from the fascia and the
tissues that are not considered as part of the fascia in the biunivocal mode.
Bone tissue corresponds perfectly to the definition of Fascia (Bone tissue is an
integral part of the fascia system). It can remodel in response to mechanical
stimuli, and it is in synergy with other structures of the human body, influencing the
systemic health of the individual. Each osteocyte communicates with all the other
osteocytes in the bone where it resides. Bone is a part of the fascial continuum.
Osteopath B. Bordoni DO. Et al. March 2018, New Proposal to Define the Fascial
System, Complementary Medicine Research, DOI: 10.1159/000486238
Osteopath B. Bordoni et al; Jan 2019, Bone tissue is an integral part of the fascial
system, Cureus Publishing. DOI:10.7759/cureus.3824

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