IAHE Therapies

The latest techniques for proven success

The International Alliance of Healthcare Educators, in conjunction with the International Association of Healthcare Practitioners, is committed to the presentation of high-quality educational programs for interested healthcare professionals from all disciplines.

Click on the therapy names for brief overviews or to find information regarding:

  • Available courses
  • Conditions treated
  • About the developers
  • Study groups
  • Case studies and testimonials

Upledger CranioSacral Therapy / SomatoEmotional Release

The craniosacral system (a physiological system like the cardiovascular and respiratory systems) provides the physical environment in which the brain and spinal cord develop and function. The light-touch technique works with natural and unique rhythms of our different body systems to pinpoint and correct source problems.

(SER) is a therapeutic process that expands on the principles of CranioSacral Therapy to help rid the mind and body of the residual effects of trauma. Joint research efforts by Dr. John Upledger and biophysicist Dr. Zvi Karni led to the discovery that the body often retains (rather than dissipates) physical forces. This is often the result of an accident, injury, or emotional trauma. The dysfunctional area is isolated, creating what is called an "energy cyst". Although a reasonably healthy body can adapt to "energy cysts," extra energy is required to perform normal bodily functions. As time passes, the adaptive pattern of the body loses its effectiveness. Symptoms begin to appear and, over time, become more difficult to suppress. The SomatoEmotional Release process requires extreme sensitivity on the part of the therapist and a positive attitude and trust from the client/patient.

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Barral Visceral Manipulation / Neural Manipulation / New Manual Articular Approach

Visceral Manipulation
The visceral system relies on the interconnected synchronicity between the motions of all the organs and structures of the body. At optimal health, this harmonious relationship remains stable despite the body's endless varieties of motion. But when one organ cannot move in harmony with its viscera due to abnormal tone, adhesions or displacement, it works against the body's other organs and muscular, membranous, fascial and osseous structures. This disharmony creates fixed, abnormal points of tension that the body is forced to move around. And that chronic irritation, in turn, paves the way for postural distortion, neuromuscular dysfunction, and disease processes.

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Neural Manipulation
Neural Manipulation as developed by Barral and Croibier examines mechanical relationships between the cranium/spine hard frame to the dura and neural elements. It provides assessment and treatment approaches to address restrictions of the dural and neural components not commonly focused on with musculoskeletal symptoms. Neural Manipulation identifies and releases local nerve restrictions while at the same time examines the effect these local fixations have on the rest of the body, and by accessing this relationship, resolves the more comprehensive (global) dysfunctional patterns.

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New Manual Articular Approach
New Manual Articular Approach (MAA) is a manual therapy modality that applies a comprehensive approach to the treatment of joints. It integrates all aspects of the joint including the nerve, artery, bone, capsule, and ligaments, as well as visceral and emotional connections. MAA delves into the joints like never before. It examines the nerves of each joint, along with the arteries, meniscus, ligaments, capsule attachments and folds. It incorporates soft tissue mobilization of the associated bones, while looking at direct and indirect relationships between the bones of the body. The relationship between the viscera and the joints is not widely understood. MAA shows how interconnected they are and that without addressing this visceral connection many joint issues may not fully resolve.

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D'Ambrogio Total Body Balancing / Muscle Balancing / Joint Balancing / Fascial Balancing / Lymphatic Balancing

Dr. D'Ambrogio started lecturing in 1988 and has taught in over 20 countries worldwide. He is recognized throughout Canada, the United States, Mexico, Brazil, Venezuela, China, Hong Kong, Japan, New Zealand, Australia, the Philippines, South Africa, England, Scotland, Wales, Ireland, Germany, Italy, Norway, and Israel as an exceptional teacher of manual therapy. He is a certified instructor recognized by the International Alliance of Healthcare Educators (IAHE).

His integrative blend of both Eastern and Western medicine, prompted by an initial thorough whole body pre and post treatment evaluation (ARTS), is the key to unlocking perplexing pain issues for patients. This method surpasses the traditional tendency in Western medicine to merely treat the patient’s symptoms locally, at the site of pain, instead of searching for the root cause of their complaint.

