FASCIA - Anatomy Trains

“ STRUCTURAL INTEGRATION IS SUITEDTO THOSE PEOPLE WHO WOULD REALLYLIKE TODEEPERTAKE THEIR MASSAGEAND TO BE ABLE TO AFFECTPEOPLE'S MOVEMENTS IN A MOREPROFOUND WAY. “In structural integration, we're looking for how canwe get the body fully moving, and can we findthose places that are stuck either due to physicaltrauma or emotional trauma, and get those to beincluded in the body image, and get those to beincluded in the body movement? So, that's numberone.The second thing is this orientation to the fascia.Now, I want to be clear. You can't touch a bodywithout touching the fascial system. It's not thatthe fascia is something new. That fascia has beenthere all along—and we've been working with it allalong. Every time you put your hands on a body,you're working with the fascia. But if you're thinkingmuscles or you're thinking joints, as a chiropractoror physiotherapist might, you could miss where thisfascial fabric has been tied down. That becomesa limiting factor in people [when] restoring theirmovement. So, the second thing is this fascialidea.The third idea is that we work in a series ofsessions so that we work progressively over thewhole body, rather than doing the whole body inone session.KM: You have launched the Anatomy TrainsStructural Integration Certification Program, whichis a hybrid learning experience for people. Tell usabout that.TM: Most of our students are people who havebeen massage therapists for, anywhere betweenthree and ten years and have kind of hit on thetop of their original training and are looking forsomething else.Structural integration is suited to those peoplewho would really like to take their massage deeperand to be able to affect people's movements ina more profound way. I'm not saying anythingbad about massage by saying that. The regularmassage is great stuff. It's just when you startlooking into changing people's patterns, then youhave to be able to work with more depth, with moreanatomical proficiency, than is usually given in theinitial massage therapy training.Self-care for a practitioner is really part of yourresponsibility as a practitioner. It's not extra. Itis a requirement of the job that you take care ofyourself and you develop yourself.So, what we've done with our training is to tryto put everything that we can online so that ourstudents can use their own time and their ownschedule to get the anatomy and the backgroundand evolution and embryology and things that we'dlike them to have.KM: It's closer to three years, unfortunately.KM: I've gone through the Rolfing, or structuralintegration, 10-series twice now and it's beenlife-changing. I'm taller and I stand differently. So Iknow, as a client, it's been profound.TM: A lot of us, and I number myself in this, got intothe bodywork profession because we wanted to beof help. And it's quite easy when you want to be ofservice to other people to say, "Oh, well, don't mindabout me. I'm just going to be in service to you—sothis is all about you. It's not about me."And that's true. But if you really want a longpractice, you have to pay attention to yourself,to your own development. Am I developingspiritually? Am I developing emotionally? Am Igetting bodywork, this stuff that I give out? Am Iactually going and getting some myself?You and I know—we look at the statistics that alot of people get into the massage profession andthey're back out of it again within five years. Youcan probably tell me the figures of what it actuallyis.TM: So, I'm very sorry to say this. But I'm an oldman and I can say it. You don't really get gooduntil you've been at it for at least five years. Weneed people to be earning a living and taking careof themselves so that they get to be those longterm practitioners who will, one, teach the nextgeneration, and two, push the profession alongby developing something new, and number three,really be able to work with their clients in a holisticway, not just the way that you happen to havebeen trained or just the way that you like to work.You really need to be working in a way that thatperson needs to be worked. And that meanshaving a wide vocabulary of touch. You just can'tdo that if you're asleep.You've got to be awake in your practice and takingon new stuff.KM: Thanks, Tom.

