Integrating biomechanics (including micro biomechanics) and fascial function

Terminology explained:

Neuromusculoskeletal - our muscular, myofascial and nervous systems operate as a team and are mostly inseparable.  Any applied therapy will affect all 3 systems.

Neurokinetic - a thorough examination of the whole body employing a system of resisted movement tests.

Kinematic chain - a series of interconnected myofascial continuities and sequences that work together to transfer motion and forces in a mechanical system.

In neuromusculoskeletal treatment and exercise intervention approaches, rarely are biomechanics and the myofascial system put together.  There is an enormous amount of credible research released in the last 40+ years in relation to the myofascial system yet still, it is often not taken into consideration, which seems somewhat negligent, given the advanced knowledge and treatment benefits it provides. The issue with incorporating it is, it signifies learning some things all over again and, moving away from those comfortable diagnostic labels. 

The myofascial and nervous systems are intrinsically related and have a documented and researched solid scientific foundation spanning some 40+ years. Effecting the myofascial system reflects in the nervous system.

Carla, Antonio and Luigi Stecco have revolutionised knowledge and research into the fascial system. Their work is extensive and provides unequivocal evidence of its function and relevance in neuromusculoskeletal treatments.  Carla's book "Functional Atlas of the Human Fascial System" is by far the best depiction of fascial anatomy I have ever experienced.  

In recent years Thomas Myers “Anatomy Trains”, has provided us with the visuals he designed which, are integral in simplifying the understanding of how things link together. That said, it is again, a simplification of the true anatomy much like, the iliotibial band in anatomy visuals.  The latter of which is an artifact cut out with a scalpel from the fascia lata that covers the entire proximal (upper) thigh.  The removal of fascia completely from the prosected specimens many see when studying anatomy yet again, provided a simplified visual that allowed labels to be adhered to muscle and their origin and insertions.

These decisions were made at a time when fascia was the tissue removed and discarded during dissections, it was deemed unimportant because its function was unknown.  Unfortunately what it has done is encourage one dimensional and singular approaches to a three dimensional and complex system.  Despite the evidence available many still want to take a section of fascia and apply it to a single area, thus allowing them to stay in the comfort zone of diagnosing a problem, treating one area and naming a portion of related fascia. However, the system simply does not work that way, tension and poor slide in one area will affect an area distally from it. Therefore the full kinematic chain must be addressed.

My aims are to help dispel these approaches and teach patients and practitioners to think outside the box. 

The way we walk is rotational around an axis, as one shoulder goes back and slightly externally rotates the opposite hip has to go forward and slightly internally rotate.  Therefore from a myofascial and neurokinetic perspective with have both upper and lower body chains working as a team.  This gives us an integral link with both areas in general function.  This considered what kind of impact would poor shoulder and/or hip biomechanics or injury have on this system, also what about the other structures affected by these areas, knees, ankles feet, elbows, wrists, fingers, neck and cranium, basically everything else? 

When an injury occurs did come from trauma? If so was it an impact or failure trauma? If it was the latter, why did it fail and, is the area in question primary, secondary, tertiary or even quaternary in the kinematic chain? Without assessing this you will never know, if you do not assess it then problems will recur.

I start with the basics of history taking and observations, both should be extensive. The observation should include scanning what I call “micro-biomechanics”, for example:

What effect will hip dysfunction have on load transference through the knee and rocker motion in the calcaneus, what is connected in this kinematic chain and how important is it? The answers depend both on the patient and their symptoms however, to not consider all structures has proven, time and again, to lead us to assumptions.   This in turn moves us toward what we are comfortable with, rather than looking outside the box and solve an issue instead of just treating some of the symptoms.

In my experience lack of kinematic consideration results in many things which are usually labelled as:

Rotator cuff dysfunction/tear/tendinopathy

Golfers/tennis eblow

Carpel tunnel syndrome

Bursitis

Impingement (hip or shoulder)

Psoas irritation or tendinopathy

Achilles dysfunction/tear/tendinopathy

Plantarfaciitis

SI joint irritation

Lumbar/cervical disc/radiculopathies

Sciatica

This is but a small group of overused diagnoses which, when considered from a kinematic perspective are influenced by many other structures and areas.  These rules also apply in treatment, if you treat only the area where the pain is, you really are missing the point as again, from a kinematic viewpoint many other areas and structures can affect the area of pain. Also what if someone is in so much pain they can bear very little hands on treatment? Do you do minimal and stop there or, do you do minimal in the area of pain and go on to treat distally from this area? Yes is the answer to the latter, you can have amazing results with this method. 

This does not indicate you should be treating the entire body every time you see a patient however, if you trace the kinematics relating to the pain area you are not only doing a much more thorough treatment, but also helping to relieve the entire system which results in faster pain reduction and longer term relief.  Couple this with active care and integrative movements/exercises and you have a happier, healthier patient who is learning to take care of themselves.