The seminar series, at the D'Ambrogio Institute, reflects this core philosophy and was developed to train practitioners to perform the full body evaluation (ARTS) and, more importantly, to incorporate the most effective treatments strategies to obtain optimal results for the client. The D'Ambrogio Institute offers the following courses through IAHE:

  • Evaluation & Integration: Total Body Balancing
  • Joint Hypomobility: Joint Balancing
  • Protective Muscle Spasm: Muscle Balancing
  • Fascial Tension & Scar Tissue: Fascial Balancing
  • Fluid Stagnation & Swelling: Lymphatic Balancing

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BioAquatic Explorations / Dolphin Assisted Therapy

In partnership with Integrative Intentions, BioAquatic Explorations programs were developed to allow CranioSacral Therapy practitioners to develop a holistic, cooperative relationship with the ocean and its healing resources, while performing CranioSacral Therapy techniques. Most programs are four days, and you'll even spend time in the water with dolphins learning Dolphin Assisted Therapy.

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Healing From The Core

Living in today's world places many daily demands on us. As therapists we strive to maintain strong, healthy, therapeutic relationships in our work. As human beings we also seek to have more depth and connection in our personal lives. Yet burnout is often the outcome if we do not first hold a healing space for ourselves.

While each person's journey through life is individual and unique, basic underlying principles for wholeness and integration in that journey are the same. The Healing From the Core (HFC) curriculum is designed to explore these principles conceptually, physically and emotionally using such resources as intention, felt sensation, hands-on protocols, expanding and reframing awareness, breath, sound, movement, drumming, drawing and journaling. Courses also teach skills to deepen intuition and interpersonal awareness.

Through the Healing From the Core process you will:

  • Discover how to hold a strong therapeutic presence - a vital skill in the application of any modality
  • Maximize treatment outcomes
  • Improve your evaluation and palpation skills
  • Create healthy boundaries that enhance your connection to the world, while avoiding burnout
  • Learn to meet your clients where they are

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Body Alchemy

Body Alchemy is a transformational process of healing and recovery from trauma, abuse and post traumatic stress (PTSD) experiences. In this 3 day intensive workshop craniosacral therapists will learn specific skills to manage these intense states of body deregulation caused by a loss of trust and safety due to abuse, trauma and PTSD.

Students will learn how to develop their therapeutic presence with a client, how to restore the body of trust and apply specific skills to assist a client’s nervous system to regulate and repair from their history. The body alchemy process integrates CranioSacral Therapy with appropriate somatic therapies and the expressive arts. Students will learn to strengthen their own therapeutic and ethical boundaries and develop communication skills to explore a client’s past so that they can more fluidly guide a client through the body releases of past hurt, pain and fear. Utilizing the current theories of trauma they will also learn how to gently release the freeze/shock from the body and brain, while structurally and compassionately rebuilding resilience and trust. Using metaphor and storytelling that accesses deep body communication, students will discover ways to guide a client through the change making process so that they can find their own creative resources and reframe their traumatic experience to one of hopeful resilience integrating body, mind and spirit.

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Equine CranioSacral

These workshops are designed to teach participants the anatomy and physiology of the craniosacral system and its relationship to health and disease in people and animals. Class work is divided between lectures, demonstrations with loads of hands-on practice.

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Zero Balancing

Developed by Fritz Smith, MD in the early 1970s, Zero Balancing is a powerful body-mind therapy that uses skilled touch to address the relationship between energy and structures of the body. Following a protocol that typically lasts 30 to 45 minutes, the practitioner uses finger pressure and gentle traction on areas of tension in the bones, joints and soft tissue to create fulcrums, or points of balance, around which the body can relax and reorganize.

Zero Balancing offers many powerful benefits to people of all ages. Here are some of the compelling reasons why you should seek Zero Balancing:

  • Increases feelings of health and well-being
  • Releases stress and improves the flow of energy in our bodies
  • Reduces pain and discomfort
  • Enhances stability, balance and freedom
  • Amplifies the sense of connection, peace and happiness
  • Releases mental, emotional and physical tension
  • Supports us through transitions and transformations
  • Improves quality of life and increases capacity for enjoyment

Zero Balancing focuses primarily on key joints of our skeleton that conduct and balance forces of gravity, posture and movement. By addressing the deepest and densest tissues of the body along with soft tissue and energy fields, Zero Balancing helps to clear blocks in the body's energy flow, amplify vitality and contribute to better postural alignment. A Zero Balancing session leaves you with a wonderful feeling of inner harmony and organization.

Zero Balancing Core-Pak Program available here.