A FEW THOUGHTS ONPerifasciaBY GIL HEDLEY, PH.D."Fuzz" is a silly and fun word which I latched ontosome 25 years ago when I began studying humananatomy in earnest. I didn't know what else to callthis stuff I was seeing during dissection but hadn'tseen in my anatomy texts. Perhaps that is becausedissection images in books reveal completed,perfected and idealized tissue presentations, ratherthan images of the dissection-in-process whichis a bit messier (and possibly more instructive). Iwasn't too sure this white cotton-candy-like fibrousfuzz showing up between so many adjacent namedstructures even belonged there.Tom Myers had taught us in our Rolfing pre-trainingabout hydrogen bonding in our connective tissues.I formed pictures in my mind. In the practitionertraining we learned to "differentiate" the tissuesof our clients. I took my reading of Dr. Rolf at herword that tissues should glide over one anotherlike silk stockings. And, I had imagined "muscles"to be a bunch of discreet nameable units tetheredto bone at their ends, or to various fibrous septa.Put all of that together and it's no wonder I mighthave concluded that perhaps that "fuzzy stuff" thatyielded to my fingertips when placed in tensionduring the dissection process might be the footprintsof hydrogen bonding and aberrant tissue adhesion.I wondered if this was exactly the stuff that Isupposed I was manually freeing up in my clients.Over the course of ten years this story developedinto "The Fuzz Speech," which I recorded as alark while filming The Integral Anatomy Series. Bythen, around 2004, I had already started to call thistissue "filmy fascia." In anatomy, when you findsomething once or twice, it's called an anomaly.When you find it every fifth or tenth time or so,we'll call it a variation. When you find it 100% ofthe time, we start to call that human anatomy. Soit was with that fuzzy stuff. It was always there!Live and learn. And anatomists did have a namefor it. They called it loose areolar connectivetissue. Despite being given a name, it somehowdidn't rank high enough to get its own image in theanatomy books, no less much discussion, being,as it were, the stuff you scrape away to get theimage that actually did make it into the book!Still, some folks who believed otherwise wouldinsist to me that it was a product of the embalmingprocess, or that it "grew" in the dead. Not so.Our normal, healthy bodies, 100% of the time,include these tissues. Embalming, however, doessignificantly change the texture and appearanceof these tissues. Embalming fluids are used topreserve the body and extend storage and studytime. Those fluids which are introduced includedesiccants, which help to chemically dry andset-up the tissues in what amounts to a kindof chemical "cooking" that renders the tissuesfixed, preserved. However, embalming does notpropagate the production in the body of anythingthat is not already there.It merely sustains it in its shape and dries itout a bit, enabling one to explore the form overan extended period without it decaying. Gooddissection takes time and you only have to readLeonardo's journals to know the challenges onefaces doing art/dissection of unpreserved tissuesin a rush on a cold winter's night in Florence!It turns out that "filmy fascia," which is a distincttissue texture with its own structural organizationrelative to either superficial or deep fascia, is at theinterface of all tissues demonstrating a capacityfor differential movement in the musculoskeletalsystem. Because the tissues of the body arecontinuous, nature has figured out that to generatecomplex differential movement of tissues withvarying textures and functions, we need a healthycomplex of filmy, superhydrated fascia betweenthem. In the dissection process you pull apart thatmembranous fascia intervening there between twostructures capacitated for differential movement,and it looks fuzzy. That's because it has driedout a bit and you are tearing apart the "felted"fiber organization, which is demonstrated by thatcloud of "cotton candy." The same phenomenonis demonstrated in live tissue by JC Guimberteau,that I demonstrate in cadavers. We are seeinga membrane in tension, being torn. What isimportant to remember is that in situ, in function, inthe living, it does not look like that fuzz at all! Theappearance is the artifact of the process of takingthe tissue out of its anatomical "normal."Undisturbed, this tissue is nearly transparent andeasily overlooked. A filmy mucoidal membrane,this slippery interface, this movement facilitatingmembranous system, functions as a fascia. It is anaggregate of connective tissue which is dissectibleinto a sheet, which wraps other tissue. I finallydecided to call it perifascia after ten years of callingit "fuzz," and another thirteen years of calling it"filmy fascia" because it is found, among otherplaces, around and near (peri) fascia. It's a fasciafascia!Perifascia (loose, areolar connective tissue inGrey's anatomy) is easily distinguishable fromsubcutaneous adipose (superficial fascia in Grey'sAnatomy) and dense regular fibrous fascia (deepfascia in Grey's Anatomy), both in dissection andin palpation. Superficial fascia is a relatively "fluffy"layer found in abundance immediately continuouswith the dermis, so that it is also called the"hypodermis."