The Core-Pak Program offers students an opportunity to sign up for a series of courses at a substantial savings over regular tuition. Core-Pak tuition also includes payment for the Zero Balancing Certification Program. Contact IAHE at 800.233.5880 or 561.622.4334 to register and arrange for your payment plan of $100 per month. Your payment will be processed each month on your credit card. You may select the seminar dates and locations as it suits your schedule. (This program is available for North American courses only. Certain residential courses may not be eligible for Core-Pak.)

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Soul Lightening Clinical Acupressure and Process Acupressure

Process Acupressure
Process Acupressure (PA) was developed by Aminah Raheem, Ph.D. as a holistic way to work with the active energy of both body and soul for healing and growth. She has taught the method internationally for more than twenty-five years.

PA is an exceptionally effective method for clarifying and magnifying the fullest potential of the receiver—physically, mentally, emotionally and spiritually. Practitioner and client work together to create a supportive and potentially transformational experience.

The session is given while the client rests on a massage table, fully clothed. The practitioner applies firm, gentle finger pressure to specific acupoint combinations, and encourages the client to notice what they are experiencing. Often, by acknowledging and addressing symptoms or signals that arise during a session, positive change can begin to occur. By following this natural process the unique essence of the individual is magnified and brought into clearer focus. The client is empowered to choose the pace and depth of this exploration at all times. A full session lasts about one hour.

Normally, a PA session has several phases:

  • Relaxation: As a state of relaxation occurs, the client may become aware of issues within the body and/or consciousness.
  • Awareness: As the session progresses, the client may go into a deeper state of awareness, beneath surface tension, to access clarity or guidance about the issues at hand.
  • Integration: Finally, integration and completion of the process occur as the session is closed with chakra balancing and grounding.

Process Acupressure can stand alone as a therapeutic modality, or it can be combined with psychotherapy or other bodywork modalities. It is does not replace medical care, and is not appropriate for severe medical problems or psychosis.

Clinical Acupressure
Sometimes described as "acupuncture without the needles," Clinical Acupressure (CA) promotes wellness and rejuvenation by accessing and addressing the vital energies of the body.

CA is derived from traditional acupressure which uses touch on specific points to release and rebalance the way energy flows through the body. Specific point combinations are held with firm, gentle finger pressure as the body, mind and spirit return to balance.

Clinical Acupressure is not intended to replace medical care for serious conditions, however those who receive this method report that it addresses common symptoms easily and effectively, with no harsh side effects.

CA is often used to complement more traditional methods such as physical therapy, massage, or nursing. It also stands very well on its own. A full CA session takes about an hour, and the client stays fully dressed while receiving the session.

This method of working with the human energy system was developed and refined by Aminah Raheem, Ph.D. She is the creator of Process Acupressure (PA) which facilitates emotional and spiritual awareness during bodywork. She has been teaching this method internationally for more than twenty-five years.

Seva Stress Release
The Seva Stress Release can be used for self-care, addressing a wide range of needs, including general relaxation and well being or extreme shock and stress. Anyone can learn this simple but effective way to help themselves. This dynamic and interactive workshop allows the participant to fully experience the Seva Stress release through demonstration and hands-on practice. Workshop participants learn a unique touch method, various effective acupoints and how to use this protocol for self care. In this workshop participants learn about the healing and transforming power of acupressure, practice techniques to use for self-care, learn Chakra Tai Chi, and take home skills they can use for the rest of their life.

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Mechanical Link

Developed in the late '70s by French osteopath Paul Chauffour, Mechanical Link is a gentle manual therapy that encourages the balance of tensions in the fascial system - that complex web of tissue that interconnects and affects all other body systems. It spreads throughout the body uninterrupted, providing physical stability while also allowing flexibility and mobility.

Think of the fascial network as a spider web. Imagine what happens if one area of the web is pinched or tightened: everything else distorts. The body compensates for physiological or traumatic stress in much the same way - by producing patterns of tension called lesions that affect the entire structure.

These patterns are intended to relieve pain and disability and protect the body from further stresses. Yet the long-term effects of such compensation can prove debilitating.

Mechanical Link therapy is guided by the body's own wisdom about its unique needs. The work stimulates to the body's self-corrective responses, promoting normal mobility, tissue tone and posture. Mechanical Link brings tension into equilibrium and allows the body to return to optimal functioning ability, so all its systems can improve - including the immune system.

Mechanical Link helps alleviate a range of illness, pain and dysfunction, including:

  • Fibromyalgia
  • Indigestion
  • Migraine Headaches
  • Premenstrual Syndrome
  • Asthma
  • Chronic Fatigue
  • Motor-Coordination Impairments
  • Chronic Neck and Back Pain
  • Central Nervous System Disorders
  • Emotional Difficulties
  • Temporomandibular Joint Syndrome (TMJ)
  • Stress and Tension-Related Problems
  • Orthopedic Problems

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Applications of the Feldenkrais® Method for CranioSacral Therapists

The Feldenkrais Method® is a unique and sophisticated approach to human development, learning, and movement. Invented by Moshe Feldenkrais, an Israeli physicist and martial artist, the Method is internationally known for its ability to improve areas of human function such as posture, flexibility, and self image. Benefits of this four-day workshop include:

  • Increased kinesthetic awareness of self, enabling one to use self more effectively and help others to do the same.
  • Improved posture and body mechanics.
  • Ability to work with own breathing, diaphragms, dural tube, and CSI to promote better health, and to help others do the same.
  • Improved kinesthetic awareness and understanding of anatomy of TMJ and avenue of expression, with ability to release unnecessary tension from these areas.
  • Improved understanding of anatomy of cranium, with ability to apply this understanding to craniosacral work.
  • Improved ability to empathize with children, through re-experiencing exploration of early childhood development.
  • Knowledge of active assisted range of motion techniques which facilitate the efficacy of craniosacral work.

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Integrative Intentions

Integrative Intentions (II) is dedicated to the integrity of wholism, the integration of body, mind and spirit including our relationships and the environment.

We are cooperating and co-creating innovative programs with a broad range of CranioSacral therapists who share integrative intentions.

II takes on many forms as we evolve.

Currently we are:

  • Evolving integrative therapeutic principles and practice
  • Developing and implementing Comprehensive Therapy Programs
  • Providing clinical services
  • Teaching classes
  • Developing an aquatic modality based in CranioSacral Therapy
  • Facilitating study groups, workshops and retreats
  • Guest lecturing
  • Providing a forum for therapists to exchange treatments and therapeutic modalities
  • Developing an integrative approach to Dolphin Assisted Therapy
  • Opening to interspecies communication as a co-healing process
  • Promoting the ecology of health within relationships, community and environment

Integrative Intentions hopes to provide a forum, a place, a space, a time and a process that allows for the infinite, for each individual to discover their way of healing.

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Fascial Integration

Fascial Integration offers complementary skills in postural analysis, physical assessment, problem solving and fascial manipulation, especially for tricky clients not responding to one's current methodology.

Developed by Bruce Schonfeld after extensive studies in Rolfing Structural Integration and Visceral Manipulation, Fascial Integration (FI) is a natural continuation of Ida Rolf's method of Structural Integration (SI).Paying forward her whole body approach to physical alignment through fascial manipulation and education, FI looks through the same architectural lens and applies a 'local and global' logic to the next layer deep, the interfacing membranes. Like the biomechanics of other body-based systems that require normal range of motion to fully function, membranes also need to slide and glide and are a critical component of more comprehensive fascial continuity. Whereas Structural Integration segmentally balances fascial components of the overall musculoskeletal system, Fascial Integration embraces systems anatomy and balances the body with additional depth and dimension. FI evolves Rolf's holistic relationship with the musculoskeletal system by linking it with the underlying membranes and larger visceral ligaments. Finding dynamic balance within a deeper fascial web, of compounding internal and external forces, FI takes a dynamic, volumetric and three dimensional approach to balancing membranous tension.

"Structure and function are inter-related."

A.T. Still

A natural companion to Jean-Pierre Barral's systemic approach to a dominant lesion (The Primary Lesion), FI examines the relationship between the parts and the whole. Providing a broader context of mobility for The Primary Lesion upfront is frequently strategically helpful. Typically with more longstanding issues, where adaptive shortening has insidiously spread across systems over time, regional and global anatomy are both in play and in need of attention. Troubleshooting the body regionally and holistically, the idea is to anatomically see and feel more of the big picture. Embracing elements from both schools of thought, FI offers inter-disciplinary skills and strategies to offset compensatory patterns (The Lesional Chain) throughout the general body. Fascial Integration holds perspectives of both a specialist and a generalist. One part structural and one part visceral, FI presents a unique Structural-Visceral perspective in the world of fascial manipulation.