This adipocyte and lipid-rich layer has a distinctyellow-orange color, thanks to the presence ofcarotene, ample fatty deposition and a spongylook in cross section. When you palpate itperpendicularly through the skin, it demonstrates acharacteristic buoyancy.Now if you place a broad palm in contact withthe skin and drag the skin with its underlyinghypodermis to and fro, you will demonstratethe slippery sheering interface betweenthe superficial and the deep fascia. This isanatomically represented by the perifascia. Youwill, however, not find perifascia underlying 100%of the undersurface of the superficial fascia. Itis characteristically absent in the face, palms ofhands, soles of feet and various other key pointsanatomically where slipperiness is less serviceableto the human organism than secure fixation. Wecan't be walking on banana peels after all.The deep fascia consists of more orderly arraysof relatively thicker and linear bundles of collagenfibers. Perifascia both underlies the deep fasciaas well as overlies it. Perifascia enables thesuperficial fascia to sheer over the deep fascia andit enables the muscle tissue to sheer under thedeep fascia. It is the anatomical basis of "play" inthe musculoskeletal system.Play with it! Palpate the different surfaces of yourbody and notice the differences in "excursionpotential" of the skin and superficial fascia overthe deep. To readily access the deepermembranous layers of perifascia beneath the deepfascia, palpate to the deep fibrous layer and thenactively move the muscle tissue underneath. Youwill feel the differential movement of the musclerelative to the deep fascia and in so doing you willintentionally engage the perifascia. This is not anew technique. We are simply adding here someanatomical information to specify the intention ofthe touch.You have always been touching and engagingperifascia. But if you didn't know it was there, youwere doing so accidentally. Now you can do it onpurpose.But why bother? Well, because it's there! If youwant to give, or take, a thorough tour of thehuman body, you do well to identify what is belowthe surface with some dollop of knowledge.If the perifascia is as implicated in differentialmovement as its apparent distribution, structuraland physiological properties strongly suggest,then it would also be implicated in movementinhibition. This is a superhydrated movementinterface. Stasis, dehydration and inflammationlead to changes in the tissue. Small changes inhydration amplify dysfunction at many levels. Thehydrogen bonding I learned about from Tom in mypre-training is indeed taking place in these tissues.This is however a microscopic phenomenon,contrary to my earlier macro-imaginings. Alongwith the fiber crosslinking and other chemicalalterations to which chronically static, dehydratedand inflamed tissues are subject, the perifasciaeshift from slippery to gummy. Lowered viscositycan fortunately be reversed through touch andmovement. Chronically gummed up tissueshowever are at risk of the formation of crystalsfrom complex combinations of fats, proteins andsugars. Brittle tissues are harder to recover fromthan merely gummy ones.Perifascia is worth adding to your sense of what'sin there. It is easy to access: move! But if you aremoving in the same old ruts as always, some ofyour tissues will retain their vibrant healthy sheercapacity, while other tissues will be "set aside,"as it were. So explore movement deeply. Find theunfound places in yourself and let yourself playthere again. Become a somanaut, courageouslynavigating your inner space. Enjoy!

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COMING TO LIGHTMY OWN JOURNEYWITH THE FASCIAL NET PLASTINATION PROJECTBY LAURI NEMETZ,AN ATO MY TR A IN S FA C U LTYAN D A N ATOMY TR A IN S D IS S E C TION SPHO TO WI TH LAURI NEM ETZ, JEAN- CLAUDE G UI M BERTEAU AND G I L HE DL E YAT THE FASCI A I N A NEW LI G HT EXHI BI TI O N, BERLI N 20 1 8

INTRODUCTIONI am thankful to Anatomy Trains for theirsponsorship in getting me to Guben, Germanylast summer where I participated as a memberof the Fascial Net Plastination Project with anincredible team from around the world. Likemany people in our fascia community, I hadlong imagined that we should be able to createfascia plastinate models. Several years back,after a presentation at the Experimental Biologyconference, I spoke directly with representativesfrom the Plastinarium in Germany to inquire if thismight be possible. Others were simultaneouslyasking the same question from various corners ofthe world. However, this work was destined to waituntil just the right group of people came togetherwith a united vision and the support of the FasciaResearch Society. It seems the momentum ofa passionate, international team has shown thePlastinarium that there is growing interest in thisfield of study for research and for the larger public.What began as a small project with ambitiousdreams has grown to the world’s first exhibition of3D, human fascia, plastinated forms at the recentFifth International Fascia Research Congress inBerlin, Fascia In a NEW LIGHT: The Exhibition.I was thrilled to be invited to be part of the projectover a year ago by Gil Hedley, who is part of theproject’s scientific advisory board. Two teamscame together, first in January and then in June of2018, with a final group organizing the exhibitionto share the work of the project. Part of my ownextended Anatomy Trains family involved in theproject include Gary Carter, David Lesondak,Gina Tacconi-Moore and Alison Slater. Teammembers came from all over the globe, includingEngland, Austria, Finland, Israel, Switzerland,USA, Australia, Singapore, Brazil and Germany.Everyone volunteered their time and talent as wellas faced the challenges of clearing schedules towork in this enormous group effort.As noted on the Fascia Research Society website,“In January 2018, the Fascia Research Societypartnered with Somatics Academy and GubenerPlastinate (GmbH), to embark on a new journeyin fascia anatomy education with the world’s firstHuman Fascial Net Plastination Project. Directedby fascia research scientist Robert Schleip,professor of anatomy Carla Stecco, and with theassistance of clinical anatomist John Sharkey,the project is taking place at the world-famousPlastinarium in Guben, ation).MY OWN BACK-STORYWITH THE PROJECTI truly believe that how we perceive the bodychanges with what we can literally see at anypoint, either because of our own thought limitationsor dissection techniques. We have all heard thestories of how fascia has traditionally been takenaway from our pristine images of muscle and bone.However, I have always been intrigued by theolder illustrations from anatomical books such asJean-Baptiste Marc Bourgery’s beautiful imagesof the fascial septa or the historical varnishedpreservations from the 1800s that often destroyedmany tissues but occasionally kept a partialinterosseous membrane intact.My own history of coming into the project startedaround 2014 when Tom was showing Jeffrey Linn’sspinning image of a thigh from the Visible HumanProject (2003), which was computer-generated toshow the thigh with all tissue with the exception ofthe larger areas of fascia. Tom often mused thatit would be wonderful to see this someday as aseparate model.Soon after, I started to investigate the work of Dr.Doris Taylor, the Director of Regenerative MedicineResearch (Texas Heart Institute). Her workcontinues to be concentrated on de-cellularizingorgans to leave the extra-cellular matrix behindas a scaffold for re-seeding the organ with healthycells for organ transport. In my mind, this wasimmediately a way to create a fascial model andI began a process of creating fascial hearts, andthen later fascial kidneys, all stripped of theirmuscle fibers but leaving behind their fascialstructures. Much of this work I outlined in theAnatomy Trains blog (2016), “Creating FascialOrgans: Exposing Organs’ Fascial Matrix” -bylaurice-nemetz/)