Supporting professional development and lifelong learning, FI is appropriate for seasoned professionals and beginners alike. FI empowers multi-disciplinary practitioners with user-friendly skills through lecture, video, demonstration, postural analysis, palpatory assessment, hands-on exchanges and supervision. Grounded in physical reality, FI regularly motion tests the body for healthy mobility and range of motion restrictions. FI's emphasis is tactile, hands-on and with an end goal of practical clinical applications. Strategically, FI assesses the body for the top three motion restrictions across multiple systems.

FI brings a moderate's approach to the use of force. Valuing direct and indirect styles equally, FI regularly uses Direct Technique in the first phase of fascial manipulation. FI modulates the amount of force being used based on what's appropriate for each person. To that extent, the client's subjective experience and proprioceptive feedback are essential ingredients to optimize body-based receptivity. Like styles of yin yoga that relax and settle into postures long enough to let the mechanical load transfer from red to white fibers, FI is patient, respectful, slow and stretchy. With the intention of working with inherent and subtle motion as well, Indirect Technique is applied in the second phase of fascial manipulation. Utilizing elements from both styles in the third phase of fascial manipulation, Combined Technique fills out the therapist's toolbox within a wider spectrum of tools, techniques and technology.

FI employs a self reflective approach to the mind-body continuum that emphasizes embodiment, mindfulness and the therapeutic container. Helping people identify, sense and feel non-obvious holding patterns in their body is a critical component to fostering more sustainable change. These low-grade holding patterns are often unconscious, functional and seem to operate like a guarding mechanism. Psychologically speaking, the process is associative in nature and prioritizes the feeling function, sensory-perceptual receptivity and being in the moment. On both sides of the client-centered therapeutic relationship, proprioception is paramount.

Within a culture and era of medical specialization that is generically hands-off, A.T. Still's premise remains largely marginalized, underestimated or neglected. Metaphorically 'the anatomical elephant in the room', membranous and visceral restrictions have nonetheless lurked in the shadows of orthopedics and physical medicine for a long time. Perhaps currently categorized under idiopathic, non-obvious and non-specific headings in the scientific literature, the bio-mechanical effects of this deeper anatomy still remain largely uncorrelated. While fascial research is a long way away from quantifying underlying mechanisms, it is an emerging arena where evidence-based investigation is in a healthy growth phase.

Towards contributing to the evolving field of Integrative Medicine, Fascial Integration offers physicians from diverse disciplines practical and clinically oriented applications from Complementary Alternative Medicine (CAM). Manual therapy contains critical components of a missing link in the Integrative equation. When relevant, it can be a potent non-surgical alternative. Dovetailing the Doctor's physical examination, complementary skills in physical assessment investigates relationships between local and global bio-mechanics, interior/exterior and adaptation. FI explores non-obvious mechanisms and territory. In accord with a Doctor's discretion, and trying less invasive options before more invasive ones, the Integrative edge offers patients the best of both worlds.

As Abraham Verghese MD says in his TED Talk; A doctor's touch,

"When we shortcut the physical exam... we are losing much more than that... we're losing a ritual that I believe is transformative, transcendent and is at the heart of the patient / physician relationship. I'd like to introduce to you the most important innovation, I think, in medicine to come in the next 10 years and that is the power of the human hand..."

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Neuromuscular Therapy

NeuroMuscular Therapy for the Posterior Spinal Muscles offers training in the anatomy, physiology, function and dysfunction of the cervical, thoracic and lumbar areas. Specific conditions addressed include whiplash, scoliosis and disk disease.

Coursework includes:

  • The role of soft tissues in chronic and acute pain patterns/syndromes
  • How to develop a step-by-step therapeutic protocol for specific areas of the body as well as common pain syndromes
  • Medical terms and conditions you should know that can enhance your professional communication skills
  • Neurological laws that govern pain and healing
  • The science and art of massage therapy
  • Opportunities to enhance and refine your palpation skills

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Qigong T'Chings

"QI" is breath or vital life force. "Gong" is discipline or cultivation. Qigong is an inner discipline anyone can learn. This class empowers you with the knowledge and awareness of self-healing and gives basic tools for self-healing and well-being.

Millions of people around the globe practice Qigong because it:

  • Makes them feel good, perform better, experience higher levels of energy and stamina, and reach their level of optimal health.
  • Supercharges the immune system as it oxygenates the cells of the body.
  • Reduces stress, chronic pain, and brings about wellness and inner peace.