The very first public presentation of this workwas at the Fascia Research Congress in 2015,“The Heart of Fascia, Initial Steps to a ThreeDimensional Model” (http://www.fasciacongress.org/2015/Abstracts/33 Nemetz.pdf)I spoke with Gil Hedley about the possibility ofdoing this process with more superficial layersand was later invited by Gil to witness some of thework he developed in lab, along with dissectionlab assistants Juno Ujjayi and Christopher Tortaro.He outlined this in the 10-minute film (“Fascia isall around us!”) that he shared at the congressand has put on his website: https://www.gilhedley.com/p/clipsGil became interested in getting the lipids out ofthe subcutaneous adipose layer manually (asopposed to my basic chemical process) to revealthe superficial fascia that he likens to a “protectivefleece, a comforting cloud” and to show its inherentstrength. His latest interest is in the area he callsthe perifascia, the filmy layer highlighted as the“fuzz” in his previous talks, which is layered thinlyaround and into the deep fascia. His additionalwork places the importance of looking more closelyat these tissues and their body-wide relevance.Fascia atlases such as Carla Stecco’s FunctionalAtlas of the Human Fascial System (2015)and Hanno Steinke’s Atlas of Human FascialTopography (2018) are new additions to theconcept of anatomy that help to expand ourunderstanding of the relevance of the fascialconnections. Additional pioneers in the field offascia that have been exploring this ground shiftin imaging the fascia system include Jaap van derWal’s early writing about the fascia pockets in his1988 doctorate thesis, Peter Huijing’s, PhD (VijeUniversiteit Amsterdam)3-D reconstructions of fascial continuities in thecrural compartments of rats, and of course TomMyers’ concept of Anatomy Trains that was initiallytheory and has now been subsequently dissectedand studied by others in the field such as JanWilkes.Each time we open up the way we are looking atthings, our understanding of functionality and formshifts.

THE PROCESS AT THE PLASTINARIUMAND TEAM MEMBERSAbove, pics by the author of the Plastinarium inGuben, Dr. Robert Schleip and with Dr. CarlaSteccoThe author (right) with Rachelle Clauson(Committee member for the Fascial NetPlastination Project at Fascia Research Society)in front of the Plastinarium in Guben, Germany.I was unable to attend the Fascial Net PlastinationProject’s initial five-day gathering in January dueto prior commitments, including our own dissectionlab teaching schedule. However, I was excited towatch from afar as the team began the dissectionsthat would be the basis for the project.Several excellent specimens were being created,including the iconic heart and diaphragm dissectedby Jihan Adem and Tjasa Cerovsek Landes. Itmade me smile to think back on my own initialghost hearts and my desire to connect the fascia ofthe pericardial sac to the larger deep front line. Asnoted in the November 2018 Massage & BodyworkMagazine, the initial uplit photos of this specimencalled to mind Gil Hedley’s quote, “Your heart ismade to be light”, which helped inspire the namefor the FRC exhibit, Fascia In a NEW LIGHT: TheExhibition.

Photo by the author showing one of the team members working with a specimen afterthe six-month plastination process before being positioned and gas-cured.The process of plastination was interesting to me,particularly that the lab uses preserved tissue todissect, which certainly makes it easier to workon the level of detail they attend to, but it alsodoes change the texture of the fascia itself. Theplastination process involves first a series ofacetone baths to replace all the water in the tissuewith acetone. Then the specimen soaks in a bathof liquid polymers where the acetone is replacedwith plastic. The baths can take six months ormore depending on the size of the specimen. Atthis stage the piece is meticulously positioned intoits final shape and then is gas-cured to make theshape permanent. The team experimented withdifferent methods of pre-treating the superficialfascia to manually remove the adipose in additionto the chemical removal from the acetone baths,but found that the additional manual processpreviously used so beautifully by Gil

the fascia and how the human body negotiates between stability and mobility. He has practiced integrative bodywork for over 30 years in Europe, the U.K. and the U.S., and presented at the prestigious International Fascia Research Congress and at many other bodywork and massage conferences. Tom is also a MASSAGE Magazine All Star, one