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Lymphedema Management

Following extensive training in Lymphedema Management, Joachim Zuther founded the Ulmkolleg/Department of Lymphology (University of Ulm, Germany) in 1990 after he received his degree as a certified instructor for Manual Lymph Drainage (Vodder Technique) and Complete Decongestive Therapy (MLD/CDT) from the German Physical Therapy Association. The Ulmkolleg is one of the leading schools for Lymphedema Management in Europe.

In 1994 he formed the Academy of Lymphatic Studies, the first school to offer Lymphedema Certification courses in the Continental United States, according to the European curriculum. Then in 2004, he published the first textbook on Lymphedema Management titled "Textbook for Comprehensive Lymphedema Management".

The Academy of Lymphatic Studies (ACOLS) conducts Certification Courses in MLD/CDT (135 hours)- Many of which are held in Universities, Outpatient Rehabilitation Facilities, Hospitals and Cancer Centers.

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Stecco Fascial Manipulation®

Stecco Fascial Manipulation© is a manual therapy method that has been developed by Luigi Stecco, an Italian physiotherapist from the north of Italy. This method has evolved over the last 40 years through study and practice in the treatment of a vast caseload of musculoskeletal problems.

It focuses on the fascia, in particular the deep muscular fascia, including the epimysium and the retinacula and considers that the myofascial system is a three-dimensional continuum. Initially via collaboration with the Anatomy Faculties of the René Descartes University, Paris, France and the University of Padova in Italy and more recently with a host of different collaborations, Dr. Carla Stecco and Dr. Antonio Stecco have carried out extensive research into the anatomy and histology of the fascia via dissection of unembalmed cadavers. These dissections have enhanced the pre-existing biomechanical model already elaborated by Luigi Stecco (1,2) by providing new histological and anatomical data.

This method presents a complete biomechanical model that assists in deciphering the role of fascia in musculoskeletal disorders.

The mainstay of this manual method lies in the identification of a specific, localised area of the fascia in connection with a specific limited movement. Once a limited or painful movement is identified, then a specific point on the fascia is implicated and, through the appropriate manipulation of this precise part of the fascia, movement can be restored.

In fact, by analysing musculoskeletal anatomy, Luigi Stecco realised that the body can be divided into 14 segments and that each body segment is essentially served by six myofascial units (mf units) consisting of monoarticular and biarticular unidirectional muscle fibres, their deep fascia (including epimysium) and the articulation that they move in one direction on one plane. Numerous muscle fibres originate from the fascia itself (3, 4) and, in turn, myofascial insertions extend between different muscle groups to form myofascial sequences. Therefore, adjacent unidirectional myofascial units are united via myotendinous expansions and biarticular fibres (3) to form myofascial sequences.

While part of the fascia is anchored to bone, part is also always free to slide. The free part of the fascia allows the muscular traction, or the myofascial vectors, to converge at a specific point, named the vectorial Centre of Coordination or CC (5). The location of each CC has been calculated by taking into consideration the sum of the vectorial forces involved in the execution of each movement.

The six movements made on the three spatial planes are rarely carried out separately but, more commonly, are combined together to form intermediate trajectories, similar to the PNF patterns. In order to synchronize these complex movements other specific points of the fascia (often over retinacula) have been identified and, subsequently, named Centres of Fusion or CF.

Fascia is formed by undulated collagen fibres and elastic fibres arranged in distinct layers, and within each layer the fibres are aligned in a different direction. Due to its undulated collagen fibres, fascia can be stretched and, thanks to its elastic fibres, it can then return to its original resting state. Given that fascia adapts to muscle stretch, it is unable to transmit force like a tendon or an aponeurosis. If these histological and functional distinctions are not taken into consideration, then one can confuse fascia with aponeuroses or, likewise, confuse the deep fascia with the subcutaneous connective tissue (superficial fascia). Subcutaneous connective tissue forms a very elastic, sliding membrane essential for thermal regulation, metabolic exchanges and the protection of vessels and nerves, whereas the deep fascia envelops the muscles, and surrounds the muscle’s aponeurosis up to where it inserts onto bone.

The above-mentioned anatomical studies have, however, evidenced differences between the deep fascia of the trunk and that of the limbs (6). The first is formed by three layers, each of which includes or surrounds different muscle groups, namely a superficial layer (latissimus dorsi, gluteus maximus, external obliques), a middle layer (serratus posterior inferior and superior, iliocostalis) and a deep layer (interspinali, intertraversarii, multifidus, trasversus abdominus). In the limbs, the deep fascia is particularly thick, resembling an aponeurosis, and well organised, connecting and synergizing the muscles of the lower limb via its collagen fibres arranged in sequences and spiral formations.

It is hypothesised, that the richly innervated fascia (7) could be maintained in a resting state of tension due to the different muscular fibres that insert onto it. Due to this optimal resting state, or basal tension, of the fascia, the free nerve endings and receptors within the fascial tissue are primed to perceive any variation in tension and, therefore, any movement of the body, whenever it occurs.

Deep fascia is effectively an ideal structure for perceiving and, consequently, assisting in organizing movements. In fact, one vector, or afferent impulse, has no more significance to the Central Nervous System than any other vector unless these vectors are mapped out and given a spatial significance. In human beings, the complexity of physical activity is, in part, determined by the crossover synchrony between the limbs and a refined variability in gestures. Whenever a body part moves in any given direction in space there is a myofascial, tensional re-arrangement within the corresponding fascia. Afferents embedded within the fascia are stimulated, producing accurate directional information. Any impediment in the gliding of the fascia could alter afferent input resulting in incoherent movement.

It is hypothesised that fascia is involved in proprioception and peripheral motor control in strict collaboration with the CNS.


Therapeutic implications

The fascia is very extensive and so it would be difficult and inappropriate to work over the entire area. The localisation of precise points or key areas can render manipulation more effective. An accurate analysis of the myofascial connections based on an understanding of fascial anatomy can provide indications as to where it is best to intervene. Any non-physiological alteration of deep fascia could cause tensional changes along a related sequence resulting in incorrect activation of nerve receptors, uncoordinated movements, and consequent nociceptive afferents. Deep massage on these specific points (CC and CF) aims at restoring tensional balance. Compensatory tension may extend along a myofascial sequence so myofascial continuity could be involved in the referral of pain along a limb or at a distance, even in the absence of specific nerve root disturbance. In clinical practice, cases of sciatic-like pain and cervicobrachialgia without detectable nerve root irritation are common (8).

This method allows therapists to work at a distance from the actual site of pain, which is often inflamed due to non-physiological tension. For each mf unit, the area where pain is commonly felt has been mapped out and is known as the Centre of Perception (CP). In fact, it is important to place our attention on the cause of pain, tracing back to the origin of this anomalous tension, or more specifically to the CC and CF located within the deep fascia.


References

  1. Stecco L Fascial Manipulation for Musculoskeletal pain, Piccin, 2004
  2. Stecco L & C. Fascial Manipulation Practical Part, Piccin , 2009.
  3. Stecco C, Gagey O, Macchi V, Porzionato A, De Caro R, Aldegheri R, Delmas V.
    Tendinous muscular insertions onto the deep fascia of the upper limb. First part: anatomical study.
    Morphologie. 2007 Mar;91(292):29-37. PMID: 17574470 [PubMed - in process]
  4. Stecco C, Porzionato A, Macchi V, Stecco A, Vigato E, Parenti A, Delmas V, Aldegheri R, De Caro R.
    The Expansions of the Pectoral Girdle Muscles onto the Brachial Fascia: Morphological Aspects and Spatial Disposition.
    Cells Tissues Organs. 2008 Mar 19; [Epub ahead of print]
    PMID: 18349526 [PubMed - as supplied by publisher]
  5. Alessandro Pedrelli, Carla Stecco, Julie Ann Day
    Treating patellar tendinopathy with Fascial Manipulation
    J Bodyw Mov Ther. 2009 Jan;13(1):73-80. Epub 2008 Jul 26.
    PMID: 19118795 [PubMed - indexed for MEDLINE]
  6. A. Stecco · V. Macchi · S. Masiero · A. Porzionato ·C. Tiengo · C. Stecco · V. Delmas · R. De Caro
    Pectoral and femoral fasciae: common aspects and regional specializations
    Surg Radiol Anat 2008 DOI 10.1007/s00276-008-0395-5
  7. Stecco C, Gagey O, Belloni A, Pozzuoli A, Porzionato A, Macchi V, Aldegheri R, De Caro R, Delmas V.
    Anatomy of the deep fascia of the upper limb. Second part: study of innervation.
    Morphologie. 2007 Mar;91(292):38-43. PMID: 17574469 [PubMed - in process]
  8. Day JA, Stecco C, Stecco A.
    Application of Fascial Manipulation technique in chronic shoulder pain--anatomical basis and clinical implications.
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